BFHI, the Bullying Friendly Hospital Initiative

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Last week I wrote about the fact that so called Baby Friendly Hospital Initiative has been worse than a failure.

Not only does it fail to achieve its objective, it is actively harmful.

The BFHI is not a medical program; it’s the institutionalization of lactivist bullying.

  • The BFHI bans pacifiers despite the fact that the scientific evidence shows they don’t interfere with breastfeeding and that they prevent SIDS.
  • The BFHI bans judicious formula supplementation despite the fact that the scientific evidence shows it doesn’t interfere with breastfeeding and prevents dehydration, brain damage and death.
  • The BFHI enforces prolonged skin to skin contact despite the fact that the scientific evidence shows it leads to deaths from Sudden Unexpected Postneonatal Collapse (SUPC).
  • The BFHI enforces 24 hours rooming in and encourages closing well baby nurseries despite the fact that the scientific evidence shows it leads to infant injuries and deaths from falling out of or being smothered within the mother’s bed.

The BFHI is not friendly to babies, but deadly to babies. It’s friendly to lactivist bullying.

It’s been a depressing series of decades for those who find deep and abiding satisfaction in bullying others. You can no longer bully people for being divorced or for having a child without being married. You can’t bully people of different races, sexes or religions. You can’t bully people for being gay and at the rate things are going, it won’t be long before it will be frowned upon to bully people for being overweight. But, in this world of ever decreasing bullying opportunities, there are still some tried and true opportunities available: you can still bully another women for being a bad mother.

The practice of mother bullying is practically a competitive sport. All the traditional options are still available: “I can’t believe your 14 month old is not walking”; or “My Johnny is always picked first for sports teams”; not to mention the ever popular “I’m so sorry that your child is going to a state college and not the elite college my child is attending.” Breastfeeding has provided some deeply satisfying new options for lactivists bullies. These include bullying women if they did not meet an arbitrary standard of breastfeeding duration or exclusivity, or (heaven forfend!) never breastfed at all.

The BFHI is not a medical program; it’s the institutionalization of lactivist bullying. Even better, the BFHI allows its proponents to pretend that they are bullying another mother, not merely for her child’s benefit, not merely for her benefit, but for the benefit of public health. It’s a win-win: all the fun of bullying another mother plus a heaping helping of self-righteousness.

Baby Friendly Hospitals represent breast bullying on steroids. Locking up formula in hospitals is oh so painful for mothers and so satisfying for bullies. If only they could require prescriptions for formula, breast bullies’ lives would be complete. And best of all, they are doing the shaming for the public good!

To hear lactivists tell it breastfeeding prevents every disease known to man; it cures every disease known to man; there is no problem that exists that cannot be solved by squirting breast milk at it! A mother who can’t or (worse!) chooses not to breastfeed is purportedly harming her child, AND being a selfish slob who puts her convenience ahead of her child’s brain functioning.

Nothing could be further from the truth. In countries with easy access to clean water the benefits of breastfeeding are trivial.

Being a bully is fun. Being a breastfeeding bully is better than fun; it is a public service! The BFHI isn’t friendly to babies; it leads to their suffering and even death. The BFHI isn’t friendly to mothers; it torments them for failing to mirror lactivist beliefs back to the lactivists who created it. The BFHI is friendly only to bullies and should be dismantled and replaced as soon as possible.

We can and should support breastfeeding without supporting bullying and we should not allow lactivists to convince us otherwise.

  • Jessica Rojakovick

    Thank you so much for pushing back, Dr. Amy! I’m a mother of three healthy thriving children who never got an ounce of breastmilk. (I’m the type of monster who just didn’t want to breastfeed.) While I was insecure about that decision with my first child, I’ve become an out and proud formula feeder now. It was the best thing for me, my husband, AND my children because they were being nurtured by a mom who was sane and happy. My sister is having her first baby and she’s having the baby at the same hospital I did. The only one in our city which still allows well baby nursery time for mothers to recover. I’m so happy there are still a few hospitals which believe in caring for women AND babies. (And is saving babies’ lives in the process, as you’ve outlined in your posts.) Thank you!

  • mamajb

    CDC Survey of Maternity Practices in Infant Nutrition and Care (mPINC) CALIFORNIA Results Report:

    “Breastfeeding is a public health priority, and the implementation of evidence-based maternity care practices supportive of breastfeeding in birthing facilities contributes to improved breastfeeding rates.”

