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.

  • fean

    i was in one of those hospitals for my sons birth but they had bassinets on wheels so baby could still sleep separate and i didnt breast feed i bottle fed and they were supportive of that. our hospital is known for its birthing facilities and making sure both mom and baby get what they need. if you had c-section or are alone so u cant recover and do baby stuff all alone they help and will wheel him or her out so u can sleep and keep an eye on them for you. they even ask if u bottle feed if u want to be woken or if u want them to do it so u can rest. honestly it was amazing. i chose to do everything myself and didnt sleep til i was home, after the terrible preggo and birth i had i was paranoid any second i wasnt watching him he wouldnt be okay, so i didnt sleep until 4 days after he was born. they didnt push and they were supportive. i loved it. seems like not all of the places getting rid of nurseries are as kind and understanding though.

  • AlysrianXian

    My son was recently born in one of these terrible hospitals (though I didn’t know it at the time…). He was to be formula fed from the start, no questions asked. Yet…the nurses/LC asked me every 10 minutes WHILE IN LABOR if I was absolutely sure (and every HOUR after labor, they would even wake me and little man up to ask more questions about why formula!!!). All of my 3 children were formula fed (and coming soon 4th will be too). I was not changing my mind. I have done more research than all of those LCs/nurses combined…and I had to argue it WHILE IN LABOR (so stupid). (There was actually a thing on the computer every time my blood pressure cuff went off during labor, that asked repetitively if I was breastfeeding or formula feeding… Eventually a godsend of a nurse just put breastfeeding so people would stop harassing me. That stopped the computer from asking.)

    My son was placed in my room after delivery, and I didn’t have a break from then on (mainly from the nurses/LCs). I am 4’10, and they placed him in his little plastic crib that was easily higher then I am while laying down and the bed all the way up. I was actually recovering from severe SPD, where my hip was dislocated by 4 inches (owie) and I couldn’t walk until after I got home (it popped back into place during my stay, but I wasn’t really walking until the next day). So, there was no way I was going to be able to get up and put him in that crib thing.

    I wound up sleeping with him on my knees. He was in no danger, as I am a super light sleeper (even after delivery), but I really wish I could have reached that plastic crib to put him in for a few minutes to have a break. (My own husband passed out after the delivery) I really didn’t get ANY sleep while in the hospital, mainly due to the constant train of nurses/LCs annoying the bejesus out of me. I understand normal routine things, but when it’s just to “pop in” with a question about my formula choice…again and again…that’s where I draw the line. I was annoyed about every hour on the hour.

    They DID require 10-12 feedings from him. I tried to adhere to that (but we are a feed on command family), and he eventually was puking at every feeding after the first 5 hours. So, I made up numbers for feedings and pretended at how much he was actually eating…because he was obviously NOT going to eat that much. I am not ashamed to admit, I lied my butt off to make sure they weren’t making me overfeed him. (They wanted 10-12 feedings a day, 2 ounces at least each time, every 2 hours basically. Too much for my son.)

    I know they really wanted me to do the 1 hour skin to skin contact. I was angry about this. I wanted my husband to hold our son first (I had held our girls first), and it was fair for him to do so. However, when my son was born…they tried to do the skin to skin with me and I was furious. I had stated numerous times I did NOT want to hold my son first, I was NOT doing skin to skin, and I would definitely never hold a bloody baby (I have issues with blood). They all tried to ignore my wishes/demands, and my husband had to step in after they tried to return my son to his little plastic crib without ANYONE holding him. I made my husband follow my son around and basically ignore me after that. (He said that there were some shady things that were going on while I was in the recovery room…and he was no pleased)

    I even remember at one point having to yell at TWO LCs to get out of my room. They were not there to offer any advice on drying up breastmilk (which traditional methods wound up NOT working due to contracting viral meningitis in said hospital), but were there to STRONGLY argue my formula fed ONLY diet. I was pissed, to say the least.

    I also had to explain to the head of nursing WHY I was naming my son with MY last name. According to her, she wanted to make sure the paperwork was accurate and I wasn’t “roping anyone into child support payments”. Those were her exact words. I was furious, my husband was furious. (All of my kids have MY last name, family choice) This is the same woman, who on day of my discharge, informed my husband to stop playing with the baby…because that was not a man’s role (huh??).

    I pushed to be released within 24 hours, as I was fed up with how they were treating me. They required me to watch 16 hours of information dvds, 10 hours of which were breastfeeding information (only 10 minutes worth of formula feeding…not nearly enough) before leaving. I left it playing even while sleeping just to get it over with. The nurses told me I could skip the breastfeeding information section because it didn’t apply to me, with a remote they would get me, but after numerous attempts to get said remote…I gave up and let it play to their heart’s content.

    They also tried to claim my son had jaundice, he did not. They tried to keep us in said hospital for additional time because “hey, it’s already all paid for by your insurance!!”. Don’t care. Want to go home, NOW. Unless, I am dying…I want to be home with my family! (My pediatrician confirmed the next day that he did NOT have jaundice.)

    There were so many policies I HAD to adhere to, that my stay was MISERABLE. I was SO relaxed by the time I came home (and we did bond so much better at home then at the hospital), mainly because I was out of their “web of conditions” (aka everything they kept coming up with to try to change my mind or force us to stay longer so they could change my mind later).

    So, yes, those breast nazis DO exist… I am already looking at a different hospital to deliver in (over 3 hours away), just to avoid all of the drama this time. I NEVER had this issue with my two oldest girls, but now with all these breast nazis here…well, it was only a matter of time before I came across a breastfeeding hospital from hell.

    Side note: Not only did I contract viral meningitis during my stay and later have to be hospitalized for a month without any contact with my kids (flu ban), but I had undiagnosed eclampsia throughout my pregnancy (OB is IN the hospital) and they didn’t notice AFTER birth (my BP skyrocketed immediately). My pediatrician sent me to the ER 3 days after birth and basically saved my life. The ER at said BFHI tried to send me away once, and then my pediatrician called them and MADE them run the tests. Good thing they did, as it was in my spine/head already. IF I had changed my mind about BFing little man, I would have killed him with my viral meningitis. (My meningitis stay is a whole ‘nother story of nurses trying to force me to pump…idiots. My breast milk was leaking so bad – due to the menigitis inflammation – that I was using BATH TOWELS to soak it all up. Nothing worked to dry it up, until I received massive doses of antibiotics. It was also extremely painful – more so then a normal leakage.)

    Come to find out, this same BFHI is now on Obamacare and they no longer test urine for protein (a sign of pre-eclampsia). My OB claims that even with a previous history, that she cannot change the hospital’s policy. It went into effect THIS past April, and I have to see my normal doctor to have urine tests now every month. It was mainly changed due to lack of funding and them not seeing a NEED to test for it.

    The list could go on and on…but in general, I am NOT a fan of BFHI…at all.

    • fean

      omg i am so sorry you had such a terrible experience. the hospital i had my son is was the same but you got a choice in everything. no pushing, no rules, ect. hope you can find a better place next time. one with more understanding and much more helpful.

      • AlysrianXian

        I did wind up having my daughter in the same hospital. They had completely removed Obamacare policies by then, but still adhered to the “no testing for pre-eclampsia”. We still had an issue with giving her my last name, because they didn’t want to rope him into child support (seriously, wtf). We still had issues with people pushing breastfeeding on us constantly. We were released within 12 hours, because I knew by then how to skirt around their rules.

        Bonded better at home, and was walking/doing things at home instead of being annoyed constantly about my choice to formula feed. If I had even attempted to breast feed my son or my daughter, I would have killed both of them with my viral meningitis – that still acts up to this day. So, to all the breastfeeding nazis…fuck off. I’m not killing my kid just because you have an agenda.

  • Laural

    Dr. Amy,
    You have hit the nail on the head with this. I am an experienced mother and have had dangerous incidents with my last two babies due to the lack of a newborn nursery and suffering from extreme exhaustion. I was sitting up in my hospital bed in an attempt to not allow myself to fall asleep whilst nursing my son, I woke up as he was falling out of my arms to the floor, only to catch him at the last possible second. I still shudder. With my last baby girl, I accidentally dozed off in the hospital bed while nursing her under the same indescribable exhaustion. It is awful to imagine the consequences and I wholeheartedly agree that eliminating newborn (well) baby nurseries is dangerous.
    I hate to open myself up to criticism on this forum, as it can be ruthless, but I think mothers DO need more breastfeeding support from their doctors and nurses, not from a hospital policy. My last two babies had problems nursing and I was completely on my own without recourse in the medical community. My pediatricians have been ill equipped to assist with lactation. That is unacceptable.
    Thanks for bringing attention to this topic.

    • Young CC Prof

      I am sorry the hospital forced you into a dangerous situation.

      And, definitely there are families who need more breastfeeding support than they get. Certainly women shouldn’t feel forced to breastfeed, but there are quite a few who want to and struggle.

      I also think we need real research into what the physical and medical barriers actually are and how they can be surmounted, what helps breastfeeding and what doesn’t. (Real as in not driven by a breast-at-all-costs agenda, and actually based on evidence rather than anecdote or hypothesis.) It’s not just that professionals are uneducated, but that the literature on how to address breastfeeding problems is so limited.

  • Meerkat

    The important question here is what can we do to change this stupid policy? I guess changing your hospital is one way, perhaps writing letters to the hospital administration? Is there a more effective way to make a difference?

    • Young CC Prof

      Possibly passing laws that all hospitals with a labor and delivery ward must also provide a well-baby nursery with sufficient nurse coverage? Really, that’s the issue. Not the baby-friendly initiative, but the fact that some hospitals have used it as an excuse to save money by doing things which are obviously unsafe.

      • Meerkat

        So I guess we should contact our states’ senators. I am not sure it will make much difference, but hey, we can try.

        • Belle

          As I said in an earlier post, the 24 hour only maternity coverage the insurance companies tried to get away with was outlawed… maybe the same can be done with forced rooming-in.. it’s certainly worth a try..

          • Roadstergal

            I think what helped the 24-hour coverage was the term ‘drive-through deliveries,’ which struck a chord with the voters. I remember that phrase from the campaign. Maybe something similar would help with this.

    • LaborRN

      Best way to change it is to give the hospital bad scores when you get your Press-Ganey or whatever your hospital uses for rating your satisfaction. Medicare reimbursement is now tied to the hospitals scores. If you want changes hit them in the pocketbook.

  • meglo91

    I am logging in to say that my youngest daughter could easily have been one of these dead babies. I had pre-e and was still on magnesium sulfate and feeling pretty weird after she was born. The military hospital I gave birth in, a “baby friendly” (ha ha) place, had no nursery. My husband had to go home for the night to care for our other child, so I was left alone with my baby, drugged up and woozy after about 48 hours with no sleep. I fell asleep holding her and woke up just in time to stop her from falling off the bed, as my grip on her had loosened while I was asleep.
    Not allowing new mothers to send their babies to a nursery is barbaric and dangerous.

    • Young CC Prof

      So scary! I’m sorry they did that to you. Have you considered a complain letter?

      • meglo91

        I guess I hadn’t really thought about that. But honestly, I doubt it would make a difference. Military hospitals are very much about the bottom line, and not having nurseries is far cheaper and also means that they’re “baby friendly”, which is a nice bullet on the hospital commander’s performance report.

        • LaborRN

          Baby-Friendly designated hospitals receive Federal Funding that is really the issue

  • questionquest

    So is the safest thing to do these days to tell every medical professional you come into contact with that you are NOT breastfeeding? That way the baby gets the formula it needs in the first few days, you get the sleep you need, and if you decide to try breastfeeding you can do it alone and in peace?

    • EmbraceYourInnerCrone

      YUP, although I can’t say for sure because I did NOT want to breastfeed at all but lied about because of all the BREAST IS BEEESSSTTTT! messages I got from, co-workers, OB, childbirth educator, etc. Always stated in the ” You ARE breastfeeding aren’t you?” tone…And that was in 1994!
      At least in the hospital they were pretty Ok with giving you a ready to feed bottle of formula if you wanted it. I was also lucky in that while rooming in was expected of all the mothers, you could take your baby back to the nursery for a few hours so you could sleep. I did not have a C section but with 2 tears and the episiotomy from the vacuum extraction I had a lot of fun with all my stitches!
      I could not sleep and had the shakes for 12 hours after the delivery, If I would have had to take care of her all the time and get up every 2 hours to feed here those 2 days I probably would have just checked myself out of the hospital.

    • KarenJJ

      Sounds like a great plan! Breastfeeding is so “supported” in those early days you’l be forced to jump through all sorts of rituals and tests..

    • Courtney84

      An overly aggressive, umm I mean helpful, LC milked me while I was in hospital. It was uncomfortable and awful, but I didn’t feel like I could tell her no. When I reflect on it, it was the most negative experience of my hospital stay to deliver my son (pre-e, mag, induction, CS). I was so stressed and my milk still hadn’t come in when I was finally discharged four full days after the birth. It came in on the car ride home – I can’t help but think it was the relaxation of knowing we were going home.

  • araikwao

    Had both my babies in BFHI-certified hospitals. Hubby roomed in after #1 as she was born via CS, and was sleepy enough (due to her attempts to exit couple of weeks early) that the night feeds weren’t too crazy. Kiddo #2 however…a big boy at 9lb 4oz who wanted to feed all night on his second night on earth (after I’d been awake most of the night before due to the post-partum buzz, plus a hungry baby in the other bed who also wanted to feed all night). The MW suggested setting him up in my bed so I could feed in side-lying and get some sleep. I was in so much pain post-delivery that it was hard to roll over in bed anyway, so maybe that saved us…? I wouldn’t have chosen it, and I feel worse about it now, reading that babies have died in the hospital from this, but what else could I do? I just couldn’t see that there was another option at that time, and, you know, if the staff suggest it, it must be right?

  • Esther
    • Young CC Prof

      “in each case there were known risk factors associated with sudden infant death.”

      How about a desperately exhausted caregiver, or one under the influence of medications? That’s a risk factor, and an essential, unmodifiable one. The folks who wrote that completely missed the point, which is this: While BFHI had good intentions, in some hospitals is being applied in ways that create inherently unsafe situations. NOT random unpreventable accidents, accidents that resulted from inherently unsafe conditions.

      All you have to say, UNICEF, is that if a mother immediately postpartum asks for help with her child, she should get it. By discounting rather than absorbing this study, you are endorsing a policy of abandoning a mother on the hardest day of her life.

      • Cobalt

        All of UNICEF’s “points of note” mean absolutely nothing if the mother is exhausted and unable to stay awake.

        It’s like holding your breath. Sooner or later, you just can’t fight it anymore, and your body gives in to its own demands. There is no will, or environment, or education, or amount of breastfeeding that is going to change that.

    • KarenJJ

      Well that was a bit of a non-response… Make sure women understand the risks doesn’t actually help when a mum is so exhausted or on medication that she can’t physically do skin-to-skin or care for her infant immediately after birth.

