Be afraid, Baby Friendly USA, be very, very afraid!

angry, annoyed woman, you talking to me?

The single most important thing every prospective mother needs to know about breastfeeding is this: it has serious risks as well as benefits.

Baby Friendly USA is petrified that women will find out.

Sadly for the babies who have been injured and died and their grieving families, we found out the risks of breastfeeding hard way. The scientific literature is burgeoning with papers* detailing the high rate of insufficient breastmilk especially in the early days after birth (up to 15% of first time mothers) and the brain-threatening, life-threatening consequences. We are experiencing a dramatic increase in neonatal hypernatremic dehydration, hypoglycemia and kernicterus (severe jaundice). Exclusive breastfeeding is associated with tens of thousands of newborn hospital readmissions per year at a cost of hundreds of millions of dollars.

Ethical professionals ask, “What can we do to prevent this from happening again?” Baby Friendly USA asks, “What can we do to avoid blame?”

The press is bristling with reports of lawsuits over babies who died IN HOSPITALS. They fell out of or were smothered in their mothers’ beds in the wake of closure of well baby nurseries at the behest of breastfeeding professionals. Though we’ve spent millions on major public health campaigns to alert parents to the dangers of babies sleeping in an adult bed, babies sleeping with soft bedding and babies sleeping with anyone impaired by drugs, the Baby Friendly Hospital Initiative effectively ENCOURAGES all three.

Keep in mind that the hospitalizations, brain injuries and deaths are iatrogenic. They happen BECAUSE of aggressive breastfeeding promotion.

When a baby suffers iatrogenic harm, ethical healthcare professionals ask, “What can we do to prevent this from happening again?” Baby Friendly USA asks, “How can we discredit Fed Is Best for pointing it out?”

Their answer is to attack the whistle blower who is bringing the news of deadly harms to others. In this case the whistle blower is the Fed Is Best Foundation, a non-profit formed expressly to ensure that the brain injuries suffered by a founder’s son did not happen to any other babies.

Take a look at Baby Friendly USA’s latest attempt to retaliate against them for exposing injuries and deaths. It’s a 1200 word rant claiming that the Fed Is Best Foundation is misleading people on the issue of jaundice and breastfeeding. As you read it, ask yourself:

Is Baby Friendly USA trying to avoid infant brain injuries and deaths or are they trying to avoid blame and loss of market share?

The Baby Friendly USA rant appears to have lots of points but actually makes only two:

1. How dare the Fed Is Best Foundation show that breastfeeding professionals know that breastfeeding is implicated in 90% of cases of kernicterus in the US?

Pediatrician Lawrence Gartner acknowledged this in a slide used in a lecture to breastfeeding professionals, a slide that had been uploaded to a public website.

What does BF USA propose to do about kernicterus? NOTHING of course except offer blustering nonsense:

The slides from Dr. Gartner’s lecture were posted without his permission, a gross violation of accepted professional protocol.

But you DON’T need permission. Using a small piece of an article or presentation as a vehicle for a broader discussion is “fair use.” If anyone would know about that it’s me as I sued another blogger in Federal Court for accusing me of almost the exact same thing.

2. The Fed Is Best Foundation may have used numbers that overstate the incidence of jaundice and therefore the associated brain injuries.

What does BF USA propose to do about actual cases of jaundice and associated brain injuries? NOTHING beyond quibbling about the size of the increase.

BF USA insists on maintaining the status quo. They suggest doing nothing more, changing nothing, telling member hospitals nothing as if that isn’t what led to these cases of jaundice and kernicterus in the first place.

The Fed Is Best Foundation exists precisely because this has already been an ABJECT FAILURE. The whole point is that babies are suffering iatrogenic injuries as a result of aggressive breastfeeding promotion.
But BF USA fears reform will cut into their bottom line since their source of income IS aggressive breastfeeding promotion.

The rant concludes:

We would rather not spend our time “fact checking” this organization, but we will continue to do so if that’s what is necessary to ensure mothers and families get accurate information. We consider the constant drum-beat of these falsehoods to be reckless and negligent behavior and once again call on this organization to be more responsible in providing the public accurate and scientifically-grounded data.

It would be far more accurate to have acknowledged that they’d much rather spend their time “fact checking” Fed Is Best than protecting babies from harm. BF USA is right to be afraid of the Fed Is Best Foundation. No amount of suppressing the truth or attacking Fed Is Best for exposing it avert reform; it can only delay it at the cost of further infant hospital readmission, brain injuries and deaths.