    Hmmm, The CDC, AMA, ACOG, AAFP, WHO and all other health organizations world wide must be overrun by “lactivists”.

    mPINC in animation https://youtu.be/ua1rN_7oFh0 featuring the CDC Director, Dr. Thomas Frieden’s perspective on the impact that evidence-based maternity care practices supportive of breastfeeding have on the health of mothers and infants.

    This could be a refresher course for some physicians.

  • Cobrn

    You people are extremely nasty and short sighted. I work in a baby friendly unit. I am an LC. The “ten steps” are seen as guidelines. We do not bully anyone. We support every mother’s choice and her wish to do what is right for her self and her own child. We teach about SiDS and the judicious use of pacifiers. We support skin-to-skin but do not “force” it on our patients. Our babies are neither falling out of bed nor dying of starvation, as they are watched vigilantly, and supplement is indeed offered as needed. Our moms are grateful that we offer the chance to be successful but that we do not force our supposed “beliefs” on them. We offer support groups, a “warm line” and practical advice that meets the mother where she is in her life and her curcumstances.
    You people who present such a negative point of view should look at yourselves. What is driving your sense of outrage? There is room for all of us to get along while we keep the mother and baby at the forefront of our concern.
    I have read the author’s book. While she makes many valid points I found her validity to be outdone by her negativity and disrespect of those whose professions are devoted to a fair and balanced application of scientific principals to the art of breastfeeding. I find it to be ridiculous and childish to denigrate LCs by lumping us into one group of pushy, fault-finding, rigid and self-serving practitioners, eager to bully women into breastfeeding. While the passion may be there, the proof is not.

    • SporkParade

      What is driving my sense of outrage? My own experience of being bullied, gaslighted, and having my child’s life endangered by policies intended to reduce formula supplementation, all despite the fact that it had never been my plan to exclusively breastfeed in the first place. Only to be told by know-it-alls like you that it was all in my head.

    • Sarah

      If your account of your practice is a genuine one, and you really don’t pressure anyone and do support the right to choose, that’s great. Really. The reality, however, is that not all practitioners are like you: this is not a matter of opinion. And that is what is driving many of our senses of outrage. I, for one, haven’t the slightest interest in getting along with people who shit all over a woman’s right to choose what to do with her body, spread misinformation and bully women when they are at their most vulnerable. Soz. Gaslighting people who have experienced mistreatment from the worst members of your profession is not the answer.

      By all means have stylistic objections to the way Dr Amy writes, that’s your business, but do apply that uniformly across the board won’t you? I hope you’re spending as much time complaining to people who are equally combative who take the opposite view on these matters to her.

    • mamajb

      Ahhh, a breath of fresh air. Even though your thoughtful and caring (and evidence-based) concern is regarded as “lactivism”.
      Interestingly, members of La Leche League were called zealots. Interestingly, the APP recognized the information and support LLL offered as medically realavant.

  • Ayr

    I was at the chiropractor, waiting to be seen, when a lady walks out of the doctors room and sees the receptionist holding my three month old son, the first thing out of her mouth was not how cute he is or how old is he, but ‘he looks like a breastfed baby, is he breastfed?’ The question was of course directed at the receptionist, who to anyone with eyes is well beyond child bearing age, has not a single ounce of resemblance to the baby she is holding. She replied saying she didn’t know, he is the son of a patient. The woman then proceeds to say how she can tell he is breastfed because she is a member of La Leche League and has been for 20 years or some such crap. I then reply to her saying he is formula fed and has been mostly formula fed since he was born. The look on her face was priceless! Like I had broken her favorite toy into a million tiny pieces, she then tells me, he looks too healthy to be formula fed. Too healthy! Good grief.

    • corblimeybot

      Oh man, something just like this happened to me. The woman who taught our infant CPR class was a lactation consultant, too. She told us that she could tell our baby was exclusively breastfed, because of how nice her skin was. And of course, our baby never was exclusively breastfed! She was combofed from the beginning.

      • Ayr

        Ha! They think they know so much, I would love have to seen that lady’s face when you told her.

