Closing newborn nurseries: what if we’re doing postpartum breastfeeding support all wrong?

Dressing baby dolls

The central conceit of organized efforts at breastfeeding promotion such as the Baby Friendly Hospital Initiative (BFHI) is that we can best support breastfeeding by recapitulating the experience of our ancestors. The most obvious difference is technology. Hence lactivists have focused their efforts on depriving women of access to technological innovations like formula supplementation, pacifiers and well baby nurseries. Remove these “unnatural” additions, so the reasoning goes, and women will be inspired/pressured to make breastfeeding work.

But what if the obvious difference isn’t the most important one? What if we’re doing postpartum breastfeeding support all wrong because the critical difference is in our philosophy, not our technology?

A defining feature of postpartum care in nearly all other cultures is that mothers are NOT expected to exclusively care for their infants.

We live embedded in a neoliberal society. Neoliberalism is primarily an economic philosophy but it has important implications for the way that we think about families and individuals.

According to We Need to Talk about Family: Essays on Neoliberalism, the Family and Popular Culture:

Neoliberalism is usually defined as the expansion of economic thinking in all spheres of human activity, including the family, with emphasis on individualism and practices of extending and disseminating market policies to all institutions and forms of social action…

The individualistic conception of selfhood central to neoliberalism accepts that an individual is both an ideal locus of sovereignty and a site of governmental intervention. The individual is a rational, calculating unit, looking after her or his own needs. Moral responsibility is equated to rational action…

Neoliberalism places a premium on individual responsibility and minimizes the value of collective action. We see this in contemporary political philosophies that venerate private industry and derogate goverment support. But we also see its impact in mothering philosophies that place a premium on individual maternal action and ignore the impact of the family and “the village.”

In many ways, the philosophy of intensive parenting, aka attachment parenting, is an expression of neoliberal values.

Intensive parenting refers to a style of parenting defined by tremendous energy, time, money and financial resources being devoted to children and rationalised through the discourse of acting “in the best interest of the child.”

Although theoretically either parent can undertake intensive parenting, in practice it is nearly always the mother. Intensive mothering minimizes or ignores the value of grandparents, aunts, friends and neighbors. It is assumed that ONLY a mother working alone can meet a child’s needs. Because we live immersed in neoliberal culture, we forget that it is a relatively new philosophy that differs dramatically from the traditional philosophy that “it takes a village to raise a child.”

The closing of hospital well baby nurseries is a paradigmatic expression of neoliberal philosophy. In order to “promote breastfeeding,” new mothers are being forced to room in 24/7 with their newborns. It doesn’t matter that these women are exhausted, in pain and often taking sedating medications. Promoting breastfeeding is considered to be more important and neoliberal philosophy places responsibility squarely on the mother.

The results, not surprisingly, are deadly. Interventions Intended to Support Breastfeeding Updated Assessment of Benefits and Harms and in Unintended Consequences of Current Breastfeeding Initiatives, both published in JAMA in October 2016, attest to the growing number of preventable injuries and deaths that occur because babies, instead of being in the well baby nursery, are being smothered in and falling from their mothers hospital beds.

Moreover, the insistence of immediately placing full responsibility for childcare on postpartum mothers is in direct contradiction to everything we know about postpartum practices in other societies.

According to Traditional postpartum practices and rituals: a qualitative systematic review:

Organized support, usually in the form of family members caring for the new mother and her infant for a specified period of time, is almost universally provided in the early postpartum period by the mother, mother-in-law, other female relatives or husband. Respected elder female community members, traditional birth attendants or young women from the community may also be involved in providing care for the mother. The support often includes practical assistance (e.g., household chores or cooking), as well as information for the mother regarding how to care for herself and the infant…

Organized support typically corresponds to a prescribed period of rest, during which the mother is prohibited from performing her usual household chores. In most cultures, the rest period spans between 21 days and 5 weeks, and is considered a period of vulnerability for future illness.

In other words, a defining feature of postpartum care in nearly all other cultures is that mothers are NOT expected to exclusively care for their infants and are assumed to need assistance for WEEKS. New mothers can rest when and as often as they need to because others are there are always others available to care for the baby. In a very real sense, we’ve missed the critical difference between our ancient foremothers and contemporary mothers; the difference is not technology, it is support.