      Their also calling the evidence of these deaths being attributable to BFHI shaky when I thought the evidence of the long term benefits of forcing mothers to do skin to skin also was shaky. Once again, nice option to have skin to skin, but sheesh let women and their carers use some judgement and keep it optional..

      • bonding is bull

        Skin to skin helps babies in places without incubators. In the U.S. that’s not an issue so it’s been lumped into the million other things a mother is supposed to do to promote “bonding.” Since bonding is b.s. and unmeasurable, it’s a great stick with which to beat women.

    • MLE

      “This study has collated data information which is not fully complete. For example, there is no data comparing outcomes for other infants cared for in the same environment. The study is also purely descriptive with no critical analysis or control for compounding variables e.g. socio-economic status of the parents, qualifications and training of staff etc.”

      Is this implying that the BFHI has saved some unknown cases? Is so, I would think they would have been able to show that before the policy was implemented. Otherwise it’s just a fun experiment…

      • MLE

        *saved some lives in unknown cases

      • The Computer Ate My Nym

        IIRC, breast feeding (without cosleeping) is supposed to be associated with a minor decrease in SIDS rate. So there could be a few cases, but if so where’s the evidence?

        • Amazed

          But is it about breast feeding straight after delivery, in those first few days when many women have no milk to speak of? I’d say EBF in those circumstances would have caused a not so minor increase in NICU admission rate.

        • Cobalt

          I always wondered about what it is about breastfeeding that is protective. Is it the milk, the waking more often, or just the baby’s tendency to fall asleep while sucking? Using a pacifier when falling asleep also decreases the risk, and they have no nutritive value. No campaigns on behalf of the magical empty silicone nipple.

          • LovleAnjel

            It’s thought that BF’ed infants get hungry sooner, so they sleep lighter and wake more often – they are less likely to go into the deep, deep sleep in which SIDS occurs.

        • Young CC Prof

          The other question is, do the extreme BFHI practices actually increase breastfeeding? I doubt it. I can’t imagine that hospitals with mandatory “baby-friendly” practices produce more successful breastfeeding relationships than ones that permit and encourage lots of bonding time, but still provide new parents with plenty of help, including the chance to really sleep.

          • The Computer Ate My Nym

            The other question is, do the extreme BFHI practices actually increase breastfeeding?

            Good question. I don’t know that there’s any data on it. Probably not. It may actually decrease breast feeding rates as women may be more fatigued and dehydrated and have a harder time getting their milk in properly.

            It’s not about women and babies, though. It’s about making the hospital look good while it’s saving money.

      • Amazed

        Very interesting. So, higher socio-economic status of the parents, higher qualifications and training of staff, etc. can overcome the very basic, NATURAL need to doze off when you’re so tired that you’re basically sleeping with your eyes wide open? Good to know.

        And those are the people who venerate Goddess Nature and think we should always defer to her when it isn’t blatantly dangerous.

        Only that, in this case, it is.

        An anecdote: a few months ago, a friend of mine had a lovely baby via a peaceful C-section. I visited the very next day and she remembers I was there. That’s all she remembers, though. Not what we talked about. No sir.

        Mind you, she was fully “there” for the conversation. Just not enough “there” not to phone me on the very same evening and plan for me to go and visit her the very next day because “we haven’t seen each other in months!”

        Would I leave her baby with her 24/7 those first days? You have one guess.

        • fiftyfifty1

          “So, higher socio-economic status of the parents…[…]… can overcome the very basic, NATURAL need to doze off ”

          Higher socio-economic parents are likely to have a higher sense of responsibility/willpower/professionalism etc. They just need to remember this and it will overcome the negative effects of sleep deprivation. After all, it is said to work for medical residents.

          • mouth gaping open

            Wow, fiftyfifty1, you’re comparing mom’s who’ve just given birth, some by c-section that are on sedating drugs, to medical residents! Great comparison. Since residents can stay awake and care for people, so can new moms who’ve just been through hell! Let’s make them all room in! Those moms that are dozing off aren’t awake enough to breastfeed anyway! The bottom line is this whole initiative really has has little to do with breastfeeding! I can’t believe that you’re not appalled by 18 infants dying! Nurses and OBs, who understand what it takes to keep newborns safe immediately postpartum when moms at too exhausted to care for their infants (and dads are completely exhausted too) are fighting to keep newborn nurseries open! They know what they’re talking about! They care for moms and babies everyday! If one baby falls on a hard hospital floor and cracks it’s skull or dies while doing skin to skin with a sleeping mother, that’s one too many! 18 is unacceptable!!! You also have to love Unicef’s response to this too! Their response is pretty much no real response! Infants died…..let’s be outraged because it realm has NOTHING tod o with breastfeeding!

          • Young CC Prof

            You are absolutely right. Fiftyfifty was being sarcastic, and willpower cannot fight exhaustion forever.

          • fiftyfifty1

            I completely agree with you MGO. I was being sarcastic.

          • Poogles

            Erm…I’m fairly certain fiftyfifty’s comment was sarcastic.

  • just me

    My hospital has a baby friendly cert (CHOMP–Google it if you want). They’re not all bad. This hospital doesn’t allow vbacs. You room with the infant but in a bassinet not bedsharing. My first kid had to be in nicu after the first day, for a few days, due to high bilirubin. At one point the pedi took one look at me and ordered a small amt of formula. And with my 2nd the first nite a nurse took the baby to nicu/ nursery for a few hours, allowing us to sleep (at this hospital the dads room in too-/ the birthing rooms have told out beds for dads. So, all in all good.

    And there was no dissuading against epidurals or anything like that. Both were induced–the first b/c of IUGR– and I had monitors on constantly (which I was thankful for).

    • Hannah

      No VBACs? Jesus.

  • Anna T

    I roomed in with both my babies but would NEVER think to bed-share in the narrow and unsafe hospital bed. They were in a bassinet next to me at all times when they weren’t nursed, changed, or cuddled. It is still possible, of course, to fall asleep during breastfeeding, and mothers must be cautioned against bed-sharing at least in those first few days when you can barely see through a haze of tiredness. If a mother is unable to keep awake, there MUST be an option for her to leave baby with hospital staff and get some sleep.

  • Esther

    Playing devil’s advocate for a moment – I suspect the NCB response to this will go something like: 15 dead babies out of tens of millions born in that time frame is a negligible number compared to the hundreds of babies per year saved by their mothers’ Magickal Breastmilk (cue Melissa Bartick), which is made even more magickal when you do the Family Bed thing. You’re just playing the “dead baby card” again.

    sigh.

  • rachel

    Yes, Yes, Yes!!! I recently delivered my third baby. Since the birth of my second child 4 years ago my hospital has received Baby Friendly certification. With my second child I sent him the nurses’ station (the hospital had already abolished it’s well-baby nursery) both nights and he was brought to me to feed every three or four hours as needed. I slept well between those times knowing he was being cuddled and loved-on (I’m an ob/gyn at the hospital and work closely with all the nurses). With my third child I only stayed one night but she stayed in the room with me. I delivered in the late afternoon and my husband was back home with our other children by mid-evening as we have no family nearby to watch them. I cared for this child entirely by myself all night and certainly didn’t want to call for help (I didn’t want to be “that doctor”). At one point my nurse came in to do a set of vitals and woke me–I had fallen asleep feeding the baby. I certainly had no intention of co-sleeping and never planned to fall asleep with my baby half-buried under my huge breast!
    I think I have a unique perspective on the Baby Friendly Initiative–I’m an ob/gyn at a hospital that has achieved certification and support some of it’s tenets. I’m also an exclusively breastfeeding mom who as a patient found many of its restrictions burdensome. The recommended one hour of skin to skin has been very nice. Most patients are pleased to have their babies all to themselves for the first hour, it limits visitors, truly does seem to help with breastfeeding initiation, and seems to make for quieter, calmer babies while I’m finishing up. The 24 hour rooming in is great if that is wanted. Your baby shouldn’t be removed from your presence unless medically necessary if that’s important to you. However, the requirement that all mom’s adhere to this rule is ridiculous. As my unit worked toward certification there were many heated discussions regarding rooming-in and maternal exhaustion. The proponents solution was that the “support person” should be soothing baby, changing diapers, etc while mom slept. My argument was that many mom’s don’t have a support person staying overnight (myself included) and that many other support people are less than helpful, sleeping themselves, etc.
    I’ve seen nurses in tears because they’ve had to tell exhausted mothers that they can’t take their baby to the nursery for a few hours. I’ve heard nurses state that they’ve been told by administrators that they’ll be fired if they take the baby to the nurses’ station regardless. I’ve fielded many patient complaints about several of the Baby Friendly Initiative steps.
    I’ve delivered in both Baby Friendly and non-Baby Friendly hospitals. I’ve worked in both as well. I’ve bonded with all of my children, loved them all, and breastfed them all as long as I wanted.

    • Cobalt

      The quiet bonding time immediately after birth is great. The lack of totally reasonable assistance in postpartum is awful. Why can’t they make it all optional, and assessed case by case?

    • MidtownParent

      I completely agree with you. I delivered at a baby-friendly hospital, and I loved having baby to breast immediately, and the lack of interruptions in the early hours. But after 35 hours of labor, both I and my husband were beyond exhausted. We were fortunate to have a baby who was a good sleeper, because neither of us was in a position to provide 24-hour awake supervision after 48 hours without sleep. I put baby in the bassinet within arm’s reach, and we both slept. I am very thankful the nurses supported us in that.

    • Who?

      Sounds to me like it’s cheaper. Stick in a few more private rooms or four bed wards where the nursery used to be, adjust the staffing downwards-no midwives required to care for those freeloading babies-and up go the financial stats. The accountants must be laughing all the way to wherever it is they go.

      I’ll never forget the midwife who told me she didn’t think my daughter (a couple of hours old, screaming her lungs out, passing mec, very sad, couldn’t feed or settle) would ‘settle down’. Thankfully she was my second baby, not the first. I’ll also never forget the look on her face when I told her that I’d lost the instructions for re-insertion so I thought we’d best just get on with it. I assume she meant to say something kind and encouraging and it came out wrong, lucky one of us was able to clearly communicate her message.

    • mostlyclueless

      Very interesting and useful comment. I agree with almost all of it. I am the only person I know who actually did not enjoy the “golden hour.” I had a c-section and during my golden hour my body was still halfway paralyzed, yet the painkillers were wearing off. I was sobbing, shaking, and vomiting. But the golden hour was not optional at my hospital — so my husband took his shirt off and did skin to skin with the baby.

      • Cobalt

        That’s why all these ‘rules’ should be choices. And if it’s not clear from medical or expressed needs, they can ASK. There is no reason to force newborn care on an immediately post-op patient that is immobilized, in pain, and still having difficult side effects from delivery and anesthesia. It would be appropriate to ask what contact you want (within current capabilities), and to help make that happen.

      • FormerPhysicist

        Vomiting, sobbing and shaking, and it wasn’t optional?!! I am very very profane right now, so I’ll stop here.

        • The Bofa, Being of the Sofa

          I don’t understand it. Recall how during pregnancy, OBs are sure to point out that “they have two patients” to take care of.

          Why is it that as soon as the baby is born, the OB is not providing any care for the mother any more? Not dealing with recovery? Not dealing with issues like sleep?

          They aren’t responsible for the baby any more, but they still have a responsibility to care for the mother. Why doesn’t the OB walk in and say, “I have to deal with my patient first!”

          • Cobalt

            How involved are OBs in the recovery room after the surgery is over? I have no idea, I’ve never had a cesarean. The only surgery I’ve had the surgeon wasn’t even in the hospital by the time they got me awake. After birth, I usually saw the OB once the next day before discharge, and they never seemed to be fully involved in what the postpartum nurses were doing.

          • rachel

            Not much. After I finish a C-section I go speak with the family briefly while the patient goes to recovery. Generally that is back on LDRP unless she had general anesthesia which requires two recovery nurses and the main OR recovery room in my hospital. Unless I’m called by nursing I won’t see my patient again until the next morning. Anesthesia tends to be responsible for the initial recovery phase–nausea, vomiting, pain control. I’m most likely to get called for bleeding.

          • rachel

            The OB is still entirely responsible for the mother but I can’t countermand hospital policy. I’d love to be able to tell a mother that we’ll take her baby to the nursery for the night so she can sleep but I have no nursery to take that baby to, no nurses to watch that baby, and surprisingly little influence in hospital policy. I will admit to occasionally taking an exhausted mother’s baby to the nurses’ station and cuddling him/her myself, maybe even giving a bottle if formula feeding if I’ve got the time. I’ve also prolonged my rounding time to sway and walk a fussy baby long enough for mom to scarf down her breakfast before the next feeding. I’m not special–most people would find that the majority of us do these little things to ease the postpartum transition. We’d like to do more but our hands are often tied.

      • Amy M

        I didn’t. Even though my babies were born vaginally, because they were 36wkers, the doctor and nurses took them right away to make sure they were fine. My husband went with them, but didn’t do skin-to-skin. A few hours later, my husband and the babies came to my room, and I was able to hold them. I did some skin-to-skin while attempting to nurse, but they didn’t stress it at this hospital unless you had a little preemie in the NICU. Of course, this was also in 2009, and I don’t think the whole skin-to-skin thing was getting as much press back then. I don’t feel like I’ve missed out on anything, I have a great relationship with my children.

      • Busbus

        The “golden hour” being forced on people is just ridiculous! I’ve heard a lot of bad things about BFHI, especially the thing about no newborn nurseries. But that almost takes the cake! Who makes these rules!? Who in their right mind is going to tell a shaking, sobbing new mother, “this isn’t optional”? Whatever was supposed to be achieved by immediate skin-to-skin is most decidedly not achieved in a situation like that. Move on, and have that first get-to-know moment later, when everyone is rested and ready. What’s so hard about that!?

        mostlyclueless, I hope the rest of your hospital stay was better! 🙂

    • Susan

      I love your post. Most of baby friendly is great and wanted. What’s not is the hard line inflexible approach. I started to say that some of these
      Parents of smothered babies are going to sue and that will restore sanity. But of course it won’t. Individualized care that respects the parents and gives nurses and doctors the leeway to base decisions on individual needs. That’s what’s missing from this!

      • EmbraceYourInnerCrone

        I am not sure baby friendly is wanted by “everyone” some of these seem a little much, and some parents would probably prefer to formula feed, if they were not led to believe that breastfeeding is SOOOOOOOO much better than formula and you are just a bad parent if you don’t at least TRY to breastfeed…also there is the whole EXCLUSIVE breastfeeding must be the goal! thing: (From the BFHI webpage)

        “Baby-Friendly hospitals and birthing facilities must adhere to the Ten Steps to receive, and retain, a Baby-Friendly designation.
        The Ten Steps to Successful Breastfeeding are:

        Have a written breastfeeding policy that is routinely communicated to all health care staff.

        Train all health care staff in the skills necessary to implement this policy.

        Inform all pregnant women about the benefits and management of breastfeeding.

        Help mothers initiate breastfeeding within one hour of birth.

        Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

        Give infants no food or drink other than breast-milk, unless medically indicated.