  • Megan

    When they finally come to their senses, there’s going to be a really large ugly unpainted spot on the wall of our L&D floor where the giant “Keystone 10” (PA’s version of BFHI) placard was. Wonder if that’ll ever happen? Ideology is hard to trump…

    • Mattie

      maybe they could put a nice big formula and pacifier cabinet there instead

  • carovee

    I just read an article about that study. The study authors were critical of what they called a ‘one size fits all’ approach. In the age of increasingly personalized medicine, who on earth thought treating all women who give birth exactly the same was a good idea? BFHI made no sense on any level.

  • J.B.

    The only good thing about everyone’s opinions on motherhood is that no matter what you do as a mom, you are doing it wrong according to someone (who will happily inform you of this fact.) So if you can realize and internalize during your child’s infancy that it doesn’t matter what the world thinks and decide what is best for your family wins, then the rest of your life gets easier.

    Signed, someone who is so incredibly grateful that her very strong willed children are cared for by others during the day, and that said children have very clear limits without spankings 🙂

  • Sue

    As I read about another newborn who almost starved because the mother refused to supplement with formula due to fear of “chemicals”, I came to this thought:
    Why don’t we list the HARMS of exclusive BF and the BENEFITS of formula?

    In most areas of health, any specific approach has benefits and risks.

    Both BF and FF bring advantages and risks.

    It’s not enough to say, for example, “exclusive BF prevents x number of respiratory infections or gastro” without also saying “exclusive BF causes x cases of dehydration, failure to thrive and jaundice”.

    • Madtowngirl

      Follow the money…

      It is infuriating, though, that every pill that is FDA regulated, every procedure that your doctor suggests, and other treatments with scientific evidence backing them require informed consent – a list of risks and benefits. But noooooo, not breastfeeding. Nacheural things don’t need informed consent because natural = best, right?

    • Who?

      Same reason the risks of delivering the old fashioned way are not fully spelt out-because it really isn’t a procedure, it’s something that happens, and goes well or doesn’t, and when it doesn’t doctors step in to help out. Yay doctors.

      As others have suggested, if the true risks of ‘natural’ delivery were spelt out in all their gory glory, there would be a big uptick in mrcs, and the usual suspects would dial up their complainits about fear peddling and playing the dead baby card.

      It may be that the use of formula would uptick if the risks of breastfeeding going awry were fully spelt out. And the usual suspects would be out in force, again.

      My neighbour was the judge in that case, I honestly don’t know how judges do their jobs, I would despair. People who think that trial judges are out of touch have no idea of what they speak.

    • Elaine

      I think exclusive breastfeeding harmed my career. Pumping at work definitely gave the busybodies I work with something to gossip about behind my back.

  • Petanque
    • StephanieJR

      Oh no.

    • sdsures

      I wonder how long it will be before the kid is starving to death once more?

    • mabelcruet

      It says in the report the baby made a full recovery, but that only means that his weight has increased. What about the effects of starvation for 6 months on his developing brain? Its too early to say if there is any long term cognitive impairment. Protein-energy malnutrition has horrible effects on the developed adult brain-must be even worse for the still developing infant brain. Please let this family be on the child welfare radar and get removed at the first sign of the mother being absolutely fucking stupid again.

    • Charybdis

      I made this to make the lactivist’s heads spin around. Maybe explode.
      http://www.memes.com/meme/1269344

  • guest

    I love state university systems. I am the product of one, and I work in one. I know their flaws inside and out, but I also know their achievements and their potential. The problem right now is that states are divesting from funding these institutions. Wherever you live, advocate for increased funding for public schools.

    • Sean Jungian

      Product of state university here, too! If not for public university, I most likely would never have been able to attend college and earn a degree. So you bet I’m grateful 🙂

      • guest

        Right on!

      • MI Dawn

        Product of 2 of them, actually. For undergrad and grad!

        • Sean Jungian

          Actually I think you might have gone to my rival college – I am a Spartan! 🙂

          But don’t worry – some of my best friends are Wolverines lol

  • MaineJen

    “There is no problem that exists that cannot be solved by squirting breast milk at it!” Laughed out loud at this one. 🙂

    • kilda

      ::::squirts some breast milk at Donald Trump::: Nope, dammit, he’s still there.