When a baby suffers iatrogenic harm, ethical healthcare professionals ask, “What can we do to prevent this from happening again?” Baby Friendly USA ask, “What can we do to avoid blame?”

It’s an incredibly ugly look!

 

*Recent publications:

  • United States Preventive Services Task Force (USPSTF) guidelines
  • Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms
  • Unintended Consequences of Current Breastfeeding Initiatives
  • The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature
  • Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding
  • The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial
  • KeeperOfTheBooks

    I. effing. HATE. BFHI. Hospitals.
    Five months ago, I had my third baby in the same BFHI hospital. Y’know, I thought they just might have learned something in the last two years. They asked me for my experiences with Baby Books 2, seemed interested in hearing what I had to say about the safety issues inherent in leaving a newborn in the care of a post-surgical, hallucinating mom who couldn’t get out of bed, etc.
    They learned not one damn thing. Baby was still in my room. I was in the worst pain I’ve had post-CS, and with the prior two deliveries, I didn’t have much post-op pain. I honestly thought something was wrong when I was whimpering in bed two days in, when I’m usually up and walking briskly about the room after a day. I brought this up to my nurse. “Oh, you can have X drug in Y dosage–we just haven’t offered it to you before, but your OB wrote a script for it.” “Then, ibuprofen aside, what the hell have I been taking?” “Half the dose, if you asked for it. Did you want us to schedule you to get it instead?”

    At that point, I told them I wanted meds, and the full dosage, thanks, as soon as it was time for them, and while I was at it, I broke down into an only kinda-faked display of tears, sobs, etc about how I couldn’t do this and they HAD to take the baby for a while. It was 3 AM, I’d slept a few hours over the course of the last two days, I couldn’t move without a LOT of pain, and I was in and out of bed every ten minutes or so to take care of baby. The nurse got huffy, but took baby so I could get some sleep, and my OB entirely approved of my fit when he saw me the next day.

    He, alas, is retiring from OB. I cried when he told me, but on the bright side, this means that if Baby Books 4 becomes a possibility, I will never, ever, EVER deliver at that hospital, or any other BFHI hospital, EVER again. I will go to the non-BFHI one in town, and will let the BFHI hospital know exactly why. They don’t give a shit about moms or babies; they only care about their bottom line and catering to lactivists. Now that my OB is gone, I have no reason to go there again. I won’t, and I’ll be loud and clear about my experiences in their health system, too. (I’ll phrase the letter with a bit less profanity, but the gist will be the same. 😉 )

    • momofone

      Sorry your experience was what it was, but congratulations on Baby #3!

  • androidsdream

    OT, but I saw this shared on Facebook and thought of you guys. What’ve they got against light therapy for jaundice? https://uploads.disquscdn.com/images/49b1e5d011de9999dddc9682a96eb00561185516317818d1a3d03980c2af57d5.jpg

    • RudyTooty

      Well, here’s an LC who says jaundice is not harmful, and maybe even *beneficial*

      “In most cases, jaundice is a normal, possibly even beneficial process”

      https://www.breastfeedingbasics.com/articles/jaundice-in-the-breastfed-baby

      So maybe she wants her baby to get all the health benefits of excessive bilirubin?

      Good lord.

    • guest

      W

      T

      F

      btw…what’s with the placenta in the cheek thing?

      • RudyTooty

        Midwifery Today did an article a few years ago about how cats eat their placentas and don’t hemorrhage after giving birth. They decided if humans are their placentas, they wouldn’t hemorrhage either. So now it’s a thing.

        • kilda

          and also we would be able to always land on our feet, and see in the dark!

        • androidsdream

          Do you guys remember the lady that thought you could just blow candy breath in the mum’s face and it would stop a PPH? So much wisdom!

          http://www.skepticalob.com/2013/01/midwifery-today-a-journal-of-buffoonery.html

          • RudyTooty

            Yeah. Erhm.

            I remember.
            But: No.

          • I think of this every time I have a cinnamon hard candy. Every time.

          • fiftyfifty1

            Me too. Every time.

          • Heidi

            Whaaat? I thought most people knew enough to save the “natural remedies” for non-emergent stuff, like sure, slather some coconut oil on your baby’s red bum, but for hemorrhages?!

