The Baby Friendly Hospital Initiative is worse than a failure

Stop Doing What Doesn't Work

An extraordinary editorial in the latest issue of JAMA confirms what I have been writing about for years: the Baby Friendly Hospital Initiative is worse than a failure. It not only doesn’t work at promoting breastfeeding, but it actually harms infants and mothers in the process.

The editorial accompanies publication of the new USPSTF (United States Preventive Services Task Force) breastfeeding promotion guidelines. Interventions Intended to Support Breastfeeding Updated Assessment of Benefits and Harms by Flaherman and Von Kohorn is remarkable for its honesty.

It’s the inevitable result of replacing scientific evidence with lactivist ideology.

The BFHI doesn’t work.

…[O]nly individual-level interventions demonstrated effectiveness at improving breastfeeding, whereas system-level interventions, including the World Health Organization’s Baby-Friendly Hospital Initiative (BFHI), did not.

That’s a stunning admission. After millions of dollars in expenditure and countless tears of starving infants and guilt ridden mothers, the BFHI doesn’t even achieve its only objective: to increase breastfeeding rates.

If that weren’t bad enough, it has become clear that the BFHI is actually harming babies.

How?

The BFHI bans pacifiers in contradiction to the scientific evidence.

Counseling to avoid the use of pacifiers in the newborn period is an intervention commonly used to support breastfeeding. However, evidence has been building that infant use of a pacifier may be associated with a reduced risk of sudden infant death syndrome,7 the most common cause of postneonatal death in the United States. The evidence review showed that avoiding pacifiers was not associated with any breastfeeding outcomes assessed in the evidence review. A recent Cochrane systematic review reached the same conclusion. Thus, routine counseling to avoid pacifiers may very well be ethically problematic.

The BFHI bans formula supplementation in contradiction to the scientific evidence.

Counseling mothers to avoid giving infants any food or drink other than breast milk during the newborn period is step 6 of the BFHI and one of the primary care interventions most commonly used to support breastfeeding. Three randomized trials have specifically examined the effectiveness of counseling to avoid giving newborns any food or drink other than breast milk; none showed a beneficial effect of such counseling on breastfeeding duration.

And that’s harmful:

… For women who have scant colostrum and no copious milk production for 4 to 7 days, exclusive breastfeeding in the first few days after birth is associated with increased risk of hyperbilirubinemia, dehydration, and readmission.14- 16 Although these conditions are generally mild and often resolve rapidly, their frequency is high; 1% to 2% of all US newborns require readmission in the first week after birth, and the risk is approximately doubled for those exclusively breastfed.15,17 If counseling to avoid food and drink other than breast milk is not an effective method to support breastfeeding, the frequent low morbidity and rare high morbidity outcomes could potentially be avoided without reducing breastfeeding duration.

That’s in addition to previously described harms.

As noted in Unintended Consequences of Current Breastfeeding Initiatives:

Enforced prolonged skin to skin contact leads to deaths from Sudden Unexpected Postneonatal Collapse (SUPC).

Reports of SUPC include both severe apparent life-threatening events (recently referred to as brief resolved unexplained events) and sudden unexpected death in infancy occurring within the first postnatal week of life. A comprehensive review of this issue identified 400 case reports in the literature, mostly occurring during skin-to-skin care, with one-third of the events occurring in the first 2 hours after birth …

Infant injuries and deaths as a result of enforced 24 hours rooming in and closing well baby nurseries.

An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight … This may result in prone positioning and co-sleeping on a soft warm surface in direct contradiction to the Safe Sleep Recommendations of the National Institutes of Health. In addition, co-sleeping also poses a risk for a newborn falling out of the mother’s bed in the hospital, which can have serious consequences.

How did a program designed to promote breastfeeding end up harming so many babies? It’s the inevitable result of relying on lactivist ideology instead of scientific evidence. Sadly, hospitals, doctors and nurses allowed the breastfeeding industry, including lactation consultants, to set policy.

Lactivists and lactation consultants appear to believe that only continuous, extended, exclusive breastfeeding has value, but that’s not what the scientific evidence shows. Instead of promoting science based support of breastfeeding, the BFHI promotes depriving infants of vital formula supplements, life saving pacifiers and safe sleeping arrangements. Instead of promoting science based support of women who want to breastfeeding, the BFHI focuses on shaming and blaming mothers who can’t or don’t wish to breastfeed.

The deadly results that I and others have been warning about for years were tragically inevitable.

Pediatricians have taken critical first steps in acknowledging that the tenets of the BFHI lead to preventable infant deaths, but it’s long past time to start dismantling the BFHI. How can we possibly justify maintaining a punitive program designed by lactivists designed to enforce an unscientific ideology in hospitals, facilities devoted to promoting infant and maternal health?

  • Jeanne Batacan

    Dr. Amy,
    I am hoping you read the latest JAMA article on the BFHI that also mentions the importance of rooming-in. I know you have access to the full [referenced] article but your readers do not, so here are some facts:
    By Joan Younger Meek, MD Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee. Lawrence Noble, MD Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York
    “A recent meta analysis revealed that improved breastfeeding globally would annually save 823,000 deaths in children younger than 5 years and 20,000 breast cancer– related deaths in women.4 In addition, it found that breastfeeding reduces morbidity and has an economic impact in improving the educational potential of children and their earnings as adults. Improved breastfeeding rates would reduce treatment costs by at least $2.45 billion annually in the United States alone.1”
    “The American Academy of Pediatrics has recommended that pacifier use be restricted for healthy, term newborns until breastfeeding has been well established, to promote a good maternal milk supply and to eliminate potential risk of nipple confusion, especially during the first few weeks of life when sudden infant death syndrome is less common.2”
    “The Ten Steps to Successful Breastfeeding include development of a breastfeeding policy, education of all staff, and altering the paradigm under which maternity care is delivered. A key element involves allowing as much uninterrupted contact between the newborn and family as possible, beginning immediately after birth with skin-to-skin care and followed by continuous rooming in throughout the hospital stay. A meta-analysis of 34 randomized trials with 2177 participants revealed that early postpartum skin-to-skin contact increased breastfeeding rates, with no clear negative outcomes.6 In addition, skin-to-skin contact decreases hypothermia, hypoglycemia, and crying and promotes cardiorespiratory stability, especially in the late-preterm newborn. One study found that rooming in in-creased exclusive breastfeeding during the first few days of life.7”
    “Infant safety and the prevention of sudden unexpected postnatal collapse are of paramount importance, but so are implementation of the Ten Steps to Successful Breastfeeding and designation of Baby-Friendly maternity facilities. These are not mutually exclusive goals and both can save infant lives.”
    2016 American Medical Association. http://archpedi.jamanetwork.com/

    Informing and educating women about risks and benefits is not bulling or bashing. It is an essential part of good, evidence-based health care.