  • Mel

    At my last OB appointment, I got a four-page double sided lactivist manifesto about why I should breast-feed Spawn. Since Spawn is still gestating, I felt that this was a tad premature.

    Every damn trope was on there.

    *Breast feeding is a public health issue, not a lifestyle choice. (Spare me the guilt trip. You can’t pick out a EBF baby from an EFF baby in a lineup – let alone figure out in a 3 year old or an adult.)

    *Breast feeding can help prevent obesity, asthma, allergies, eczema etc. (My husband dead-panned that breast-feeding clearly made him into the skinny, calm immune-system person he is today. We both laughed.)

    *Breast feeding can prevent a whole slew of infant illnesses. (Good luck with that.)

    *Pain medication during labor can interfere with breast feeding. (My husband wants to know if humans have missed the connection between adrenaline production and let-down failure because that’s been known in cows for decades.)

    *The “Golden Hour” is totes critical for bonding and milk production. (In sheep, sure. In humans, nope. Anecdata: Every living preemie and their mothers who eventually produced breast milk)

    *No one sleeps well in hospitals. You shouldn’t expect to be well-rested after labor. Plus, you’ll really be better at sleeping with your kid in the room. (Never seen that trope in other floors of the hospital before….)

    *Bottles and pacifiers are EVIL. (Of course, pacis seem to decrease the risk of SIDS, but we don’t want to confuse people.)

    *Proper breast tissue development requires nursing on demand AND allowing the baby to suckle for comfort as long as they want for the first two weeks after birth. (Show me a fucking paper on that one because that would break most rules of how cellular development feedback cycles work. Plus, more than one mom of a preemie has managed to begin lactation in the absence of a consistently suckling baby.)

    *Babies are supposed to lose weight after birth; babies have really small stomachs so they don’t need much milk at first; if you are worried, just remind yourself that breastfeeding is natural and stop worrying. (Jesus-Fucking-Christ. Are you trying to kill newborns?!?!?)

    • MI Dawn

      I’d hand it back with “show me the peer-related articles proving this information is accurate or tell me why I should believe this garbage”. Signed A Mom who breastfed both kids at least 4 months.

      • Gene

        I second this!

        Signed, a mom who breastfed three kids for at least a year each and, oh yeah, is a pediatrician with two doctoral degrees including a science based PhD. So, yeah, totes more street cred.

        Seriously: feed the baby and love the baby. I don’t care how as long as baby AND FAMILY are happy.

    • MaineJen

      I’m sorry…you got this crap about BFing preventing obesity, asthma etc. and about pain medication during labor interfering with breast feeding *at your OB’s office?* Is he/she aware of what is in these pamphlets?

      • TheArtistFormerlyKnownAsYoya

        I got the same from my OBs office. It’s produced by our local health authority. Mine had a new one I’d never seen before: breastfeeding prevents cavities!

        • Roadstergal

          Yes. Sugary drinks are well-known to prevent cavities.

        • FormerPhysicist

          Could somebody tell my kids that and pay me back the $ on dental bills. Baby bottle mouth happens to EBF babies too. 🙁

      • Mel

        I doubt my OB has ever read it. She’s really non-woo-ish. I’m going to mention some of the more disturbing problems – namely the ban on pacis and the weird anti-painkiller rhetoric – at my next appointment.

        Honestly, the local BFHI hospital has gotten so weirdly woo-ish that the OB practice has started their own childbirth classes for free that cover the real benefits of painkiller use and why a CS can be a great idea.

        • Erin

          “Breast milk is a living fluid providing perfect
          nutrition, changing according to the baby’s
          needs and stimulating his budding immune
          system. Antibodies in breast milk help babies
          to fight common infections. Formula milk
          has none of these qualities.
          The quality of your breast milk always
          remains high, even if you are unwell, you
          smoke or your own diet is not ideal ”

          Is one of the leaflets I’ve been given by the NHS.

          “You can be proud that it’s all your own work.”

          is apparently another benefit!!!!

    • guest

      OMG. My EBF son has asthma and allergies. His EBF twin sister doesn’t. It’s almost as though there isn’t really a connection there at all…

      Oh, and I had ALL the drugs, surgery, no “golden hour,” separation from the newborns for a week and a half, pacifiers, and no car to drive to LLL or other breastfeeding groups and I still was able to breastfeed. Each mother should use whatever support or approach works for HER, but none of that stuff is a death sentence for breastfeeding is my point.

