Ireland shutters Baby Friendly Hospital Initiative

Old blue closed sign hanging in a shop window

Hallelujah! A national Baby Friendly Hospital Initiative is being shut down.

Without consultation or notice, in early 2016 the HSE Health Promotion & Improvement, Health & Wellbeing Division reduced the grant-aid it had been providing to the BFHI (which ranged over recent years from slightly under €50,000 to zero). The HSE then directed maternity units not to participate in BFHI activities, ceased all funding, and would not engage in any discussion of these precipitous HSE actions…

Why? Because it doesn’t work.

“There was no difference in breastfeeding rates in hospitals that had achieved baby friendly designation and those that had not achieved this designation. “

As a member of the Irish governing party explained:

The initiative is funded by the Health Service Executive, which in 2016 commissioned a research team at Trinity College Dublin to undertake a review of the initiative… A key finding of the Trinity review was that there was no difference in breastfeeding rates in hospitals that had achieved baby friendly designation and those that had not achieved this designation. Following completion of the Trinity review, the HSE initiated engagement with the baby friendly hospital initiative and other stakeholders on developing a revised model.

What about all the healthcare dollars/euros that lactivists insist would be saved by increasing breastfeeding rates? No one — not the government nor the BFHI — can point to any real world savings.

I’ve made no secret of my contempt for the breastfeeding promotion campaign known as the Baby Friendly Hospital Initiatve (BFHI). Nearly a year ago, I contended that the BFHI has been a deadly failure. I cited three papers:

Together these US papers show that the BFHI doesn’t work, ignores the science on pacifiers, formula supplementation, and Sudden Infant Death Syndrome (SIDS) and leads to preventable infant injuries and deaths when babies fall from or get smothered in their mothers’ hospital beds.

And that doesn’t even take into account the babies who have sustained brain injuries or died due to dehydration, hypoglycemia and severe jaundice because the BFHI refuses to acknowledge that up to 15% of first time mothers cannot produce enough milk to fully sustain a baby.

The BFHI is the epitome of paternalism in medicine. Lactation professionals have decided what is “best” for mothers and babies without consulting mothers themselves. They insist that “science” shows that breast is best and therefore, they are justified in forcing breastfeeding on every woman regardless of her experiences and values, and regardless of whether it is a safe or realistic goal.

Yet informed consent requires presenting the risks of breastfeeding — insufficient breastmilk, dehydration, failure to thrive — as well as the benefits. Informed consent means that it is up to MOTHERS to determine whether to offer supplemental formula or pacifiers, NOT up to providers.

BFHI Ireland does not deny this; it does not even mention it. Instead of addressing the failure of the BFHI to increase breastfeeding rates, and the injuries and deaths that have resulted, BFHI Ireland defends itself thus:

An independently evaluated and published survey in March 2017 found that directors of midwifery and clinical midwife specialists in lactation were overall happy with the Initiative as currently run, valued the Initiative, and thought there would be negative effects if it was discontinued.

But the fact that those who were employed by the program were happy with the program has nothing to do with safety or effectiveness. Indeed, it supports my view that the program isn’t “baby friendly”: it’s “lactivist friendly” and baby-harmful.

What now?

If the BFHI were based on science, its members would ask themselves why it doesn’t work and investigate how it could be made more effective and safer. But the BFHI is based on personal conviction, not science, so there will be no attempt made to understand why it is ineffective.

A news story in The Times laments:

Only 15 per cent of children in Ireland are exclusively breastfed for the first six months, as advised by the WHO, compared with a global average of 38 per cent.

Yet Ireland has one of the lowest infant mortality rates in the world (3.3/1000), far lower than many countries with much higher breastfeeding rates. That’s not surprising since there is no real world evidence from any country that breastfeeding rates have any correlation with infant mortality.

The sad truth is that the BFHI is a boondoggle for lactation professionals, no more and no less. It was started with the best of intentions, but it is based on personal belief, not science and, indeed, is contradicted by the best scientific evidence. Hopefully Ireland will be merely the first of countries that recognize that money spent on funding the BFHI is money wasted. The end of the BFHI will be both baby friendly and mother friendly; it can’t come soon enough.

  • maidmarian555

    OT: Little Miss arrived yesterday, via elective section. 6lb 12oz so over 2lb smaller than her big brother but is already showing signs of an equally stubborn personality and a very impressive set of lungs!

