In 1991, the World Health Organization and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI). BFHI contains a series of ten evidence-based steps that allow hospitals to help moms and babies breastfeed successfully.
The Centers for Disease Control and Prevention (the CDC) started surveyingthe maternity facilities beginning in 2007, in the United States to see how well they conform to these evidence-based steps. As of 2009, the average US hospital got a grade of 65 out of 100. Despite the best intention of caring doctors and nurses, hospitals routinely engage in practices that make it much harder for moms and babies to establish breastfeeding. Often mothers blame themselves if breastfeeding doesn’t go well. In actuality, the hospital policies and practices unwittingly undermining their efforts to breastfeed. It’s time to change this.
Research shows that what happens in the hospital has a powerful effect on how long mothers breastfeed, and this effect lasts months. The first hour after birth is especially important. A baby should be placed skin to skin on his mother’s chest immediately after birth. The baby rests on the mother’s chest, covered with a blanket. Nothing is between the mother’s skin and the baby’s skin. (Diapers are optional). Research shows that this practice helps keep the baby warm and calm and greatly facilitates the first breastfeeding.
If left on his own, the baby will eventually use his arms and legs to crawl over to his mother’s breast. The baby will then start familiarizing himself with the breast by smelling it and licking it. Finally, after about 45-60 minutes, he will latch himself on to the breast all by himself, and this gives him the best chance of imprinting the perfect latch. (If the mother got medication during labor, this first latch may take much longer because the baby may be drowsy). A good latch is not painful for mom, and it allows the baby to transfer as much milk as possible to his belly, which helps him satisfy his hunger and grow. Good milk transfer from a good latch also helps mom make plenty of milk. Most healthy babies will eventually latch on by themselves. However, it might take longer if the mother received pain medicine during labor, which can cause some babies to be a bit groggy.
Doulas are trained birthing coaches. Research has shown that when doulas assist a family during the birth process, the mother is much less likely to need pain medicine, or require birth interventions such as vacuum extraction or cesarean section. These birth interventions can stress the baby and are associated with difficulties in establishing breastfeeding. Nonetheless, with other good supports in place, nearly all healthy babies can breastfeed successfully.
As of 2012, fewer than 5% of all US births occur in hospitals that are officially designated as Baby-Friendly®. In the United States, Baby-Friendly USA is the non-profit non-governmental organization that serves as the national authority for the Baby-Friendly Hospital Initiative. It guides hospitals through the Baby-Friendly process and issues a certificate to all hospitals that pass the rigorous accreditation standards. The last step in the certification process is a site-visit from the staff at Baby-Friendly USA, which includes interviews with hospital staff and mothers.
The Ten Steps of the Baby-Friendly Hospital Initiative include things that mothers themselves can demand of their birthing hospitals, even if they are not Baby-Friendly. One of the most important steps is avoiding formula in the hospital if there is no medical reason for it. Getting formula in the hospital when there is no medical reason has been shown to powerfully undermine the establishment of breastfeeding. Other important steps are breastfeeding in the first hour of birth, and keeping moms and babies together, both day and night. Another step is avoiding pacifiers. If supplements are needed for any medical reason, they are given by spoon, other ways besides with a bottle.
Adopting the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative generally requires hospitals to significantly change the basic way they provide maternal and lactation care. This can be challenging for hospitals and staff, especially when they have done things the same way for generations. The great news is that national public health entities and breastfeeding organizations are aligning to help hospitals with this quality improvement and practice change.
Hospital administrators really listen to their patients. If families start asking their hospitals to adopt the Ten Steps and go Baby-Friendly, that is a big motivator to get them to change their practices. We urge you to contact your hospital and ask that they adopt the Ten Steps and pursue the Baby-Friendly designation. It can be as simple as an email or a letter with just one paragraph.