          • RudyTooty

            “I thought most people knew enough to save the “natural remedies” for non-emergent stuff”

            Yeah. Think again.

            Okay. Okay. Maybe we can give MOST PEOPLE this benefit of the doubt.

            These people – these midwife people – ARE NOT MOST PEOPLE. They risk the lives of their patients/clients/mamas with their magical thinking woo nonsense. And cinnamon breath.

          • Heidi

            But the cinnamon candy one just really is special. I wonder if most cinnamon candy is even flavored with cinnamon oil? I’d think it might be flavored artificially so even those people who put way too much faith (which to me is any faith) in essential oils wouldn’t think huffing in someone’s face would stop a hemorrhage? That’s just wow! Scary! You’d think at least a diffuser with real cinnamon oil would be the go to. It’s funny in a “Have to laugh not to cry” sort of way.

          • Heidi

            So now I know not to be shocked when I see a midwife claim a woman nearly died (or even died) because s/he requested the mother provide her with a pack of hard cinnamon candies for the birth, the family stupidly bought a pack of Spanglers which are artificially flavored, and of course the only reason the trick didn’t work is the candy wasn’t flavored with natural flavorings.

          • PeggySue

            Actually, no, they don’t. I worked with a home hospice family, patient dying of cancer, family members very much into alternative, they found some weird powdered berry supplement that “was proven SCIENTIFICALLY to cure cancer,” got some, and were getting it into the patient as much as possible in the patient’s last days. Patient died, family members furious at doctors for not alerting them to this PROVEN CURE, they had to find it themselves, and by the time they started it, the patient was so sick FROM ALL THE CHEMO DRUGS that it was too late.

          • RudyTooty

            This reminds me of the Right to Try laws.

          • Good grief, yes. Even the antivaxxer-homebirthing-childhood disease-is-good lady at my church goes to the doctor if she thinks something’s seriously wrong.

          • Shawna Mathieu

            I thought that was a midwife who did cinnamon candy and blew on the lady’s vagina.

        • StephanieJR

          We should all mother like animals! Like a first time mother rabbit I recently heard of, whom had twelve kits in a litter, had no idea what to do with them, didn’t even feed them at all, and her whole litter died. What strong maternal instincts, from a creature practically designed to constantly breed.

          At least it’s better than hamster cannibalism…

          • I see that you’re discussing my area of expertise here.

          • StephanieJR

            Always best to call in an expert.

        • Mimc

          Someone should explain to them that human babies are larger relative to the pelvic opening than kittens.

          • We can thank bipedalism for that. Almost all quadriplegic animals have a much easier time of birth than we do. As our pelivis adapted for standing upright, it also got harder for us to give birth… but apparently not harder enough to be selected against.

        • Heidi

          My dogs eat cat turds and have no problems sleeping at a drop of the hat. Perhaps feline turd munching could cure my mild, occasional insomnia!

        • rational thinker

          I would assume its for a primal reason that cats eat the placenta because of the danger to her babies if a predator smells the blood.They also bathe their kittens right away. So don,t forget about all the Jeffery Dahmer types lurking around maternity wards.lol

    • RudyTooty

      And another that says jaundice is protective against newborn sepsis.
      http://www.gentlebirth.org/archives/jaundice.html#Benefits_of_Jaundice

      There is no bottom to the depth of the delusion, is there /

    • swbarnes2

      So…no C-section if she’s having seizures from eclapsia? Or any kind of breech? There have to be 5 million things that could go very wrong with her health where the first step of treatment is “get the fetus out pronto”. And surely there are more things that could go wrong with the baby besides those three things listed.

      Shouldn’t the doctor be saying “Sorry, I can’t take you on as a patient with all these restrictions”?

      • androidsdream

        It does kind of make you wonder why she’s having a hospital birth at all if she’s this convinced that the evil OBs are out to cut her up and destroy her baby’s microbiome.

    • Merrie

      Wow, what a nut. I’m surprised she’s not birthing at home unassisted.

      • kilda

        I like how it starts with a pretty flower at the top, and ends up at “I know my rights, I will sue!”

        • momofone

          In pretty purple ink, no less.

    • Valerie

      My favorite is “No hat,” as if that’s something really important to communicate to your healthcare provider. The hatting procedure is completely reversible.

      • lsn

        I managed to completely miss that the first time. What on earth does she have against headwear?!

