Baby Friendly USA is backpedaling as fast as they can

Illustration of a bull moose sitting on the handlebars of a red bicycle and pedaling himself backwards.

I’ve always said it was only a matter of time.

For years, the Baby Friendly Hospital Initiative (BFHI) and its US outlet Baby Friendly USA have been exaggerating the benefits of breastfeeding, ignoring the risks of breastfeeding promotion and shutting women out of decisions on feeding and caring for their own babies. As a result, exclusive breastfeeding has become the leading risk factor for newborn re-hospitalization, tens of thousands of babies are re-hospitalized each year and countless women are suffering mental anguish.

They don’t claim insufficient breastmilk is rare, don’t claim newborn stomach size is only a teaspoon and don’t describe insufficient breastmilk as “misperceived.”

They’ve finally woken up to the fact that they have lost tremendous ground to the Fed Is Best movement. It has been led by the Fed Is Best Foundation but has now expanded to include hundreds of thousands if not millions of women who are no longer silent about the terrible treatment they and their babies have endured at the hands of lactation professionals.

BFUSA is backpedaling frantically.

First they attempted to address the issue of the closure of well baby nurseries. Mothers are forced to room in with their infant 24/7 and care for those infants. The result has been a rising incidence of babies being injured and dying in the hospital from smothering in their mothers’ hospital beds and sustaining skull fractures falling from them. In addition, mothers’ exhaustion from delivery (as well as surgery in the case of C-sections) is not merely ignored; it is worsened. Women are furious.

BFUSA trying to shed responsibility and dump it on nurses.

On August 1, Trish McEnroe wrote Let’s Talk about Clinical Standards and Clinical Judgment. She was attempting to argue (with a straight face no less) that the astronomical number of re-hospitalizations was not the result of the Ten Steps of the BFHI — required by hospitals to gain and maintain certification. It was a result of the fact that individual clinicians were following them too rigidly.

…[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.

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

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 …

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.

If that’s the case why do the Ten Steps FAIL to mention the important role of clinical judgment?

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.

Why should individualized care of babies be based on CAREGIVERS’ beliefs and training and not MOTHERS’ needs and preferences?

BFUSA is backpedaling but refusing to make substantive changes to the guidelines that are causing the problems.

The outcry hasn’t merely continued; it has grown. Every month finds more articles, celebrities and social media posts declaring “Fed Is Best.”

Their most recent efort shows that BFUSA is backpedaling even faster.

The cause of most of the tens of thousands of infant re-hospitalizations is insufficient breastmilk, a condition that affects up to 15% of first time mothers, particularly in the early days after birth. The BFHI and the lactation profession have spent decades denying the fact that insufficient breastmilk is common. They’ve declared it to be rare (a lie). They’ve created models of newborn’s stomach size to show infants don’t need and can’t accommodate more than a teaspoon of milk (a lie) and they’ve labeled women’s reports of insufficient breastmilk as “perceived” insufficient breastmilk.

As of this week, BFUSA had suddenly “discovered” the problem. They published What SHOULD Happen When Baby Does Not Get Enough Milk from Mom.

It is perhaps the most important and complex question for hospital staff and medical professionals caring for newborn babies with mothers wishing to breastfeed: what are the proper procedures to ensure the safety of the baby when the mother’s milk is not yet (or never becomes) sufficient to satisfy the baby’s nutritional and hydration needs?

The article is remarkable because it doesn’t claim insufficient breastmilk is rare; it doesn’t claim that newborn stomach size is only a teaspoon; it doesn’t claim that women who fear they are producing insufficient breastmilk are “misperceiving” the situation.

“Delayed lactogenesis is actually increasingly common because the risk factors for it are potentially increasing,” Dr. Rosen-Carole says. “When a baby is born into that situation, the goal is to closely monitor what the baby is doing, instead of giving a bottle right away. Does the baby appear satisfied at the breast? Is the baby distressed? Are they peeing and pooping? And are they having regular weight loss or excess weight loss?”

“If the baby is hungry and they’re not getting enough milk out of the mother’s breast, then they need to be supplemented,” she says. “If lactogenesis hasn’t happened and you’re at day 2 or 3 and the baby is not acting full at the breast, they have excess weight loss, or they are not peeing or pooping appropriately, then I think every breastfeeding expert is going to agree that it’s time to develop an infant feeding plan that includes supplementation.”

Dr. Bobbi Philipp concurs:

“That’s why educating all staff is so important,” continues Philipp, “so everyone on the unit has the knowledge needed to see the early warning signs and they can work together to ensure infants and mothers are adequately monitored and assisted with breastfeeding.”

I wish I could believe that it was the hundreds of thousands of newborn re-hospitalizations that made lactation professionals realize that lying about the physiology of breastfeeding was wrong. But if that were the case, they would have stopped lying years ago. I suspect that they’ve stopped now because the Fed Is Best movement has made the lies deeply unpopular and undermined women’s trust in lactation professionals. In other words, this isn’t about infant outcomes; it’s about maintaining market share.

Although the BFUSA has reversed itself on its approach to insufficient breastmilk, the article is nonetheless filled with misrepresentations. This is a fallback position, not yet an acknowledgement that the scientific evidence doesn’t support the bulk of their claims.

But BFUSA is backpedaling steadily now. I sincerely hope that over time, they’ll arrive at the truth:

Breastfeeding is an excellent way to feed a baby, but its benefits have been grossly exaggerated; its harms have been ignored and Fed Is Best!