    • Erin

      “Informing and educating women about risks and benefits is not bulling or bashing.”

      It depends entirely on how it’s done.

      And therein lies the problem. When I was first pregnant, I raised a concern about breastfeeding with my midwife. I questioned that if I couldn’t bear my husband touching my breasts would I have an issue with breastfeeding. I was told not to be so silly. Of course when my son was born, it turned out that I did have a huge issue. I found it massively triggering (not helped by the circumstances of his arrival) and how did the “professionals” help… they came out with offensive garbage like “shouldn’t have got pregnant if I wasn’t over being raped”. I’m not a fan of language like “birth rape” but those midwives and NICU nurses certainly did an excellent job of mirroring the same phases and words that my rapist used. The grabbing of my breasts without asking was rather upsetting too and yet because it was by a woman, none of the other midwives I complained to could see it as problematic.

      Instead of considering my mental health and the effect that maternal mental health issues can have on child development, the majority of them treated me like I was the worst mother ever. My inability to pump was tantamount to child abuse and of course I ended up with fairly severe PnD and a diagnosis of PTSD.

      I’m now pregnant with number 2 and my experience of the BFHI was so bad that I will be discharging myself asap and I will not be even attempting to breastfeed whilst I’m in hospital. Somehow I don’t think that’s what was intended.

      Which brings us back to:

      “Informing and educating women about risks and benefits is not bulling or bashing”

      If someone informs me of the risks/benefits of two options and I choose option x (which we’ll call formula) that should be the end of it. No bringing it up at every opportunity, no emailing me random studies, no attempts to put down my experiences or telling me I just need to try harder because that crosses the line into bullying & bashing.

    • Heidi
  • Stormie Mcmahan

    If you don’t breastfeed simply because “you need sleep” you’re beyond selfish. Newborns sleep at least 16 hours a day whether they’re breastfed or not. So I’m pretty sure you could have managed. When you become a mother you should be concerned about what’s best for your baby instead of what helps you get more sleep.
    #breastisbest

    • corblimeybot

      It must suck to be such a nasty harpy. Hope you get help for that.

    • Heidi

      Getting more sleep can very well be best for baby. You know that, though. Breastfeeding is probably the only thing you have. Well, woot.

    • Heidi_storage

      Congratulations, Ms. Sanctimommy. You are wrong.

      Not all newborns sleep 16 hours per day. Furthermore, some of them sleep in 20-to-60-minute intervals (hello, firstborn kid); how the heck can you function at all if you can’t hand off feeding responsibilities to someone else for 3-4 hours?

      Also, you need sleep if you have toddlers running around trying to kill themselves every 10 minutes, or even older children to look after.

      What about women with health problems that are made worse by sleep deprivation? Or are you suggesting that such women shouldn’t become mothers? Frankly, I’d take the parenting of a kind, loving woman with, say, fibromyalgia over the parenting of someone who thinks it’s okay to judge mothers for making perfectly good feeding choices.

      Finally, some women have to go back to work very soon after giving birth–which is terrible, but reality for many. Those women need sleep more than they need to confer the trivial (in industrialized countries) benefits of breastfeeding upon their babies.

    • Roadstergal

      I’m going to repost my comment from below:

      “BTW, I want ‘selfish desire to sleep’ to be held up as a perfect lactivist quote. I suppose eating and pooping are also selfish desires.”

      • momofone

        I selfishly showered every day too. I not only slept and ate; I took care of my own personal hygiene too. Figures.

      • guest

        I selfishly desired to be a human being.

    • Charybdis
    • momofone

      “So I’m pretty sure you could have managed.”

      I’m pretty sure you have no idea what someone else could or should manage, and that it isn’t your business to begin with.

    • demodocus

      i broke my son’s leg when i was carrying him and was literally so tired i couldn’t walk straight

    • guest

      If you don’t ever sleep because “you need to breastfeed,” you likely already suffering from sleep deprivation psychosis.

  • Gertie

    What can we do to help get this changed?! How can we help?

    Harms vulnerable mothers and infants in the process of failing at its stated goals? Causes more readmissions to the hospital??? How did it get implemented in the first place? What motivation could their possibly be….?

    Hmmmm…what motivation indeed….?

    $

  • The BFHI is particularly dangerous in that it plays on the emotions of families going through a vulnerable and stressful time. When you’ve got a million and one things to deal with as a new parent, sitting down and evaluating the actual evidence isn’t as comforting as “natural” parenting advice sold as “baby-friendly”. Not to mention the social pressure put on new parents to conform to whatever dogma the natural birth industry is pushing. The phrase “baby-friendly hospital” itself is disconcerting: presumably all other hospitals hate babies?

    • StephanieA

      I’m an OB nurse and am completely against forced rooming in and pressuring mothers to breastfeed. I thought I was pretty confident in my beliefs, and I still gave in to pressure when I had my second baby. My doctor convinced me to breastfeed against my instincts, and I only sent my son out to the nurses for a couple hours even though I desperately needed sleep. So if I, someone who is comfortable with the nurses I work with and general labor & delivery setting, has trouble with the “baby friendly” pressure, I can’t imagine what other parents must feel. We ended up leaving at the 24 hour mark because I felt more comfortable switching to bottles at home, and I figured that if I was going to not sleep I might as well do it in my own bed.

      • Jenna

        Your instinct should be to breastfeed. Thats what your breasts are for. What you felt was just selfish desire to sleep. If you wanted sleep so much, you shouldnt have gotten pregnant. Babies naturally take away their parents’ time and sleep, no matter how they are fed.

        • corblimeybot

          Are you a Poe? Really can’t tell.

          Lactivists are often so stupid that they can’t understand why bottle feeding may result in more sleep for both parents. Because the work can be distributed across more than one person. So while this comment should be obviously a laughable parody, I’ve seen too many real idiots espouse this viewpoint to know for sure.

          • LaMont

            Yeah I’m at 70/30 on this one in favor of it being real. Somehow, the decision to become a parent (and accepting some loss of sleep) means that you sign away all rights to sleep EVER, even while recovering from serious physical ordeals like birth? There isn’t enough jokey over-the-topness in the punchline to convince me it’s sarcastic, unfortunately.

          • Mariana

            And babies have no problem latching on to bottles and take 30 min at most to empty it… While a newborn can take over an hour to get off the boob, and have trouble latching in the first place.

