A cardiologist’s experience with a “baby friendly” hospital

A guest post from a practicing cardiologist:

Before getting pregnant, I had never set foot in our L&D ward. My only interaction with OB’s was when they needed ICU beds for their sickest patients (severe preeclampsia, catastrophic bleeding, amniotic fluid embolism, you catch my drift). From treating these patients, I have no illusions whatsoever about the potentially lethal consequences of childbearing. I had never spoken to the midwives at all.

My first glimpse of the ‘natural childbirth culture’ came from a nocturnal cardiology consult. I was called by a young OB resident for a postpartum patient with shortness of breath and low oxygen saturation. I requested a chest CT with intravenous contrast, suspecting pulmonary embolism. I was baffled when the resident refused to do this. When asked to explain, she said the patient should not be given intravenous contrast under any circumstances. This wasn’t for a severe allergy. It was because the patient’s breastfeeding would be disturbed by the IV contrast. Just to be clear, at this point the patient’s opinion in the matter had not yet been asked. And even if it had, I’m very doubtful that the decision-making capacity of a severely hypoxic patient would hold up in court if things didn’t end well.

I was, again, baffled for a few seconds. I had never before heard of a patient’s treatment being determined by any other motive than that patient’s best interest. I replied that this was a critically ill patient being denied the care she obviously needed, and that the resident would have a very hard time getting a dead woman to breastfeed her baby. This dose of reality did the trick, and the patient got the chest CT, heparin drip and ICU admission she needed. I must say I don’t really know how things ended with her breastfeeding, but she left the hospital alive.

Fast forward to my own pregnancy. I’d had a first trimester miscarriage before. When I went in for my 12 week ultrasound, I was pretty nervous about seeing that heartbeat. When the midwife-US tech called us in, I was very anxious to get on that table and see what was going on. First, however, she insisted on giving me an educational lecture about…. breastfeeding. That’s right, before establishing the presence of a live fetus! I politely sat through it, but I still don’t know what I’d have said if it had turned out to be another miscarriage!

My pregnancy was uneventful except for the breech position. My OB is very skilled and experienced in external version, but for various technical reasons I wasn’t a candidate. So an elective CS at 39 weeks was agreed upon. However, just like in critical care, there is no planning in obstetrics.

At 36 weeks, I came to work feeling well, and started my rounds. After the second patient, I had to sit down. I had a headache, a stomachache and was seeing flickering stars. Also, incidentally, I had gained ten pounds in the past 2 weeks. People all around were commenting on how swollen I looked. I myself was firmly in denial of the glaringly obvious diagnosis, and tried to sneak home muttering something about a stomach bug. A collegue with more common sense simply grabbed my sleeve and dragged me to L&D. My OB lost no time in diagnosing pre-ecclampsia and admitting me. Overnight I deteriorated and the next morning I had my c-section. Which was the start of an extreme culture shock…

I had been planning to breastfeed my baby, to the extent that I hadn’t even listed for any bottles or feeding accessories. As the baby was 3 weeks early and I literally hadn’t had a single day of maternity leave before I delivered, I hadn’t read up on breastfeeding practicalities yet. However, the baby-friendly hospital protocol sprung into action, and my little girl was put to my breast before I had been wheeled out of the OR. As I lifted my hospital gown to latch her on, the midwive tsk’ed: “you have extremely flat nipples”.
Never before had my nipples been called deficient in any way, but as soon as my baby tried to latch, I saw the problem. She was slightly premature with a small mouth and a weak suck, and there just wasn’t enough for her to grab. Moreover, for all her enthousiastic attempts, absolutely nothing came out of said nipple.

