U.S. Hospitals Not Breastfeeding-Friendly?


I'm pleased to share a guest post by Dr. Alison Stuebe, originally posted on the Academy of Breastfeeding Medicine blog.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine. She is a member of the Academy of Breastfeeding Medicine.  You can hear my podcast interview with her about Ban the Bags.

Imagine you are running your first marathon. You’ve been training for months, and you’re looking forward to the sweet satisfaction of crossing that finish line.  When you arrive at the start, you are dismayed to discover that you didn’t register for a “runner-friendly” race.

An official confiscates your shoes and your water bottle. “We recommend that you run 26.2 miles today,” you are told. “Good luck.”

It’s an absurd way to start a marathon. And if you’re a mom who planned to breastfeed and birthed in an American hospital, it also sounds familiar.  Breastfeeding after an American birth is disturbingly similar to running a road race without shoes.

Consider that the CDC’s mPINC survey found that one quarter of US hospitals routinely formula-feed healthy term infants and 45% routinely provide pacifiers, despite strong evidence that such practices undermines breastfeeding.  Seventy percent of hospitals hand out formula company marketing packs to breastfeeding mothers, despite evidence from multiple studies that this practice directly undermines a mother’s ability to adhere to recommendations to exclusively breastfeed for the first 6 months of life. On a scale of 1 to 100, the mean hospital score for breastfeeding-supportive hospital policies was a 63.

This is the starting line for the American mom’s breastfeeding marathon. “We recommend you breastfeed your baby for six months, but we’re taking him to the nursery tonight for more formula that his tiny stomach can hold in 24 hours, and then we’re sticking a pacifier in his mouth. And because we don’t think you’ll be able to cut it breastfeeding, we’re sending you home with a tote bag filled with formula. Good luck.”

Fortunately, there’s a metric to sort out whether your hospital is going to allow you a fair start: The Ten Steps to Successful Breastfeeding. This internationally-developed standard guides hospitals and birth centers in how to get mothers and babies started breastfeeding successfully. Those that implement all Ten Steps are eligible for designation as Baby Friendly.  As of July 2, 94 US Hospitals and Birth Centers met the standard.

The science backing the Ten Steps is strong: These policies directly impact a mothers’ likelihood of reaching her own breastfeeding goals. Ann DiGirolamo studied the number of steps a mom experienced and her chances of meeting her own breastfeeding goals, and found that 97% of moms who experienced all steps met their own goal to breastfeed for at least 6 weeks, whereas only 70% of moms who experienced none of the steps met their own goals.

Think about this. Three out of ten moms delivering at a “no steps” facility will fail to meet their own infant feeding goals. And because “Baby-Hostile” hospital care is more subtle than an official saying,  “I’m sorry, we don’t allow shoes in this marathon,” three out of ten moms will most likely blame themselves for a painful, disappointing breastfeeding experience.

This World Breastfeeding Week, mothers around the world are celebrating the Ten Steps. If your maternity care set you up for success, take a moment to write a thank you note. And if you endured Baby Hostile care, transform some of your frustration into constructive criticism. Hospital administrators are stunningly responsive to letters from patients — far more responsive than to published articles in peer-reviewed medical journals. Write a letter – here’s a rough draft to get you started.

Dear Maternity Center Director:

I gave birth at your facility in XXX of this year, and I intended to breastfeed my baby. I had looked forward to receiving high-quality care for myself and my baby. The Ten Steps to Successful Breastfeeding are internationally-developed, evidence-based practices that support initiation of breastfeeding. At your facility, I did not receive breastfeeding-supportive care. Specifically, my caregivers did not:

-       Allow me to hold my baby skin-to-skin and initiate breastfeeding in the first hour after birth (Step 4)

-       Provide my baby nothing but breastmilk, unless medically indicated (Step 6)

-       Support my desire to have my baby to room in with me (Step 7)

-       Allow me to breastfeeding on demand, rather than on a schedule (Step 8 )

-       Avoid routine use of pacifiers (Step 9)

-       Provide me with information on breastfeeding support before I was discharged (Step 10)

As a consequence of the poor quality care I received during my maternity stay, I encountered tremendous difficulties with breastfeeding.

I was deeply disappointed in the quality of care I received at your hospital, and I look forward to learning what steps you are taking to improve the care that you deliver to breastfeeding mothers and babies.

Thank you for your attention to this matter.


Cc: Hospital CEO

Director of Obstetrics

Director of Pediatrics

(Tanya's note:  I'd add a cc to "Risk Management," too)


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