          • Heidi

            I don’t think she is a Poe. Take a gander at her Disqus profile.

            “If i lived in lousiana, i would move out asap to a state that doesnt get hurricanes, floods, and tornados so often!”

            Oh, yes, because all the residents of LA have spare money and can easily find a job elsewhere to move!

            “Why doesnt africa just import their food like america does? People managed to live in africa for centuries without gmo crops, so they can continue to do so, even without imports.”

            Yeah, you dang Africans! It’s soooo easy to do! (Do ya think she even realizes Africa is a whole continent as opposed to a country?)

          • Roadstergal

            How does someone that clueless manage to get out of bed and put clothes on?

          • corblimeybot

            hahahhahahahhaaaaaaHAHAAHHAHAHahahaaahAHAAAhaha!!

            Oh shit, that’s good.

          • mabelcruet

            Yep, really not a Poe. Anti-Semitic, anti-vaxxer, Trump apologist (says she doesn’t support either candidate but then praises the orange hued one every chance she gets), Big Pharma consipracy theorist. So, basically, uninformed and really rather unpleasant.

        • Box of Salt

          “you shouldnt have gotten pregnant”

          Way to support your fellow women, Jenna.

          /sarcasm

        • Amy Tuteur, MD

          Who are you to decide what anyone should or should not feel instinctually? Why should anyone care what you think?

        • Who?

          Oh dear, a ‘should’, a value judgment that wanting sleep is selfish, and the crass assumption that all pregnancies are planned or even the result of consensual intercourse.

          Jenna, are you the new Brooke?

        • Anj Fabian

          Sleeping is biologically normative.

        • Azuran

          And your instinct should be to have sex every time, and ONLY when you are fertile, in the hopes of producing as many offspring as possible in your lifetime.
          After all, that’s what your uterus is for.
          Are you following your instinct?

        • Erin

          Because I’m feeling charitable, I’m going guess you’re either very young or very lucky.

          I wanted to breastfeed. I read all the leaflets my midwife gave me. I had concerns that I might have a problem which made it impossible but my fears were allayed by midwife who told I’d be fine, that was totally different. I went to the 4 hour breastfeeding preparation course offered by the NHS in our area (we could only talk whilst holding the knitted breast complete with relatively realistic nipple – with hindsight we should have gone “Lord of the Flies” on the midwife taking the course) and listened to everything we were told.

          Then my son was born. I put him on the breast without any prompting from the midwife in recovery (she was off making me tea and toast because apparently I looked like I needed it) and instead of those feelings of love, the rush I felt was one of revulsion. My instincts were to push my baby away, to turn my head.

          How I thought I would feel and how I actually felt were worlds apart. Telling me I shouldn’t have got pregnant when I’m sat there holding a baby is as I pointed out to the midwife who actually said that to me “not very helpful”.

          Also according to both my MiL and my Grandmothers what used to happen in our families (all European but culturally reasonably different) was that you’d have your baby. You would breastfeed and then someone else (Mother, Sisters, Aunties, Older daughters, Friends) would take the baby whilst you slept for the first couple of days. When baby got hungry, they’d bring baby back and either wake you up or just hold the baby on your breast whilst they fed. Rinse and repeat.

          Sleep is important. Forcing an enemy combatant to stay awake for days is torture…forcing a new Mother to stay awake for days is baby friendly?
          Personally I don’t think drowsiness, fatigue, irritability, and hallucinations are particularly good symptoms for someone in sole responsibility for a newborn to be suffering from.

        • momofone

          What exactly are your qualifications to speak on instincts, or on “what breasts are for”?

        • Roadstergal

          Nope, my breasts are for decoration and my own pleasure.

          “Babies naturally take away their parents’ time and sleep”

          They also take a lot of money, but it still doesn’t make it a good idea to throw money away randomly. Quite the opposite – the money that’s required makes it critical to budget money according to what’s important, and the time they demand makes it even more critical to budget the time parents give them according to what’s most important.

          BTW, I want ‘selfish desire to sleep’ to be held up as a perfect lactivist quote. I suppose eating and pooping are also selfish desires.

          • Michael McCarthy

            Nope, my breasts are for decoration and my own pleasure.

            As my old boss can attest, breasts are excellent for manipulating men. On 3 instances I was in the car with her when she was pulled over for speeding. A couple of popped shirt buttons and a well placed hand later and she was given a warning. (granted she was blessed with a pair of perfect tatas, and I say this as one with no interest in female breasts)

          • Roadstergal

            I wish that worked for me. I’ve never gotten out of a ticket. Of course, I have A cups… one is not even a full handful for Mr R. :p

          • BeatriceC

            I used to for for Hooters. I can count on one hand the number of times I’ve paid for my own drinks in a bar. I’ve also gotten out of more than my fair share of speeding tickets. I know all about how to use my boobs to manipulate men. It’s kinda evil, but I’m okay with that.

          • Michael McCarthy

            I don’t think it qualifies as evil. Immoral, maybe, but that’s all a subjective societal construct anyway. I don’t see anything wrong with it, no different than pretty people using their looks.

          • BeatriceC

            I’m fairly unapologetic about it. My boobs paid my way through college. It was legal, and waiting tables isn’t an easy job. Even at my current age (40), I almost never pay for my own drinks if I go out without MrC. I make no pretenses about anybody’s chances of taking me home with them (zero), but they still pay, and as long as we’re all honest about our intentions, I don’t see a problem there. I’ve never actually asked to get out of a ticket, but when you have G-cup boobs, they’re kinda hanging out no matter what you’re wearing, and a cop is standing up looking down, so it’s just sort of unavoidable. I figure that if they’re gonna be stupid, I’m going to take advantage of the break. But I’m also not an idiot. The second a man started acting like I owed him anything on account of those drinks he’s buying or the ticket he’s not going to write, is the second I’m gonna pay for my own drink or make sure I can get his badge number so I can report his happy ass.

          • Michael McCarthy

            You sound so much like my old boss, it is amazing. She was awesome.
            This isn’t quite so effective typed on a chat board as in person, but….
            *work it, gurl* (snap!)
            😀

        • Heidi

          I guess I’m selfish for wanting enough sleep to not make dangerous bad decisions for the safety of my baby! I’m horrible! I decided I didn’t want to fall asleep with him in my bed and suffocate him. I also decided SELFISHLY I’d rather him get enough to eat and drink instead of being hospitalized for dehydration, weight loss, and jaundice. I had instincts to keep baby and I in good health. I am so effed up!