The following 72 hours we continued in that way, being encouraged and aided by a variety of midwives and lactation consultants. I’ve had at least 10 different perfect strangers manhandling my lady parts. All commented on my apparently severely deficient nipples, as if there was something I could do about them. Silicone prosthetics were called in, but that didn’t get us any milk. For our efforts, I got cracked and blistering nipples and extreme sleep deprivation, and baby got absolutely nothing. She made her displeasure known at ever increasing volumes, until she got so exhausted she stopped trying and slept continuously. I was in the middle of my ‘baby blues’ period and literally hadn’t slept since the c-section as I was told to latch and pump every 3 hours day and night to get my milk in. I cried continuously, and looking back I believe I have never felt so desperate and miserable in my life. I felt like a total failure. I’m an alpha type personality, one of my core beliefs being that hard work can achieve almost anything. Breastfeeding, however, doesn’t work that way.

The pediatrician saw baby’s weight loss and stepped in: she needed formula. Another defeat, and even less sleep as my 8 shifts a day now consisted of a/ latching baby on, b/ giving her bottle and c/pumping (which yielded next to nothing). As befits a baby friendly hospital, mom and baby couldn’t be separated under any circumstances ever, so the midwives stepping in for any of the night feeds was out of the question. There I was, 4 days post laparotomy, not allowed any pain medication to speak of for my grotesquely swollen and extremely painful breasts, and unable to get any REM sleep for over 96 hours. Miserable doesn’t begin to describe it.

In the ICU literature there is a massive load of evidence that sleep deprivation produces undesirable outcomes. Sleep deprived patients have more deliria, worse wound healing, more infections and about any other complication you’d care to name. ICU staff try their very best to get patients to sleep at night. Apparently, none of this is valid or applicable to obstetrics. When I begged the midwives to help me get at least some sleep, they flatly refused. I had to keep on trying breastfeeding, under no circumstances would they consider taking the baby for part of the night or letting me skip the fruitless pumping. Didn’t I want what was best for my baby? And, driven by guilt, I soldiered on.

My husband and family got very worried: I looked terrible. When I look at pictures from those days, I barely recognise that pale, distraught woman with the dark circles under her eyes. My husband begged me to stop the breastfeeding attempts, but I would not take it from him. I was determined to be a good mother. When my husband tried to share his worries with the midwives, they reacted very passive-aggressively: they were not making me do anything, the decision to breastfeed was entirely mine, they only pointed out the best interests of our child. It sounded as if I was considering taking up smoking.

In the end, rescue came from a friend of mine who is a private CNM. She came to visit me in the hospital, saw what was going on and told me to just stop it. Running myself into the ground would not help my baby, she said. It was time for me to start to heal. Coming from her, I could accept this as the truth. I told the hospital midwives that I would stop my attempts at breastfeeding, as my baby was almost entirely formula-fed anyway.

The midwife didn’t say anything, she just removed the pump and all accessories from my room without comment or explanation. 6 hours later, I thought my breasts would explode. I was in terrible pain. No-one had said anything about the need to gradually diminish pumping in order to avoid mastitis. It was as if they had simply dropped me as a patient. I called my CNM friend for advice, and she advised me to ask for the pump back so I could gradually decrease my pumping frequency. The pump was put back grudgingly, without comment or advice. I pumped 2 more times and then went home with a rented pump and the help of my CNM friend.

I handed the baby to my husband, took a good painkiller and slept for 24 hours while he took care of her. I was a different person afterwards.

Looking back, I don’t feel guilty anymore. Just angry. What were they thinking, treating me like that? Did they really believe that by keeping me awake, in physical pain and psychological distress endlessly, somehow the breastfeeding would magically work out? Or were they dumbly following a cookie-cutter protocol, waiting for me to buckle and give up so the responsibility would be mine and not theirs?

And what objective was really being served throughout my hospital stay? It certainly wasn’t my or my baby’s best interest! Shouldn’t ‘first do no harm’ be the first rule of any patient-provider relationship? I feel like they did us a lot of harm. At the very least, they turned the first week with my baby into a purposeless bootcamp. I went through internship, residency and 2 fellowships without ever getting as miserably sleep deprived as I was in that maternity ward. And none of it brought me or my baby any advantage.