It’s very similar to the bizarre BFHI policy banning formula supplementation. As I’ve written previously, the practice of prelacteal feeding spans time and culture. Odds are high that it reflects the fact that 5-15% of women (or more) have insufficient or delayed production of breastmilk. Without supplements, those babies would have died of dehydration. With pre-lacteal feeds, babies lived who would otherwise have died. We’ve ignored those insights about supplementation, ascribing them to ignorance, in favor of our preferred belief that women in indigenous cultures breastfeed early and exclusively. Once again we’ve missed the critical difference between our indigenous foremothers and ourselves. Early supplementation of breastfeeding itself is not harmful; it only looks harmful when the only available prelacteal feeds are contaminated with bacteria.

In a very real sense, the BFHI is cargo cult science.

Physicist Richard Feynman coined the expression in his 1974 commencement address at CalTech.

…In the South Seas there is a cargo cult of people. During the war they saw airplanes land with lots of good materials, and they want the same thing to happen now. So they’ve arranged to imitate things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head like headphones and bars of bamboo sticking out like antennas –he’s the controller– and they wait for the airplanes to land… So I call these things cargo cult science, because they follow all the apparent precepts and forms of scientific investigation, but they’re missing something essential, because the planes don’t land.

Lactivists know that our ancient foremothers breastfed exclusively. They want the same thing to happen now. So they’ve arranged to imitate the lack of technology and they wait for women to breastfeeding exclusively. It’s cargo cult science because they follow what they think are the precepts and forms of ancient breastfeeding support, but they are missing the most essential insight since the BFHI doesn’t appear to increase breastfeeding rates.

The most essential insight is that supporting breastfeeding does not require banning technology; it requires providing care. In closing well baby nurseries, lactivists imagine they are copying nature but they’re doing the exact opposite!

Lactivists don’t understand this because they are prisoners of neoliberal philosophy that places all responsibility for outcomes on mothers and accuses them of moral laxity for failing to comply with breastfeeding injunctions.

If lactivists really want to increase breastfeeding rates they’d stop trying to recapitulate the absence of technology in nature and concentrate on recapitulating the different philosophy in nature: it takes a village offering a tremendous amount of support to raise a child. Instead of closing well baby nurseries, they’d be demanding that they stay open.

  • StephanieJR

    Funny how privileged white women are encouraged to give birth like poor brown women, but when it comes to actually looking after the baby after birth, they’re on their own.

    • spicytuna00

      White privilege doesn’t exist Hun.

      • StephanieJR

        First of all, don’t be condescending and call me ‘hun’. I am neither made of honey, nor from Mongolia.

        Second of all, I never said ‘white privilege’. I said that women whom were both white AND privileged were told to copy much less privileged women, most of whom are non white, when it benefited the NBC’s agenda, but told to ignore any other part of their culture (though I’m pretty sure most poor women/those in developing countries would choose a hospital birth over a home birth), such as receiving help after the birth, thinking themselves oh so much better by asking themselves martyrs. They are both white and privileged, plus enjoying a hefty dose of white privilege.

        Thirdly, ‘white privilege’ does exist, if you had any ounce of self awareness, but judging from your comment history elsewhere, you have your head so far up your racist ass, you could probably pass for a brown person if you ever bothered to take it out.

      • MI Dawn

        My, my. Aren’t we patronizing. Of course it does. Any intelligent white person would know it and recognize it. As a white woman, I can stand on a corner next to my car and have police stop and ask if I’m having car trouble. My black friends get accused of soliciting.

      • demodocus

        White privilege exists in the same way that able-bodied privilege exists. It may not look like anything to you but that doesn’t mean someone else isn’t going to have more problems getting that apartment because they’re black or have cerebral palsy, or that job because someone doesn’t want to deal with the added complications of buying a freaking screen reading program.

  • Catherine Whary

    I’ve experienced both 24/7 baby in room and a well nursery iption. I preferred staying with my baby 24/7 and the hospital with the nursery constantly removed my child from the room to do their evaluations which sometimes took 2 hours. Keep the nursery for those who need it, but stop taking babies from rooms when the mother doesn’t want it.

