Is the Baby Friendly Hospital Initiative really the Baby Deadly Hospital Initiative?

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It’s the biggest oxymoron in contemporary patient care. And now comes word that it may actually be killing babies. What is it? It’s the Baby Friendly Hospital Initiative (BFHI).

I’ve written about it before. There is nothing baby friendly about efforts to promote breastfeeding to the exclusion of a mother and baby’s actual needs. There is not, and there can never be, anything “baby friendly” about destroying the confidence of new mothers and making them feel guilty about a decision with trivial consequences.

A new paper raises the possibility that it isn’t only maternal confidence that is being killed. The paper is Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards published earlier this year in the Journal of Perinatology.

It starts with the obvious. Bed sharing (co-sleeping) is known to be deadly to babies, and the risk is highest when mothers are impaired by drugs or alcohol:

Although bed sharing with infants is well known to be hazardous, deaths and near deaths of newborn infants while bed sharing in hospitals in the United States have received little attention … These events occurred within the first 24 h of birth during ‘skin-to-skin’ contact between mother and infant, a practice promoted by the ‘Baby Friendly’ (BF) initiative … We report 15 deaths and 3 near deaths of healthy infants occurring during skin-to-skin contact or while bed sharing on maternity wards in the United States. Our findings suggest that such incidents are underreported in the United States and are preventable. We suggest ways in which close maternal infant contact to promote breast feeding may be done more safely.

What factors contributed to these 15 deaths and 2 near deaths?

In eight cases, the mother fell asleep while breastfeeding. In four cases, the mother woke up from sleep but believed her infant to be sleeping when an attendant found the infant lifeless. One or more risk factors that are known or suspected (obesity and swaddling) to further increase the risk of bed sharing were present in all cases. These included … maternal sedating drugs in 7 cases; cases excessive of maternal fatigue, either stated or assumed if the event occurred within 24 h of birth in 12 cases; pillows and/or other soft bedding present in 9 cases; obesity in 2 cases; maternal smoking in 2 cases; and infant swaddled in 4 cases.

In other words, mothers were encouraged to keep babies in bed with them even though multiple modifiable risk factors for infant suffocation were present, including maternal impairment due to sedating drugs or exhaustion and soft bedding. Why? To encourage breastfeeding, of course.

The author notes:

… A stated aim of BF USA [US branch of the BFHI] is to ‘help mothers initiate breastfeeding within one hour of birth’… BF USA advises that infants and mothers share a room continuously and that infants be breast fed on demand without restricting the duration of the feeding and with a minimum of 10–12 feedings in 24 h. In addition United Nations Children’s Fund encourages in-hospital bed sharing. These recommendations will likely result in bed sharing for prolonged periods of time, particularly for mothers who have had cesarean sections or others, who do not wish to leave their beds frequently to breastfed.

As a result, hospitals have felt free to abolish well-baby nurseries, thereby reducing costs. An unholy alliance of lactivists and hospital administrators have conspired to force new mothers to keep babies with them at all times DESPITE the fact that we know that such behavior is not safe for babies.

An important question is: can in-hospital bed sharing be done safely? … In the United States, breastfeeding during bed sharing is regarded as safe so long as the mother is awake … The present and prior reports clearly show this is not the case during the immediate post-partum period. Frequent bed checks by nurses at 5–10 min intervals is advocated in the BF literature, but as deaths or injury can occur in a few minutes, such checks would have to become nearly continuous to entirely prevent death or injury.

How can we prevent these entirely preventable infant deaths?

When a mother is in close contact with her infant, one-on-one supervision of infant and mother should be undertaken by a person trained to monitor the infant’s wellbeing as well as the mother’s wakefulness. In many cases, nurses will be unavailable for these duties… In some cases, dedicated relatives or friends might perform this function. An alternative approach would be to electronically monitor infants (heart rate or arterial saturation) with alarms referred to the nursing station to avoid disturbing parents with false alarms. This would offer considerable protection for infants in close physical contact with mothers…

Or, here’s a radical thought: we could mandate well baby nurseries in all postpartum wards and allow mothers to send their babies to the nursery when they want to sleep!

It is long past time to reassess the “Baby Friendly” Hospital Initiative. Anything that kills babies CAN’T be baby friendly. It’s really the Lactivist Friendly Hospital Initiative since lactivists are the only ones who seem to benefit from forcing mothers to breastfeed and shaming and blaming them when they don’t.

When you frame an issue, you own an issue. Lactivists framed their personal desires as baby friendly. The truth is that efforts to force mothers to breastfeed are deadly, so we need to re-frame the issue. We must demand an end to the Baby Deadly Hospital Initiative or more babies will die entirely preventable deaths.