        • StephanieA

          I’m really not sure if this is sarcasm? I’m hoping so. I had zero ‘instinct’ to breastfeed. None. My selfish desire to sleep was driven by the fact that I kept falling asleep with my newborn in the hospital bed, which is dangerous. And I shouldn’t have gotten pregnant? Misogyny much? No shit babies take time and sleep away, but let’s not consciously try to make it even harder for parents.

        • kilda

          wow. Well, aren’t YOU just a lovely person.

        • Maud Pie

          I gave up on breastfeeding out of laziness. Explaining to ER personnel, CPS workers, and cops why I let a baby starve just seemed like a huge hassle compared to giving the baby a bottle. Sleeping a few hours at a time was much easier then dropping or suffocating or doing something else stupid and injurious because of sleep deprivation. I just didn’t want to be bothered with funeral planning.

          • Heidi

            I’m there with you! Shit moms unite!

        • sdsures

          What if the mother doesn’t want to breastfeed and has planned to FF? What if she is a rape survivor and gets triggered by anything touching her breasts? Stop being so ridiculous. What’s important is that the baby gets fed.

        • Ayr

          Judgmental much? How can a mother possibly take care of an infant if she is too exhausted from lack of sleep? Which your body needs by the way. Not every woman feels a burning urge to breastfeed, I didn’t. I tried, but there was no desire for it, and I didn’t produce much anyway, so when I ended up on blood thinners and could no longer breast feed I was relieved.

        • Emma

          Disregard this person’s comments – she’s an anti-vaxxer and Trump supporter. Enough said.

        • Charybdis
          • Who?

            Entirely off topic but I am having no success with your perfume sample.

          • Charybdis

            Well, phooey. I appreciate you looking. It is becoming a mission for me to Find Some. Hopeful something will show up for the holidays.

          • Bombshellrisa

            What perfume??

          • Charybdis

            Poison Girl by Christian Dior. It’s been my understanding that it won’t / isn’t going to be available in the U.S. and as a Poison fan, I Must Have Some. I asked if anyone not in the U.S. would be willing to find sample.

          • Bombshellrisa

            I saw it on Amazon!

          • Bombshellrisa

            http://www.fragrantica.com/perfume/Christian-Dior/Poison-Girl-35561.html
            There are links here. Hope you can get your perfume.

          • Who?

            Me too! And I don’t wear perfume!

        • guest

          What’s selfish is a society that expects parents to take over 100% childrearing that used to be a communal effort. “Oh no, I couldn’t possible spell you for four hours by giving your infant a bottle. I have all these important shaming internet comments to write.”

      • Jonathan Graham

        I think there’s a lot of weirdly intense pressure around child rearing. Most of it focused on moms.

  • Jinx

    So… how much money do hospitals save by making new moms take care of their babies round the clock?

    • Dr Kitty

      Quite a bit, given that in the USA you can charge twice for the room if both of them are using it, even if mum is providing all the care for the infant.

    • sdsures

      How much money do hospitals save if an exhausted mother falls asleep and her baby falls out of her arms and onto the floor?

  • CSN0116

    Severe food allergies kill kids too, so can we please call out BFHI’s rigid policy that babies receive nothing but breast milk for the first full 6 months of life, despite copious amounts of research showing that (specific) foods need to be introduced prior to 6 months to decrease the risk of developing allergies?

    BFHI has fucked up numerous layers of infant and child well-being.

    • sdsures

      Hear, hear! (I’m lactose-intolerant. Is this something I can pass on to my kids?)

        • sdsures

          Thank you!

          This might sound odd, but for most of my life (let’s say 32 years; I am 35 now), I didn’t have any intolerance to cow milk. Then out of the blue, a couple years ago, I began reacting very violently to it. :'( What could cause a sudden change in my ability to process lactose?

        • sdsures

          It is – thank you!

  • Irène Delse

    The BFHI should go down in history as a cautionary tale for policy-makers, about the dangers of putting process before outcome. That’s the only silver lining I can see.

    • CSN0116

      My students thoroughly analyze BFHI in an epidemiology course I teach when I get to a section on policy — “This is how you totally fuck up a health promotion policy”.

      • Irène Delse

        Bravo!

      • BeatriceC

        If I ever go back into teaching I think a statistical analysis project based on BFHI might be in the works.

      • Melaniexxxx

        I want to do a woman/child focussed MPH… would LOVE to analyse BFHI but i fear the politics and drama is still too strong for anyone to accept it as a project supervisor 🙁

        • CSN0116

          Whaaaat?! That’s a shame. I supervise a lot of capstone projects and my role is to guide and assist students, regardless of whether or not their interests and passions align with my own. I would take you on in a heartbeat!

  • “Individual Level Interventions” – the kind of quality personalized care that lets a woman determine what may or may not be best for her and her infant in her own personal circumstances, those kinds of things are the things that work. I bet you those kinds of things are also associated with better outcomes generally, and more satisfied moms.

    • Young CC Prof

      Example: “Hi! My name is__and I am a board-certified lactation consultant. I’m here to help you. Your chart says you are interested in breastfeeding. How’s that going so far?”

      If folks really feel the need to measure something breastfeeding-related in the hospital, measure whether all mothers who want to breastfeed get appropriate help in figuring out how to do it.

      • D/

        Heck YCCP, we hospital-folk evidently can’t even manage the data collection challenge of just acknowledging maternal feeding preferences. How in the world would we shoulder the burden of determining what appropriate help is and if we were giving it?!

        A little over a year ago Joint Commission completely dropped the quality indicator of acknowledging maternal preferences to not exclusively breastfeed due, in part, to the “challenge” of simply capturing data on the mother’s preferences. Data collection related to maternal medical exclusions has also been dropped because those conditions are “unusual”, affecting ~2% of patients.

        Tag line of the benefit of this decision: “Reducing the burden of data abstraction to allow concentration on strategies to increase exclusive breastmilk feeding.”

        This announcement (along with my organization’s decision to have a 100% EBF goal) drove the nail in my acknowledging-exclusive-breastmilk-feedings coffin.

        I work to figure out what the mother in front of me wants (and needs) and then do everything I can to help make that happen. I specifically encourage families to share details of how we actually helped them (or didn’t) during my rounds and in their satisfaction surveys. I forward patients’ statements that are shared with me to my manager. Evidently our rates are increasing from what I hear, but I truly have less than no interest in what those rates actually are. Thankfully, so far, I haven’t had any negative repercussions from this approach.