        Practice rooming in – allow mothers and infants to remain together 24 hours a day.

        Encourage breastfeeding on demand.

        Give no pacifiers or artificial nipples to breastfeeding infants.

        Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.”

    • mouth gaping open

      Rachel, Well-written by someone who knows what she’s talking about from a professional and personal standpoint! Why we are pretending that these babies won’t bond with their moms if they’re not skin to skin constantly or in mom’s room constantly?! It is ridiculous!! A sleeping mom or a dead baby can’t breastfeed! Safety first. All of these moms and babies will bond just fine! They don’t need to be tied to each other for the first 48-72 hrs when the mom is too exhausted to care for them constantly. She needs sleep to recover! I’d love to see the postpartum depression rates in these hospitals without nurseries! Listen to the nurses! They know what they’re talking about! They live these scenarios daily!

  • Dr Kitty

    I co-slept in hospital after my CS, at the suggestion of the midwives.
    Since the only alternative I was offered was a sleeping tablet and my baby being formula fed at the night nursery (neither of which I wanted) it seemed like a good idea at the time.

    I had plentiful colostrum and a hungry little baby that liked to feed 24/7, so side lying while feeding and sleeping seemed like the best option.

    It doesn’t seem such a good idea in hindsight.

  • PrimaryCareDoc

    These stories turn my stomach. Withholding analgesia, forcing new moms to sit up straight while feeding so that they don’t fall asleep…ridiculous.

    I am SO grateful for the nurses at the hospital I delivered at. My first son had severe jaundice, and we were readmitted after being home for less than 24 hours. He was supposed to eat every 2 hours and go right back under the bililights after that. Since it took him at least an hour to eat, I was basically ALWAYS feeding him. But they wanted to monitor what he was eating, so I had to pump and note how much he ate. So I was always pumping or feeding him. I remember collapsing into tears, and a nurse firmly saying to me, “We’re going to take the baby to the nurses station and put him under the lights there. We’re going to give him formula for his next feed. And you’re going to sleep.” That’s exactly what happened…and like a miracle I woke up and my milk had come in like you wouldn’t believe. I went on to nurse him for a year.

    For my second…he was huge and hungry. So hungry. He was freaking out the second he got near my breast and couldn’t latch because he was so eager. The awesome LC brought a syringe full of formula and showed me how to squirt it in his mouth to get him to calm down…no more problems.

    • Cobalt

      “For my second…he was huge and hungry. So hungry. He was freaking out the second he got near my breast and couldn’t latch because he was so eager. The awesome LC brought a syringe full of formula and showed me how to squirt it in his mouth to get him to calm down…no more problems.”

      That’s kids for you, sometimes they want something so much they can’t even take yes for an answer.

  • lawyer jane

    We live in a sad, crazy culture that refuses to help mothers who just gave birth 🙁

  • Dr Kitty

    OT
    Women are more than their body parts, but how they feel about their bodies is illuminating.
    http://www.theguardian.com/lifeandstyle/2014/sep/06/womens-breasts-laura-dodsworth-photography

    Also, it turns out, the Nazis invading can prevent your milk coming in.

    • Dr Kitty

      Article contains picture of breasts.
      NSFW

  • KeeperOfTheBooks

    This sort of nonsense was rife at my hospital, too. It wasn’t a BFHI hospital yet, but the LC told me they were working hard on getting certified. As a result, I spent the three nights I stayed at the hospital alternating between trying to get my daughter to feed and dozing with her asleep on her tummy on my chest, with the bed at a semi-reclined angle.
    The first night wasn’t too bad because I still had my catheter in. (I had a C-section.)
    The second and third nights–and, frankly, days–were nightmarish. I couldn’t put her in the bassinet while sitting in bed because the bassinet was too high and on wheels, so I couldn’t hold it steady while getting her up and over the side of it. However, because of the C-section, I had ZERO core strength; in order to get out of bed, I had to grab the bed rail with both hands and haul myself over the side. Not really possible with a baby in arms, but I couldn’t put her down because I couldn’t reach the bassinet, and after you have a catheter when you need to pee (and I did often because I was guzzling water in an effort to get my milk to come in), YOU NEED TO PEE NOW.
    The one thing I will say is that while only one nurse offered to take her to the nurse’s station for me (which I, as a “good” breastfeeding mom, flatly refused, of course…pardon me while I roll my eyes at my own stupidity), the nurses and patient care techs who would come when I rang the call bell would almost always change her diaper for me while I was using the bathroom, so I would only have to get up, pee, and return to my bed to be handed a clean baby.

    • KeeperOfTheBooks

      Forgot to mention: I was on Vicodin for the C-section for those few days…and yet it seemed like a good idea for baby and me to sleep together? Who thought that one up?

  • Jocelyn

    I actually JUST wrote a email (last week) to the hospital where I delivered my daughter last November, telling them of my experience of falling asleep with her in the bed after an exhausting labor and no help at night and no nursery to send her to. They haven’t sent me any response.

    • Jocelyn

      I forgot to mention the part where I was scolded at 2 am by the nurse for asking for a pacifier, because “they really don’t encourage those.” Nevermind my milk hadn’t come in and my baby desperately trying to nurse was the reason I couldn’t go to sleep.

      • KeeperOfTheBooks

        My clearest memory of that kind of thing was of the nurse I frantically called to my room in the middle of the second night. She was pregnant and, incidentally, was wearing a mask. Asked why, it’s because she “doesn’t want to get the flu shot while pregnant”–some thing that my OB recommended wholeheartedly and which was heavily enforced on the standard hospital discharge paperwork, but whatever. “My baby hasn’t stopped screaming for over two hours, and she keeps trying to nurse but pulls off because she’s not getting anything. What should I do?” Her: “See this marble on my name badge? That’s how big her stomach is. She doesn’t need much food!” The next day, I was catching flack because DD had lost over 10% of her body weight. You seriously can’t win.

        • Anj Fabian

          I absolutely LOATHE the line “That their tummies are tiny – that’s why you shouldn’t worry if they nurse all the time, or only nurse for a short while.”.

          Feed. The. Baby.
          Do that and you can avoid most problems.

          • S

            Speaking of which, here’s a dumb question: Do we know if their tummies aren’t just small because they’ve not been filled yet?

            (My first pooped out a tremendous amount of blood that he’d eaten while being born. I’m not convinced of the tiny tummy thing.)

          • Karen in SC

            I am not convinced either but NoLongerCrunching uses one of those marbles in her work with new mothers.

          • fiftyfifty1

            Yeah, it’s total nonsense.

          • wookie130

            My son was taking nearly a full 2 oz. of formula when he was less than 72 hours old…if his tummy was so tiny, I would think he would have spit up what his stomach could not contain…he hasn’t spit up yet, and eats like a Viking at 3 weeks old!

          • auntbea

            We actually had that discussion a few weeks ago. At least one physician here says it’s nonsense.

          • fiftyfifty1

            It simply isn’t true. Their stomachs are not the size of marbles either filled or unfilled, they are much bigger. Bottlefed newborns typically take 2 oz at a feeding, often 3 oz.

          • KarenJJ

            All this attempting to convince women that babies are “getting enough” and not to worry about feeding, when the baby is screaming from hunger is pitiful and goes against every mother’s instincts. Geez even in Asia, newborns were sometimes fed chewed up cooked rice before a mother’s milk came in (which was one of the practises WHO was trying to stop with their “exclusive breastfeeding” policy).

        • Box of Salt

          Marbles?
          I was once told that an empty stomach is about the same size as the fist.

          Newborn fists are bigger than marbles.

          And they can expand. A lot.

          • The Bofa, Being of the Sofa

            Newborn fists are bigger than marbles.

            See above. A typical newborn fist wouldn’t be a bad estimate for the lower limit, and you are right, it’s bigger than a marble.

        • The Bofa, Being of the Sofa

          OK, here’s some info:

          Marbles are typically 1/2″ or 1″. A 1″ diameter marble has a volume of 8.5 cc (cubic centimeter). Since 1 cc = 1 mL, that means that a 1″ marble has a volume of 8.5 mL.

          I don’t know anything about anatomy, but I know that when my oldest niece was born by c-section back in 1981, she drank 1 oz of fluid (water, maybe sugar water) in the first hour, while her mom was still coming out of anesthesia. Therefore, I can say unequivocally that a newborn’s stomach can hold AT LEAST 30 mL (1 oz). Assuming it is a sphere, that would have a diameter of at least 1.5″, so 50% bigger (in diameter) than a normal large marble. And that is the lower limit.

          As others have noted, babies drinking formula can have larger servings not long after that.

          Therefore, the whole “newborn’s stomach is only as large as a marble” is clearly nonsense, and would be obviously nonsense to anyone who had experience with newborns and could do a little math.

          There is no way that an L&D nurse can know less about newborns than me. This is just a result of casual experience having nieces and nephews, not something I learned from going to baby class or anything.

          • Young CC Prof

            My brother-in-law, who was an unusually large, possibly GD, baby, apparently was on 5-ounce bottles before leaving the hospital. The nurses were impressed.

          • Cobalt

            Wow. Cobalt 2.4 didn’t hit 2oz in a bottle till 10 days. He’s a lazy little sucker though, so he might be getting more at a time when drinking straight from the tap.

        • NICU-RN

          It certainly doens’t look to be the size of a marble on X-ray…

        • Susan

          Maybe it was one of those magic Amber teething marbles that the cool babies wear that of course no baby would ever choke on because they are made of Unicorn poop.

          • Allie

            I took so much flack on a gentle parenting site one time for daring to suggest it might be dangerous to leave that thing on overnight. It didn’t seem advisable to me and my husband said absolutely not. We only used it under close supervision. It does work, though. I stuck it on my wrist for a bit while I was still trying to figure out what it was all about and my whole arm went numb.

        • CSN0116

          I bottle fed my last newborn (now 3 months old) when she was just 25 minutes old, while still in recovery. She took 2 oz. At 25 minutes old. No puking, no discomfort. It was followed by a deep, peaceful sleep. She was up to 4 oz feeds at discharge 48 hours later. Born at 8 lbs 11 oz. All five of my babies were consuming 4 oz (typically every 4 hours all day long) by the time they were a week old.

          • fiftyfifty1

            “All five of my babies were consuming 4 oz (typically every 4 hours all day long) by the time they were a week old.”

            Yep. This whole thing about the size of a newborn’s stomach being only a teaspoon (or the size of a marble) is a myth. Sure, it may be that size when it is totally empty. But stomachs are made to expand with food. An adult’s empty stomach is only the size of a clenched fist. But my fist is smaller than an apple, and I have no trouble eating an apple….and then a sandwich and a glass of milk and a salad and a cookie, all at one meal, without difficulty. If I had to stop when I had eaten a fist size portion at every meal, I would be frantically hungry. I would want to feed every hour! Just like breastfed infants do when their moms don’t have large carrying capacities.

            In contrast, when infants’ intakes are limited only by their own natural satiety cues, they will typically take larger amounts and less often. So infants who get formula (or who have moms with high production and storage abilities) will often take 4 ounces at a feed and not need to feed again for 4 hours. My own mother had a huge milk storage capacity. Her diary from my first weeks documents that I breastfed every ~4 hours during the day, and slept straight through the night before 3 weeks of age. But this sort of feeding schedule isn’t possible if a woman is barely making/storing enough.

            But in the land of lactivism, mothers don’t need sleep! And babies don’t get hungry and suffer, no never!

          • Monkey Professor for a Head

            The first night that I had mini monkey at home (when he was 3 days old), I hand expressed milk and my husband and I syringe fed him so that my nipples would have a break. I was expressing twice as much milk as I was told he needed in a feed, and he was still hungry. I don’t buy the marble thing either.

            Of course, I might just have an exceptionally hungry baby – in the past 7 months he’s gone from 50th centile to over the 85th in both weight and height. And despite me having plenty of milk, he still spent his first few months feeding every 90 minutes during the day.

          • fiftyfifty1

            A mother can have plenty enough milk, as measured by the fact that her baby is growing very nicely, and still have a small storage capacity. The baby will just have to feed often. It’s like the difference between meat cows and milk cows. The calf of a meat cow can thrive, but it has to feed repeatedly all day long because its dam’s udder has a small carrying capacity. And if the calf doesn’t feed frequently, the mom dries up. But milk cows have huge carrying capacities, and they keep producing even when milked only twice a day. Their moms can feed them less often and calf will still thrive.

            You say your baby fed every 90 minutes for the first few months. Was that because baby refused more (e.g. you could have pumped more ounces immediately after the feed but baby didn’t want it), or because the breasts were emptied?

          • Busbus

            I would agree with that. My LO was terribly upset the first two weeks of his life and cried most of his waking hours, while I was struggling with nursing, pumping, and syringe or spoon feeding. Once we decided to disregard the LC’s advice and went to regular bottles, he downed an entire bottle at once and went to sleep for several hours. When he woke up, he was a changed little guy!

            From what I hear, that doesn’t seem to be an uncommon experience. Also, my LO was quite overdue and large – no wonder he needed more food than the puny little tea spoons of milk we were giving him!

      • Anka

        That was exactly my experience. I gave birth in June 2013 and still haven’t sent my letter in because it’s going on fifteen pages (the dumbassedly aspirationally BFHI hospital was only one component of the whole terrible experience), and every time I try to finish it I just get angry and depressed again.

    • mouth gaping opent

      WRITE, WRITE, WRITE to your hospitals! Write if your hospital has a nursery and you needed it and appreciated it! Write if your hospital didn’t have a nursery and your care was horrible! Be honest on your Press Gainey surveys that the hospitals send you. If patient satisfaction starts dropping in the “baby-friendly” hospitals and they aren’t being reimbursed for care, they may wake up and change back to common sense practices! The 24 hr discharges stopped when infants were going home with undiagnosed problems and weren’t even feeding well. All hospitals in the US should be required by law to have a nursery for patient safety! I don’t care what “baby-friendly USA” says! If patients fight and support the nurses and doctors who are trying to fight but loosing, we can change things! It all comes down to money! If hospitals aren’t getting paid because patients are unsatisfied, they will be FORCED to change! Don’t be afraid to speak up!

  • Guestll

    My daughter was born at a BFHI. All I’m going to say is this — I remember each and every single one of you nurses who defied hospital policy — to get me food from Starbucks when none was available at the hospital as she was born at night — to sitting with me in my room during your half hour break and watching her so I could rest my eyes in the middle of the night — to changing her diaper and swaddling her when I didn’t know how — to being the de facto LC because my baby was born on a Saturday and the LC didn’t work weekends — to refusing to discharge me despite all of the “out in 24 hours” infographs all over your walls because my BP was 83/38 the morning after she was born and you said, NO, NO, she stays for another day — thank you. I remember every single one of your names and I think of you often. You really helped this brand new mother out, even when it violated protocol.

    • FormerPhysicist

      I love that they helped you, I despise that they had to violate protocol to do so.

