Questions for Trish MacEnroe of the Baby Friendly Hospital Initiative

Close-up Of Raised Hands

Yesterday, coinciding with the beginning of World Breastfeeding Week 2019, Baby Friendly USA published a piece by Chief Executive Officer Trish MacEnroe, Let’s Talk About Clinical Standards and Clinical Judgment.

Let’s!! I have questions!

MacEnroe writes:

Exclusive breastfeeding has become the LEADING risk factor for newborn hospital readmission, Ms. MacEnroe. What do you and BFUSA plan to do about that, besides blaming others instead of yourselves?

As I write this, there are 576 Baby-Friendly designated facilities in this country. This seemed unattainable when I joined Baby-Friendly USA (BFUSA) almost ten years ago. In a few short years, we have seen massive change in an industry that is typically slow to shift its deeply-embedded and commercially-influenced practices.

We have achieved a significant and important cultural shift because, as a global public health initiative, the Baby-Friendly Hospital Initiative (BFHI) promotes evidence-based best practice standards that increase breastfeeding rates and advance the wellbeing of mothers and babies across the population.

1. Ms. MacEnroe, where is the evidence that this “significant” shift has had a significant (or any!) impact on the wellbeing of mothers and babies across the population?

I also wish to remind everyone that Baby-Friendly protocols are not the only way to practice under all circumstances. It is imperative that clinical judgment also be exercised…

2. If that’s the case, Ms. MacEnroe, why do the Ten Step FAIL to mention the important role of clinical judgment?

Baby-Friendly guidelines are just that – guidelines – and should be followed in most circumstances. However, there are times when rigid adherence to these protocols is not the best thing. We depend on the wonderful, talented, compassionate caregivers at Baby-Friendly designated facilities to know when to individualize care for the mother or infant based on the circumstances that present themselves in each unique situation.

3. Ms. MacEnroe, why is the care and feeding of babies individualized based on CAREGIVERS’ beliefs and training and not MOTHERS’ needs and preferences?

…[M]others describe being unable to care for their infants shortly after birth due to some combination of extreme exhaustion, pain and medications and not having a family member or friend with them for support. Their experience was one of feeling unduly pressured to keep the baby in the room and shamed by their healthcare providers when they asked to have the infant removed from the room for a while…

Clearly, this should not happen.

4. If mothers are not supposed to feel pressured to keep the baby in the room, Ms. MacEnroe, why do the Ten Steps fail to include this critical point?

Rooming-in is one of the Ten Steps to Successful Breastfeeding, and therefore part of the BFHI, because strong scientific evidence has shown it facilitates mother-baby bonding and breastfeeding initiation.

5. Then why does the latest scientific evidence show the OPPOSITE, Ms. MacEnroe?

Mother-infant bonding is not associated with feeding type: a community study sample was published in April 2019. The authors found that breastfeeding had NO positive effective on bonding and some negative effect.

Rooming-in is the standard of care and the right policy for the vast majority of cases – and most mothers love it and feel it enhances their postnatal experience.

6. Ms MacEnroe, why isn’t maternal preference the standard of care?

Baby-Friendly protocols are designed to support appropriate clinical decision-making, not inflexibility or rigid adherence at all cost.

7. Then why, Ms. MacEnroe are tens of thousands of babies readmitted to the hospital each year as the result of inflexibility and rigid adherence to protocols at all cost?

And my final question:

8. Exclusive breastfeeding has become the LEADING risk factor for newborn hospital readmission, Ms. MacEnroe. What do you and BFUSA plan to do about that, besides blaming others instead of yourselves?

Let the backpedaling begin!!

  • rational thinker

    I think a big problem is that a lot of the people in the US probably are not even aware this crap is going on and don’t know what the BFHI is. Unless you have had kids in the past 15 or 20 years or are pregnant this is not a subject that is even thought about by a large amount of the population. So I have an idea, Dr. Amy maybe you could write a book with about 200 testimonials from women who have given birth at these BFHI facilities. They could range in severity from mothers about mistreatment during hospital stay, stories of babies having to be readmitted and the babies who have suffered brain damage or death. A book like that with a lot of testimonials could help to bring attention to the unsafe/deadly practices of the BFHI. If more people know what is being done to moms and babies and complain about it then maybe this shit show would be shut down.

    ( I have not read push back yet so I don’t know if you already tried this kind of approach or not)

  • mabelcruet

    They can’t resist the temptation to lie even in their supposedly neutral political briefing papers: this is from Ireland, setting out the history of the baby friendly hospital initiative in Ireland for UNICEF-

    http://www.babyfriendly.ie/images/History%20BFHI%20Ireland%20for%20UNICEF%2025%20year%20review.pdf

    “Marketing of breast milk substitutes, though no longer present in maternity units, is very widespread on TV, magazines, websites and other media, as well as to some community health personnel. This marketing fuels attitudes of parents, families and health workers that breastfeeding is for young babies, hard work and “when you move on” that substitutes are very nearly as good as mother’s milk”

    It’s a half-truth and a deliberate attempt to mislead. In Ireland, marketing of formula is banned as a first food-the formula companies can ONLY advertise follow-on milk, not formula for newborns, but this paper obfuscates that.