It seems like “baby friendly hospital” is really code for “breastfeeding before patients’ interests hospital”.

How did this crooked situation come into being? Whose interests are served by all this? I really don’t know. You tell me!

Will I ever try to breastfeed my next child? Right now I don’t think so. My daughter is a happy, thriving baby and her father and I are equal partners in her care. I don’t see any reason to put myself through all that misery again. My nipples haven’t gotten any less flat, so a repeat of this scenario is very likely. Now that I’m a rational human being again, I don’t see any reason to feel guilty anymore. I’m just happy with what I’ve got, bottles and all.

  • Suzanne

    I love this article. I’m an RN on a postpartum floor and I often feel like we torture our patients, both Mom and baby, because we don’t want to get in trouble with the lactation nurses who aren’t even there overnight with us to help with their “baby-friendly” bullshit. I think the best way to be baby friendly is to not starve babies who aren’t breastfeeding successfully and to give our Moms a chance to sleep. I have no qualms about taking a baby to the nursery and giving formula for a feed when the baby is hungry. Skipping one or two pumping sessions or breast feeds is not going to ruin a mother’s milk supply, but giving her a hard time after a c-section and not letting her sleep may ruin breast feeding for them both forever.

  • And just for the record, this stuff goes bad in the other direction too. The hospital where my son was born in 1996 was not at all equipped to help new mothers with BFing. I got shown into a room with a pump and encouraged to use it because my son had to spend his first few days in the nursery under observation. (He did not have quite sufficient pulse O2 and they wouldn’t let him room with me til he did. Except for a scalp laceration and bruise from the vacuum extractor, he was otherwise fine.) The nurse had no idea how to use the pump and there was no LC anywhere.

    My daughter was born in late 2004 and *that* hospital had LCs on staff and the one assigned to me had no idea what she was doing. She SHOVED my baby’s head onto my breast, like that was going to help anything.

    Turns out that babies actually need to be vertical in orientation to the nipple, especially when they are first learning to nurse. By vertical I mean if you were sitting upright and feeding your baby, the baby needs to be sitting upright and facing you. All the holds they teach you are pointless and hurt your back, hurt your shoulders and arms, hunch you over and don’t make it as easy for the baby to get a good latch, which by the way needs to take in more than the nipple, up to about an inch into the areola surrounding.

    Do they tell you this stuff? Nope. They don’t even know.

    It’s not the baby-friendly thing that’s failing. It’s the so-called “medical experts”. I need medical experts who understand normal human functioning, not just medical experts who can patch me after a heart attack, if God forbid I should ever have one.

    • Young CC Prof

      The real issue is that there is no remotely adequate externally validated breastfeeding knowledge base. No one really knows how to fix breastfeeding problems with any reasonable reliability, or if they do, no one has passed along the knowledge to professionals as a group. Your experts gave you solutions that probably worked fine for them, or for a handful of women they’d worked with, but didn’t work for you.

  • You had a c-section at the end of going through pre-eclampsia, so your body was traumatized and was trying to prioritize other things besides feeding a baby, who was premature in the first place and might have needed extra help with latch. On top of that the concept of the baby-friendly hospital is still fairly new in the U.S. and lactation consultants are not uniformly trained and what they do learn is therefore not always accurate. You had several strikes against you and it was no wonder things went wrong. You could certainly try to breastfeed again next time and just see how it goes. You might very well succeed at it. Skeptical OB probably hates the Kellymom website, but I’m betting they have some advice from experienced mamas about dealing with the flat-nipple issue. You could try there just to see what possibilities there may be for you.

  • Erin

    I know this is old, but I could have written this exactly – minus the c-section. My birth was in August of 2014, and I am still angry about it. I naively chose my hospital specifically because it was baby-friendly…who wouldn’t want that? In retrospect, I now see the huge flaws in this system, and I will be going to a different hospital for my next birth.