      • Jessica

        Yes. I wanted to breastfeed my first son, but we had difficulty latching in the hospital. The nurses weren’t much help, and the one lactation consultant on duty that weekend was so busy that everytime I buzzed her to help with a feeding, it would take 30-45 minutes for her to make it to my room, by which time my son had fallen asleep. I had to consult with a private lactation consultant in the community to get some undivided attention for more than 10 minutes and suggestions how to spoon feed colostrum. It took another four WEEKS for him to learn to latch.

  • Marki

    Well there is no harm keeping the baby skin to skin and breastfeeding is a good thing when it works u need a good careprovider that support your babies needs and your needs. Sometimes thats means giving formula in the start becourse the baby have a ruff start and needs the xtra energy. Nothing is just black and white and why not make a plan before you deliver your baby what you want for your baby and your self It’s your baby not anyone elses I think that’s so even in the US

    • swbarnes2

      Well, skin-to-skin can be bad if mom is so exhausted that she falls asleep with a newborn lying on her on its stomach.

      And what people are saying is that “making a plan” is doesn’t work if the staff has been instructed to browbeat you, or deny your requests.

    • fiftyfifty1

      “why not make a plan before you deliver your baby what you want for your baby and your self ”

      My plan was a nice, uncomplicated vaginal birth and lovely, nourishing, breastfeeding without problems. Turns out Nature had very different plans ….

    • Young CC Prof

      Babies have been suffocated or dropped when caregivers encouraged prolonged or continuous skin-on-skin with an exhausted postpartum mother. That’s the harm, not doing it, but pushing it too hard without appropriate safety measures.

    • FEDUP MD

      I was so drugged after my emergency csection (general anesthesia) that when the required skin to skin occurred, I told the recovery room nurse I was worried I would drop the baby on the floor. I was a board certified pediatrician at the time (let that one lapse!) so not like I did not know what I was doing- the opposite, actually, as I (correctly) noted I was too impaired to be safe to the baby. I was told you made him, you wanted him, you deal with it, and given the baby. My husband held him next to me, and I have video of me trying to hold him slurring crazily and every so often my eyes rolling back and me trailing off for a few seconds- gee, like someone high on narcotics and/or benzos, just like I’d just gotten! I was unable to get up from bed myself due to epidural and a foley. If I had been without a support person I could easily have given him a skull fracture or smothered him during that time, because the BFHI nurse sure wiped her hands once he was in my arms.

      • Sue

        “I was told you made him, you wanted him, you deal with it”

        That is appalling, unprofessional behaviour.

        Yes, you made him, you wanted him – that’s why you didn’t want to risk harming him.

        • FEDUP MD

          It was. Especially at the time, it was very upsetting, because i had just had a very difficult birth (including a mostly unmedicated c-section until they put me under after the epidural failed) after having had two miscarriages in a row of very wanted pregnancies, not to mention having a kid with low Apgars and being on tons of medication.

      • Anion

        That’s horrific. I am so sorry that happened to you.

        I’ll never forget the look of shocked disgust on the nurse’s face when I asked her if she could take my baby (my first) to the nursery (I was post-section, too). “We don’t do that,” she said, in tones that suggested I’d asked her to go score me some heroin. “You need to take care of your baby yourself.”

        That was obviously nowhere near the response you got, but geez. The way new mothers are treated by this “baby-friendly hospital” thing is just disgusting.

        • Erin

          Roughly around the time I had my emcs, one of my Uncle’s had keyhole surgery to fix a hernia. He was treated as he was made of glass. When he was discharged, he was told that an adult must stay with him for 24 hours in case of issues and not to do anything strenuous like looking after his grandsons.

          I had an emcs after a long labour and was expected to just get on it with.

          • FEDUP MD

            I had the same surgery, after having had 2 sections.

            The first thing I said was, geez, this is so much easier recovering without being solely responsible for a tiny human! And it was!

          • sdsures

            Oh for pete’s sake!

      • TheArtistFormerlyKnownAsYoya

        This story is horrifying!

      • sdsures

        OMG!

    • AnnaPDE

      Are you a troll, unable to read, or just completely ignorant of how this birth thing plays out in reality?
      “Why not make a plan” — oh wow, thanks, we stupid women couldn’t come up with anything smart like this! So glad you could explain it to us. Please, tell me more about how things always go to plan with childbirth, how wishes and plans are always respected, and how everyone is in excellent shape right after having the baby so they can deal with any difficulties perfectly and quickly.

    • Irène Delse

      I’ll be charitable and assume you haven’t read the article in full and are fuzzy about what BFHI means. The problem is that it’s official policy, right now, to assume everybody not only wants and can but needs to breastfeed, so they’re not acknowledging maternal preference about breastfeeding, or even the fact that many mothers have delayed lactation. They don’t acknowledge either that their policies are not evidence-based – to the contrary, indeed!

    • Charybdis

      It is this general attitude that having a plan is a good thing; writing stuff down helps you think and work through what you would have happen. The problem is, that once it is written down, it suddenly becomes The Standard To Which You Want Things To Happen. It can’t just be a list of preferences or a “let’s see how things play out” kind of thing.

      This whole BFHI thing ALMOST makes me want to get pregnant again (no chance, but I would LOVE to fly in the face of the whole thing), JUST SO I COULD BE A PAIN IN THE ASS.

      “So, Charybdis, let’s talk about your birth plan.” Me: “Okay. Here’s how I’d like it to go. I’ve had one CS, so I would like another, scheduled CS. Absolutely NO interest in a VBAC. Sorry, not sorry. Repeat CS. No skin-to-skin after delivery. Remove the baby, clean it up and hand off to Dad or Grandma while the CS is finished. Not interested in breastfeeding within the first hour after birth. Give the baby some formula. I prefer Brand X. Or let Dad or Grandma give the formula. None of the cup feeding or syringe feeding nonsense. Pop a nipple on a nursette bottle and feed away. Nope, I don’t even want to “try breastfeeding” again. No LC’s, IBCLC’s allowed in my room afterwards. Does the hospital have a well baby nursery? If so, I will be using it overnight. If not, then I will be having someone other than me staying to help care for the baby overnight. Pacifiers are just fine to use, my baby will have access to one. If they don’t want to use it, fine. But it WILL be an option for soothing. Thank you for asking.”

      Then I would prepare for the worst: bring some pacifiers with me, bring a stock of nursette bottles with RTF formula and a large NO LC/IBCLC sign for the door. Have the patient satisfaction/care advocate on speed dial, along with my OB and Pediatrician. Have my phone nearby and ready to record audio/video when/if staff give me grief or start pressuring me. Make sure I get names, times, etc. Take pictures of any and all forms presented to me regarding my choices.