    • Kq

      Bully for you. Meanwhile I was hallucinating from sleep deprivation and they propped my son between me and a pillow on the hospital bed rails. Because there was no nursery and no option other than rooming in.

    • LaMont

      Keyword is “option”. If they’re taking the baby when it’s not necessary and you don’t want it, that’s not great. If the 24/7 rooming in situation was *required*, even if you liked it, it’s dangerous and a potential serious problem.

    • FormerPhysicist

      I hated the lack of a nursery. My experience was more like Kq’s; expected to care for my infant when I couldn’t care for myself and was dangerously ill and overtired. Luckily for me, a sane nurse took my infant for a while and held her.

    • aerie_star

      I had the option of sending my daughter to the nursery at the hospital I gave birth at, but all evaluations were done in my room. I did send her one night, hated and regretted it, but probably didn’t matter in the end because she was brought back to me within 2 hours cause they couldn’t get her to settle down once she woke up. The point is that the option should be there and babies shouldn’t be removed unless the parents permit it.

      • Merrie

        I delivered my 2 kids at 2 different hospitals, both had well-baby nurseries. One had all their protocols set up to take the baby for evaluations and bring them back later. We had to fight to keep her with us or accompany her and we didn’t even always get to do so. At the other hospital they said no problem when we wanted to make sure the baby was not removed from our presence. They either did the evals in our room or let us come to the nursery.

        If there had been a medical issue that necessitated it, I would have been okay with them removing the baby, but this was all for routine stuff.

    • SporkParade

      It’s nice to have the option, but I understood after my most recent hospital stay why it’s difficult to implement. When the baby is in the nursery, the hospital nurses know exactly how often the baby is eating and peeing and pooping. With 24/7 rooming in, they have to rely on the parents’ memory. And the parents are often too exhausted to remember.

      • MI Dawn

        Parents’ memory? Geez, hospitals are getting worse and worse. Back in THE DARK AGES (TM) when I had my kids, if you roomed in, you were given a nice little clipboard with places to simply check for diaper changes (wet/poop/both) and feeding (bottle fed you wrote oz, BF you noted minutes/side). It took only a few seconds and the nurses were well able to see how the baby was doing. Of course, this was back before the Lactivists really took hold.

        I roomed in, with severe pre-eclampsia, knowing I could easily send my baby to the nursery when I needed to rest. If I’d been forced to keep them, it wouldn’t have been good.

        • MI Dawn

          And, you also had the option, if bottle feeding (or if you offered water/sugar water after nursing), to just put the used bottles in the “empty” drawer under the bassinet, so the nurses could simply view how many bottles and amounts per feeding. It’s not important how much per feeding, of course, it’s over the day.

    • Heidi_storage

      I don’t think anyone is disagreeing with you. I preferred keeping my babies with me, too, but I had uncomplicated labors and easy recoveries. If I had had a rough labor topped off with an emergency section, and maybe the epidural didn’t work so I was given other anesthesia, then there is NO WAY I would be wanting to keep a freshly born human alive all by myself. So, yeah, choice is great–but do keep the nurseries open.

  • fiftyfifty1

    Yeah, this worship of supposed “natural and primitive” cultures is not only racist but also 180 deg opposite of what the cultures they refer to actually believe. NBC advocates say trust birth because pregnancy is not a disease. My immigrant patients believed the exact opposite–when I was pregnant, they offered up prayers that I would not die or be maimed in childbirth. Lactivists say 100% exclusive breastfeeding. But my immigrant patients (whether from Africa, Asia or Latin America) all gave their babies prelacteal feeds. Here natural parenting advocates insist of rooming in, bed sharing and attachment parenting. My immigrant patients told me that if I lived with them postpartum that they would do all the baby care (as well as cooking and cleaning) for weeks. I would not have to lift a finger, my only job would be to regain my strength.

    • StephanieJR

      Your patients sound nice.

    • SporkParade

      I’m just going to point out the irony that it’s the people I know from places without safe formula who take me combo-feeding for granted. It’s only the English-speaking expats who give me a hard time about it.