  • rational thinker

    I can’t understand why hospitals keep giving them money to put their own patients at risk. At this point they are not paying USABF a “fee” they are paying them blood money.

    • KeeperOfTheBooks

      It’s because it’s a brilliant marketing strategy.
      Moms are told from before they even conceive that breast is best, breastfeeding is the Only Way, you MUST breastfeed if you want to be a good mom, etc. They’re also told nonstop that hospitals are universally out to sabotage your breastfeeding relationship…
      …unless they’re a BFHI hospital. Those are the GOOD hospitals. THOSE hospitals won’t force-feed your baby formula and only let you see him/her for a couple of hours a day. THOSE hospitals are the only place you have even a chance of making breastfeeding succeed, and so, if you’re a Good Mom, you’ll do your best to deliver at them.
      I swallowed the whole damn thing hook, line, and sinker while pregnant with my first. Sigh.

  • mabelcruet

    Any response from her yet? There’s nowhere on the website that you can leave comments, and their Facebook page is basically just a list of centres that have managed to get their BFUSA accreditation.

    • Emilie Bishop

      They don’t want to hear anything from anyone. I spoke to one of their patient relations folks two years ago about how my son almost died because I was lied to in one of their facilities. They told me that because I refused to have a follow-up meeting with my hospital (where I knew I would be gaslighted just like I was in the letter they sent in response to my initial complaint), they weren’t going to relay any of my complaints either. Make no mistake–they know what they’ve done. They just don’t care.

      • mabelcruet

        I can well believe that. I get a very strong impression that should anyone make any remotely critical comment on their FB page, it’ll be instantly deleted on the grounds that this is a ‘safe space’. That’s not the behavior of a health care institution that is based on evidence and science, that’s the behavior of a cult.

  • KeeperOfTheBooks

    GRRRRR.
    I’m remembering a conversation I had with some hospital employee, a patient satisfaction experience type, shortly before being discharged with one of the Baby Books. She asked if I had any concerns about my stay. I said, “yep,” and explained something about how “look, if I told you that I planned on leaving my baby in the care of a person who couldn’t get out of bed, was severely sleep-deprived, was on opiod painkillers whilst immediately post-op, you, as a mandated reporter, would be legally required to report me to CPS, and you jolly well should.
    However, this state of affairs is somehow considered an acceptable caregiving situation in your hospital. I quite clearly explained to my nurse that I did not consider this a safe setup. I expressed concern that I could fall asleep holding my baby, or drop the baby from exhaustion, and with the exception of someone taking my baby for a couple of hours one night, you all did absolutely nothing. This is grossly unsafe, and it’s a death and a lawsuit waiting to happen.”
    Her response was that most moms wanted things to be like this, and she said it in a tone of voice that shamed me for daring to say what I said–read, I’m a bad mom for wanting to sleep after a C-section, or thinking that someone incapable of getting out of bed wasn’t the ideal caregiver for a newborn.
    I have no idea if we’ll have another baby, but I’ll say right now that between that incident and the one where I was hospitalized at 28 weeks in the same system and their biggest concern wasn’t that my kidneys were shutting down, or that I could go into labor, but that I wasn’t sure if I would breastfeed and my birth plan consisted of “live baby and mom, period,”…there is no way in HELL I will ever, ever deliver there again. There’s only one hospital near me that isn’t BFHI, and that’s where I’ll deliver.

    • Mel

      I’d ask the nurse to put in writing that the fact that most moms wanted their newborn babies to be left with bedridden post-op patients who were on narcotics was a legal excuse not to report child neglect under mandated reporting guidelines.

      Then I’d be sending that to the State Board of Nursing.

      Of course, I’m not postpartum…but I like being prepared.

  • The Bofa on the Sofa

    BFHI rules are not mere guidelines as she asserts. They are accompanied by performance metrics, which, if not met, will lead to the loss of BFHI status.

    Therefore, they are not guidelines, but goals.

    Every instance of clinical judgement that goes against bfhi guidelines hurts the place, and therefore is disencouraged.

  • rational thinker

    When I had my first it was at a BFHI. the nurses would not even take the baby so I could take a shower. They said I had to have a visitor babysit if I wanted to shower. I had to wait until I got home to get cleaned up. I did not know any better I was just 17 at the time I really wish I had known to assert my rights as a patient and a human being.

    • alongpursuit

      Wow that’s cruel! But not surprising. I definitely felt infantalized in the postpartum ward at the BFHI where I had my first — and I was over twice your age so I can only imagine the nonsense you dealt with as a teen. Then I had surgery for another reason and recovered on a mixed ward where I had staff offering to wash my hair! I felt like I was at the spa, but in reality it was simply a place with an interest in my recovery. BFHI has zero interest in the mother’s recovery after birth – in my experience, the nurses actually harmed my recovery by not allowing me to rest, by harassing me constantly about BFing, and then by then discharging me when things were going terribly for baby & me so that they could still count me as EBF.