    We are thrilled with her, and I’m so pleased we booked the elective. She was breech a couple of weeks ago but had managed to wedge herself into a fully transverse lie under my ribs so even with the section they had a bit of a job getting her out. It was so nice knowing it didn’t matter and she was coming out safely. I was also able to donate my placenta to a research project, which we thought was a better use for it than making a fry-up (although that probably would have been a marked improvement on the hospital food). Thank you so much to everyone for all your kind words and support, this pregnancy, birth and my post-partum stay in hospital were all massively improved with the knowledge I’ve gained here. https://uploads.disquscdn.com/images/4dae1c317dee6253f5d3ebc876f3f4df1c7b6b0268fc8346fb8d79a1871e39bb.jpg

    • Lilly de Lure

      Congratulations! She is beautifull!

    • Roadstergal

      Oh wow! Congratulations! So glad it all went fairly smoothly, and hooray for the new girl!

    • mabelcruet

      Congratulations! She’s lovely, chubby baby cheeks are so squishable! I’m so glad you got the birth you wanted.

    • BeatriceC

      Congrats! She’s definitely much cuter than my family’s addition* yesterday. Though my addition is definitely cute. Just not that cute.

      *Long term foster bird we’re caring for until her human recovers from a car accident and gets back on her feet.

    • momofone

      She is beautiful! Congratulations!

    • Dr Kitty

      Congratulations!
      Enjoy the newborn stage, be gentle on yourself and rest while you can.

    • lsn

      Congratulations, and glad it all went so well. She’s beautiful!

    • MI Dawn

      Congrats! What a beautiful baby. Glad to hear you are both doing well.

      • MI Dawn

        and don’t you just want to nom on those baby cheeks and smell that indescribable new baby smell?

    • Empress of the Iguana People

      Congrats! She’s adorable

    • Montserrat Blanco

      Congratulations! She is adorable! Try to rest and do enjoy her!

    • Lnden

      Congratulations! How lovely she is!

    • StephanieJR

      Congratulations!

    • attitude devant

      Yaaay! congratulations!

    • TheArtistFormerlyKnownAsYoya

      She is gorgeous!

    • KeeperOfTheBooks

      Absolutely beautiful!!! Congratulations!!

  • Gretta

    Thank goodness! Let’s hope the US follows in abolishing this failed initiative.

    • Lilly de Lure

      Ditto the UK!

  • Sheven

    Between this and being the first country to get in gay marriage by referendum, I’m liking Ireland more and more.

    • Dr Kitty

      There is going to be a referendum on the eighth amendment next year and then a referendum on abortion after that- happy happy joy joy!!

      • Sheven

        I just saw that today. Hoping that goes well.

    • attitude devant

      Not so fast. They’re still the same country who didn’t close down the Magdalene Laundries until 1996 and who still hide atrocities committed there from the public. They’re also still the same country whose antediluvian attitudes about pregnancy termination killed Savita Halappanavar.

      • swbarnes2

        Right, but those very incidents might very well be moving the population away from Catholicism, and is probably pushing a lot of neutral people into being hostile to the church’s influence over laws and policies.

        • attitude devant

          From your mouth to God’s ears, as the saying goes.

  • Young CC Prof

    The BFHI has been in operation for 25 years. In that time, there have been no changes to the key guidelines, nor has the Initiative done any studies to test specific recommendations, even those that were introduced on the basis of very weak evidence.

    If you had cancer, would you want to go to a hospital that used a 25-year-old chemotherapy protocol? If you needed heart surgery, would you want the techniques commonly used in 1991?

    Then why on Earth are they still pushing neonatal care guidelines that they haven’t even examined in 25 years?

    • Sarah

      And that do such a massive shit on the nothing about us without us principle.

  • Mel

    Shorter BFHI Ireland response: The professionals who benefit from BFHI really like BFHI Ireland and don’t want it to change.

    That is true – but not relevant to maternal or infant health.

    • Young CC Prof

      I know. They think it works? They feel that it would be bad to change? If they can’t provide some evidence for these claims, why do they have jobs?

  • Zornorph

    Looks like they decided to ‘Punt’ that one. It was a Fianna FAIL! Of course, in Ireland, they insist that their babies drink Guinness, not breast milk.

    • Dr Kitty

      There is a large hospital (St James’s) in Dublin not far from the Guinness factory. The Coombe Women and Children’s Hospital isn’t far either.
      Patients in both were still getting pints of Guinness after surgery or delivering a baby (donated by the brewery) until well into the 1980s…

      Mostly, you have to persuade inner city Dublin mothers not to put sweet tea and baby rice into the bottle!

    • Steph858

      It’s not just an Irish thing. My (British) mum drank a small stout daily while she was pregnant with me. Doctor’s orders to treat her mild anaemia!

  • Roadstergal

    A win for families. Even if they didn’t call out the harms, at least they noted that it does not succeed at the one thing it’s supposed to. :p

  • fiftyfifty1

    Yay!