HJBR Nov/Dec 2019

Healthcare Journal of BATON ROUGE  I  NOV / DEC 2019 47 Mindy L. Calandro, MD, FAAP Pediatric Medicine Baton Rouge Clinic I just couldn’t keep my eyes open any lon- ger.” And then there is the pressure placed on new mothers from the social media world of blogs and Facebook groups. While the intention may be to give encour- agement, the message is that if you don’t keep going with the breastfeeding, and in- stead cave in to giving formula, you have somehow failed your new, precious bun- dle of joy. The pressure on new mothers is relentless when it comes to breastfeeding, and as providers, we must be keenly aware of the mental health toll and possible in- creased risk for postpartum depression that this rhetoric may cause new families. When looking at outcome studies in regards to BFHI, the results are rather in- teresting. Some studies show an increase in the rate of exclusive breastfeeding when leaving the hospital, as well as in- creased overall breastfeeding rates during the first year of life here in the U.S. How- ever, one study of over 6,000 mothers in Queensland, Australia published in Pedi- atrics in April 2013 entitled “Baby-Friendly Hospital Accreditation, In-hospital Care Practices, and Breastfeeding,” found the rates of exclusive breastfeeding at one month of age to be lower in the cohort born at BFHI-accredited institutions com- pared to non-BFHI-accredited. The rates of breastfeeding were the same at four months, regardless of birth at a BFHI-ac- credited location. Another study from Pediatrics in June 2013 entitled “Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk In- fants,” found that in infants 24-48 hours old who had lost >5 percent of birthweight, the use of 10 ml of formula after each breastfeeding session until mature milk came in led to less formula use at one week of age, and increased rates of exclu- sive breastfeeding at three months of age. Ahuge limitation to this study was the very small sample size, but it would be interest- ing to see if such results were reproducible within a larger study cohort. It is import- ant to note that to this point, the data on maternal mental health outcomes, as well as infant readmission for things such as hyperbilirubinemia, hypoglycemia, or hy- pernatremic dehydration is lacking. These are important counterbalance points that need to be considered when measuring the overall risk/benefit of BFHI. By no means am I advocating for pop- ping a bottle into a newborn’s mouth the moment they enter this world. I encourage all mothers to attempt breastfeeding, es- pecially early on, as the early milk, or co- lostrum, is the “liquid gold” of antibodies and nutrients. I tell mothers to utilize the help of lactation consultants and nurses while in the hospital to help get a good latch established, and to hopefully get off to a great start on their breastfeeding jour- ney. But a system that essentially shames a mother and makes her feel guilty or not friendly to her baby if she chooses to use formula or a pacifier, is not friendly to ei- ther mother or baby. At the end of the day, I always tell new parents that I need a happy, healthy mom- my to get a happy, healthy baby. For some this will include breastfeeding, and I am absolutely going to support the decision for exclusive breastfeeding as long as there is not a medical indication otherwise. However, I think those of us in the health- care profession can encourage breastfeed- ing without it becoming the sole focus and only outcome measure of the newborn period. We need to make sure that new parents, especially those exhausted new mothers, understand that their worth as a parent or the health of their newborn is not, and should never be measured by what is produced or not produced from their breast. That is how we become baby and mother friendly. n