  • Young CC Prof

    Our unfortunate reproductive biology is the entire reason we have social structures in the first place. New mothers need help to survive and to keep a child alive, especially during the first weeks.

  • Amy M

    YES, very loudly. I know I’ve mentioned this here before, but I ran into philosophical differences with the facilitator in a class I took a few months ago around this issue. My project was designing a campaign to improve safety on neonatal wards and the first thing I wanted to do was reinstate nurseries. However, the facilitator was opposed to this, so I did leave it in, but I buried it and made it less central, so I could pass the class. Anyway, I found slide decks online from various hospitals, indicating that some at least, were aware of the smothering/falling issues, but none of them suggested the nursery. They did mention other steps that would probably be good ideas, including increased supervision, but it seems like a no-brainer, really and they just kept avoiding the nursery idea, godforbid they offend a lactivist.

  • Emilie Bishop

    Your title shouldn’t be a question. We are totally doing postpartum care all wrong in this country, especially in BFHI facilities. I’ve heard many NICU moms say they had easier hospital stays because they at least got to sleep. In what universe is that okay?!?!? I had my husband or mom with me the first six weeks, but I spent the whole damn time triple-feeding and visiting LCs and my son’s ped. I had help, but it sure didn’t feel like it when everything was focused on getting my hypoplastic breasts to produce more milk than they could and latching my unlatchable son. Inexcusable.

    • Mattie

      Currently in the UK lots of postnatal women aren’t getting meals, or access to clean bathrooms, but it’s cool because we have 24 hour rooming in and postnatal care in the community *eyeroll*

      • AnnaPDE

        A friend of my sister in the UK checked herself out of hospital in the wee hours of the morning after her C-section. “At home at least I have a toilet, a quiet bedroom and non-trained people looking after me and baby, that beats listening to 7 other babies crying in an 8 bed ward, with a bassinet that’s too high to get baby in and out by myself, and trained staff ignoring me pointedly,” was how she explained it.

        • Who?

          Many years ago I was placed in a seat next to my bed within hours of giving birth to my son, with the buzzer out of reach. I sat there a long time. Couldn’t stand up with him in my arms. Didn’t want to put him on the floor. No one else on the 4 bed ward. Pretty scary.

          We survived it, but not fun. They also told me if I wanted a bath I would have to clean it myself before and after. At which point I was out-if I’m going to clean a bathtub, even me as a sweet young thing thought, it will be my own.

          • Heidi

            Wow, that’s just awful. I just can’t wrap my head around expecting people to clean their own tubs. I know at the hospital we used cleaners a bit stronger than household ones for obvious reasons, and I just wouldn’t trust that people wouldn’t get harmed from them. But a woman who just had a baby? My in-laws would barely let me do anything. I did not scrub tubs, that’s for sure. The first few days I sat around on a boppy I used like a donut and waddled everywhere.

      • EmbraceYourInnerCrone

        Wow! I gave birth in a Catholic hospital in L.A. 23 years ago and while they had rooming in and pushed breastfeeding, they also had good food, individual rooms with private bathrooms for each woman and a well baby nursery. there was also a fold out chair/bed if your support person wanted to stay with you. Is it just postnatal women who don’t get meals or is it everyone who is not on a surgical floor?

        • Mattie

          It should be everyone, and there are meals, it’s just that often they are only provided at set times (not great if you’re between service times) or they are brought and women are expected to get up and collect their meal from the trolley. Women have complained that they were not told that the trolley was there, or where it was, or they literally couldn’t get up to get the food. There is very little assistance with eating if you’re unable to get up, there’s also not always access to water regularly or to ice for the water.

          • AnnaPDE

            This is incredibly barbaric.

