Closing newborn nurseries is unethical


I’m deeply disappointed to learn that the hospitals in my state, Massachusetts, are closing their newborn nurseries. It reflects short sighted capitulation to lactivists, and doesn’t accomplish its stated aim. Most importantly, it’s unethical.

As the Boston Globe explained:

The shift is part of a national movement designed to promote breastfeeding, bonding, and parenting skills by having mothers and healthy newborns room together around-the-clock, attended by nurses who look after their needs. Many postpartum specialists now believe that nurseries, long a life raft for recovering mothers, is not the best, or most natural, way to provide care…

Women seeking a few hours of rest after hours of labor or a caesarean section often are surprised to learn that Massachusetts hospitals are increasingly restricting nursery access or, in some states, have closed the nurseries altogether. In Boston, Boston Medical Center began widespread “rooming-in’’ years ago, Mass. General followed suit more recently, and Beth Israel Deaconess Medical Center is taking similar steps. They collectively deliver more than 11,000 babies a year. Brigham and Women’s Hospital also expects to move in this direction.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There no evidence that rooming in leads to increased breastfeeding rates and there’s no plausible mechanism by which it would do so.[/pullquote]

The national movement is the Baby Friendly Hospital Initiative. The initiative is the crowning glory of the breastfeeding industry’s effort to shame women into breastfeeding. The appellation “baby friendly” is a deliberate slap in the face to women who can’t or don’t want to breastfeed. It offers a hospital credential (for $11,000) provided the hospital can demonstrate that it has done everything possible to harass women who don’t want to breastfeed by lecturing them about its purported benefits, making formula inconvenient and humiliating to obtain within the hospital, and depriving women of gifts of free formula to use when they go home.

What’s wrong with the Baby Friendly Hospital Initiative?

1. In first world countries with easy access to clean water, the benefits of breastfeeding are trivial: a few less colds and episodes of diarrheal illness across the entire population of infants. That’s it. What about all the other amazing claims about breastfeeding? They’re based on research that is weak, conflicting and riddled with confounders.

2. The breastfeeding industry’s understanding of the relationship between rooming in and breastfeeding is precisely backward. Rooming in (baby in the room at all times) doesn’t promote breastfeeding; breastfeeding promotes rooming in, because the women most ideologically committed to exclusive breastfeeding are also ideologically committed to keeping their babies with them at all times. Not only is there no evidence that rooming in leads to increased breastfeeding rates; there’s no plausible mechanism for it to do so. The implication of forced rooming in policies is that women make serious infant feeding decisions based on trivial factors like whether or not they can get some sleep when exhausted by sending the baby to the nursery.

3. Forced rooming in is UNSAFE. Rooming in safely requires a the presence of someone to watch the baby while the mother sleeps. Why is a second person needed? Because many mothers have trouble lifting babies out of hospital bassinets and therefore keep babies in bed with them. It is potentially DEADLY for babies to sleep in hospital beds with their mothers. We know that both soft bedding (such as that in hospital beds) and maternal impairment from narcotics (given for pain relief after C-section or vaginal tears) are associated with sudden infant death.

And that is exactly what has been happening in hospitals. Healthy babies have been dying, either dropped out of bed or accidentally suffocated by their mothers’ bodies. According to the  paper Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards in the Journal of Perinatology:

We report 15 deaths and 3 near deaths of healthy infants occurring during skin-to-skin contact or while bed sharing on maternity wards in the United States. Our findings suggest that such incidents are underreported in the United States and are preventable.

What factors contributed to these 15 deaths and 3 near deaths?

In eight cases, the mother fell asleep while breastfeeding. In four cases, the mother woke up from sleep but believed her infant to be sleeping when an attendant found the infant lifeless. One or more risk factors that are known or suspected (obesity and swaddling) to further increase the risk of bed sharing were present in all cases. These included … maternal sedating drugs in 7 cases; cases excessive of maternal fatigue, either stated or assumed if the event occurred within 24 h of birth in 12 cases; pillows and/or other soft bedding present in 9 cases; obesity in 2 cases; maternal smoking in 2 cases; and infant swaddled in 4 cases.

Lactivists, being privileged women themselves, envision that everyone else is like them: privileged to have a partner who will participate in in-hospital baby care, who can take time off from work to be there, and who has enough money to pay a babysitter to stay home with any older children. It doesn’t make any difference to lactivists if they can’t send their babies to the nursery while they sleep; someone else is there to watch the baby. But that’s not the case for most women; they are solely responsible for the care of their newborn even if they are exhausted by a long labor, in pain from surgery or vaginal tears, and impaired by pain relieving narcotics. Closing well baby nurseries doesn’t merely deprive these less privileged women of time to recover; it literally puts their babies at risk for death at their own hands. That is unethical.

Keep in mind that no one is preventing rooming in. If lactivists want to keep their own babies in their rooms 24/7, they are welcome to do so. But that’s not enough for them; they want to FORCE other women to keep THEIR babies in their rooms with them whether they want to or not. And the kicker is that there’s no evidence that rooming in promotes breastfeeding and no plausible mechanism by which it would.

Any initiative that results in the preventable deaths of babies can’t possibly be baby friendly and it isn’t mother friendly, either. So whose needs are being served by closing well baby nurseries? The Baby Friendly Hospital Initiative should really be called the Lactivist Friendly Hospital Initiative, because it is only the needs of lactivists that are being served. But that’s enough to give hospitals cover to save money by cutting out the nursing staff needed to maintain well baby nurseries. So privileged women have given hospitals the convenient excuse to save money at the expense of poor women and their babies.

How convenient!

How unsafe!

How immoral!