  • Ash

    The JOINT COMMISSION is using this as a core measure? I am appalled. For any advocates of this policy, I suggest that for any inpatient stays, advocates are required to room-in with a colicky baby without choice of what you eat. Practice accountability!

  • Vanessa Primavera

    I just had a similar experience at Howard County Hospital. 1.
    I had to beg for my epi because they didnt know if some1one was
    available 2. My hands were badly bruised from a nurse that was unskilled
    in IVS. I know I am an easy stick. She ended up putting it in the SIDE
    of my dominant hand so I couldn’t move my hand the entire stay. 3. After
    the main iv line was taken out blood was backing up the short tube and
    the day nurse REFUSED to check it. 4. NO FOOD after delivery because my
    daughter was born at 1132 5. No nursery to send the baby to in order to
    take a shower after delivery. I have an older child that my husband
    needed to be with, so this was a huge issue at this time of night. 6.
    Not being checked on at ALL the first night there. 7. Sending TECH
    support into my room to fix a computer when I FINALLY got to sleep with
    the newborn after dealing with her with a hand that I couldn’t move! 8. A
    nurse trying to force me to nurse after being informed we area formula
    family ( after being informed of this a nurse tried to force my child on me. I promptly moved her and gave the nurse a dirty look) . 9. Having to justify my choice to formula feed to EVERYONE but
    the lactation consultant. ( This is my 2nd child I know what WORKS for
    my family. The only wonderful staff members were the lactation
    consultant who was sent there because they forgot to inform her that we
    were a formula family and nurse Patti who was sweet and the nurse the
    night before discharge. 10. Your techs don’t check carseats before
    discharge at ALL, she didn’t even look to see if the chest clip was on
    correctly.11. i was never checked by a dr before release

  • guest

    Well said.

  • guest

    You are correct that bf doesn’t work in all cases. But it can in most.

    Sadly, the area of lactation is one of the most misinformed out there.

    Our nation has a 6 month exclusive bf rate of 16%. Obviously we can do better than that!

    Check out the CDC’s Breastfeeding Report Card for this year:
    http://www.cdc.gov/breastfeeding/data/reportcard.htm

  • guest

    Can you share any research to back up your ideas?
    I would be very interested to see anything on this.

  • Guest

    I know this thread is really old… but I’m not understanding some of these comments. Obviously if there are breastfeeding problems and a baby isn’t getting nourished, baby has to get fed. Does the staff at these hospitals not feed dehydrated babies? I mean, there is a way to work through most feeding problems… you just feed baby (however needed) and work on the problem via the best practice we know how per moms choice. It isn’t usually 100% “works” or “doesn’t work”. There are a whole spectrum of possibilities, most of which are fixable if mom desires.

    I find that most new mothers in my area don’t know much about breastfeeding and have very little confidence. They usually benefit greatly from reassurance and education. I don’t get complaints about being pushy and I appreciate it when my patients “own it” regarding their feeding decisions. Frankly, my time is limited and I don’t want to waste everyone’s time if mom isn’t interested in breastfeeding, so no problem there! I guess that’s why I never understand the “pressure” thing… our lactation team doesn’t even usually SEE moms unless they want to breastfeed… so they aren’t pressuring patients who don’t want to. Our nurses likewise help and give education according to what mom says she wants to do. Now, if a mom is saying she wants to breastfeed and is asking for unneeded supplements, is the nurse going to educate her on that? Of course – if it isn’t needed, she’s going to explain why it isn’t needed and give her whatever help she may need. If she isn’t having a medical/feeding problem and has in fact changed her mind and wants to combination feed or quit breastfeeding, then that’s her choice.

    Often it takes practice as a nurse to get in the right place without coming off as too pushy or going the other extreme and not even using evidence-based breastfeeding care.

    Moderation, common sense, respect, and evidence based breastfeeding care CAN coexist.