      • Clorinda

        I swear that my child with the milk allergy was allergic from the womb. Totally anecdotal, but that pregnancy, I could not tolerate any milk products for most of the pregnancy. Very weird because I love milk, cheese, etc. She was exclusively breastfed.

        • guest

          Huh, wonder if my kid will have chocolate issues; I’ve been having migraines from it for months, not realizing they were migraines (they took on the symptoms of a retinal detachment until two weeks ago, when they actually got painful, whee). Good thing to look out for!

        • BeatriceC

          Anecdata: My mother claimed that tomatoes in any form made her sick as a dog when she was pregnant with me and I got vicious diaper rash if she ate them while she was nursing me. Today I have an allergy so severe it generally takes two epi-pens to keep me breathing long enough for rescue to get to me. I also have additional allergies, mostly adult onset, that she didn’t report caused trouble for her. The tomato thing though…I’ve been allergic to them for as long as I’ve been eating solid foods.

          • MI Dawn

            Very interesting! You don’t think of allergies starting prior to birth…

          • BeatriceC

            I honestly don’t know if there’s any real correlation, but that’s what she reports. So who knows.

          • Maud Pie

            I know someone who reported the same pattern with her child’s tomato allergy.

    • Taysha

      “(Jesus-Fucking-Christ. Are you trying to kill newborns?!?!?)”

      Only those that don’t breastfeed, obviously, cause they’re deficient

    • Ceridwen

      I slept great in the hospital. Both times. Because I sent both babies off with the nurses overnight and only had them brought to me for nursing every 2-3 hours. One didn’t get formula until 9 months when my work interfered too much with pumping for me to continue producing enough for her time at daycare. She still nursed some until I weaned her at 14 months. The other is still nursing (albeit only once a day now because I’m in the middle of weaning him) at 13 months and never really got formula. So clearly sending them off terribly undermined our breastfeeding relationship. I also didn’t have STS with the first until over an hour after birth due to a PPH and gave them both pacifiers on day 1 and bottles starting at a week old. It’s almost like those things don’t actually undermine breastfeeding when you study them carefully…

    • Emilie Bishop

      I’m sorry, Mel. I hope you enjoyed burning that packet or whatever else was cathartic to you. I so wish I’d discovered this site before my son was born and I also believed all the lactivist crap. Anecdotally, I thought from the propaganda at my BFHI health care system that the reason my husband and I have been prone to sinus and respiratory infections all our lives was that neither of us were ever breastfed. After I gave up nursing, I thought maybe it was because we had both grown up around smokers. Now that our son, who is never around cigarette smoke, shows our same gift for turning simple colds into widespread infections, I have to plead genetics or random chance. But breastmilk has NOTHING to do with it.

      • Mel

        My husband got a superficial sinus infection that took the better part of a year to cure using antibiotic nasal washes. I’m the queen of eczema. We are both asthmatic. We were both breast-fed exclusively for at least 4 months.

    • Madtowngirl

      I need to dig out the pamphlet I got from the hospital when my daughter was born. That needs to be screenshotted and shared here. It’s such crap, and it pisses me off that hospitals are pushing this nonsense.

    • Tumbling

      “babies have really small stomachs so they don’t need much milk at first”

      I had to laugh at this one. I was born in the early 1960s and my mother was not able to breastfeed for medical reasons. One of my mother’s favorite tales of my childhood was that I was whisked away after birth to be cleaned up and to allow her to recover from a very difficult birth. About 4 hours later the doctor approached my mother to ask permission to give me *additional* formula–because they had already fed me the amount that they usually gave in THREE DAYS, and I was still hungry!

      For what it’s worth, I was underweight until I was in my 20s. Obese now, but that’s down to a sedentary job and a few physical injuries that kept me from moving much. I wish that I could blame the evils of formula, but alas, I don’t think that I can make that stretch.

  • Steph858

    “There is no problem that exists that cannot be solved by squirting breast milk at it!”

    http://s3.amazonaws.com/stripgenerator/strip/49/88/20/10/00/full.png

    • StephanieJR

      Oh god never stop being awesome.

      • Steph858

        Thanks, but I can’t claim all the credit. I made it with a little help from stripgenerator.com.