          • Who?

            Well that’s 20 seconds of my life I’ll never get back.

          • Heidi

            Of course! You know, I think I left my baby’s hat off, and no one cared. Imagine that! I just thought it was tradition more than anything.

          • swbarnes2

            People lose a lot of heat through their heads, and lots of babies have little hair to retard that. And they are little, and maybe not so great at keeping their temperatures up, so it makes sense to help them stay warm with a hat.

            I still have the little white wool hat my kid wore in those first weeks.

          • Heidi

            They were too big for my kiddo’s head. Shrug. But everywhere the baby was was kept at a cozy temp anyway.

          • The great hat debate continues to baffle me.

          • It is well known that every piece of clothing on a baby knocks its IQ down by 3 points. This is why I got a skin graft that enabled me to store my naked babies against my skin 24-7. I

          • kilda

            right, that’s why elimination communication is so important. It gets rid of the diapers so baby can be totally naked at all times.

          • rational thinker

            Omg just read the article you linked. What a load of bullshit. The more horrible thing is some mothers will read that and think the article is medically factual.Eventually crap articles like that are going to cost someone a baby.Oh wait they have already.

    • Who?

      That has fear, anxiety and control freakery written all over it.

      As well as ignorance and hubris.

    • RudyTooty

      Here’s what I learned from working in a hospital with OB patients – because I used to believe that they could refuse what they wanted to refuse, and that a document basically stating that they were refusing everything would demonstrate that we, as health care providers, were just following their wishes.

      We still have to demonstrate that we are providing (or attempting to provide) a standard of care that protects their bodily integrity, their health, their lives.

      We can’t just shrug and say ‘as you wish’ and let their train wreck of a labor unfold, no matter how emphatic they are about it. No matter how much they say “I’LL SUE!!”

      Our legal and regulatory responsibility is to provide care consistent with best medical standards. We could honor their wishes, end up with a damaged (or dead) patient (or two), and these patients who refused everything could sue us for failing to provide the care that they were refusing. Because they have no legal or regulatory obligation as patients, really. But we, as licensed professionals, do.

      It’s kind of mind-effery.

      Midwives (of the lay or CPM varieties) do not really have these same legal and regulatory responsibilities — even when they are licensed. It’s easier for them to roll with this kind of delusional patient request.

      I had the same question that many of you had – why isn’t this person just homebirthing?

      • Who?

        She wants a bet each way. Somewhere in her lizard brain-I mean no disrespect, we all have one-she knows this is BIG.

        So she scrawls her little words of safety-like a spell, really-to cast out the danger she knows deep down is there.

        As it happens she has given both of them the best chance to come out okay. A monstrous pain while she’s under the hospital’s care, of course.

    • Mimc

      No touching? How is that supposed to work?

    • HailieJade

      What I get from this is a woman with extreme low self-esteem and control issues. A lot of other commenters are asking why she didn’t just have an unassisted home birth, seeing as that’s pretty much what she’s described in her delusional “birth plan” anyway. My best guess would be her partner is the one insisting on a hospital birth (possibly at a doctor’s recommendation), and for whatever reason, she felt powerless to say no to him, and this is her way of lashing out and desperately trying to grab back some kind of control over the situation.

      I could be wrong of course, but I’ve personally witnessed so many women who don’t feel like they have any control in their relationship, latch onto birth and motherhood as the one area of their life where they actually have some level of control, and the result is crazy like this. Two of my aunts are neonate nurses and they say this kind of insane birth plan is also most common among women with failed home births when they arrive at hospital, usually at the insistence of a partner- they’re so angry that things didn’t go as they’d perfectly planned it out in their heads, that they seriously lash out and start making the most ridiculous demands of the hospital staff, and are overall the most hostile, unpleasant patients you’re ever likely to encounter.

      Again, I could be wrong. Maybe she’s just your average run-of-the-mill nutter. I feel sorry for her child, either way.

      • swbarnes2

        Half the fun of being delusionally vain is showing off your supposed superiority in front of others. She can’t do that at home alone. She requires an audience.

        • HailieJade

          Very true!

    • tokophobia

      So, obviously the example posted is unrealistic to the point of absurdity. It may even be written as a joke.

      But what do you recommend patients do if they want to be taken seriously?

      I thought the purpose of a birth plan was to list things like emergency contacts, medication allergies, current medical conditions, etc. and preferences regarding things like hospital transfer or chaplain services if things go wrong.