          • Mattie

            Yep

      • Abby

        American women have no idea how awful postnatal care can be, judging by all this stress at lack of well baby nurseries! What the heck is a baby nursery? I had a 36 hour labour, forceps delivery, retained placenta, and was dumped on a postnatal ward with my baby to look after all by myself with a bathroom the other end of the ward to walk to after an episiotomy and an epidural, absolutely no help from the midwives apart from one telling me I would kill my baby as I had put her on the bed where my feet had been… i had a friend who was left alone to postpartum haemorrhage all over the floor and another who was discharged at 11pm after her first baby delivered earlier in the day, I can honestly say the NHS does not care two pennies for post natal mothers

        • Mattie

          Yeh, I don’t want to be ‘my horse is bigger than your horse’ over who has it worse, but definitely in the UK there are much bigger and more pressing issues with basic care, until they are addressed you have no hope of tackling the other stuff.

    • Gæst

      Yep. NICU mom here. I recovered from pre-e and a c-section swiftly and easily. I had a lactivist telling me I needed to wake up to pump once or twice a night, but she also gave me a pamphlet about using a pump to increase breast milk supply for twins. It had a list of target amounts to try and reach by each day. Since I was already exceeding the targets, I chose to sleep through the night. It really helped both my mental and physical recovery.

      • BeatriceC

        I believed that line with my first and woke up around the clock. My milk came in halfway through the third day. With my second I was exhausted and didn’t wake up at night and just pumped during the day. My milk still came in halfway through the third day. With my third I basically told the lactation consultants to jump off a bridge, didn’t pump at all (baby was on TPN, so it didn’t matter), and guess when my milk came in. And I had a massive oversupply with all three. Actually, my oversupply got worse with each baby. So based on my experience we could say that pre lacteal pumping *reduced* my supply. Editing to add: What I really think happened is that I was better rested and farther along in my recovery, which allowed my body to produce better. Or it could just be that with each kid my body got better at it. Who knows. What I do no is that pumping had absolutely no effect on the timing of my milk production.

        • Gæst

          I don’t know if the pumping schedule helps much with anyone in those early days, but at least the target amounts gave me some sense of when enough was enough. I mean, I had no clue how much two neonates would actually eat in a day. Imagine what my oversupply would have been if I just assumed I wasn’t making enough! (I still ended up with oversupply later on – I’m pretty sure I could have fed triplets.)

          • BeatriceC

            I joke around that my body thought I’d given birth to an entire, fully grown, NFL team. Once my milk came in, I produced a minimum of 30 ounces in a ten minute pumping session. I could literally just lean over, relax, and out would come several ounces. With the older two, that eventually regulated, as they were nursing directly from the breast. The youngest didn’t quite get the hang of latching so I pumped exclusively. Pumping was super easy for me, and since I had such a massive oversupply, I only pumped 3-4 times a day and had more than enough. I quit when I had an entire small commercial freezer (so bigger than a standard freezer, but smaller than the big walk ins that you see in larger places) stuffed to capacity with bags of pumped milk.

    • BeatriceC

      Yup. I’ve said many times that one huge advantage of having your kids go straight to NICU is that you get proper recovery time. When I had my second there was a huge blow out in the room next to me over the lack of a well baby nursery. I didn’t get all the details because I was just overhearing all the yelling, but I gathered mom had a rough delivery and needed to rest and nobody could take the baby and dad had to go home with the other kids.

  • Sheven

    Gratitude is, apparently, a less enjoyable emotion than self-satisfaction.

    “I did everything for my child,” is more enjoyable than, “thank you all for helping me.”

    • J.

      Scary to think what sort of mothers-in-law this generation of mothers is going to turn into.

      • Sheven

        I hope they run smack into the next generation of parenting trends. They’re going to be like moms who smoked in the front seat while letting their kids ride without seatbelts in the back.

      • Cidalia Martins

        An understanding generation, I would hope. I’ve been through this Baby Friendly Initiative bull* and will not allow any hospital to bully my future grandchildren or their mothers. I’ve already supported and backed up my nephews mom who was falling apart in hospital and helped her discharge herself and baby home where I offered supoort so she could catch up on sleep. Nurses had attempted to pressure her into staying longer, saying she had postpartum blues because she was crying. Postpartum blues, my foot. The poor girl just needed a night’s sleep.