      • mouth gaping open

        Lots of nurses will break protocols if it means giving their patients better care! Let’s face it, the “baby-friendly” initiative isn’t started by nurses! Nurses know better! If nurses are truly being threatened with being fired if they take infants when a mom WANTS them to so that she can sleep (even if they have to take the babies to the nurses’ station), that’s horrible! Nurses need their jobs! If you hear a nurse tell you that she will be fired, WRITE to your hospitals, that’s all I can say! Obviously don’t mention names of nurses (then they will surely be fired). Just write that the nurses were strictly NOT allowed to take infants out of rooms due to the 24 hr rooming-in policy! And tell the hospital that you thinks it’s bull shit too!

    • guest

      My son wasn’t born at a BFHI, but I think they were/are aiming for it. They don’t have a well baby nursery or nurses to take care of babies when parents are exhausted. My son was an induction at 2am after I had been up since 6am, with 4 hours of sleep and mild to moderate contractions all day. He was born at 7:45am and I got an hour of sleep that day. It was also a pretty rough delivery, and I lost a lot of blood.

      My husband had been up roughly the same time and had a cold. The evening after my son was born my husband passed out (and, honestly, I wouldn’t have even wanted him to care for our newborn as exhausted as he was) and the baby kept fussing. I kept nodding off while I rocked him. It was so scary.

      My nurse came in at 10pm (so we’re talking almost 48 hours with maybe 5 hours of sleep) and I begged her to take the baby so I could just sleep for an hour. I had nursed him the hour before and anticipated trying again in another hour. She, breaking the rules, said “you poor thing, of course, get some rest.” Bless that nurse, she let me sleep for FIVE hours. FIVE!! She came back and told me we had both slept the whole time and who was she to wake us up. Oh, I could have kissed her. I felt like a new woman.

      I think doing away with newborn well baby nurseries is a terrible idea, and I’m planning on delivering at a different hospital the next time. One with a nursery. It’s just way too dangerous.

      • guest

        And, for what its worth, he did fine with nursing. The nurse told me that a 6 hour break is fine during the first day of life as long as the baby seems ok. I was so happy that she was willing to assess the situation based on both mine and my baby’s needs, not on some rigid protocol that might have absolutely no bearing on our condition, right there and then.

  • Allie

    10-12 feedings in the first 24 hours?! Are they insane? I don’t think my baby took a single feeding in that time, and we went on to nurse very successfully. She did room in with me, but in a separate cot with no soft bedding and no swaddling, which is no longer the practice at the hospital where I gave birth. I think they are getting away from the “baby friendly” thing. They don’t have a well-baby nursery, but they seem to be quite generous with the reasons for babies to spend a little time in the intermediate care nursery. My LO stayed with me and slept most of the time… until, that is, we took her home. Then she never slept again : /

    • toofargone

      I thought the same thing. My daughter nursed once shortly after she was born and then refused to nurse for like 1-2 days. All she did was sleep. I would have lost my mind if it weren’t for the nurse that said since her weight was ok don’t worry about it.

      • It has always seemed to me that the reason nature organized full milk supply to arrive not at birth, but approx. 3 days later was because the majority of babies aren’t all that interested in, nor need, large amounts of food prior to that. In my experience, most babies develop an appetite as the meconium clears the gut. I don’t know how many hysterical mothers I’ve calmed after they didn’t have the glorious delivery room nursing experience described as critical to bonding and breastfeeding success simply because Jr. wasn’t interested.

        • Sue

          How did any of us bond with our mothers if we didn’t get immediate skin-to-skin? Could all those thousands of hours of loving affection subsequent to birth balance the ”deficiency”? Still working for me…

          • If you were born between the early 20s through the beginning of the 70s, more likely than not your mother was [1] sedated in labor, often heavily, [2] did not have any skin-to-skin contact while in hospital, [3] fed you formula. This, mothers were told, was the modern, “scientific” way of giving birth and infant care.

            Amazing how well the vast majority of us survived it without killing our mothers or becoming wildly maladjusted.

            Watching so many theories go full circle since 1967, when I began working in the maternity field, medically, psychologically, and philosophically, have convinced me that the only real way to give birth and raise children is “do what works” [and is medically sound]

          • Roadstergal

            I was born in ’76 – I don’t know what I got when it comes to skin-to-skin and formula/BF and all. There’s no way I could remember, and I absolutely don’t give a damn. I remember _so_ many things about my mom, and the boundless love she gave me, and the ways she cared for me when I was growing up – the way I exited her and what happened in the first day of life only matters to the extent that I survived to experience all of the rest.

            I was recently cleaning up my belongings, and I found a beautiful cross-stich she made when I was born – I’ve moved all over the country many times, so I don’t know how I managed to hang on to it, but I did. It shows me, and the little angels she imagined around my crib (the crib my dad originally made for my oldest sister, the one we all slept in), and my full name and birthdate in elaborate script. Nothing about whether or not she had pain relief or a vaginal birth or skin-to-skin or… any of that stuff that seems so important these days.

        • Trixie

          Huh — both of mine were super into it right away. The second time, my milk came in as I was pushing. They definitely nursed at least 8 times in the first 24 hours.

          • Notice I never write “all” but rather “most”. NOTHING in obstetrics is “one size fits all”. The biggest problem, IMO, is the rigidity of far too many in the profession. Flexibility is everything in having a baby and raising it.

        • Elaine

          My daughter was only interested in nursing about every 6 hours during the day (more frequently at night) when she was brand-new. We had all the nurses hyperventilating… drove me nuts. They kept telling me that she needed to nurse more often or it would hurt my supply. That was definitely not the case! My son, by contrast, was a ravenous little beastie who nursed twice on each side before we even made it up to the post-partum floor.

      • Theoneandonly

        Same thing with my little one. She got 6ml colostrum in a syringe from her father (hand expressed from me by a hospital midwife) while I was in recovery – and slept all day and most of the night after that. We even did a heel prick to test her sugar levels – but she was fine. Milk came in the following night and breastfed for 15 months after that.

  • I’ve thought more than once it might be the “Mother Toxic Hospital Initiative” – I have a hard time seeing how much of what it does and how it does it is at all good for maternal mental health. Further, a baby without a mother, or with a seriously depressed mother is not very well served. The whole thing gives credence for those who want to jude others for reasonable choices.

  • Cat10

    I just recently gave birth via c-sec at a “Baby Friendly Hospital” and while they made a point out of discouraging co-sleeping in bed, the bassinet for the baby that was placed next to my bed was so high that I seriously struggled to get the him in and out of that thing without dropping him or being myself in excruciating pain, especially during the first few hours after delivery. There must be a better way to do this, seriously. Height-adjustable bassinets or bassinets that can be safely attached to the hospital bed?

    Another thing that seriously irritated me and is a bit OT (sorry): My baby was born large for gestational age (8lbs 15 oz) and so his blood sugar was monitored every two hours for 36 hours after delivery. On two occasions during this time, his blood sugar dropped below 45 and he was given a tiny amount of formula (which was fine by me, whatever is necessary to make sure he is OK). However, as soon as his blood sugar stabilized and they stopped monitoring him, formula was “taboo.” He cluster-fed for seven hours on the second day and I was so exhausted that I was in tears and really, really needed some sleep. I asked the nurse if she had any suggestions what I could do differently (this is BTW not my first baby, my first one was breast-fed) and she only replied, “I hope you are not considering formula.” At that moment I was actually not considering formula but it seemed a bit strange to me that formula was OK a day ago to make sure the baby is doing fine but when a mother is completely exhausted and does have the best intentions to breast-feed her baby, she is denied? After shift change a different nurse had mercy on me and (probably against hospital policy) offered formula which I accepted. The baby went to sleep within 10 minutes and I got some much needed sleep. BTW, since we are home, he is exclusively breast-fed and gaining weight. But I guess for the lactivists I blew it…

    • MLE

      Formula is poison! Oh unless you really really need it, in which case it’s a life saving miracle. Miracle poison.

      • Sue

        But don’t you recall from the ”contracts”? Formula is MEDICINE!

  • Zornorph

    I ‘roomed in’ with my baby, but I certainly didn’t keep him in the bed with me. There was this portable thing that sort of looked like the drink cart on an airplane that was right next to my bed that he was placed in. I also, in the 48 hours I was in there with him, twice took advantage of night nurses offers to feed him, having read that you should do what you can to be most rested and let them help if they want (they likes the novelty of me, so were extra friendly, I think). Of course, I was nowhere near as tired as a mother would have been, having not given birth. I don’t know if the hospital had a nursery or not – I don’t think it was a ‘baby friendly’ one – certainly the formula wasn’t hidden. I quite liked the idea of skin-on-skin, but it was more that I was opening my shirt to hold him against me and since I was giving him a bottle, I was engaged enough that I don’t think I would have fallen asleep doing that. But all this encouraging women to have the baby in the bed with them – it was bound to have these sorts of results.
    Stupid question, can women lay down to breastfeed? Or do you have to sit up? I was always sitting up to feed LO and I can’t go to sleep in that position (except on a plane and that with great difficulty). But if I tried to feed him laying down, I could see drifting off that way.

    • I could do so, but I was very paranoid about bed sharing so did what I could to put the baby in their bassinet as soon as they were done feeding. Glad to hear things are going well with your LO, Z, he must be getting big by now!

    • Actually, nursing in bed while semi-reclining, on pillows or with the head of the bed raised, is practically the WORST way to nurse. The angles are all wrong; you have to heft the baby up onto your chest at an unnatural angle. Whenever possible, I get the woman up and into a comfortable chair, usually with a pillow on her lap. Being vertical, the next thing is to teach her how to hold the infant, so that the baby’s mouth is facing the nipple, the face not turned to the ceiling [amazing how many women do this — I suppose it is because they want to look into the baby’s eyes as he nurses]. I’m a fan of the “football hold” [baby tucked under the arm with the breast hovering over the baby’s mouth] because [1] the mother can more easily position the nipple correctly with her free hand, and [2] if the mother has had a C/S, there’s less pressure on her incision. Very good for large-breasted women. But it isn’t “traditional”, and some women have a tough time understanding that the baby can’t fall.

      Can one nurse lying down? Of course, but the bed has to be completely flat, and the woman on her side, baby facing her. This takes a bit of practice, and the mechanics of burping and turning over in order to offer the other breast, while still holding the infant, can be a bit awkward without someone around to help out while the woman turns over. I’ve found that most immediately postpartum women don’t find this position all that comfortable, but later on, many like it.

      • Anj Fabian

        Side lying was my preferred position. I had wiggly babies and it’s really difficult to restrain a baby who is flailing, kicking, arching his back and turning his face away – with the arm that is supposed to be supporting him…
        …while squishing the breast so his tiny mouth can latch properly.

        Lying down means the bed does the supporting.
        I’d snuggle his body up against me to help quell the thrashing.
        I still had both hands free to position his head and my breast.

        I didn’t do that on the first day post CS. That day I used the pump which doesn’t scream, doesn’t fight and gets a good latch almost every time.

        • Trixie

          I couldn’t get my boob to line up with their heads until they were a couple months old in side lying. Everyone is different….

        • MaineJen

          I liked side-lying too, but only my 2nd babe would do it. My son flatly refused. He wanted to be in my arms or on that boppy, with me sitting up. (That should have told me a lot about his personality…)

      • Guest

        So that was normal that the baby is facing my body! I was thinking how do women bond while breastfeeding if the baby can’t look at them and I thought that was because my breast is small LOL (My oldest was FF). After all these difficulties with her not sucking I found the bottle feeding makes me happier and contact with her better while feeding that I had the usual uterine contractions and breast leaking while FF! (I have experienced the uterine contractions while FF with my oldest too)

      • Trixie

        A wonderful position (though not great for keeping yourself from falling asleep) is leaning back with the baby on top of you. In this position one of mine could latch herself from birth with no hands from me.

        • Cobalt

          So comfortable! I put the boppy pillow around my waist to hold my elbows up and nurse leaning back. It’s easy for both of us and it’s easy for my husband to pick the baby up afterwards, since me and the baby are both about asleep. We do it a lot when it’s his turn to be awake during night feeds.

      • theadequatemother

        huh….my favorite nursing position with both my kids was semi reclined, leaning against the pillows or a wall with my knees bent, feet flat on the bed. That kept the baby at the right height (resting on my thighs) without the need for a nursing pillow and was super comfortable for me, even with second degree tears. But I did have a parade of OB RNs in my room coming to see the funny multip with her weird nursing position. Second favorite was side-lying…but only because baby 2 is a chunkster and I was getting carpal tunnel in my wrists from holding him to nurse. Never burped him and fed only one breast per feeding because I overproduced. I did fall asleep while nursing him a few times side-lying once we got home in very unsafe sleeping conditions. In hindsight I should have made the bed as safe as possible (gotten rid of all pillows, blankets, possibly the husband (kidding)) instead of strictly admonishing myself to be more wakeful (which didn’t work).

    • Cobalt

      I nurse laying down fairly often, but have to be mindful of the urge to nod off. I could fall asleep in a sitting position too, though. Any position that is comfortable enough to hold for 15 minutes of breastfeeding is comfortable enough to drop off in, especially when already tired. Breastfeeding also makes me kind of sleepy anyway, it’s part of the lactation hormonal response.

      After combining the effects of late pregnancy, delivering the baby, constant interruptions at the hospital, and the hormonal effects of lactation, I could see falling asleep standing up. And that’s before adding the impact of a long labor or emergency surgery.

      • araikwao

        Heck yes, I’ve started to fall asleep in standing when getting up to my son for the zillionth time that night. And he is far from a newborn now..

    • Maria

      You would be surprised at how easily you can fall asleep in all sorts of positions after giving birth! Exhaustion does that to you. I would fall asleep, pop awake because I was convinced my baby was still in the bed with me only to find she was safely sleeping in the bassinet. I would have no memory of how she got there. Did I put her there, did my husband take her from me and put her there? No clue. Those first few days are kind of a scary delirium for some new parents.

    • moto_librarian

      After my second delivery, I fell asleep while they were stitching up my 2nd degree tear. Since our son had a rough start, we were not doing skin-to-skin, but it would not have mattered. I was simply that tired.

    • wookie130

      I am as flat-chested as a woman gets, so it would have been like trying to get my baby to latch onto a cutting board while lying down to breastfeed. With larger breasts, I suppose it works…

    • Box of Salt

      “can women lay down to breastfeed?”
      It’s going to depend on the both the mother and the baby. I never got that to work, with the exception of one exceptionally cold night while camping with my first baby sharing my sleeping bag.

      It was not an issue for my second child who starting sleeping through the night at 3 mos old (and since I value my brain function over AP-sanctimommy points, I let the baby sleep!).

    • An Actual Attorney

      I was able to lay on my back while Actual Kid breastfed. I could also stay asleep. Useful when I went back to work because the Actual Wife stayed home with him. She could get up, put him on, and I never noticed.

