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!

  • rational thinker

    I was just reading the link in the post and I saw this-

    “The decision to supplement is a delicate one,” she continues. “Infant
    formula changes the infant’s gut. It can also negatively impact the
    establishment of the mother’s milk supply, thus affecting long term
    breastfeeding success. Practitioners and parents should carefully weigh
    the risks and benefits of these decisions.” – Wow everything in that paragraph is a lie. Then this was in the very next paragraph-

    MacEnroe, Rosen-Carole and Philipp all recognize these decisions are complicated by social pressures.
    Rosen-Carole says she spends a lot of her time helping patients
    understand that how much milk they have is not what defines them as a
    parent. “We need to start divorcing this from the idea that this is
    what’s going to make you a great mom,” she says. “This is a part of your
    parenting, but it’s not your whole parenting.”

    So tell the mom who is emotionally vulnerable about how formula will mess up the babys gut for the rest of his life and all the (alleged) risks there are with formula feeding.
    Then tell mom that breastmilk is not what makes you a good mom.
    Do they even proofread this shit before they post it.

  • rational thinker

    These are the 10 steps to successful breastfeeding of the BFHI

    1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

    2.Train all health care staff in the skills necessary to implement this policy.

    3.Inform all pregnant women about the benefits and management of breastfeeding.

    4.Help mothers initiate breastfeeding within one hour of birth.

    5.Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

    6.Give infants no food or drink other than breast-milk, unless medically indicated.

    7.Practice rooming in – allow mothers and infants to remain together 24 hours a day.

    8.Encourage breastfeeding on demand.

    9.Give no pacifiers or artificial nipples to breastfeeding infants.

    10.Foster the establishment of breastfeeding support groups and refer
    mothers to them on discharge from the hospital or birth center.

    This is what hospitals have to do to keep BFHI status. Number six basically says only give baby breastmilk, if mom does not have any yet let baby sit and scream until moms milk comes in. Only give formula if child has lost over ten percent of birthweight and is very yellow, lethargic and near death.

  • Anna

    I feel that blaming the staff for following BFHI too rigidly is just another cop-out. I’ve seen articles, comments and I think even one research paper claiming any shortfalls in BFHI are because staff aren’t following the “rules”. The nuttier end of the lactavist spectrum in Australia HATES the ACM because they administer BFHI in Australia but they aren’t hardcore enough.

    • Pevensie

      It’s a total cop-out and gaslighting to boot. This nonsense here:

      “If a mother feels unable to care for her baby after her birth and requests time apart, giving her a respite may help her regroup. Her provider should engage her in a collaborative conversation to ensure she understands the reasons for the rooming-in policy, gently work with her to see if there are ways that they can support her to room-in, but if not, document her informed decision, and then respect the request without making the mother feel any guilt or shame.”

      Look at this trash. If she FEELS unable, because she certainly can’t be trusted to KNOW when she’s unable. There’s no chance she’s already tried to conform to the policy and found herself stretched to the limit. Nope. She just had a whim, like a toddler who wants an ice cream cone before dinner.

      “May help her regroup.” Not heal, not recover, even if she had a multi-day labour, surgery, PPH. “Regroup.” Pull herself together. Shake it off.

      Make sure she UNDERSTANDS THE REASONS for the policy, in other words, explain to her (possibly for the umpteenth time) why her request is bad and will hurt her baby. She obviously hasn’t given this the slightest thought or consideration, or she wouldn’t dream of asking for a break.

      “Gently work with her” to convince her that she doesn’t really need what she thinks she needs. Can we “support” you to not hurt you baby? It’s really important.

      Then, if she persists in her defiance and incomprehension, make sure you DOCUMENT that you did everything you could to dissuade the patient from doing this bad, bad, baby-hurting thing.

      By the time you’re “respecting the request” (the bad, bad, unreasonable request that you’ve engaged her in prolonged argument about, making it crystal clear you DON’T want to grant it) it’s far too late to avoid making the mother feel any guilt or shame for, you know, being a bad mother who doesn’t care about her baby. I have no doubt McEnroe knows this, too. The doubletalk is despicable.

      • Griffin

        “Her pain and exhaustion aren’t serious. She just thinks they are, poor foolish dear.”

        I share your disgust and agree – the whole BFHI crap and the breastfeeding hysteria of the last 2 decades is predicated on a profound disrespect for women. I always thought this, and of course Dr Tuteur has made this point many times on this blog.

        What has shocked me the most about the whole thing is that women are as bad as men – maybe even worse – in having these nasty condescending paternalistic attitudes.

        • Pevensie

          In many patriarchal societies — maybe all? — women are assigned the task of keeping other women (and children) in line, and often that’s the only way for women to exert significant power. I think Dr Tuteur’s most recent post about making breastfeeding harder really brings this home — lactivists, like La Leche League, come out of precisely that kind of tradition. And feminists haven’t been at all immune to reproducing this kind of behaviour with other women, even if their stated goals are different.