      I have a complicated medical history, and have prepared a birth plan that is less than a typed page and is meant to convey important information that impacts my medical treatment – like a note about an anaphylactic allergy to a common medication. I also included a note about a previous spinal injury that impacts my mobility and balance.

      I am afraid that my attempts to communicate my medical needs will be met with derision. Like “Oh, she brought a typed birth plan? That’s cute. Must be some high maintenance bitch with a lot of hippy dippy BS requests. Put it in the circular file”

      Are all birth plans and patient requests now associated with the fringe natural childbirth community? Are they all treated as a joke, with disdain?

      • Who?

        Maybe don’t call your document a ‘birth plan’, if only because it isn’t-it’s a collection of useful information (great name, btw) that it would take doctors a while to put together without you able to assist with a history, which is more what your document sounds like.

        I think it misunderstands what’s going on to suggest this woman won’t be taken seriously-as RudyTooty points out below, medical professionals don’t get a holiday from their obligations just because they have a patient like this. Everyone will be deadly serious with her because they have no choice. She’ll be the first one complaining if everything isn’t tickety-boo with a bow on top, despite whatever medical advice she ignores and whatever medical attention she refuses. What a monster.

        Top tips in your situation? Call your document a name that accurately reflects its contents. Don’t write an impossible list of fanciful demands on floral paper with a statement about all your rights and a threat to sue at the bottom. And apply the golden rule-be respectful to the people you are talking to and expect respect in return.

        Good luck with the baby.

      • Heidi

        I have experience working in a medical setting (non-degree job as a tech but still hands-on with patients performing medical stuff), and I think most staff would appreciate the reminder of your allergies and injuries. Medical staff people are human like the rest of us so being reminded “I have an iodine allergy,” for example is appreciated or “I have a dialysis port in my right arm” is another example of useful things to be reminded about. If nothing else, it can make things more expedient. Yes, I looked at notes when entering a patient’s room (and allergy stickers should be on their bracelet), especially because some of my patients were unconscious, but if someone says walking into their room, “Don’t use my right arm and I have a latex allergy,” that makes it go faster and smoother, and I never once resented a patient for telling me that. Also as someone with a serious allergy to sulfa, I get it. When I was pregnant and having dental issues, I had to go out of my way to tell the x-ray techs. It probably was or should’ve been on my chart, but for whatever reason, they were missing the info, either because they were very busy or someone left it off so I just said something. I hope no one gets offended that I want two leaded vests, or in the case of the sulfa allergy, I don’t want to risk dying, but if they are offended, they were at least professional enough not to let it affect my care.

      • RudyTooty

        I like birth plans / patient requests / information provided in written format that tell me things that will help me and everyone else take better care of the patient. Most of the time the information and requests from patients are very reasonable and easy to accommodate.

      • I had a “birth plan” for my first delivery. The staff had clearly read it and respected my wishes as far as they were able. Your L&D nurses will try very hard to accommodate you unless you ask for stupid things, and they are generally a wonderful, kind, helpful lot. (I’m sure there are exceptions, but the hospital I delivered at and the hospital I volunteered at had marvelous labor and delivery teams.)

      • Madtowngirl

        I don’t think your birth plan will be met with derision. The things you mentioned that you put in your birth plan are things that caregivers want to know, and may even ask you if you haven’t written it out already. I was asked if I had a birth plan for my daughter, and I sort of did, and my wishes were respected, or at least a reasonable attempt to honor them was made (I wanted an epidural, I got a spinal block because C-section). I know that hospital will even honor requests for music, scents, etc. Where they start meeting disdain is when the birth plan intimates that the caregivers are “only interested in interventions,” or that the mother knows more about medicine than the providers.

      • demodocus

        It isn’t really a birth plan so much as your personal warning label, which is totally legit. They’d probably even try to take that silly one above into consideration, since they are professionals. Yours sounds like simple good sense.

    • mabelcruet

      So sucking on a chunk of placenta as though it was a wad of chewing tobacco will stop her haemorrhaging? So that’s what we’ve been doing wrong all these years…

      • Heidi

        Doesn’t major blood loss usually cause feelings of wooziness? And I’ve always associated wooziness with nausea. I’m just imagining the idea of chewing on a raw, bloody piece of organ meat to be off-putting anytime (never been a fan of offal myself) but oh hell no if I’m not feeling well.