  • NICU-RN

    I’m a NICU nurse in a “baby-friendly” hospital. Since we joined the initiative about 2 years ago we’ve had a least 3 babies admitted to our NICU from post-partum with skull fractures. Skull fractures that happened because exhausted moms dropped their babies. Our moms are now discouraged from holding, feeding, or provinding skin to skin while laying in bed. They are being pushed to sit up in a chair during these activities to prevent harm. So now they are just dropping the babies from the chairs when their poor exhaused bodies succumb to sleep. Nurses are continually pushed to “educate” mothers on not sleeping while holding (as if they are doing it on purpose!), MDs yell at nurses when they walk in on sleepy moms with babies in their arms, and mommies are feeling horrendous guilt when they drop their babies and crack their poor little heads! Oh and one more ridiculous thing…we as nurses are no longer allowed to wear scrubs that depict bottles or pacifiers on them. You know, because that might give them the idea that such things are “OK”.

    • Cobalt

      Because moms usually think losing consciousness while holding their newborn is just dandy.

      • KarenJJ

        Yes, lucky there are nurses there to tell women that they shouldn’t be falling asleep in the chair and dropping their babies. Otherwise we’d never have known it was such a daft idea.

        Poor nurses – so telling women to stop being so tired isn’t working…

    • auntbea

      Maybe you just give them all yoga mats and have them lie on the floor? You could even make little lofts and get twice as many moms in room that way.

      • Young CC Prof

        Don’t say that too loud, someone will try it. (Can you imagine how difficult it would be to get up the first time post c-section if you’re lying on the floor?)

        • auntbea

          Why do you need to get up? Your breasts are right there on the floor with you!

        • S

          Obviously not a serious suggestion, but i slept on the floor with my first baby, and i vividly remember how my crotch hurt while holding him upright after feedings (pukey). And that was like a month postpartum, vaginal birth.

    • Sue

      What an appalling situation – we have sacrificed the safety of newborns for an ideology.

    • Amy Tuteur, MD

      That’s horrifying.

    • Young CC Prof

      “Educate mothers on not sleeping while holding.”

      Yup. When a woman falls asleep while holding her child after giving birth and being up for two days straight, obviously the problem is that she wasn’t educated in newborn care and didn’t realize that dropping babies from several feet off the ground is hazardous.

      So, rather than buying fire insurance, I should just tell my house not to burn?

    • Ash

      And these are only 3 infants that you know if in your facility, correct? Logically, this must occur at other facilities, as well as other injuries that may not require NICU admission. I do hope someone publishes case studies which may lead to further research and documentation of these events.

    • The Bofa, Being of the Sofa

      Our moms are now discouraged from holding, feeding, or provinding skin
      to skin while laying in bed. They are being pushed to sit up in a chair
      during these activities to prevent harm.

      O.
      M.
      F.
      G.

      How stupid are these people?

    • Anj Fabian

      This sounds like abstinence only sex education. Don’t tell children about sex or they may get ideas! Sex should be delayed – forever if necessary.

      I’m certain that most women already know about bottles and formula. What they probably don’t know is how to prepare and store formula correctly and how much their baby should be eating.

    • Guest

      That is ridiculous!
      I found many moms reviewing some kids books on Amazon disliking them for having a picture of bottle! What’s wrong with letting your baby know that some people do things differently and teach them to respect the differences! They will eventually know that bottles exists!
      Wait! maybe the baby pictured is having some pumped milk!

      • Cobalt

        One of the moms on my birth month board announced in a discussion of which bottles are best that she wasn’t going to have any bottles because all she needed was her chest.

        But what if you have breastfeeding issues? Or breastfeeding is going fine but something else happens? I had an unexpected emergency surgery when one of mine was only a week old (issue completely unrelated to birth). Made me glad I had been so insistent on making sure we had bottles, emergency formula (thank you for hospital samples!!!), and I had my pump already.

        Treating bottles like gang affiliation symbols is stupid.

        • The Bofa, Being of the Sofa

          One of the moms on my birth month board announced in a discussion of
          which bottles are best that she wasn’t going to have any bottles because
          all she needed was her chest.

          Tell her to go away. She has nothing to contribute to the discussion. It is a discussion of what bottles are best.

          This is just like those pretentious assholes who feel they need to interrupt a discussion about some TV shows to tell everyone that they don’t watch TV.

          Good for you. Now go away, because you have nothing to contribute here. Asshole.

          • Guest

            Exactly! Also on some board one mom was asking for a gentle formula for her 5 months old baby (No one knows weather she was successfuly BFing or not). One EBFing mom came across telling her that no need to listen to the pediatrician’s suggestion which is just marketing because he didn’t invent formula and all formulas are the same (shit << I can hear the word from the way she is talking) and that all of them are dried cows milk with hydrogenated palm oils and some vitamins then ended her piece with telling her nothing is better than the breast, no colic, no problems! (As a FF I interpreted her words as bragging and trying to shame other moms)

          • The Bofa, Being of the Sofa

            As a FF I interpreted her words as bragging and trying to shame other moms

            Of course it was. It was all about “look at how good I am! You should wish to be like me! Aren’t I wonderful?”

            Again, go away. Contribute to the discussion, or go away.

            This is so friggin common, and subtle. I remember with our oldest on the monthly group, someone came in a week or two after most were born asking, “Does your baby lift your head up during tummy time yet?”

            Oh, right. Like that was what she wanted to know. No, it was obviously more like, “I have my baby doing a lot of tummy time, and isn’t she special because she is lifting her head up and yours isn’t.”

          • Elaine

            It seems possible that rather than the poster herself being the sanctimommy, it was her friend, who saw her 3 week old doing tummy time and commented “Oh, my babies were always lifting their head during this time!” and that made the poster insecure and worried. (Or maybe not… obviously I don’t know this poster or her prior history.)

          • The Bofa, Being of the Sofa

            I don’t know about a history, but no, she didn’t say anything about her baby being behind. It was all about showing off. Why specify tummy time if not to be boasting about doing it? I mean, where else is the baby going to lift his head?

            Think of it in terms of this response:
            “Does your baby lift up his head during tummy time?”
            “As opposed to?”

            When else would a newborn be lifting his head?

            As I said, it was just boasting about doing tummy time. Imagine this answer, “We haven’t done a lot of tummy time yet.” Would have been a great opportunity to shame them, of course.

    • MaineJen

      Sitting in a chair…I am picturing stitches, and I am picturing those lovely ice-packs the hospital uses for PP moms, which were the only way I was sitting upright on anything those first few days after giving birth. I wanted to sing songs of praise to those ice packs…

    • Smoochagator

      This is horrifying.

  • Jack

    Reading all of this is very strange to me, because none of the hospitals I or any of my coworkers have ever worked at have ever allowed bed sharing. EVER. Period. End of discussion. Perhaps, being in a very busy metropolitan area, we all collectively remember the SIDS epidemic a little too well to allow such foolishness?

    I never allow a post c-section mother to be alone with her baby until she is able to get out of bed without assistance(and can get the baby back into their crib), and never after I’ve given pain medication. Even for vaginal deliveries, I will refuse to medicate mothers with anything stronger than motrin if they plan on feeding the baby. As a night nurse, I also make it a point of practice to ensure that all of my babies are in their cribs to sleep when mom is medicated and comfortable for the night. At the bigger facility I work at, where rooms are not all private and visitors do not spend the night, our policy is to do frequent rounding and discourage bed sharing. At the small, community facility where dad is usually there, I make our bed sharing policy clear at the start of the evening. Both facilities still currently have a well baby nursery and we are dedicated to bringing the baby to mom for feedings if that’s what they want (we still do feed-ins…it’s remarkably helpful and more like what the new family will experience at home..).

    After delivery? I’m all about the skin to skin! But only when someone is in the room. Which isn’t hard, because I’ve got tons of stuff to do at the bedside while the family is bonding with their baby for the first hour before they get transferred to the nursery for admission. If there isn’t any family and I’ve got to leave the room? Skin to skin time is over. The policy backs me up on this as well.

    Obviously neither hospital has reached BFHI status 😛

    And yet…we’re doing pretty well with breastfeeding rates! Not nearly as well as we’d like, but that has more to do with our population- most of whom have little to no desire to breastfeed upon entry to the hospital, let alone when they go home 🙂 Considering that barrier, we’re doing pretty great! And the newborn nursery and lack of bed sharing/breastfeeding at all costs? Not a problem.

    I hope our policies don’t change. I like where they’re at right now- family friendly.

    • Belle

      You’re lucky.. so-called baby-friendly designation is a joke.. i

    • Ash

      If a woman has orders for opioids, what are the feeding options?

      • Leah

        Breastfeeding is perfectly appropriate for a baby whose mother is receiving opiate analgesia. Rates of transfer into milk are relatively small and widely considered to be harmless.

        • Ash

          Seems to me that it doesn’t make sense to withold opiates or some other meds (ketorolac, etc) if the woman is BFing.

          Jack, if a patient’s orders includes opioids, are you sure that it’s not OK to give opioids in ALL cases if she’s planning to feed the baby? If you are worried about excessive sedation during feedings, doesn’t it make sense to determine what the plan should be on a case by case basis rather than arbitrarily saying that no woman taking opioids should feed? If you’re not sure, ask the attending or residents about the feeding and medication plan.

          It seems to me that a policy of no meds other than OTC NSAIDs for a woman who plans to feed her child will lead to inadequately treated pain.

          • Dr Kitty

            No.
            Just no.
            You can’t say “you’re breast feeding, so first step on the WHO analgesic ladder for you missy!”

            Pain is pain. Moderate to severe pain will require strong analgesia. Yes, you will have to monitor mum and baby, but that is not a reason to under treat pain.

            I have a VERY high natural tolerance for morphine, and can’t metabolise codeine. The last time I was in hospital I needed a bolus of 28mg IV morphine to manage my pain. I weigh 45kg. I am very thankful I had anaesthetists who knew me and know to treat me rather than to stick rigidly to protocols.

            Nothing stronger than Motrin is a horrible policy.

          • Medwife

            The decision is above his pay grade. Thank goodness.

        • fiftyfifty1

          ***With the exception of codeine in ultra-fast metabolizers. Case reports of breastfed infant death. Codeine ultra-fast metabolizers are rare in Western Europeans, but common in East African/Middle Eastern populations.

          • Leah

            I almost added that as a caveat, yes. I’m newly graduated (RN) and I haven’t seen or heard of codeine being prescribed to a postpartum woman for that reason. Most common here is hydromorphone by IV or hydrocodone once oral meds are desired/tolerated.

          • Trixie

            They offered me codeine for afterpains and I declined because this freaked me out. And also, my afterpains weren’t that bad.

          • Dr Kitty

            My local maternity hospitals have actually decided that since 98% of their mothers are white and Irish, they’re going to keep using codeine, with alternative options for women likely to be ultra-fast metabolisers or known non metabolisers.

            I’ll be requesting Oxycodone/oxynorm because codeine does NOTHING for me, but I’ll be in a minority.

      • Siri

        Opioids and breastfeeding are perfectly compatible, and withholding analgesia from women in pain is barbaric and unnecessary.

        • araikwao

          Was just looking at this on lactmed (http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~6MNp5g:1) where it suggests that opioids are probably ok prior to milk coming in, as colostrum is small volumes only. From small numbers studied, it is potentially harmful thereafter.

          But totally agree on the unethical-ness of withholding analgesia. I have been on the receiving end when unable to take the ibuprofen offered with the paracetamol/acetominophen. An acceptable alternative to ibuprofen was apparently NOTHING, and let me tell you, paracetamol does stuff-all for severe afterpains and a fresh episiotomy. Sorting that out was not fun – it’s kind of hard to advocate for yourself when you’re a quivering mess from painpainpainpainpain and the MW looks at you blankly when you suggest a COX-2-selective NSAID.

          • Siri

            Fortunately, most post-section women only need the stronger stuff for a short while, and by the time their milk comes in, they’ve moved on to simple analgesics such as paracetamol or ibuprofen. I feel for you trying to obtain relief from your afterpains and epis – ouch!!

    • S

      I like that! Family friendly hospital initiative.

    • Leah

      You refuse to medicate mothers with anything beyond Motrin if they’re planning on feeding the baby? Did I read that correctly?

      Withholding pain medication to a postpartum woman who is requesting it is not evidence based, actively harmful, and an abuse of your power.

      Think of the choices you’re forcing your patients to make.

      • S

        Yeah i didn’t catch that on first reading. What the hell? I’d think severe untreated pain would be a potential barrier to breastfeeding!

    • Siri

      Skin to skin time is over? You withhold pain relief? What are you, their boss or just a plonker with a boss complex? Your patients are adults, and their babies belong to them, not you. Get over yourself.

    • Medwife

      Who are you to decide a patient whose provider has left clear orders for analgesic to withhold that medication? If I worked with you I’d report you so fast your head would spin. Ditto on your deciding when skin to skin time is over. Who the hell do you think you are?

    • Guest

      And forcing breast feeding rates to be higher while mothers have no desire to breast feed adds what to you? number on papers?!!

    • Fuzzy

      Sweetie, if you worked at my hospital,your butt would be fired so freaking fast it isn’t funny. The docs order analgesia, you don’t get to decide who does and doesn’t get it. Hypotension, rr< 6, RASS-1 or lower—and a patient still in pain? You call for orders. Somehow, you remind me of the corpsman who handed me alcohol prep pads and told me to sterilise my nipples, and I have a sad sneaking suspicion you work in a military hospital.

    • Jack

      Op here, still as a guest.

      Should clarify, I don’t withhold pain meds. Ever. I do, however, encourage mom’s to take the heavy hitting stuff after they’ve finished feeding their baby, especially if they’re alone. It’s about teaching- this med might make you very sleepy, do you want to try ice packs, topicals and motrin before I give you a percocet(which most of our docs don’t give for nsd unless very bad lac)? Most of my pt’s will choose to wait until right after their feeding so they can catch some sleep, and not nod off mid holding their baby.

      It’s not about transmission of the med, which is insignificant- I’d be a pretty terrible nurse if I didn’t know that?? It’s about the patient being comfortable enough with their level of consciousness whIle taking care of their newborn whIle already exhausted. Some handle them like a champ and others knock out, which is why our docs order non opiates as first lines…is that not common? If they’re going to be alone all night, I advise about the possible effects, if they still want it they can have it but I keep my ear to the door and make sure the baby is sleeping in the crib.

      Scheduling of Prn pain meds is important. It DOES make a difference when you take them- most of my girls will take them after their last feed at night so they can sleep, and avoid taking them in the middle of the day if they make them drowsy because of visitors.

      Serious question though, those of you who are nurses, do your docs not order non opiate Prn meds for pain, like motrin? Or topicals?

      • Dr Kitty

        “Last feed of the night”- hah!
        I was feeding for 30 minutes every 2 hrs, day and night until my kiddo was 3 weeks old, because she was little and hungry. There was no “last feed”, so that wasn’t really a consideration.

        Thankfully the maternity hospital I was in had old fashioned visiting rules- 2pm-4pm only, no kids except siblings, no more than 4 visitors to a bed at any time. That was much more restful than a visitors open season, and really the only way you can run it with open wards.

      • Leah

        I’m not sure that you should be referring to your adult female clients as “your girls” first of all. I’m sure you have good intentions and are using what you assume to be a term of endearment, but given the power dynamic of patient vs. care provider, it’s dangerously paternalistic.