          Even the way these BFHI proponents display aggression is very stereotypically and “properly” feminine — the instruction sheet for overriding patient requests, reproduced here: https://fedisbest.org/2019/11/nurses-quit-because-of-horrific-experiences-working-in-baby-friendly-hospitals-bfhi/

          All the things they tell staff not to say are direct commands or statements of fact (“You are supposed to room in”, “We don’t have anyone in the nursery to keep your baby.”) They want staff to deal with mothers by cajoling, manipulating, soothing words, passive aggression, offering “help” and “support”. The direct statements might be the truth, but they’re not nice, and women must always (appear to) be nice. It really is quite a fascinating study.

          • NoLongerCrunching

            I would say it is nice to tell mothers the truth, that they’re being forced to room in.

          • Pevensie

            I agree. I would vastly rather be told the truth. But that requires openly acknowledging your raw power over the patient, which is insufficiently passive/manipulative/”feminine ethic of care.”

            Like how lactivists constantly insist that they are just servants and helpmeets, and BFHI demands are about “empowering” and “supporting” patients to meet their own exclusive breastfeeding goals, which arise totally independent of LC advice, pressure and propaganda.

          • Griffin

            Jeez, checked out the link, am even more disgusted and angry than before. Only when “mother gets agitated” do they FINALLY “comply with her wishes”.

            So really, women giving birth need to not only prepare for the physical and exhausting onslaught of birth and its aftermath, they need to be ready to challenge the ‘professionals’ ‘taking care’ of them to make sure they don’t get railroaded and juggernauted into decisions that could kill their babies.

            This kind of stuff makes people distrust the whole medical system (of which I am part).

            I think BFHI hospitals should have their damned pants sued off. Only monetary consequences will stop this ideological horror story.

            And yes, women controlling other women with PA, sneaky, ‘nice’ viciousness because their own power lies in doing what the current (male-oriented) system wants – I’ve really understood this in the last 10 years.

            I guess that is why there is a very special hatred for collaborators in any oppressed community of people. And that is a hatred that is often exploited by those at the top…

          • KeeperOfTheBooks

            “mother gets agitated”
            My experience to a T. I asked nicely, several times, for help with Baby Books 3, and got allll those blandishments despite saying repeatedly that I was worried about how tired I was and how much pain I was in. When I broke down in a semi-hysterical hissy fit and sobbed out “I CAN’T DO THIS, I’VE NEVER HURT THIS BADLY AND I CAN’T STAY AWAKE ANY LONGER,” the nurse gave me a nasty look, but took him away for three hours so I could sleep.
            (Mind you, it still took another day for them to admit that they hadn’t been giving me my prescribed pain meds as directed, but that’s a whole ‘nother ball of wax.)

        • Anna

          Dig a bit on some of the crazier lactavists too you will find they are fairly hardcore Christians of the “women’s role is to be wives and Mothers” type.

        • KeeperOfTheBooks

          Indeed. My (male) OB was the go-to doc for VBAC, VBA2C, natural birth, et all in our area. He was extremely supportive of breastfeeding, provided it was a good fit for mom and baby. And yet he fought, in his words, tooth and nail to try to keep BFHI out of “his” hospital because he considered it cruel and inhumane, and when I cried about having C-sections and not being able to breastfeed and getting PPD, he hugged me, told me I was an awesome mom, said it didn’t matter as long as baby was healthy, there, and fed, and offered to write a script for Zoloft immediately. HE wasn’t the issue. The vast majority of (female) nurses et all most definitely WERE.
          (He also laughed and said “good for you” when I told him about my breakdown at the nurse who wouldn’t take the baby so I could sleep.)

          • Griffin

            Good on your wonderful Ob-Gyn! And by yelling at the horrid nurse, you made the world a better place for the women coming after you.

            I had HORRIBLE experiences with midwives (in the Netherlands) but eventually found a male Ob-Gyn in a neighboring country who helped me (against large odds) to get an elective CS without medical causes. My next Ob-Gyn, an Aussie, delivered my second and third children with gentle painless competent peace.

            If I was religious, I would light a candle for them and their lovely, very supportive (mostly female) midwives every week. All women should get this sort of compassionate personal care.

          • KeeperOfTheBooks

            “All women should get this sort of compassionate personal care.” Upvoted only once, but if I could I’d upvote a dozen times. Yes! And I’m so glad you did for your second and third!

