HJBR Nov/Dec 2019

46 NOV / DEC 2019 I  Healthcare Journal of BATON ROUGE column PEDIATRIC FRIENDLY TO WHOM? The Baby-Friendly Hospital Initiative (BFHI) was launched in 2001 in the United States by the World Health Organization and UNICEF, with the goal of increasing breastfeeding initiation, exclusivity, and duration. In order for a hospital or birth center to receive this Baby-Friendly des- ignation, the facility must follow the Ten Steps to Successful Breastfeeding, which includes helping mothers initiate breast- feeding within one hour of birth, offering no food or drink other than breast milk, practicing rooming-in 24 hours a day, and giving no artificial nipples or pacifiers to newborns. The program also requires prenatal education about the benefits of breastfeeding, as well as referring breast- feeding mothers to support groups upon hospital discharge. As a pediatrician and amother, the name Baby-Friendly Hospital leaves a bad taste in my mouth from the get-go. The name implies that if you are not following the ten steps suggested above, you are NOT baby friendly. I assure you, I have not spent 21 years of schooling, three years of residen- cy training, nine years in general pediatric practice, and nine years as a mother to be unfriendly to babies. On the contrary, the longer I practice medicine, the more firm I am in my belief that there is not just one path to raising healthy children. I think the BFHI fails to acknowledge the possible adverse mental health impli- cations from inferring that breastfeeding is the only way for parents to do what is best for their newborn. I have seen countless new mothers who are exhausted beyond belief after two days of cluster feeding in- fants. I have walked into hospital rooms for my morning rounds to find infants co-sleeping on the mother’s chest while sleeping in a hospital bed because, as the weary mom explains, “I was told to do as much skin to skin time as possible, and to let the baby feed whenever they cried, and Take a moment and consider the first time mother who had a pro- longed labor and attempted a vaginal delivery, only to require a C-sec- tion hours later. There is a high likelihood that this mother has been awake for over 24 hours. Now, she has a newborn exclusively in her hos- pital room, and while nurses and care staff come to check on them every few hours, the use of the newborn nursery is discouraged. Instead, this mother, who is both mentally and physically exhausted, will need to do as much skin to skin time as possible while attempting to breastfeed, something everyone told her would be so easy and natural. As the frus- tration mounts when her newborn doesn’t latch well, and then begins the normal pattern of wanting to feed hourly (also known as cluster feed- ing), this new mother is likely running on minimal to no sleep, as well as postpartum hormones. When inquiring about formula or a pacifier, she is told those things are really not recommended, and this is all normal. After all, the hospital is “baby friendly”, and considering the option of formula would just be giving up. Is this how far the breastfeeding pendu- lum has swung? For those hospitals going for the Baby-Friendly desig- nation, it seems this just might be the case.