The Journal of Pediatrics highlights deadly outcomes of the Baby Friendly Hospital Initiative

Poor little toddler baby fell down from the bed while crawling on it. Dad missed to catch him

The tide is turning!

It’s been known for years that aggressive breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular are dangerous for babies. Sadly, it’s taken time for medical professionals to respond to the dangers.

The latest response is an editorial in the Journal of Pediatrics, Breastfeeding, Baby-Friendly, and Safety: Getting the Balance Right.

The BFHI endangers babies through its policies of mandated rooming in and closing well baby nurseries.

The editorial focuses on the dangers of infant smothering and falls of from mothers’ hospital beds, just a small subset of the harm that the BFHI causes. Even so, it undermines many of the claims of the BFHI.

Any medical or systems intervention comes with risk for adverse events. Overall, this has been understudied for the Baby-Friendly Health Initiative, with only 2 studies identified by the US Preventive Services Task Force as reporting any
adverse events … In this volume of The Journal, articles by Bass et al and by Bartick et al extend what is known about the safety and efficacy of Baby-Friendly.

The conclusion is that — through its policies of mandated rooming in and closing well baby nurseries — the BFHI endangers babies.

A central tenet in the Ten Steps of Baby-Friendly is to enable mothers and infants to practice rooming in and remain together 24 hours a day. This step, perhaps more than any other, has led to concerns about safety of Baby-Friendly practices, particularly when mothers accidentally or intentionally practice bed-sharing with their newborn…

The results has been an increase in Sudden Unexpected Postnatal Collapse (SUPC) and infant falls:

These early events are now referred to as sudden unexpected postnatal collapse (SUPC), a rare subset of sudden unexplained infant deaths
(SUID, defined as the sudden and unexpected death of a baby is apnea or cardiorespiratory failure occurring in an otherwise-healthy term newborn, usually in the first 24 hours of life, and during the initial skin-to-skin contact, with prone positioning, or with the first attempt to breastfeed… [M]aternal fatigue and reduced monitoring have been reported to contribute to infant falls during rooming-in.

Babies are injured and even die not because of breastfeeding, but because of the unnecessary and harmful restrictions — in this case mandated rooming in and closure of well baby nurseries — that lactation professionals have added to breastfeeding promotion.

In a recent analysis of 20 years of Centers for Disease Control and Prevention (CDC) data from 1995 to 2014, Bass et al found that although overall rates of SUID in the first year of life fell, rates of neonatal (within the first month of life) SUID increased from 9% to 10% in 1995 to 11% to 13% by 2014.7 Much of this increase occurred between 1995 and 2000. Of the neonatal SUID events, 29% occurred in the first 6 days of life and 15% on the first day of life. Overall, this translates to 125 SUPC events annually in the US …

Bartick believes that she has rebutted the implication that the rise in neonatal SUID events is the result of the the BFHI.

Bartick et al also report CDC data and found that between 2004 and 2016 (a shorter and later time frame than examined by Bass et al), the adoption of skin-to-skin care as a part of Baby-Friendly practice increased substantially in the US and in Massachusetts. During the same time frame, data from the CDC and Massachusetts Department of Health showed a decrease in the prevalence of SUID in the first 7 days of life (ie, SUPC). Their data suggest this decrease was at least partly due to a statistically significant drop in preterm deaths, but overall the trends in SUID prevalence over their 13-year study period appear similar to the report by Bass et al.

Both investigators attempted to examine the proportion of these early deaths that were directly attributable to accidental suffocation. Although both studies noted an increase in reported accidental suffocation over time, the specific rates are difficult to compare, as the age groups studied were different (

If the BFHI harms babies, alternative approaches to breastfeeding promotion should be considered, especially since there is evidence that the BFHI doesn’t increase breastfeeding rates.

The editorial concludes:

In the hospital, a balance needs to be struck between encouraging and supporting a mother and avoiding system-based practices that inadvertently increase risk to the infant. There is growing support for an individual, tailored approach to promoting breastfeeding duration. All medical personnel need to be familiar with the evolving data supporting best practices for breastfeeding support.

It’s time to end the Baby Friendly Hospital Initiative that has harmed babies and replace it with an individual, tailored approach. Lactation professionals are still in denial about the risks, but babies shouldn’t have to suffer injuries and die as a result.