    • The great hat debate still baffles me.

  • BeatriceC

    In related good news:

    A friend of mine decided to go back to college and chose nursing school. She’s just started her second term in the nursing program and yesterday they started clinicals. Her first one was in L&D. The large central Florida hospital she’s at is NOT BFHI and has not plans on getting certified. They have a well baby nursery and the instructor repeatedly advised on the benefit of supplementation, how to tell if it’s needed (and had a huge list of things including inconsolable crying), and the benefits of a well rested mother. Perhaps the tide really is starting to turn.

    • Mimc

      I wonder if that was the one I gave birth at. They were pretty good about it there. Though I’m not sure if it would have been different if my baby hasn’t been in the NICU.

      • BeatriceC

        That’s the million dollar question. I know when I had my middle son, who was promptly whisked away to the NICU, I was one of the few people on the postpartum unit that was getting any rest. I heard another mom literally begging nurses for help so she could get some sleep but since there was no well baby nursery, she didn’t get any relief. I strongly considered hauling myself to her room and volunteer to sit with the baby in the room so she could sleep, but I was post CS and having some complications of my own, and I was afraid of stepping on toes.

        • Mimc

          They did have a well baby nursery at least. They have is a pamphlet recommending we send the baby there if we both planned to sleep at the same time for safety. One thing they could have done better is filter thier pamphlets. Getting a mess of irrelevant papers whole on morphine wasn’t helpful. Also the one telling me how important it was to start breastfeeding in the first hour and hold my baby 6 hours a day for the first week made me cry.

        • I have encountered similar situations. In the UK, when I was there, 40 years ago, women who had had homebirths were often candidates, in their next pregnancy, for another birth at home. Most refused, saying they not only wanted hospital birth, they wanted the maximum permissible stay of 10 days (given to women whose homes were unsuitable for 48 hour discharge) “because this time I want to get some rest!”

  • mabelcruet

    OT-another big maternity scandal is blowing up in England, with potential infant losses that eclipse those of Morecombe Bay. Shrewsbury and Telford hospital is being investigated for multiple deaths (50+), and a previous report criticised their head of midwifery, Kathy Smith, as being inflexible, unwilling to change and defensive. She’s now being moved to head up a department to drive hospital improvement…

    So there’s a big review led by a midwife Donna Ockenden, who is part of NHS England maternity. What slightly worries me is that she is described as an independent midwife-I think this means independent from the hospital. However, she’s also a senior advisor to the Royal College of Midwives, and the thrust of the review is looking at midwives who failed to recognise issues requiring medical input, failed to record fetal status, failed to interpret or even do CTG tracings, with the potential reason being to push ‘natural birth’. So how independent is she going to be from the RCM senior boards groupthink?

  • Manly Seadragon

    I find it really strange that public health boards (us, uk and Australia) have jumped in with both feet on BFHI without too much analysis or review. You would think it would be worth their while to do a cost/analysis of all the impacts of BFHI. This should include readmission, falls and accidents, mental health and patient satisfaction.
    I think part of the trouble is that any criticism of BFHI is met with ‘you hate breastfeeding, you formula shill’ and the discussion doesn’t go much further than that. You can be 100% pro-breast feeding and still strongly disagree with the implementation of BFHI.
    I was listening to a psychology podcast last night on baby / parent attachment and what an effect this has on a child’s development. Huge, so much bigger than breastfeeding. There would be a massive positive impact if we concentrated on mental health and improved parental leave instead of micro-managing how babies get fed

    • MaineJen

      Follow the money. The closing of well-baby nurseries must have saved the hospitals SO MUCH MONEY

      • Who?

        Exactly. Though the sting in the tail is the payouts for damage caused, which means insurance premiums will go up. But still a lot of organisations would rather pay for insurance than for doing their job.

      • Chi

        But how much money are they ACTUALLY saving when you account for readmission for dehydration/jaundice/etc?

        Not to mention the legal costs of getting sued because babies have died from falling from beds or being smothered due to the encouragement of unsafe breastfeeding practices??

        • Who?

          That probably comes out of a different pot, and is an increment on the cost of having a medical unit to care for babies/young children, rather than having a separate unit for all newborns. Also, there can be wards for mothers, and birthing suites, where there used to be nurseries. It makes sense from an income perspective.