      Just to see their heads explode. But I can be like that when piqued.

      • BeatriceC

        I’m totally there with you. If the risk of actually killing me weren’t so high, I’d be tempted to have another baby just to do exactly this.

      • Emilie Bishop

        Ha! Love it. I’m not able to have a second baby, but before we realized it would be hard at best, impossible at worst, we had decided I would switch ob practices and hospital systems just to get away from the BFHI nonsense. I am grateful I had that option living in a large metro area. Now my comfort is if we have a second baby, he or she will come to us by adoption and no one will expect me to breastfeed regardless of where they are born. It will be a relief to just go straight to my comfort zone and snuggle a little one while they happily chug a bottle.

        • Maud Pie

          Throughout my pregnancy I sometimes felt envious of my friend who adopted. All she had to do was drive to the airport.

          I didn’t see her during the horrible breastfeeding debacle. I later asked her if she felt that she missed out on breastfeeding. She assured me that she did not feel bad that she didn’t struggle with feeding and didn’t deal with an LC insinuating that she was a failure at being a woman. I assured her that was exactly what I was going to tell her.

          • Emilie Bishop

            We actually tried to adopt before conceiving our son, but we were never chosen by any of the expectant parents who placed through our agency during that time. So we had stockpiled bottles and knew about formula preparation before we realized breastfeeding wasn’t going to work for us…and through the power of the BFHI, I STILL felt like a failure for not exclusively nursing my son. Though I will say, our long preparation for adoption did filter out a lot of birth and bonding woo. Thank goodness I didn’t have to second-guess my decision to get an epidural to deal with my back labor on top of everything else!

      • sdsures

        I will try to be a PITA when I have kids, just for you. 😀

      • SandyH

        This is exactly what I did! I had my little girl in May, and was NOT going to go through the tortuous hell I went through with my son. (Longest stretch was 83 hours of no sleep…needless to say I was unable to have a conversation due to the hallucinations) had formula, paci’s, signs for the door, list of retorts for any shaming they may try, etc. My OB contacted the head nurse to be sure everyone understood she would be in the nursery at night and that she would be given formula. My husband and I were SO ready to fight someone that tried to play the guilt/shame game that we were given no chance – they could sense it. I wasn’t challenged once. And it was a BFHI hospital. Result was a happy mom, super happy and healthy baby, older bro is not neglected and adores his sis, and hubby doesn’t have an anxious, extremely depressed wife. I also healed much faster from the C Section this time. I believe it was because I was allowed to sleep vs pumping, trying to breastfeed, then skin-to skin, then pumping again… Wow. That was long but felt good to get it out even though this is sort of an old thread… Thanks for listening!

    • sdsures

      “Why not make a plan…”

      Because NOTHING in life ever goes according to plan!

  • namaste863

    I suppose lactivists find uncertainty intolerable. Let’s face it, there are no guarantees when it comes to parenting. You can do everything “right,” and your kid could still grow up to be Jeffrey Dahmer. It’s comforting, if false, to believe that there is a “magic bullett” that will ensure your kid will grow up to be a Yale grad with a 7 figure salary, and (Let’s face that, too) reflect well on you.

    • mabelcruet

      Every nurse and doctor knows that health care answers don’t come in black and white, and sometimes you can’t provide answers, only possibilities and probabilities and likelihoods and statistics. The more we find out about something, the less certain we are sometimes, and the more we know that we don’t know. But some people simply can’t cope with that-they want certainties, yes or no answers, lists of what to do and what not to do. Coping with uncertainty is hard to deal with.

      I’ve never had kids (except the furry four legged kind), but I feel really sorry for parents sometimes. They have these little screaming aliens suddenly appearing in their life, speaking an unknown language, who have no social graces whatsoever, who are selfish, egotistical, demanding, smelly, farty, burpy little messers, and then they bombarded by so many different people telling them what to do and what not to do and how to do it, and the fact that they’ve had said little psychopath seems to give everyone else in the world the permission to tell the parents they are doing it wrong, no matter what ‘it’ actually is. How do you not end up walloping someone with with wet end of a dirty diaper??

      • MaineJen

        You understand parenthood better than you think…

    • Sue

      Zealots, in general, find uncertainty intolerable.

      • Jonathan Graham

        This!

  • Heidi_storage

    I may have to bring a copy of this article with me when I deliver Kid 3.

    • sdsures

      DOOOOOOO EEEEEET!

    • Sue

      Yesss! Print it poster-size and stick it to the wall.

  • lawyer jane

    Here’s hoping NY immediately rolls back the amendments to its health regulations that make the Baby Friendly Hospital Initiative a *legal* requirement in all hospitals. http://www.health.ny.gov/press/releases/2016/2016-10-19_additional_breastfeeding_support.htm

    • Sean Jungian

      I saw that you mentioned this in a previous thread but didn’t have time then to really check it out. So now we’re “criminalizing” women who don’t breastfeed – sheesh, the lactivists must have fallen all over themselves with joy over that.

    • BeatriceC

      This bothers me on so many levels. It’s one of the more aggressive ways I’ve seen recently to attempt to control women and their bodies. I can’t adequately describe how I feel.

      • lawyer jane

        Cosign. It says “the mother SHALL be the preferred source of warmth” for the baby. Um thanks?

        • Mel

          Two obvious points: First, my husband is also a mammal so his body temp after birth should be pretty good for a newborn. OFC, if your spouse/partner/support person is a reptile or amphibian, they should not be used as an infant warmer….

          Second, Mel was a super-happy baby when her Mom and Dad would take her back to the hospital to visit Sis who was still in NICU. The nurses would set up a heated bassinet for me and we have pictures of me totally blissed out in a nap….

          • J.B.

            Apparently I was a great napper on a late 70s computer…

          • Melaniexxxx

            you be cat

          • fiftyfifty1

            Really sad that your mother didn’t bond with you well enough to continue to skin-to-skin you constantly until adulthood. There is no reason mothers can’t tandem skin-to-skin all their children. Only the nasty, unnatural ones don’t.

        • mabelcruet

          What if dad has a really, really hairy chest? Surely that would be warmer for baby?

        • fiftyfifty1

          And if she ISN’T because she can’t or won’t, why then we know what sort of unnatural woman she is.

    • lawyer jane

      So the code that I linked earlier is actually the existing regulation, not the amendment. The amendment looks even worse. It requires women to be told about “possible impacts of not breastfeeding” unless they are expressly decided on formula feeding. It also requires the hospitals to discourage pacifiers and lecture mothers who ask for one about the “impact” on breastfeeding. And it mandates “skin-to-skin”. I’m not 100% this is the final text of the amendment, but I believe it is: http://w3.health.state.ny.us/dbspace/propregs.nsf/4ac9558781006774852569bd00512fda/bc57b053d335a89885257f550062878d?OpenDocument.