        Timing of PRN meds is of course important. And of course non opiate medications and comfort measures are first line defenses for pain management – in postpartum care and many, many other areas of nursing as well. People are reacting to you stating that you “refuse to medicate mothers with anything stronger than motrin if they plan on feeding the baby.” Exact words.

        I would say just one more thing – I have the training of an RN, but I’ve also been the patient on the other end of the call bell more times than I care to have been. Pain has a funny way of warping time. What may seem like an insignificant amount of time to you, may feel like an impossible amount of time to someone in acute pain. It’s important to create an environment where pain management is swift and receiving appropriate analgesia is as complication free and straightforward as possible. No waiting, no jumping through hoops, and no guilt.

    • Jack

      Also adding;

      Since we do have a well baby nursery (for now…) we can do feed in and hold babies until they’re hungry, so a lot of my pt’s will feed, take meds and then sleep whIle we watch their baby either all night or until they’re hungry again.

    • theadequatemother

      Opioids are compatible with breastfeeding. In fact there is even no need to interrupt BF or pump and dump after general anesthesia. I tell my lactating patients coming for anesthesia this but also to have their support person monitor them for sedation. If mom isn’t sleepy baby isn’t going to be sleepy. I’ve also started discussing bed sharing post surgery with them (as in don’t do it until you are off the painkillers or for 48 hrs post anesthesia – whichever is the longer interval). As an RN your job is to give the pain meds and asses the patient for sedation scale and pain scale at prescribed intervals. How do you get away with this? Do you fudge the pain scale so you are recording a lower number or do you write “pain 7/10, pt reports tolerable” when in fact told them they can’t have anything? And where did you learn this way of practice?

      • Jack

        We try none opioid measures first to make mom comfortable enough to feed. I’ll give post cs their stronger meds if they have not had strong reactions to it in the past, but since we don’t have private rooms it’s not like I can count on support people making sure they don’t nod off whIle trying to feed the baby. For those pts especially , I’ll try to get them comfortable before their feed is due to make sure they’re more awake. If the pain isn’t intolerable at time of feed, we try to make mom comfortable enough to feed without contributing to drowsiness, which we explain. There’s no fudging pain scales. If our comfort measures don’t work, I’ll medicate and stand by for the feed if need be(Because no support people at night.) Most of my pt’s prefer this- they’re just as scared of being drowsy while feeding as we are. As soon as they’re done feeding, they’ll usually call and I’ll bring their stronger meds if needed. At least after that we hope if they’re drowsy it’ll have passed by the next feed. Since we don’t room in in either hospital 100% many of my pt’s who need more pain management/rest will choose to give the baby to watch/feed-in in the nursery foe the night.

        The point here is that to avoid mom’s falling asleep holding or while feeding infants and either smothering or dropping their babies, we try not to medicate with stuff we know will make that worse as a first line while they’re already engaging in that activity. To avoid hurting babies. Which was the point of this article.

        It’s interesting that everyone’s assumed that I just let mom’s sit there in excruciating pain for the benefit of the boob or because I don’t understand the medication I’m giving. Is that a common practice elsewhere? Give opioids first when you know mom is just starting to feed the baby at 3 am and hope it doesn’t zonk her mid feed??

        • Ash

          In your post you said “Even for vaginal deliveries, I will refuse to medicate mothers with
          anything stronger than motrin if they plan on feeding the baby.” You did not say “nursing staff monitors patient during feedings if RNs feel that it’s unsafe to leave family alone during feedings”

    • meglo91

      The hospital I gave birth at didn’t “allow” bedsharing either. They also didn’t “allow” anyone to take my baby at night so I could sleep. So when she was hungry or fussy or needed something, who was it left to? Medicated, woozy, shaky, so-sleep-deprived-I-was-hallucinating old me! And that is how I fell asleep with the baby at my breast and almost cracked her poor little head on the floor. It wasn’t that I didn’t understand the risks of bedsharing. It was that I was too effing tired to sit upright, let alone care for a newborn. Making sure that baby is in the crib when mom is medicated is fine as far as it goes, but it lasts for a max of two hours before the baby is up again. Oh! Oh! Also, I was not yet allowed out of bed due to my mag sulfate drip. And no, I didn’t have a support person. We are a military family with no relatives nearby living in a very remote part of the country, and my husband was home with our other daughter.

  • Sue

    More newborns sacrificed to an ideology, as a result of a state-sanctioned policy. Ugh.

    This is a really important piece of information – let’s get it out. Any journalists reading?

  • KarenJJ

    So there is an intervention in a hospital where babies are dying preventable deaths? NCB advocates should be up in arms!!!! Demand returns of well baby nurseries!

    • Karen in SC

      Yes, does Improving Birth know about this?

  • moto_librarian

    I am horrified by this! My hospital is trying for BFHI status, and there is (so far) no attempt to get rid of the newborn nursery. I don’t buy that not rooming in is a significant issue for establishing breast feeding. Why? Because when the baby starts crying in the nursery, somebody has to feed it. It is easier to take the baby to mom than sit and feed it a bottle. It is obvious that removing newborn nurseries is simply a flagrant means of cutting costs by having fewer nurses. Well, once the lawsuits over negligence begin, those cost savings will disappear.

    The inhumanity of this is simply staggering. I am writing my hospital tomorrow to encourage them to abandon BFHI status.

  • SF Mom & Psychologist

    While in the hospital after my first was born, my OB was urging me to consider giving him some formula. She told me he was very hungry and excessively fussy (confirmed when he got “kicked out” of the nursery; they sent him back to me even though I was desperate for rest) and that my milk was days away based on the feel of my breasts. Being under the influence of lactivism, my only thought was “but… formula…bad.” The OB has a very harsh bedside manner to boot, and the pediatricians indicated that the baby’s weight was fine. I declined the formula and thought she was annoying – this was one more of those formula-pushing stories.

    In the weeks following the birth, when she phoned me multiple times at “off” hours (in the evening, on Thanksgiving day) to assess for PPD and even spoke to my husband about my mood (I had some risk factors), I started to see how very caring and compassionate she was. I thanked her, and she said “I would hate to think that someone was hanging off the edge of a cliff without help.”

    Eventually, when I asked her about the formula freak-out, she explained to me that she feels like she is the only advocate for the mom in the whole hospital system. Nurses, peds, etc. are all focused on the baby’s needs, often to the detriment of the mom. She said that she knew that if she framed it as “You need to rest,” most of her patients would ignore her (ignoring their needs), but if she frames it as “Your baby needs food,” they might listen.
    I had a huge shift in perspective about her that was very moving to me, and I am deeply grateful for her dedication to moms.

  • Are you nuts

    I can so see how this would happen. I insisted they take my baby to the nursery the first night since I hadn’t slept in 48 hours. Then at every shift change it was acknowledged, as if I had offered my child crack. I would have lost my mind if I had to try to get a 5 hour baby to sleep after the two days I had.

    • Mishimoo

      This is exactly why I opted for early discharge. My husband slept through my labours (except the important bit) so that I could rest at home in my own bed (I hate hospitals, can’t sleep in them) and he could snuggle the baby.

  • PrimaryCareDoc

    The paper reports deaths between 1999 and 2013. One has to wonder if the number of deaths is going to increase as more and more hospitals jump on this insane “baby friendly hospital” bandwagon.

    • Karen in SC

      The CEO of GM was called to testify before Congress for 13 preventable deaths over a ten year period.

  • Zoey

    The hospital I delivered my son at didn’t have a nursery either. However, after a 3 day failed induction, an emergency C-section, and being on heavy duty medications to keep my blood pressure from killing me, it was clear to everyone (except me) that I could not care for my baby. After he was born, I passed out, they sent my husband home to sleep (I had to share a room with 4 others mothers and babies so there was nowhere for him to sleep) and they took my son’s bassinette and kept it by the nursing station until I woke up in the morning.
    And here’s the kicker: I was so, so angry when I woke up. I was still into the NCB mind-set at the time that I had missed some sort of magical bonding moments that I could never get back – and they gave him sugar water! The horrors! My NCB board told me that I should have filed a complaint with the hospital, and that we were both irrevocably harmed by me not having him with me that first night and that our early separation was the cause of all my breastfeeding troubles. But then, I see something like this, and I’m thankful for nurses that broke protocol to help me. Who knows what would have happened if I had to do everything myself, alone that night.

    • Ah, the dreaded “sugar water”! BTW, try drinking boiled water. It is flat and tasteless. Babies, who aren’t fools, won’t drink it. But add a pinch of sugar…frankly, the baby ought to have had formula, but that isn’t critical in the first hours.

      I’m beginning to think NCB stands for “no common sense biddies”.

      • Sue

        I wasn’t aware of sugar-water for drinking – only seen it used for pain relief in tiny newborns. Evidence posted up-stream.

        • Trixie

          I know they gave my little sister a bottle of water in the hospital in because “it was summer”.

          • Sue

            And we are now obsessed by ”dehydration”. Real science from extreme sport or heat stroke is mistranslated to everyday life, where everyone needs to keep drinking water. All the time.

          • Kerlyssa

            Eh, if nothing else, drinking plenty of water keeps the bladder flushed, the mouth from drying out and breeding bacteria, and helps keep the poop moving. Not everything has to be the cure for cancer.

          • alas

            It’s unnecessary though. Look up the “eight glasses a day” thing on Snopes.

          • Kerlyssa

            There’s a difference between ‘8 glasses a day will prevent organ failure and give you a bikini body’ and just plain drinking water. Pretty much any diet where you’re told to eat a flat amount of X to cure all your ills is going to be bullshit, yeah, but drinking more water is rarely a bad idea- especially in the summer/during outdoor activities. I see a lot of folks with decreased appetites/limited diets for various reasons, and actively sipping water during the day does help them.

            I’d say it’s also a good idea for when the weather changes/amount of physical activity changes, and shouldn’t be any more controversial than saying someone should wear short sleeves/pants when going outdoors for long periods of time in the summer. It’s water. Unless you shotgun a gallon or two or are drinking from a polluted source, it’s not going to hurt you, just make you pee more, and it can help.

          • toni

            I feel like crap and get grouchy if I don’t drink something at least every couple of hours. 12oz every hour I’m awake is best. I know lots of people who seem to drink hardly anything and feel fine though. My husband can just ‘forget’ to drink altogether for 8 or 9 hours! I think I’d turn to dust and blow away if I didn’t drink for that long.

          • fiftyfifty1

            Yeah, it’s funny that with newborns, who really are at risk of serious dehydration, that supplementing is verboten, while healthy adults walk around sipping water non-stop as if their lives depended on it. You will see adults wearing CamelBack Hydration Systems to go on 2 mile jogs.

          • Dr Kitty

            Yup.
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001704/

            Junior Drs were more at risk if kidney injury than their patients…only they weren’t, because homeostasis is a thing.

          • Cobalt

            That’s an excellent study.

          • MaineJen

            This seems to have been the practice in the late 70s-early 80s when my sibs and I were born…they actually recommended giving water to newborns, as my mom said, to ‘fill up their tummies’ and keep them from dehydrating if the milk hadn’t arrived yet…when I had mine in ’09 my mother asked a nurse about giving him water (he was a super fussy baby and cried constantly), and she said it wasn’t done any more and could actually be dangerous to give a newborn a full bottle of water. I don’t know the details though…

        • the wingless one

          When my son was in the NICU he got sugar water for any procedures/heel pricks/etc. but they did also give it sometimes to calm him down when he was clearly feeling hungry but still too sick for real food (he was on TPN). I guess it provided the illusion of eating? they never gave him a whole bottle of it, just this little tube.

      • Allie

        I read somewhere that Mozart was raised exclusively on sugar water. I don’t think his health was good, but he composed remarkable pieces of music.

    • Trixie

      Sugar water? That’s still a thing?

      • Zoey

        I guess? I said on my intake form that I was planning on breastfeeding, so I’m assuming they did that instead of giving formula. I remember seeing little ready to feed bottles of the stuff beside his bassinette and being so mad, like they’d given him poison or something.

        • Trixie

          That’s so weird though. Is there any evidence for routinely giving sugar water?

          • Dinolindor

            3.5 years ago, my hospital used it to try to get babies interested in latching, but not by directly feeding it to the baby. It was squirted onto the nipple and then the baby placed nearby to smell/taste the sugar water and then latch. This was not done 1 month ago in the same hospital.

          • Sue

            Good recent study here:

            http://www.sciencedirect.com/science/article/pii/S0140673610613037

            Sucrose didn’t affect nociceptive brain signals but did affect behavioural response to pain, including facial grimacing.

      • Sue

        There is good evidence for oral sucrose assisting with comfort for painful medical procedures in newborns – still used where I work.

        • Trixie

          Oh, for pain, that makes sense. I meant as a bottle just given to newborns just because.

          • Dr Kitty

            If you have an EBF mother who refuses formula, yet cannot feed her baby, that is the only option you have to prevent dehydration and hypoglycaemia.

          • S

            People actually refuse formula but say yes to sugar water? Because it contains less gut-destroying poison compounds, or what?

          • alas

            Because that way they can still truthfully say that they’ve never used formula.

  • auntbea

    I was not allowed to bed-share in the maternity ward unless I was awake. Had to sign a thing. My baby wouldn’t sleep in the bassinet….so….

  • The Bofa, Being of the Sofa
    • auntbea

      Can you explain this? I don’t understand what I am looking at.

      • The Bofa, Being of the Sofa

        It’s the definition of the word apophasis “a figure of speech that contradicts itself”

        As with the example, “No offense, but you’re an awful cook”

        • Jennifer2

          So it’s “No offense but [insert offensive statement here].” Or “not to be racist but [insert racist comment here].”

          • The Bofa, Being of the Sofa

            Yep. There’s a real word for that

          • MaineJen

            “I’m sorry, but…”

          • The Bofa, Being of the Sofa

            Twitter makes this easier

            #sorrynotsorry

    • Smoochagator

      Love it.

  • mollyb

    Good Lord, this is horrible. I didn’t think anything of it at the time but looking back on it, I’m shocked by the fact that all the maternity nurses I had with my second child would just leave me alone with her for hours to BF despite the fact I was constantly nodding off due to the pain medications I was prescribed after my c-section. I have huge breasts and have to keep one hand on my breast tissue to keep it out of my baby’s face and requires constant vigilance WHEN I’M NOT DOPED UP. The fact that no one said anything or even checked on us to make sure I hadn’t nodded off (again) and suffocated my baby with my own breasts is shocking to me. But hey, at least she was getting breastmilk, right?

    • Guest

      Yes! breast milk lowers infant’s death risk!

      • Jennifer2

        Yes, everyone knows breastmilk forms a protective shield around the baby similar to a diver’s helmet that protects the baby from suffocation, right?

  • Staceyjw

    FIFTEEN DEAD BABIES??? Over something everyone knows is deadly?
    Only lactivism or NCB would think this was a good idea.