        • Mel

          The L&D department isn’t losing any money for a readmission for a neonate since it’s not affecting the amount of staffing or clients they can serve.

          The hospital presumably didn’t assume any legal costs for neonatal deaths on the ward due to being smothered or falls. Rooming-in was originally utilized with healthy moms opting-in who had spousal or family support – so a natural human logic fallacy is to assume that having everyone room-in would make all the moms healthy with family support. Clearly, that’s bat-shit crazy, but people make that logical mistake all_the_time.

          The NICU is probably getting dinged because a collapsed neonate is on 1:1 nursing care plus needing the attention of a neonatologist or experienced neonatal nurse practitioner – but unless an outside entity starts forcing those readmission costs to be absorbed by the L&D department the readmission costs will remain the issue of the NICU.

          • MaineJen

            And half the patients in the NICU are probably qualifying for Medicaid (if you’re admitted for more than 40 days you automatically qualify, I believe), so that doesn’t really hit the hospital’s bottom line either.

            Although…a readmission for jaundice isn’t likely to be in the NICU for 40 days or more, so Medicaid may not apply to many of these cases.

          • Mel

            I’d be surprised if half the NICU babies qualify for Medicaid. In Michigan, the triggering event is a 30-day or longer stay. Even with the shorter period, the majority of babies that pass through the NICU are near-term preemies whose stays are measured in days to 3 weeks or term babies who had either a really rough delivery or temporary metabolic issues that clear up in a few days.

            Spawn was at a level 4 NICU. Something like 75% of the beds were for either the transient term babies or the near term preemies known as feeders-n-growers. Those were the kiddos who came in on a 3:1 baby to nurse ratio. They also cycled a whole lot faster so the percentage of babies treated per year in this group had to be around 90%

            The remaining 25% of bed were roughly split between micro-preemies who were on a 1:2 baby to nurse ratio (and I wrote that correctly) or 1:1 ratio, babies in the cardiac-cooling unit who were generally on 1:1, and the occasional baby with another birth defect or genetic disorder that needed a longer course of tender loving medical care to get healthy enough for a major surgery or discharge.

        • Allie

          Mel is so right! Different budget line, so not their problem.

    • Sue

      ^^^^^ YES, THIS

      Ideology is so much stronger than evidence in this area – it’s taboo to even question the value of – literally – mothers’ milk.

      In contrast, let’s look at vaccination (a comparison Amy has written about before).

      Anti-vaxers accuse promoters of vaccination of not permitting questioning of the benefits of vaccination, and of being skills for Big Shot, but there is an abundance of good research and surveillance data on vaccine safety and efficacy. Vaccination risks and benefits ARE based on data, not ideology.

      In contrast, complications of breast feeding are treated like complications of vaginal birth – “natural” is seen as the norm, so the risks of the “natural” process is ignored.

      And yet, all “natural”, without modern medical/nursing/midwifery care, without infant formula and without vaccination, nature brings us child and maternal death and disability.

  • Babs

    As an economist always lurking and never posting on this site, it’s high time I point out that breastfeeding pushers should really stop saying “gold standard.” The gold standard was abandoned many decades ago for a managed float currency. The tremendous amount of global economic growth is in part due to going off the gold standard. Oh wait…the gold standard is NOT the ideal system. I stand corrected. Exclusive breastfeeding IS the gold standard I guess…hahaha!

    • attitude devant

      very funny! and true!

    • Allie

      Bazinga!

    • Empliau

      Dismal science FTW!

    • Jen

      How many economists does it take to change a light bulb?

  • Mel

    Let me get this straight: When asked how BF USA is going to respond to the increasing levels of neonatal jaundice due to low milk production in some postpartum women, BF USA’s response was “You shouldn’t know that we know that! Accepted professional protocol was breached!”

    How did BF USA miss the fact that most* people rank the well-being of infants as far more important than breaching “accepted professional protocol” for publishing a photo of a slideshow?

    The vast majority of whistleblowers brought issues to light in violation of accepted professional protocol because protecting people mattered more than unstated cultural norms.

    *The saddest part is that I originally wrote all instead of most before I remembered that BF USA clearly does not agree with my assumptions of how people rank these two topics.

    • attitude devant

      I’m still mystified by that ‘professional protocol’ business. WHAT? That’s the whole point of having a presentation. You share your data. People use it. The complaint that Dr. Tuteur commented on his data is the research equivalent of all these homebirth moms who put their intimate lives on the web and then are appalled that people have an opinion.