      • Sean Jungian

        I’m going to have to look through the archives to see what’s been posted about skin-to-skin contact. I don’t remember doing this with my son (although I did breastfeed). When did it become such a big “thing”? Just what is it supposed to accomplish?

        It may have been mentioned waaay back when I gave birth, in BabyCenter or What to Expect, maybe? But I sure don’t remember it.

        • Amy M

          I had my boys in 2009, in a non-BFHI hospital and it was never mentioned. However,it happened sort of as a side effect, because the nurses had me get the boys stripped down to diapers in an effort to rouse them enough to eat.

        • Erin

          As I’m refusing skin to skin, I’ve been given several leaflets detailing how awesome it is.

          “Important for Baby
          Regulating their heartbeat – calming them down and soothing them
          Regulating their temperature – skin to skin is an excellent way of keeping a baby nice and warm
          Regulating their breathing – again calming and settling them
          Encouraging feeding – skin to skin stimulates a baby’s natural urge to feed, whether breast or bottle fed
          Feeling safe, secure and close to their parent – with the smells, sounds and sensations they’re familiar with
          Reducing stress – releasing calming hormones and comforting them when they’re upset
          Being contented – a baby held and cuddled often tends to be more settled and less “clingy”, rather than becoming “spoilt” as some people fear

          Important for Mother

          It’s also important for mother too, in that it:

          Regulates a mothers heartbeat and breathing
          Develops the relationship between mother and baby and increases a mothers resilience to cope with the challenges the early days can bring
          Encourages the release of hormones related to breastmilk supply and breastfeeding
          It has also been found to have some pain-relieving properties for mother too, as she focuses on her baby held close to her face”

          No idea how we 70s babies survived 🙁

          • swbarnes2

            There’s a good article in “Science of Mom” about this.

            Often the studies are of babies held skin to skin, versus lying in a bassinet, so there’s no way to distinguish the effects of just being held from the benefits of actually being skin-to-skin.

            If skin-to-skin was so great, they’d be pushing it on dad’s too.

          • EmbraceYourInnerCrone

            Nope, nope, nope, I had an episiotomy, 2 tears and I always find hospitals a bit cold , temperature-wise. Combine that with my barfing on my hospital gown during transition and skin to skin was the LAST thing I wanted. They cleaned her and me up and put us in dry warm clothes and I had lost of cuddles, her dad got to hold her while they cleaned and sewed me up. If its what someone wants that’s fine but making it mandatory is stupid.

          • crazy grad mama

            If skin-to-skin was so great, they’d be pushing it on dad’s too.

            THIS. I had a scheduled C-section, and we planned for my husband to do skin-to-skin while I was being stitched up. Our son got 45 minutes of lovely snuggle time with his father. Whenever I hear people bemoaning how C-sections mess up skin-to-skin, I think, “What about dad?”

          • RMY

            A lot of those types think dad’s #1 job is to support Mom, but otherwise keep our of the way. I hate the minimization of the importance of non-gestational parents.

          • Sue

            Newborn to Dad time is one of the best aspects of c/ sections. Many Dads treasure that time.

          • Erin

            Mine hated it. He thought I was going to die and leave him to look after this little alien all by himself.

          • TheArtistFormerlyKnownAsYoya

            That’s what we’re planning to do. I don’t buy the skin to skin thing but hubby has a niggling “what if there’s something to it” feeling. So he’ll be doing it while I’m getting stitched up. I’m kind of excited for them to have that special time together.

          • Young CC Prof

            With my son, they did! The nurses advised skin-on-skin for the one real reason: They weren’t sure he could maintain his temperature on his own, so they insisted that he needed to be kept either in a heated bassinet OR skin-on-skin with one of us, to make sure he was warm enough.

            Other than that, there’s no reason you need to be naked just to cuddle your baby.

          • Chant de la Mer

            See that’s logical, there was a particular reason that baby needed to be skin to skin. He couldn’t maintain his body temp and needed an outside source to help him and if he wasn’t in his cozy heated bassinet then he needed to be skin to skin for the warmth. A reason and an alternative, too much logic for the woonatics!

          • Mel

            Most of those are totally true for stable preterm infants. For unstable preterm infants, medical intervention is better. For term infants, they are pretty good at those goals with or without skin-to-skin contact. If any of those were so important, I doubt we’d have “lost” the instinct to do it.

          • Sean Jungian

            As far as this list goes, I don’t see anything that jumps out at me as being particularly different from just holding a baby while clothed. Weird. I would have hated the sensation, it would have made me sweat. I did plenty of holding while we were both nice and warm in our clothes, thank you!

            I’ll have to see about this, it really sound like a crock the more I hear about it.

          • Clorinda

            I gave birth to my first just as a nice New York Spring gave way to the hotter, humid summer. My baby wouldn’t eat, be comforted or anything unless we both had clothes on when cuddling. She hated the hot, sweaty skin.

          • Sean Jungian

            I’m with her, I hate that sensation.

          • Sue

            My newborn had skin-to-blankie in her Dad’s arms while I was being recovered. He will never forget that magical time.

            No problems “bonding” with either parent.

          • Sue

            “skin to skin is an excellent way of keeping a baby nice and warm”…IF you have no alternative, like a blanket.

          • Sarah

            Did you thank them for the free bog roll?

          • Erin

            Because I’m trying not to get too angry, I just smiled, thanked them and when I get home, I chuck them in my desk draw along with all the “gentle” section stuff and breastfeeding cds people keep giving me.

            Plus, they’re a bit too stiff and shiny.

            One of my more “hippy” friends thinks I should make “healing” college out of them.

          • Who?

            You could file them in COFFS-circular on floor filing system.

            Very satisfying.

            Or start a small fire with them if you are that way inclined.

          • Erin

            Ooh, I saw a post from the people organizing the local bonfire for Guy Fawkes looking for flammable stuff earlier today.

            Although it’s probably coated in stuff that stops it burning. Bet they’re like cockroaches, capable of surviving anything 🙁

          • StephanieJR

            Send them to me; the rabbit can chew, piss and shit on them, and then they’ll be composted.

          • BeatriceC

            Any you can’t use can come to me. Parrots love to shred paper. We give all the junk mail to them to “recycle”.

