When I was having my first baby in 2011, I read a great deal about how breastfeeding is the perfect nutrition for infants and about the many health benefits for both mom and baby. I knew I should breastfeed, but I was nervous because I had also read many stories about women having difficulty getting a good latch, about low-milk supply, and all the things that can derail a mother's intention to breastfeed her newborn. One thing I did not consider, was that the hospital or birthplace I chose could have an impact on my breastfeeding success. It can, and it does.
The day I had my baby, I was very relieved that he latched well (with the help of the hospital lactation consultant), and there didn't appear to be any issues with my milk supply. I wanted to exclusively breastfeed with (no formula supplementation), and I made my intentions clear to the hospital staff. I woke up that first night and immediately knew I had slept too long, and that something was not right. I called for a nurse and she said "We gave your baby formula so you could sleep. He should be set for the rest of the night." I was furious, and rightly so. Upon my discharge, I was given a bag of free formula samples to take home, even though I chose to breastfeed. The hospital staff ignored my breastfeeding plan, but fortunately, it did not impact my long-term plans and I was able to successfully breastfeed my baby for over one year.
Maternity care in hospitals or birthing centers has an enormous impact on whether or not a new mother breastfeeds both at the hospital and after discharge, and whether or not a new mother breastfeeds exclusively. The American Academy of Pediatrics recommends 6 months exclusive breastfeeding, meaning no formula or other food supplementation, and breastfeeding for at least one year with combined foods. Experiences with breastfeeding in the first hours and days of life significantly impact an infant’s later feeding practices. (Source: CDC.gov citing DiGirolamo A, Grummer Strawn L, Fein S. Effect of maternity-care practices on breastfeeding. Pediatrics. 2008;122(Suppl 2):S43-S49). Because of this, it is crucial that good breastfeeding practices are used immediately after birth and continued for the duration of the hospital or birthing center stay. And therefore, it's crucial to choose the best birthing facility that supports your breastfeeding goals.
In 1991, the World Health Organization and the United Nations Children’s Fund established a global program called the Baby-Friendly Hospital Initiative, which supports and recognizes hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. You may be thinking "Aren't all birthing facilities Baby Friendly?" Unfortunately, the answer is no. The Baby-Friendly Hospital Initiative recognizes birthing facilities that successfully implement the "Ten Steps to Successful Breastfeeding" (listed below), and the International Code of Marketing of Breast-milk Substitutes. One study found that mothers who stayed in hospitals that did not follow any of the 10 Steps were 8 times as likely to stop breastfeeding before their infants were 6 weeks old compared to mothers who stayed at hospitals that followed 6 of the steps. (Source: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Citing: Breastfeeding DiGirolamo A, Grummer Strawn L, Fein S. Effect of maternity-care practices on breastfeeding. Pediatrics. 2008;122(Suppl 2):S43-S49.)
When hospitals and/or birthing facilities implement these steps, studies show increased breastfeeding rates. Formula feeding of breastfed newborns negatively affects overall infant health and breastfeeding outcomes. (Source: CDC Guide to Strategies to Support Breastfeeding Mothers and Babies).
The "Baby-Friendly" designation requires that the hospital or facility implement a policy that restricts formula and that the 10 Steps are displayed in all areas that care for mothers and infants. All infants in the hospital are considered breastfeeding infants unless the mother, after being offered help to breastfeed and after giving birth, specifically states she has no plans to breastfeed. Mothers are to be protected from promotion of formula.
The hospital must have written maternity care and infant feeding policies that address all ten steps, protect breastfeeding and adhere to the International Code of marketing breast-milk substitutes (must refuse to accept supplies of formula and feeding supplies at no cost or below fair market cost to protect new parents from influence of vendors of such items).
The 10 Steps to Successful Breastfeeding Are:
Step 1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
Step 2. Train all health care staff in the skills necessary to implement this policy.
Step 3. Inform all pregnant women about the benefits and management of breastfeeding.
Step 4. Help mothers initiate breastfeeding within one hour of birth.
Step 5. Show mothers how to breastfeed and how to maintain lactation even if they are separated from their infants.
Step 6. Give infants no food or drink other than breastmilk unless medically indicated.
Step 7. Practice rooming-in- allow mothers and infants to remain together twenty-four hours a day.
Step 8. Encourage breastfeeding on demand.
Step 9. Give no pacifiers or artificial nipples to breastfeeding infants.
Step 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
There has never been a bigger global push to encourage breastfeeding and discourage formula. Breastfeeding promotion has come a long way in the 5 years since I had my first baby, and there is still a long way to go. The hospital that gave my baby formula against my wishes, is now in the process of becoming a Baby Friendly Hospital, it no longer gives out free formula to new mothers, and no longer accepts free formula from formula companies.
If you want to breastfeed your baby, choose a provider that supports breastfeeding. If you have a choice, don't choose a facility that may derail your breastfeeding goals. Talk to your doctor, lactation consultants, hospital staff and other mothers, and ask questions. Ask if the facility is Baby Friendly or if the facility is taking steps to become Baby Friendly, or if the facility practices the Baby Friendly policies. There are currently only 319 Baby Friendly designated facilities in the U.S., so doing your own research on your birthing facility choice is key. For those that do not have a choice as to a birthing facility, don't be afraid to tell your providers your breastfeeding goals and to ask for help. We all need it.
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