      • rational thinker

        Surprisingly they didn’t give me very much crap for being a teen ( to my face anyway ). I had just graduated high school one month before and I turned 18 one month after he was born. When I got home I still had blood all over my thighs. What pissed me off most was the first morning in the hospital. I had my son around 11pm and then got stiched up for over an hour ( fourth degree tears) finally got to sleep about 1am then my son woke up at 3 and I had to get up to take care of him and when I did that blood gushed out and the floor was covered in it and I was lucky I didn’t slip and fall. I called the nurse for help after I saw all the blood so she came and mopped it up and got me back into bed. Then When I woke up at 6am I was really thirsty so I hit the call button and asked for a drink. Then the supervisor of the maternity dept comes in my room with a cup of juice and lectures me about how I need to get out of bed and walk around and to stop whining (which I wasn’t, was just thirsty) and tells me the lady in the next room just had a c section.I found out later that my OB told the nurses not to let me try to get up until my second day because of how bad the tears were. Also I was supposed to have been given Tylenol 3 during my hospital stay which I was never given.

        I did not realize how messed up this all was until I had my daughter 2 years later in a non-BFHI hospital.

        • PeggySue

          Sadistic. That’s the only word that comes to mind.

    • Mel

      I was also over twice your age with my first and regret not telling the NICU LC to take a flying f*** the first time she showed up in my room.

      The only thing I regret more was not stripping to the waist in front of the LC, a neonatologist and my son’s two bedside nurses when the LC started arguing with me about the diameter of my nipples when I asked for a larger flange size on a day my son was struggling. My mistake was saying, “Well, look, I can pump here and now if you need proof” which gave her a chance to back off – but I think she would have tried to interact with me much less if she knew that any disagreement over anything involving my breasts would lead to a half-naked Mel.

      Live and learn.

      • rational thinker

        Luckily they laid off on the LC thing. I said I was only formula feeding when I was admitted, but I do remember that stupid contract they made me sign that said formula was unhealthy for my baby. One nurse did come in and put her hand on my shoulder where the ties were on the hospital gown and asked if I wanted to try to breastfeed. I said no and told her ” I just want my body back” and she said ok and left me alone. So at least that was not too much of an issue. If I ever do do have another baby I am not going to sign that form I am going to tear it down the middle say no thank you and give it back to them.

    • BeatriceC

      I was 26 years old and on my third live baby (sixth baby total, fifth pregnancy) before I had the courage to stand up to LC’s, and this was years ago when the pressure wasn’t nearly as bad as it was now. Don’t beat yourself up. Honestly, I’ve considered finding a place where I can volunteer to help teen moms, or any moms really, advocate for themselves in postpartum units, because this is fucking nuts.

      • rational thinker

        A big problem is teen moms tend to just listen to nurses because they are the adults in charge. I did not know what they were doing was wrong. Pregnant teens and first time moms should be given information about their rights as a patient prior to their hospital stay especially since more and more hospitals are becoming BFHI.

        • BeatriceC

          That’s exactly why I want to focus on teen moms. They need somebody who can help them learn it’s okay to stand up for themselves, and to do it for them if they’re too scared. It’s a rough transition going from being able to be grounded for not doing the dishes to being a helpless newborn’s only advocate.

          • rational thinker

            I know teen moms sometimes don’t get all the info they should be getting. I have also heard of some parents punishing their daughters by not giving consent for an epidural so they can use it as a form of punishment. Luckily that wasn’t the case with me but that is cruel and they need to change that policy so it cant be used as a punishment by an angry parent.
            Also too many teens get pressured into adoption who wanted to raise their babies.
            I tell pregnant teens that It does not matter if you are 15 or 35 age does not determine your performance as a mother.

          • BeatriceC

            My parents denied my sister pain relief when she was 17 and giving birth to her first daughter, who they forced her to give up for adoption. To them. My parents are downright evil.

          • Can’t really “like,” but…yeah. That’s sick.

          • rational thinker

            Thats horrible. My grandmother experienced something similar when she was 13 or 14.

  • Cartman36

    This pisses me off. I had baby 1 at a non-BFHI and it was amazing. He went to the nursery when I needed to rest and they brought him back when I was rested and ready. They asked to give him formula because he seemed hungry. Baby # 2 and 3 were at BFHI because I did not have a choice. Both experiences were worse because the nurses refused to take the baby because “bonding”. I was exhausted and in pain. Thank God my baby days are over because I couldn’t go through the BFHI experience again.

    My oldest is 5 and both him and his brothers could not be more bonded to me if they tried. bonding is NOT contingent on a set of behaviors or rooming in.