  • Greta

    GOOD. I had one baby by C-section before this stupid mandatory Baby Friendly horseshit and one after. The baby I had in a Baby Friendly hospital I also had by C-section. I needed HELP. I needed REST. I was recovering from surgery and I needed help so I could recover and safely take care of my baby! The first baby was taken to the nursery for a while so I could sleep and rest and recover. The second was left for me to figure out while exhausted, barely able to move and on serious pain meds. I fell asleep with him in my chest in the hospital bed!! We are both LUCKY that he didn’t fall on the tiled floor! It was frustrating, sad, and awful and I’m so angry I had to go through it. I hope it changes ASAP.

  • Michael Ray Overby

    This is good, BFHI is essentially a Management Protocol, with the Intent of Lowering Costs. It’s Really Damn Hard to lower costs while protecting babies & their mothers. Calling on Mom to “Woman Up” & Just Deal With the Services so unceremoniously Withdrawn from her is turning out Not to be the way of lowering the overall cost without incurring both Monetary & Human losses. Well Baby Nursery Services started for a good reason, one that has not Just Gone Away. So bring back the WB Nurseries & Try Something Else, please… BFHI is an Abject Failure, and becoming an Embarrassment to those who originally Promulgated this nonsense.

  • rational thinker

    With my first baby I remember the first day in hospital when I was in labor and admitted. They baby was about 20 hours away at this point but I remember when the nurse said this “we have a wonderful new policy so you will get to keep the baby in the room with you for your whole stay, isnt that great”

    I did not know any better so I thought ok great. I did not realize that it was not great and it was unsafe. I was 17 so I guess my mentality was well an adult medical professional says its good then it must be. After my second baby in a non BFHI hospital I realized I was tricked.

    I was 17, a minor myself. I had a 24 hour labor with a post dates too big baby. I remember the look of horror on my Ob’s face when he saw the damage to my vagina. I said “did I tear at all” he just looked at me and said “its bad” then he spent an hour sewing me up. He did not say anything else until he finished. Then he told me it was a fourth degree tear.

    I have had urinary incontinence ever since (17 years) and a damaged pelvic floor, but the thing I am most angry about was that I was immediately expected to care for a newborn. Also when I did say I had pain they told me to stop complaining and if anyone was in pain it would be the woman down the hall that had a c section.

    • The Bofa on the Sofa

      ….and they aren’t helping her with her baby, either, so suck it up, buttercup.

    • fiftyfifty1

      Wow, what a horror show. I am so sorry this happened to you. My first was a bad vaginal birth (although not as bad as yours) and the pain made it very difficult to care for the baby. I had a maternal request CS for the second to avoid more damage, and the pain after the CS was less.

    • Desiree Scorcia

      I had two c-sections, and they were virtually pain-free. Not that it matters! If you’re in pain, it doesn’t lessen just because someone else is in pain too. I’m so sorry that happened to you.

  • The Bofa on the Sofa

    A central tenet in the Ten Steps of Baby-Friendly is to enable mothers and infants to practice rooming in and remain together 24 hours a day.

    If it only “enabled” it would be fine. But by removing nurseries, you don’t “enable” rooming in, you require it.

    I don’t know why this is such a hard concept for so many to grasp. The option of rooming in in fine – requiring rooming in is not.

    • Christine O’Hare

      This! I so agree with this. Some mothers may very well be willing and able to room-in with their infant. Others not so much.

      • The Bofa on the Sofa

        Yes, and that issue of “able” is important.

        When I was doing Dad’s Boot Camp, one of my most important messages was always to remember that the mother has been through a serious ordeal (it’s called “labor” for a reason – and not because it’s easy). You hear stories all the time of how the mother was in labor for 30 hours before the baby was born, etc, and in that time, it’s not like they are getting a good nights sleep. So she’s working on no sleep for at least 30 hours (if labor started at night, she’s been up since that morning already), and now there is a baby to take care of. No matter how much she might want to have the baby around, she may not physically be able to safely and properly care for a baby. But by forcing rooming in, there is no choice.

        • Christine O’Hare

          Very good message. I was that person, induction started at 5am, baby born via C-section at 11pm, was 1am before we were settled, and done with immediate monitoring. I was exhausted, drugged up, and as done as I had ever been. And while my husband didn’t labor, he had still been up for 20 hours himself. Neither of us were in any shape to care for an infant at that point in time. Baby had nursed and gotten a bottle and was sent off to the nursery so we could get some much needed rest.