    I knew this was a horrible idea because after a 36 hour labor, and then a CS-after already being awake an entire day- I was expected to fully care for my son. The nurse rolled him in, told me the nursery was closed all night, and left! I was responsible for feeding, soothing, and diapering, at a time where not only was I unable to stay awake, I was unable to move at all (couldn’t get up for 2 days).

    I couldn’t even reach him, so I didn’t bother. I slept, which is something the hospital may call CPS on you for, as it considered neglectful(!!!). At some point he was wailing so bad he was keeping the whole ward up (not me!), so the nurse came and got him, and took him on rounds with her.

    Later, I was told he was in the NICU (jaundice, HDN) and I was RELIEVED. You know how bad it feels to be relieved your kids in the NICU? That’s how beat up I was after a hard pregnancy, a marathon labor, and a painful CS. I would rather he be in the NICU than with me, because I couldn’t care for him, nor recover, otherwise. I then got all the rest I needed, and saw my son when I wanted too. I even pumped for him all day (not at night).

    The hospital had a nursery, but not at night, which is insane. You were expected to have help, and if you didn’t, too bad for you. I didn’t have help. I sent mine home to sleep thinking we could all use a good nights rest after this ordeal. It would have been just as deadly to let DH care for him. DH, who had been awake for a day, then my whole labor, was in bad shape too.

    And this was the specialist hospital, the only one out there just for women, and babies. (Mary Birch) They take all the sickest of moms, the complex cases, the babies that need the most care. They should know better!

    • Dinolindor

      What the hell is the point of a day-only nursery? What braniac thought that one up?

      • Amy M

        Well, if the exhausted mothers could think straight, they could leave the baby in the nursery all day and try to get some sleep then.

        • Renee Martin

          If only.
          If only my baby had been born earlier in the day!
          If only I hadn’t wasted a day and a half on a labor that was never gonna happen.
          If only moms knew all about this and could plan their labors accordingly!
          /snark

          • Cobalt

            You mean your baby’s birth time wasn’t in your birth plan? Or that you wouldn’t be exhausted? And baby would immediately be ready to sleep when you were, and for the same amount of time, because you’re magically in total sync?

      • Renee Martin

        I have no idea. AND I had never thought to ask, or I might have gone elsewhere. I mean, what place has no night nursery? JFC. Its like guaranteeing we can never have a night of sleep.

        • Amy M

          Evidently, that’s the rite of passage, according to BFHI. New mothers must survive 2 or more days without sleep, otherwise they have failed. Regardless of whether or not any BFing was accomplished.

          Clearly, a woman is not up to the task of motherhood, unless or until she can tolerate torture—sleep deprivation, constant put-downs from hospital staff, possibly watching her new baby go hungry. If she cracks or demands sleep, it is a sure sign she will not be able to handle motherhood, and her children will suffer. Uh huh.

  • Squillo

    SIDS organizations in California have a pilot project aimed at reducing hospital practices that raise risk, including bed-sharing. It will be interesting to see if they gain any traction in BFHs.

  • Roadstergal

    Case 10: “Labor lasted 30 h. Mother stated ‘she had never been so tired in (her) life.’ Mother asked the nurse to take the baby to the nursery so she could sleep. Nurse said she might not have time to. Mother then breast fed briefly and fell asleep with her infant latched on to the breast.”

    • FormerPhysicist

      I fell asleep after my first (about 12 hours of induced labor, then a c/s) with her latched onto the breast. Thank goodness all that happened was that I got a blood blister on my nipple.

    • Staceyjw

      I cannot imagine. Poor mom, was doing the right thing. I bet that nurse feels terrible.

      Reminds me of a friend that was told the nurses weren’t allowed to touch, or help with, the baby! She wanted to take a shower, but couldn’t, because no one would hold the baby! No nursery or baby nurses, at all. She left early, it was so bad. Imagine going home to 6 kids and a farm to work, instead, because you would get more help at home.

      I felt bad for her, as she was looking forward to a comfortable hospital birth after a HB loss and a miserable hospital experience. As a mom of many, this was to be her special time with the newbie, before heading back to the monumental responsibilities at home.

      This was a super nice, upscale, hospital. She had looked around and chose it especially because of the NICU, and all the amenities. Since she was planning on BF and co sleeping, she thought rooming in would be nice. she never expected no help at all.

      All of the suites and birth tubs in the world won’t make up for NO HELP once baby is born.

      • S

        Can’t _touch_ the baby? What is the rationale?

  • Ash

    In the case summary, I would find it interesting how many of these events occurred at night. I’m guessing this would be a higher risk factor, as I suspect you would have more parents sleeping (duh!) and fatigued if they have to be woken at many hours of the night.

    The primary risk factor is MATERNAL FATIGUE! How can we help with maternal fatigue? Offer a nursery for mothers as an option and on-demand, no questions asked!

    • The Bofa, Being of the Sofa

      When I was doing Dad’s Boot Camp, I always liked to have stories of non-scheduled births. Because, from a “supportive dad” perspective, when I hear stories of “she went in labor about 4 in the afternoon, and we went to the hospital around 10 pm. The baby was born the next night at 6:30”, what I hear is not the details of what happened during the delivery, but the fact that she has pretty much been up 36 hours straight (since the morning before). Yeah, with an epidural it’s possible to get some rest, but you don’t count on that, and it is usually snoozing.

      Therefore, a very important responsibility for dad in that situation is to do what you can to help mom get some rest. After being awake for 36 hours, with 24 hours of it in labor, you have a baby that has to be fed every two hours and taken care of, and she isn’t catching up on her sleep.

      Maternal fatigue, from my perspective, is one of the most important issues to deal with with a newborn.

      • Amy M

        Hell yes. Luckily, the hospital I had my children in took that into account and were very helpful. I was able to snooze a bit after I got an epidural, and maybe grab a cat nap at some point post-partum, but basically, I was up for 48hrs. That included labor, delivery and significant blood loss.

      • Allie

        Yep. I was a fool not to rest as much as possible when I was in early labour. What did I do instead? My Christmas shopping : /

      • toni

        Wish I could have swapped my husband for you during those first few days. Mine was useless. He slept almost the entire time that I was in labour, he was awake for the pushing but that was over very quickly and he went back to sleep in the recovery room immediately. He slept all that night and most of the following day. Every time a nurse or doctor came in he was snoozing in the corner it came a bit of a joke amongst the staff that he was sleeping way more than I was but of course he was oblivious to this. I was so tired and in awe of the baby and had enough help from the nurses that I didn’t really think about it at the time but it was exactly the same when we got home. He slept and played video games for his whole week of paternity leave. His contribution was making me one bowl of cereal and changing one diaper. He acted like it was the biggest chore of his life. The cherry on top was the second night home.. he had been in bed for ten minutes when the baby started crying and he got out instantly to go and sleep on the sofa downstairs without saying a word to me. I burst into tears and said please stay it hurts so much (feeding him) I’m losing my mind and he said he was exhausted (!) and told me ‘don’t go getting that post partum depression stuff for christ’s sake’ and off he went. The only thing I was depressed about was having such a crummy husband. I guess you don’t really know someone til you have a child with them. Well I knew he was lazy and inconsiderate but honestly thought he would try not to be during the biggest milestone of our marriage when he was most needed. I’m still sore about it if you can’t tell lol

        • The Bofa, Being of the Sofa

          Sounds like a wonderful guy. Not.

          • attitude devant

            You think that’s bad? Mine played a tennis match during my labor. Eff him AND his tennis buddies.

          • rachel

            I sent mine home during my last labor. He was impatient and kept asking how long it was going to take. I wanted to take a nap after I got my epidural and he was annoying me. I just called him to come back when it was time to push.

          • Lena

            My boyfriend’s father would drop his mother off at the hospital and drive off. He wouldn’t even walk his laboring wife into the hospital, just pull up to the door and tell her to call him when she was done. I was so appalled when she told me this that I suffered the most horrible diarrhea of the mouth and blurted, “And you had two more kids with him after the first one?!”

          • Smoochagator

            What years were their kids born? In this guy’s defense, there were times when fathers weren’t allowed in the birthing room… hoping that’s the case in this story…

          • toni

            we were both only 25 at the time (27 now) he’s not improved at all really but I’m hoping he’ll be less of a dipshit in his thirties. I’m told it can take a lot of men quite a bit longer to mature and be willing to put other people before themselves. My dad is fifteen years older than my mum so perhaps my expectations were skewed

        • S

          Hey, belated as hell, but congratulations on your kid! (Took me awhile to know for sure if you were the same Toni… or maybe i haven’t been paying attention.)

          • toni

            what gave it away? I think I am the only Toni/Antonia around here! And thank you 🙂 I never made an announcement here because I stopped posting for a long time. He’s one and a half now. He loves trains and wearing shoes on his hands! He’s called Tobias (Toby) Did not even think about it rhyming with my name until after i’d filed the birth certificate

          • Siri

            I have a Toby, but his real name is Torbjørn. We had a family doctor once who insisted on calling him Tobias though, which I always found quite sweet. Are you still with your husband?

          • toni

            Torbjørn is a fab name too. I lived in Denmark for a couple of years so I have met one or two. Is yours about 7ft tall and drop dead gorgeous like most Danes? 😛 we are still married, yes (for my sins lol)

    • Throughout my career, even when daytime staffing was very good, nighttime staffing on maternity wards was usually minimal “because the women aren’t sick”.

      The last hospital I worked in offered mothers the option of 24 hour rooming in. Not infrequently I’d find mothers on the verge of fainting from exhaustion at 1 a.m., and wondering how they’d cope when they went home at barely 48 hours after labor.

      One of the criteria for 48-hour “early” discharge when I was in the UK was the requirement that there be someone in the house with the mother and baby constantly until the baby was 10 days old. Fathers could get paternity leave for this. And this was 40 years ago!

      • Joy

        I was in the hospital in the UK for five days. Your partner couldn’t spend the night and the midwives wouldn’t take the baby. So if you had to use the bathroom in the middle of the night, you left the baby crying by your bed. One of the midwives put the baby in the bed with me, even though I didn’t want to co-sleep and I was exhausted. I was so worried I was going to crush her, or she would overheat in the very hot postnatal ward. It took at least 20 minutes for a midwife to respond to the bell. There was no way they were checking on anyone every 20 minutes.

      • MidtownParent

        Whoever developed that staffing plan obviously never tried to respond to multiple call bells simultaneously, with multiple patients needing help to go to the bathroom and a “call, don’t fall” policy in place.

  • Jessica

    I was encouraged to nurse my son while lying down in my hospital bed. Since my perineum was so sore sitting up was difficult, it sort of made sense. I fell asleep and woke up some time later (who knows how long) shocked and sort of scared that the baby was next to me in the bed. I was utterly, utterly exhausted from my induction (I’d not slept much at all the night before, even with Ambien) and extremely painful pre-epidural labor. I am also very overweight. I managed to get the baby back into his little crib, and all was fine, but as I had never intended to co-sleep I was perturbed by what had happened

    It would have been so much better for us to have a nursery and have the nurses bring him to me when he needed to nurse. Maybe then I could have gotten some sleep and some better help with latching. Instead we were all awakened by the too frequent vital checks (my husband slept at the hospital too), and the lack of sleep was a major factor in requesting a discharge at 24 hours post-birth despite the breastfeeding difficulties.

  • MLE

    How awful to make it through the birth thinking everyone is in the clear, only for this to happen.

  • Feminni

    Not long after having my baby I was passing out from exhaustion and asked any midwife who was passing to please put her in the crib for me as I was scared of falling asleep and harming her. I couldn’t hold her nor put her back in the crib as I was still part numb and catheterised. It wasn’t until many hours later when a midwife found me asleep with the baby tucked between my legs that she ‘told me off’ and then finally agreed to take her from me. I wept with gratitude and relief. Several years later and exactly the same thing happened but this time, no one batted any eyelid about the fact that my baby was in the hospital bed with me the entire time, much of which I was passing in and out of sleep. It has always quietly bothered me as I felt it was pretty precarious.

    • S

      My god these stories are horrifying. =(

      You’d think hospital staff might raise a stink after the first baby found in bed with an asleep mother. Maybe they do! Even more awful, then.

  • Amy M

    “..we feel that in the future reporting to a public health agency should be mandatory as is already the case for other adverse in-hosptial events.”

    Wow. Why would this not be counted as an adverse in-hospital event? Because it might cast BFHI or breastfeeding in a bad light? Does an M&M occur in cases like these?

    I know a bunch of you are doctors—if a baby dies for any other reason, while in the hospital (during birth, or in the NICU for example), is the event reported to a public health agency?

    • Susan

      I think, in reality, this isn’t just reportable but a mandatory coroners report in California.

  • DaisyGrrl

    That study was a hearbreaking read. One of the mothers asked them to take her baby to the nursery! I wonder if any of the hospitals changed their practices as a result (I really hope so).

    As for the idea that supervision will help anything, the study noted that other individuals were present in the room for 10 of the 18 events. Absent a greatly increased awareness of the danger to the baby on the part of all parties, I don’t see how having a friend or family member supervising will help.

    • Amy M

      I wondering that…maybe the Dad was there too, but also sleeping?

      • Smoochagator

        My husband had to go home the night after my daughter was born to tend to our pets because our regular pet-sitter was busy that night. We have family nearby but they’re not “dog people” and we don’t like to leave our animals alone in cages all night long. If I hadn’t been able to send the baby to the nursery I likely would not have gotten any sleep.

        • Amy M

          Yeah my babies were born at 1am on a Friday. My husband left around 3am so he could go home, shower, and go to work. (He wanted his leave to start Monday). I didn’t see him again until later, so he missed the PPH drama. If I had been at a hospital that expected him to hold the babies if I couldn’t, and he was at work, then what? Family members came later to visit, but they didn’t stay overnight.

          • Smoochagator

            And honestly, isn’t one of the best reasons for having a baby in a hospital the fact that the hospital is staffed with qualified caregivers 24/7? I mean… if I am (or my insurance company is) paying thousands of dollars for my hospital stay, I think the nurses can watch my kid for a couple of hours while I nap and, you know, RECOVER FROM GIVING BIRTH.

          • Amy M

            Absolutely. The nurses were very kind to me, and even offered to do one of the overnight feedings so I could try to get more sleep. (I didn’t really, but at least there were no crying babies and no overzealous LCs).

          • Belle

            You are right, and we would love to .. if we had a nursery and a nursery nurse! So-called baby-friendly hospitals have put parents and nurses between a rock and a hard place. Parents don’t understand why we can’t just “watch the baby”, but it’s not that simple. With no nursery, therefore no assigned nursery nurse, the only place to “watch” the baby is at the nursing station, which usually has no oxygen, suction or other emergency equipment. If the unit is extremely busy, it’s simply impossible. Parents need to demand hospitals provide staffing to care for their babies so they can rest!

          • Smoochagator

            Yes, I would not expect a nurse who is doing all her other work caring for adult patients to “babysit” my child… luckily both hospitals I delivered in had nurseries and “rooming in” was just an option. I am so frustrated by stories of hospitals that cut corners on this very important aspect of postpartum care.