          • TheArtistFormerlyKnownAsYoya

            I’m having a c section and my husband wants to do skin to skin (doctor has said baby goes upstairs with dad while they close me up). I told him it’s woo and he better be really careful not to smother the baby! Personally I feel pretty meh about skin to skin – those claims seem eerily similar to the magical breastfeeding claims.

          • Erin

            The NHS seems to have dived on the “benefits” of skin to skin. After my section (emcs, long labour before hand, passed out on the table, all the alarms going off) they wanted me to hold my son whilst they sewed me up. Didn’t matter that I didn’t think he was real.

            This time around I’m having (fingers crossed) an elective repeat under general anesthetic and I’ve had well meaning offers to have him or her held on my chest whilst I’m unconscious. As things stand, baby is going to Daddy who can do skin to skin if he wants until I’m awake enough to ask for them.

            My husband is a bit concerned that I’m going to wake up and not ask for them but we’ll cross that bridge if we hit it.

          • Charybdis

            Oh, we’re all psychopathic, sociopathic serial killers. Didn’t you know?

            I’m still game to come over and beat people with sticks or other blunt object on your behalf….

        • Heidi

          I didn’t even know it was a “thing” until my nurse asked me on birth day (10.5 months ago) if I wanted to do it. It wasn’t pushed on me, and I really don’t think it would have been if I’d said no. I did do it. I just thought it was the option to hold your baby right after birth, which I enjoyed, but I didn’t realize at the time there was so much woo and fanaticism behind it. I also enjoyed the option of keeping my baby in my room at all times, but again, I didn’t even realize rooming in was ever a forced thing at the time. One nurse even specifically offered to take the baby overnight but I *chose* not to. Imagine that! But I’m pretty sure my hospital wasn’t BFHI but still was kind of trying to act like one but not so shamey and extreme.

          • lawyer jane

            I know, right? It’s *holding your baby.* Not some kind of religious ritual that curses the baby if you don’t do it right. And not like you don’t literally have YEARS AND YEARS to hold your baby if for some reason you don’t do it immediately after birth! I did not hold Baby Lawyer after birth because he had to go to the NICU to learn to breathe better (TTN) and now 4 years later he’s still stuck to me like glue 🙂

        • Melaniexxxx

          I think its generally crappy extrapolation from data on preemies getting some benefit from being held STS/”kangaroo care”. I have EXTREME doubts it’s relevant at all for term babies.

          Definitely not always relevant or useful for mums – remember a month or so ago walking past a room where an exhausted mum was sobbing because she’d just used all her last bits of energy to feed and dress her baby in nice new clothes. MW had taken its temperature which was slightly (!!) low (perhaps cos it had JUST been bathed/dressed?!) and demanded they both get naked again and do STS 🙁

    • Anna D

      So upsetting… Last time I checked the hospital I am going to give birth at had a nursery even though I think its BF certified. I will check again, but even though I am in NY my choices are limited at this point since I am tied to my OB’s practice.

  • fiftyfifty1

    “and countless tears of starving infants ”
    Nah, they’re too dehydrated.

    • attitude devant

      ouch

  • Sean Jungian

    The tide is turning!

    Here’s to keeping our children fed, safe, and healthy, in whatever form that takes.

    • Maud Pie

      I hope so. 16 years ago, when the J-teen was born, I was stunned to find out how extreme and irrational the Boobjahedeen was. I really thought, or wanted to believe, this was a fairly new development that would be pushed back as reasonable minds acknowledged the harm done to mothers and babies. Instead it just got more extreme. The tide is way overdue for a turn.

      • Sean Jungian

        What area are you in? It was about 15 years ago for me, and I just don’t recall it being as huge a deal as it is now. I was in reasonably-crunchy Seattle at the time, and I did have a friend who was a more-extreme breastfeeder (I think until her child was 3 yrs old), but I really don’t recall getting much pressure about it. Maybe that’s because I had decided to breastfeed so I didn’t get all the weird questions?

        • BeatriceC

          I was in North Carolina with my oldest and Miami with the other two. NC wasn’t so bad, but Miami was awful. They are 17, 15, and 14 now.

        • EmbraceYourInnerCrone

          I had my daughter in Southern California and they were pushing breastfeeding there in 1994…the RN who taught the childbirth class at the hospital was ADAMANT about both breast feeding and cloth diapers. Fortunately for me the actual nursery was not so pushy, although there was a LLL person who thought it was a good idea to grab my breast an shove it into my kids mouth with out asking me. Who thinks that crap is OK?

          • Sarah

            Sexual predators.

          • moto_librarian

            Too many of them. I had this experience as well, and given the number of women who have also been treated this way, it seems to be a fairly large problem.

        • Maud Pie

          This was in the Detroit area, not a crunchy community. I’m mainly complaining about the LC who totally ignored the dozen red severe PPD signs I was waving in her face and pushed the supplemental system with pumping every 3 hours. The other problem was the XH in one of his sanctimonious phases telling me every three hours what his hyper-religious cohort thought about mothers who didn’t spout magic boob juice like the Trevi Fountain.

          I eventually resolved the XH issue by appealing to his better nature, i.e. his inner history geek. He had to admit that infant mortality and plunged in the US at the same time formula caught on.

          The LC has acquired quite a reputation. Her name came up among a bunch of moms at a kindergarten party. That’s the closest I’ve come to organizing a posse.

          • Sean Jungian

            Oh wow, I’m sorry you went through that.

            Also, I realize my experience is probably NOT typical. I had my son in 2001, but several factors kept me out of the mommy groups – I was older (37) and most of my friends were single and childless, so I really didn’t have a lot of peers pressuring me into NCB practices. The one crunchy friend I mentioned, her daughter was already 12 by the time I had my son.

            I also wasn’t a SAHM and didn’t know any, almost everyone I knew was through my career in high-tech.

            So it isn’t really all that odd that I didn’t encounter a lot of pressure to breastfeed/skin-to-skin/go “natural”/etc. I don’t recall my OB spending much time on it, although he may have asked me about breastfeeding, and I never saw a LC though I may have been offered the services of one and just said “no thank you”. Luckily for me, BF was pretty easy in our case.

          • Maud Pie

            Thanks. I love how this site exists so we can share our stories. There’s so little discussion of these issues in the “official” outlets. It can be so isolating when all you hear are the unicorn on rainbow stories.

      • namaste863

        Love the term Bobjahedeen. I’m sure more than a few heads will explode over that one, islamic radicals and activists alike.

        • Maud Pie

          Thanks. My other two associations with lactavism and religious extremism are La Leche Inquisition and Juggernaut, which conveniently provides its own pun.