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:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]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?[/pullquote]

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!!