          • Belle

            It is indeed a very important aspect of postpartum care and very frustrating for nurses having to deal with it too..if a parent can’t take care of themselves they certainly can’t care for their newborns but hospitals just won’t acknowledge that in the wake of the BFHI..

          • the wingless one

            We jokingly referred to our son’s NICU nurses as the most expensive babysitting he’ll ever have 🙂

          • Smoochagator

            But the best-trained!

    • PrimaryCareDoc

      Foisting this responsibility onto a family member is diabolical.

      • Cobalt

        Maybe, to continue the cost savings, they could expand family provided care into the post-op unit. Or the ER.

        • PrimaryCareDoc

          Or the ICU. Hey, no biggie, right?

        • Smoochagator

          Sure! Have family members do wound care and administer meds. Nothing could go wrong.

      • KarenJJ

        And another procedure where privileged women are able to follow “NCB”, single mums, partners who can’t get time off work, mums with partners that are not able to care – tough bikkies you lot….

        And I don’t know if this is a big consideration in hospitals caring for families or not, but one thing nurses are meant to ask new mums (when they’re alone) in Australia is whether you feel safe at home. An abusive, controlling partner spending all the time in hospital with mum is not going allow nurses to get mum alone and ask that question. I think it was the midwife that came to my house that asked it, but I think some hospitals were trying to ask while mum is in hospital.

        One friend of mine tells a harrowing story of her ex-husband controlling all baby contact to mum and all breastfeeding durations etc – nurses didn’t pick up on it (he was very charismatic and charming) and he was such a “supportive” husband that she was so “lucky” to have. He got increasingly controlling and abusive once they got home, locking her out of the house (and more) if she was giving the baby too much attention and telling her when she needed to wean..

      • Mel

        I don’t know if this was brought up later, but how is a family member supposed to know what a healthy newborn infant looks like compared to a baby who is in big trouble?

        A co-worker of mine held his newborn grand-daughter and noticed her feet were dusky blue. Her parents said that she still had ink on her feet from the newborn foot-printing. Turns out it was cyanosis from a severely constricted aorta that required surgery at 3 days old.

        The scary twist: Her parents were experienced medical professionals. Exhaustion does scary things to the way people think.

    • Amy Tuteur, MD

      I suspect that lawsuits will inevitably result in the return of well-baby nurseries to all hospitals.

      • Amy M

        Sad that these things had to happen in order to restore the nursery.

        • Sue

          And, the way policies seem to be made these days, they will swing from no nursery to compulsory nursery, and from compulsory bed-sharing to no bed-sharing. Sigh.

          • KarenJj

            That’s the frustrating part. Like an epidural with a button for pain relief. Set up the options that are suitable, explain how to access the options and use the options and any risks that need to be explained and then let women decide what they want to access and what is working best for them.

          • Amy M

            We can’t trust those new mothers though….they aren’t capable of making decisions, like other adults. They might choose formula, after all.

      • Cobalt

        I hope so. Super-sanctimommy wanting to keep her baby skin to skin for the first 6 months shouldn’t mean I have to recruit help for my postpartum stay at the hospital. My births were all easy, and I was still exhausted after each. It’s NORMAL! No mom should be shamed for needing sleep after delivery. Or sleep in general. It’s a basic need, like food or air.

        • Amy M

          Didn’t you hear? Real moms don’t sleep. They are up all night, either nursing and bonding with their precious snowflakes, or up all night worrying about their precious snowflakes and feeling guilty about something.

          • MaineJen

            Plus, real moms don’t NEED to recover from childbirth. They are up and about an hour later. All of them.

          • The Bofa, Being of the Sofa

            Well, someone needs to serve refreshments to the midwife.

          • And plowing the back forty. Only wimps need to recuperate.

          • Belle

            I thought they were already up.. don’t they all deliver standing? I mean really.. warrior mamas don’t need to delivery lying down..

          • Belle

            deliver..

          • Life Tip

            Well, if you weren’t so selfish and got a c-section/epidural/insert-any-evil-intervention-here, you’d be up and around with no problem.

            Fits into the typical NCB strategy. This is the mother’s fault, somehow. As usual.

          • Cobalt

            I didn’t have any evil interventions, or painkillers, or incisions. I was able to get up and walk right after delivery. I still wanted sleep. And then food. And then more sleep. Maybe the IV is what ruined me? Or maybe wanting a few hours sleep after all that IS what is actually natural.

          • Allie

            I have to confess I didn’t sleep at all the two nights I spent in hospital, although I wasn’t up nursing or bonding or worrying or feeling guilty. I was just so wired I couldn’t sleep. When I was pushing and pushing, all I wanted to do was sleep, but after I had her, I guess I was too excited.

      • jenny

        I hope so too. This is appalling.

  • Amy M

    Even if the hospital didn’t have a nursery, could they put the babies in those little plastic boxes-on-wheels thingy? Or do they already do that, and the mother, figuring she’ll have to wake a lot, just keeps the baby in bed, rather than putting it back in the box? I can see why mothers might do that, especially if they had Csections. Or, of course, if they fall asleep while nursing–maybe the mother intended to put the baby back in the box, but fell asleep before she could.

    At the hospital where my children were born, I seem to remember those boxes being higher than the bed. Another thing the hospital could do, especially if it has no nursery, is lower the boxes to bed level. Then the mom can just reach in without having to get up.

    My personal view is that it is totally sadistic to force a new mother, especially if she had a difficult delivery or Csection, to care for the baby 24/7, with no break. Clearly it can be dangerous to the baby, as well as affecting the mental health of the mother.

    • Belle

      The plastic boxes are bassinettes, and they are used in most maternity units.. the problem is just what you said, they are higher up making it difficult for mom to reach. You can raise the bed up, but that has it’s risks, falling, etc. And you are right, these poor moms are so exhausted, they fall asleep holding the baby. Then the staff has to tell them they are “not supposed to co-bed” which is insane, because what else can they do with no nursery? It is truly dangerous and irresponsible on the part of the hospitals to have allowed this nonsense in the first place.

      • MLE

        Yes, if those damn boxes were level with the bed, this wouldn’t be such an issue. I couldn’t lift mine into his box from the bed, and I didn’t even have a c section!

        • Belle

          The other safety issue with them is that the plastic box part can tip over (some are actually not secured to the base!). Even if it’s at the same level as the bed, it’s very awkward and unsafe for a mom sitting in bed to retrieve her baby.

          • MLE

            Yikes, I didn’t realize that!

        • MaineJen

          I remember this well…I tried to keep the bassinet right next to the bed with the wheels locked so that I could just lift the baby into and out of it…but it was still awkward as hell. Luckily there was a baby nursery available, at least there was THEN. (2 years ago…)

    • Trixie

      I couldnt reach the box myself after my section. I needed someone else to move him in and out for a few days.

    • Staceyjw

      The hospital I was at had them, but it didn’t matter. I still was unable to reach it, or lift a baby at all.

    • auntbea

      Mine wouldn’t sleep in the bassinet, even swaddled, even with a pacifier. My options were to put her down and lie awake listening to her scream or to hold and lie awake so I wouldn’t suffocate her. Either way, no sleeping for me.

      • Dinolindor

        You know, in theory there’s a 3rd choice – sleep stomach down. Seriously, if the baby flat out does not sleep on its back, what’s better? To share the bed with mom or to sleep on its stomach? One is definitely known to be a risk, while the other – as far as I can tell – is a “possible” risk factor for SIDS, which has unknown causes anyway.

        Actually, I’m seriously asking that question – when it comes down to practical day to day living with a newborn who does not sleep on its back, which is less risky? To just not sleep/bed share/sleep baby on its stomach?

        • Guesteleh

          The Back to Sleep initiative cut SIDS death rates by more than 50%. Definitely not advisable to put a newborn on its stomach.

          • Dinolindor

            Right, I agree. But when it’s the difference between getting no sleep and sleep, what’s the real risk?

            Meanwhile, my mom’s theory for why the SIDS rate went down with back to sleep: “Babies don’t sleep well on their backs, so people hold them instead. How can you have crib death if there’s no crib?”

          • Guesteleh
          • Dinolindor

            That article says the reduction in SIDS plateaued in 2001, and that it seems partially because of an increase in bed-sharing in developed countries. I wonder how dates and trends line up. Meaning, does this coincide with an increase in breastfeeding initiatives, since feeding in bed while half-asleep is listed as a pro for breastfeeding?

          • Roadstergal

            Interesting that they talk about breast-feeding as a means to reduce the risk of SIDS – given that all of the deaths reported in this post were due to an initiative designed to force breastfeeding, and many of them occurred in the actual act of doing so…

          • Amy M

            It also said that no one yet understands the correlation between reduced risk of SIDS and breastfeeding. That doesn’t stop crazy lactivists from assuming that breastmilk directly reduces SIDS rates. I’ve seen on message forums: “Oh I breastfeed, so bedsharing is safe!” As though they are completely immune to it, and breastfeeding cancels out all other risk factors.

          • Roadstergal

            Exactly. I wouldn’t be surprised if there are confounders at work with that connection – SIDS is rare enough that you can’t really do a discordant sibling study with it like you can with other outcomes. So when real risk factors come into play, this one disappears.

            I suppose I found it tragically ironic. “It’s not ironic, it’s just mean!”

          • Cobalt

            They also recommend letting the baby fall asleep with a pacifier to reduce SIDS risk. I wonder if it’s the same mechanism that makes breastfeeding protective. Maybe it has nothing to do with the milk, but is about falling asleep while sucking.

        • auntbea

          I did eventually let mine sleep on her stomach after she passed the prime age for SIDS because we were all so unsustainably exhausted. But there is no way I was going to be able to do that in the hospital. Do you really think the nurses would allow it?

          • Amy M

            We always put the babies down on their backs, but by 5 or 6 mos, they’d usually end up on their stomachs. Since they could turn over by themselves at that point, and we had nothing in the cribs but the mattresses, we left them alone.

          • Dinolindor

            Never in a million years.

            But does that mean it’s better to bed share? I’m sorry to harp on it, I just find balancing risks in baby care interesting. In theory, that is. In real life, I get way too panicked about making the most correct choice and being thwarted because of competing risks.

        • Cobalt

          I would think belly down in a bassinet would be more risky because of airflow concerns.

          • Young CC Prof

            Honestly, I refused to buy a bassinet altogether due to airflow concerns. Mesh pack and play, slatted crib, that’s it.

            But now we’re talking about those plastic ones in the hospital. Do they have vents in the corners? I don’t think so.

            Still, way safer than being on a sleeping adult in a hospital bed.

          • KarenJJ

            The plastic bassinets at my hospital didn’t because they were also used as baby baths.

            I imagine the design of the fully plastic shell with no gaps/corners make it simple to keep clean.

          • Dinolindor

            But bed-sharing has airflow concerns also. My question is which is less risky?

  • Young CC Prof

    Forced rooming-in should be illegal. Any hospital with a maternity ward must have a night nursery, this is the sort of thing that should have been regulated, but, up until recently, was too obvious to need regulating.

    And let’s not forget the tendency to normalize and ignore breastfeeding problems until they turn into medical emergencies. They can almost always rescue the babies from that, but it’s still stupid.

    • Belle

      Remember in the 90’s, when insurance companies decided they would save themselves millions by covering only up to 24 hours post-delivery? That became illegal.. Sounds like the same thing needs to happen now regarding forced rooming-in..

  • PrimaryCareDoc

    Wow, this is insane. I’ll put this out there- there is NO “safe” bed sharing situation in the hospital. The mother is post partum and is exhausted- there is no way around this. The beds are narrow and in between the rail and the mattress is a perfect place for a newborn to get trapped.

    • Guesteleh

      Shit, even elderly people get trapped between the rail and mattress and strangle themselves. It’s a known hazard with those beds and why safer bed alternatives are being explored for people at risk of falling out of bed.http://www.eldercareteam.com/public/572.cfm

    • Belle

      The entire “baby-friendly” thing is so insanely hypocritical. Parents are totally exhausted after a long labor and birth, yet there is no relief for them to sleep.. they are forced to room-in and mom is told that baby has to be kept skin-to-skin constantly to keep baby warm. If they fall asleep they are told “don’t co-bed, its dangerous!” So they swaddle the baby and are told, “don’t tightly swaddle, that’s dangerous!” If they put a sleeper on the baby for warmth, they’re told, don’t do that! Baby should only be kept skin to skin! And it’s back to square one… sigh…

      • Amy M

        Really? Only skin-to-skin the whole time? Where was this? The hospital provided the first clothes for my babies. We did have some skin-to-skin time while attempting to nurse, but otherwise, they were dressed. (and hatted!)

        • Belle

          This was not in the US. “Skin-to-skin only” was pushed for several hours right after delivery.. of course when mom is most exhausted.. they did provide baby gowns but mom were encouraged to keep baby skin-to-skin.. they did hat them though..

  • Amy

    This will only be fuel for homebirth advocates, unfortunately.

    • Roadstergal

      And the “Only bad mothers get pain relief” crowd.

      • Staceyjw

        You don’t need to have gotten pain relief to be utterly exhausted. I would think an NCB would be more tiring then an epidural birth, because you get some naps with the epi.

        I wonder how many HB babies have died this way? It wouldn’t count as a HB, so who would know? I am guessing it’s a matter of numbers, and HB doesn’t happen enough to make this common. It took how many millions to kill 15 babies (and 1 is too much).

        • And if a HB baby dies from being overlaid, or dropped by an exhausted mother, that’s “karma” and was always going to happen…

          • Amy M

            Of course, ’cause BFing is magic and no baby that got breastmilk ever died tragically. The HBers will just list this as one more reason to avoid the hospital, wo/thinking it all the way through….that the situation could be the same or worse at home.

          • Amy

            My thinking is that the HB crowd will look at this and say that it’s because baby was in a hospital bed, and not the home bed. Bedsharing is common with HB’ers and sleeping while nursing is often listed as a “pro” of not using a bottle and bedsharing.

          • Amy M

            Even if I had breastfed, I was terrified of rolling over on the babies if we’d tried to bedshare. Sometimes, I tried to follow that annoying adage about “sleep when the babies sleep!” and in the early days they had a period of sleep between feeds from 6am to 9am. So I’d lie down and as soon as I was comfortable, one would start fussing. I’d pick up, soothe him, put him back, go lie down. Again with the fussing, so I would bring him into my bed, shove all the covers away and fearfully close my eyes for 10secs before opening them to check if he was breathing. Then his brother would start up, so I’d bring him into the bed too. Of course, they would sleep soundly, but I couldn’t, and usually gave up and took a shower.

          • Guesteleh

            This is from a Washington Post article on SIDS:

            Many SIDS researchers believe an uptick in bed sharing may explain the plateauing of SIDS rates in developed countries. They report that 50 to 70 percent of new SIDS cases in the past few years have occurred in a bed-sharing scenario.

            “We’re now in the position we were 20 years ago with sleeping prone,” Carpenter says. “If we could get rid of bed sharing, the whole picture could change with SIDS. That’s our hope.”