    I guess a lot of it is really just a mom’s perspective. I could never be a “relaxed, healthy mom bonding with her baby” if I wasn’t getting evidence-based care in the event of feeding problems (and don’t get me wrong, I’d totally given formula if I didn’t have enough milk evidenced by excessive weight loss, etc.- and i wouldn’t feel guilty for a minute).
    “It can really do a lot of damage to a new mom trying to do everything the ‘right’ way” … huh?!
    It would do “a lot of damage” to me if things were done the ‘wrong’ way! I would be really sad and pissed if I found out that my caregivers didn’t advocate for best practice (while also respecting the *informed* choices I make).

    • Bombshellrisa

      You probably dont understand that you are being pushy in the first place, so you won’t pick up on the fact your idea of “evidence based” or “informed choice” is really badgering.

  • Guest

    My hospital is also seeking Baby-Friendly certification and I don’t feel that it’s the way you describe at all.
    It is simply using proven evidence-based practice to help moms who say they WANT to breastfeed.
    As a matter of fact, Baby-Friendly also requires giving safe formula feeding education for those who chose to bottle feed.

    It’s too bad that you’ve had a negative experience with it.

    • rh1985

      And you think forced rooming in is fair to the mothers who have a good reason for using the night nursery? Do you think women should be able to decline hearing about breastfeeding?

    • Bombshellrisa

      And by “safe formula feeding education”, does that mean telling women “breast is best”, “keep trying” or anything that implies that they must demonstrate extraordinary circumstances to get formula for their baby?

      • rh1985

        this may be a stupid question but – is formula feeding education even needed? I found it quite easy when I was a nanny/babysitter/aunt.

        • AmyP

          Well, there is the question of whether or not to sterilize bottles, how to choose a formula, how long to allow bottles to sit at room temperature or in the fridge before throwing out, how to read infant feeding cues to avoid overfeeding, etc. It’s actually not that simple.

          I believe the Fearless Formula Feeder has some stuff to say about this and a number of her guest posters have complained about the lack of education given to parents about how to safely formula feed.

        • ratiomom

          Yes it is. Which bottle, which nipple, which formula, how much, how frequently, how to prepare hygienically, troubleshooting, avoiding overfeeding, … starting to bottlefeed can be as daunting as starting to breastfeed. This Iinformation should be provided by the hospital. Expecting ff-ing parents to figure it out by trial and error is bad for babies and completely unethical.

    • ratiomom

      The author of the post did WANT to BF. She was sabotaged by the BFHI dogma that well baby nurseries are not needed and that maternal sleep deprivation is unimportant. Please point us towards the scientific evidence proving that keeping someone awake for days on end improves lactation in any way.

    • Something From Nothing

      I have to disagree. Baby friendly is only baby friendly for moms who can and choose to breast feed. As soon as someone’s plan deviates slightly, it isn’t so ‘friendly’ anymore. It isn’t mom friendly no matter how you slice it. I’ve yet to have a person explain to me in a satisfactory way how a baby friendly designation benefits mothers at all.

  • Roze of the Valley

    When I was born in 1995 I was my moms first child, she couldn’t get me to latch on and was uncomfortable and a nurse working there made her feel like a failure and a bad mother and it made her cry. Its sad women in a normal mental state pick on someone who just gave birth and will obviously be wanting to do the very best for her baby.

  • Mel

    Wow. That was a really bad experience. Maybe I’m missing something, but if a drug is needed to keep someone alive – like the IV contrast – and the patient still wants to breastfeed, can’t they pump and dump once they’re stable? That’s what we do on our dairy farm with cows who need medical treatment after birthing to start lactation.

    • Guest

      Yes, they can pump and dump if needed for a medication… but the ironic thing is that you can typically bf with IV contrast anyway.

      Sounds like there was a ton of partial and mis-education happening all around. Too bad that resulted in such a bad experience, but I would venture to say this is hardly the norm.

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  • but there breasts and there Vagina’s are sooooo important!!

  • yeah for enfamil!!!thank God for that stuff, breastfeeding is a form of torture for many of us!!

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