    • Emilie Bishop

      There are times I’ve lied to a group of moms all trying to one-up each other with how much they do for their kids all by themselves. I’ve felt momentarily ashamed by how much my husband does with our son before and after work and on weekends. I stay home with our son, so I’m not a slacker, but I also have chronic pelvic pain, so I know better than to try to be a warrior. Also, I grew up near my extended family, and my grandparents and aunts did a lot to help raise me and my brother. I know moms can’t do it all alone, or shouldn’t have to. But these times of boasting of self-sufficiency have left me feeling alone and unsupported more than anything else. I’d give anything to have someone else to thank at the end of a hard day.

      • maidmarian555

        My OH has always been really hands on with our son. I was a mess after he was born and wasn’t able to physically do much of his care in the early weeks so (thank you paternity leave) his Dad did everything other than breastfeeding. I’m also a SAHM so people tend to think that means that you should be doing everything but the reality (I find) is that I do still need a break. Especially now he’s just starting to toddle and is literally into everything 24/7. We both share nappies, feeds and taking the baby out. Some days I do more, some days his Dad does. It works well for us and my son has an amazing relationship with his father. I don’t talk much about it with other Mums though, I just avoid the conversation if I can help it as I’ve got some serious side-eye before for not joining in with the whole martyr thing. Which is madness really and does leave you feeling a bit lonely as it’s hard to share your own experience of being a parent with others. It’s like you mustn’t ever talk about things that are going well, you’re supposed to complain constantly about how hard everything is (whilst apparently making it as hard for yourself as possible). I just don’t get it. I really don’t.

        • Mattie

          There is NO job I can think of where one person is expected to work full-time 24/7 with no protected breaks or help. Except for being a SAH parent… it’s almost like it’s not viewed as a job.

        • Amazed

          One of the first memories of my life: About a month after the Intruder was born, a health visitor watched my dad make a meal for me, my mom said that this far, she had yet to change a diaper (and that by her experience with me, Dad was better at wrapping babies in anyway. Cloth diapers was all we had at the time all around here, oh joy!”) , upon which the doctor said, “Do you do ANYTHING about these kids at all?” Spoken to a woman not yet recovered from nearly dying with PPH. Charming, eh?

          • maidmarian555

            Urgh, that’s dreadful! I bet that same HV never said anything like that to any of the fathers they came into contact with.

          • Amazed

            I suppose no. The worst thing is, there was a little derision but it was mostly envy and awe. HERE STANDS A MAN WHO TAKES CARE OF HIS OWN KIDS. ALL HEIL HIM! Because we can never expect of fathers to waste their time on this and they can never be as good as mothers anyway.

            He’s currently the one who feeds Amazing Niece and teaches her to eat on her own when she’s with them. Looks like my mom did something very good in her past life. At least in this HV’s eyes.

          • maidmarian555

            We don’t have a huge support network here and our families aren’t local (other than my mother who, frankly, I would not leave in charge of my son for five minutes) so he’s only been left with others a handful of times. I don’t think on any of the occasions we’ve left him that he’s even noticed! So long as there are people to entertain him, he really doesn’t mind who it is. Children are so funny, although at least if Amazing Niece doesn’t like the front door too much she may stay away from it- which is probably for the best really!

            And yeah, OH was subject to a few patronising comments from the midwife after my son was born and before we were signed off to never have to see her again. I don’t think in this day and age that it’s so unusual for fathers to be hands on with their kids, this isn’t the 1950s anymore. I strongly suspect many of the midwives I’ve come into contact with would prefer it were though *sigh* (not my current one though, I’ve hit the midwife lottery this pregnancy and have a brilliant one thankfully).

          • Amazed

            So happy for your hitting the lottery!

            Oh, Amazing Niece likes some front doors. She’s in love with my mom’s front door because it’s either coming to visit my parents or being taken out to the car with her parents, or going to visit the neighbour she loves. But that’s something she has lots of practice with. Being left on her own in an unfamiliar room – not so much. Self-preservation kicks in. Front door bad! I didn’t think she even knew it was a front door since she was busy being cranky when they brought her in anyway and she only saw her mom’s shoulder at the time. A happy camper at her arrival, she was not.

      • Sheven

        I imagine it’s tough to step away from that kind of competition, especially when you’re isolated via parenthood and disability. Online communities can be great support, but they can also kind of spiral into pressure.