      • Mel

        The only thing I could think of was that BF USA was acting as if publicizing and critiquing a slide from a presentation is the exact same thing as using the entire presentation in an unchanged form in a different presentation.

        Yeah, if someone is going to use your entire presentation as their own presentation, people generally ask ahead of time – but far more people just write their own presentations. Professional protocol generally dictates that you do your own work unless the other person is in the same company.

        Criticizing a single slide – or an entire presentation – is a completely different proposal. Obviously, the author of the criticism is not required to secure the approval of the person who they disagree with

        Actually, I guess there is another option.

        If we treat BF USA as a gnostic religion where believers are allowed certain pieces of information at certain times, their outrage over having said information leaked makes a bit more sense. It’s still completely inappropriate – and a really shaky defense – but it at least demonstrates the way faith in a process has replaced any interest in child welfare or scientific process.

        • attitude devant

          Such a witty comment! I think you’re making the right call, this is indeed a group of people who feel we can’t handle the truth until we buy into their priorities. Sort of like Scientology? You get in deeper and deeper and the crazy is revealed?

          • Mel

            Most of NCB only makes sense to me if it is a form of a gnostic religion.

            You can’t really sell NCB if you start out with “Hiya, pregnant lady! We really care more about your adherence to a set of rituals we’ve created based on an idyllic view of the past than we do about your physical or emotional safety. We pretty much equate the survival of your infant to your ability to complete said rituals – so if your infant dies, we’re going to expect you to double-down and get it right for the next baby. Wanna learn more?”

            It reminds me a lot of Scientology – except that NCB hasn’t quite figured out how to extract the same level of obedience and sacrifice out of their followers as Sea Org requires.

          • attitude devant

            Of COURSE!!! “Other ways of knowing”!!!!!

  • attitude devant

    I was persona non grata at our department meetings for several years because I would loudly protest the updates on our Baby Friendly certification. I was literally accused of ‘being mean’, which didn’t bother me because I knew I was in good company. 😉

    Fast forward to now and the words “Baby Friendly” seem to have disappeared off our walls and websites, and poor feeding, breast or bottle, is a leading cause of extended observation in hospital for newborns. Not coincidentally the risk management department is all over rooming in policies and feeding policies. Funny how that works

    • Cartman36

      I’m glad change is happening. I’m honestly surprised risk management didn’t sound the alarm earlier. lets leave an exhausted patient on pain medication alone with a baby….what could go wrong?

      Its also sexist because no one would tell a male surgical patient he has to take care of himself and his new baby because when he gets home he won’t have nurses to help him.

      • attitude devant

        Legal processes are slow, I guess. We could see what was happening but it took a few lawsuits to get them to sit up and pay attention.

        There was this very frightening interval when the hospital organizations were starting to view Baby Friendly certification as a quality measure (much to my dismay) but that died down too.

    • Sue

      Yep. I’ve been around in health care long enough to see different trends come and ago. A bit like fashion, except that the consequences are more serious.

      For some reason, cranky middle-aged women who say “I told you so – we tried that before” are not popular in the modern workplace.

      • Who?

        We’re not so much cranky as over being ignored and patronised. Perhaps naively I imagined that would stop when I stopped looking like a young woman-it hasn’t.

        I’m also no longer interested in making friends. I have plenty of friends, and a dog, I’m fine.

        I usually stifle my ‘I told you so’ but let the obvious hang there like a beautiful balloon, for all to see. When the babble dies down, and the excuses peter out, is time for the conversation.

        Not that that is any more popular, but when has being right ever been the key to popularity?

  • lawyer jane

    They have ZERO credibility until they address: 1) the research showing that early supplementation and pacifiers do NOT impact breastfeeding rates; 2) the research showing the lack of benefits of breastfeeding; 3) the incidents of dangerous practices related to BFHI in the hospital – falls, smothering, etc, cause by inappropriate supervision of breastfeeding mothers and removing the newborn nurseries; 4) patient autonomy; and 5) the NUMEROUS accounts by many women who felt bullied or misinformed in a way that put themselves or their infants at risk. The fact that all they can do is nitpick Fed is Best’s use of stats is very telling. They clearly don’t understand that the mission of Fed is Best is to question the entire premise of BFHI; not to establish the precise jaundice rates.