Breast intentions gone wrong: new paper shows Baby Friendly Hospital Initiative harms babies

Baby Tombstone at Rose Hill Cemetery in Macon, Georgia.

I have been arguing for years that the Baby Friendly Hospital Initiative (BFHI), designed to promote breastfeeding, ignores scientific evidence and leads to preventable deaths of babies.

A new paper in JAMA Pediatrics confirms what I have been saying.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]A practice designed to promote breastfeeding is injuring and killing babies.[/pullquote]

It’s entitled Unintended Consequences of Current Breastfeeding Initiatives. Breastfeeding is a good thing and should be vigorously supported, but:

Unfortunately, there is now emerging evidence that full compliance with the 10 steps of the initiative may inadvertently be promoting potentially hazardous practices and/or having counterproductive outcomes.

The authors note a variety of serious problems with the BFHI:

1. Enforced prolonged skin to skin contact leads to deaths from Sudden Unexpected Postneonatal Collapse (SUPC).

Reports of SUPC include both severe apparent life-threatening events (recently referred to as brief resolved unexplained events) and sudden unexpected death in infancy occurring within the first postnatal week of life. A comprehensive review of this issue identified 400 case reports in the literature, mostly occurring during skin-to-skin care, with one-third of the events occurring in the first 2 hours after birth …

And inevitably:

…[A] recent publication from the American Academy of Pediatrics observed that lawsuits have surfaced in US hospitals attributed to unexpected respiratory arrest in apparently healthy newborns during early skin-to-skin care …

In other words, a practice designed to promote breastfeeding is injuring and killing babies.

2. Infant injuries and deaths as a result of enforced 24 hours rooming in and closing well baby nurseries.

An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight … This may result in prone positioning and co-sleeping on a soft warm surface in direct contradiction to the Safe Sleep Recommendations of the National Institutes of Health. In addition, co-sleeping also poses a risk for a newborn falling out of the mother’s bed in the hospital, which can have serious consequences.

3. The ban of formula supplementation is contraindicated by scientific evidence.

…[W]hen supplementation was given for a medical indication, there was no adverse effect on the duration of breastfeeding.

4. The ban on pacifier use is contraindicated by scientific evidence.

[The BFHI] requires that mothers be educated repeatedly that pacifiers may interfere with the development of optimal breastfeeding. Because there is strong evidence that pacifiers may have a protective effect against sudden infant death syndrome (SIDS), the American Academy of Pediatrics has suggested avoidance of pacifiers only until breastfeeding is established at approximately 3 to 4 weeks of age. Because a substantial number of SUPC events occur during the first week of life, this recommendation to proscribe the use of pacifiers is difficult to defend based on risk.

So the BFHI leads to preventable infant injuries and deaths and the ban on formula supplementation and pacifier use are contraindicated by scientific evidence and may lead to further injuries and deaths from dehydration. Yet, health organizations are promoting the deadly BFHI tenets.

Preventing the unintended serious outcomes from these practices has been made more challenging by the emphasis on breastfeeding exclusivity in the perinatal measures recently promulgated by The Joint Commission. Measure PC-05 requires documentation of the reasons for not exclusively breastfeeding, with no allowable exceptions for newborn conditions. In addition, the Centers for Disease Control and Prevention actively promotes the “10 Steps” and Baby-Friendly designation, and monitors “10 Steps” compliance in the United States. In Massachusetts, the recently enacted Massachusetts Health Quality Measure 3A requires increasing rates of breastfeeding exclusivity, with soon to be implemented financial implications.

Why have these deadly measure been promoted? It’s certainly not because they benefit babies (or mothers). They have been promoted because of extensive lobbying on the part of the breastfeeding industry and the lactivists who support it. The BFHI should more properly be called the Lactivist Friendly Hospital Initiative because that’s who benefits.

As the authors note:

If government and accreditation agencies wish to encourage and support breastfeeding, their focus should shift from monitoring Baby-Friendly practices and breastfeeding exclusivity to monitoring breastfeeding initiation rates coupled with evidence of lactation support both during and after the hospital stay. More attention should also be placed on ensuring compliance with established safe sleep programs, emphasizing the need to integrate safe sleep practices with breastfeeding. Hospitals should direct their efforts toward implementing practices that will promote breastfeeding safely, the common goal of both private and public groups with an interest in these issues.

If doctors, hospitals and public health officials truly care about the wellbeing of babies, they will end the BFHI.