  • mabelcruet

    This is the inevitable result of guidelines turning into must-do ‘law’. Failure to follow guidelines has been tested in court (in the UK, not sure about other jurisdictions) when doctors and others went off-piste in treating patients. Failure to follow guidelines can be justifiable, and in itself, is not prima facie evidence of negligence or malpractice. So how come breast feeding guidelines became so inflexible and rigid, and touted as ‘you MUST do this’ because otherwise the hospital will lose its accreditation or award? When did following guidelines become an absolute requirement, and assume a greater importance than treating patients as individuals to good medical/clinical standards in partnership with them? Rigid adherence to guidelines without considering the patient as an individual is not good clinical practice, so how did these breast feeding guidelines become SO overbearing and absolute? Guidelines are not necessarily authoritative, especially when based on assumptions, poor quality research or written by professional bodies or individuals with a vested interest, which is what happened here.

    • The Bofa on the Sofa

      They can claim “they are just guidelines, use clinical judgement” all they want, but when said guidelines are accompanied by metrics that need to be met, then you have removed the clinical judgement from the equation.

      • Anna

        Yes and I believe overworked paeds, especially juniors are relying too much on LCs to take care of the feeding. Nurses, in my experience, are better placed to gauge how feeding is going but they seem to defer to the LCs.

  • Cat

    Completely random, OT question, but you all seem to know a lot about kids! How common is it for three year-olds to say stuff like “you’re not my best friend anymore” when they fall out? My impression is that it’s pretty standard. I’ve heard some of my three year-old’s friends say it on playdates and I’m pretty sure she’s said it to other kids too, because she’s been known to say that (and worse!) to me on rare occasions when she gets overtired and cross. She gets a consistent message from me at home that (a) you shouldn’t say unkind things to people and (b) you don’t have to carry on playing with people if they’re upsetting you and making you sad. I also tend to talk about how it’s great being friends with lots of people rather than encouraging “best friends” talk at three. From conversations that I’ve had with her key worker from her childcare setting, I gather that she’s extremely well-liked and not excluded. She definitely has the confidence to go play with someone else if another kid is being mean. I’m big on teaching kids about toxic friendships but, equally, at the end of the day, three year olds just don’t seem that good at conflict management and saying harsh stuff when they fight doesn’t seem like an automatic bad friendship.

    Just asking because I feel that my mother always goes a bit overboard if my three year old has conflict with another three year old in childcare and comes home saying that X isn’t her friend anymore. i.e. demonizing the other child, saying “yuck, we don’t want to be friends with her” in front of my daughter. When, generally, they’ve made up the next day.

    Probably seems ridiculous, but I received a strong message from my mother when I was a child that other girls and women are bitchy and toxic and will exclude you because they’re jealous. And I feel as though she constructed a narrative for me of “you were bullied by other little girls from a very young age because they’re horrible and you’re not like them”. When, looking back, a lot of my early memories of other girls not liking me in nursery and preschool just seem like regular behaviour, preschoolers still learning to socialise and share toys stuff.

    Sorry for the novel! Just feeling guilty because my mother ends up making me feel bad/ not as loving and protective of my three year old as her.

    • AnnaPDE

      Honestly I think it’s totally normal when little kids declare others “not my friend anymore” and a few minutes later it’s all fine again. The drama level is comparable to the most stereotypical teenagers.
      Taking such declarations seriously as long-term statements of intent, and then encouraging sticking with them and painting the other kid as the villain blows such spats out of proportion and ultimately harms kids’ practice of the social skill of fighting and then making up.
      And I very much agree with you that what your mum seems to be doing breeds this unhealthy idea that everyone is being mean, bad and untrustworthy, except maybe the people who let you treat them like a doormat. One of my grandmas has tendencies like that and it hasn’t served her well in the long run.

    • Azuran

      Yea, definitely you have to tell your mom to stop putting her two cent and tell your daughter to hate her friends. That’s very unhealthy and is likely to eventually result in problems for your daughter. That’s the only thing wrong here.
      3 years old make grand ‘life changing’ empty statement that they forget in 5 minutes all the time. When my daughter is excited about going to daycare, she loves her carer and the other kids are her friend. When she doesn’t want to her, she’ll yell about not loving her carer and the other kids are not her friends. Her favourite toy is whatever one she has in her hand.
      Understanding emotions is hard, and understanding them and putting them in the proper words is hard. So kids tend to blow things out of proportion by using simpler words that they understand
      -I’m mad at you becomes: your not my friend anymore.
      -I don’t want to go to day care becomes: I hate daycare and everyone there
      Kids are a rollercoaster of emotions, it’s fine and normal.

      But again: make your mom stop, what she is telling your kid isn’t good. You are doing perfectly fine.

    • The Bofa on the Sofa

      I remember when the kids were in daycare, the teacher mentioned one time that “You’re not my best friend any more” was basically a daily occurrence. I don’t remember what age it was, but all in that preschool age.

      I think it is just a way for kids that age to process. I like your approach of encourage all kinds of friendships and not worrying about “best” friends.

      Heck, even as adults, “best friends” come and go. Not so much on a weekly basis, but common interests wane and we move on and meet others.

    • Cartman36

      My 5 year old says stuff like that all the time. I stay out of it. My view is it is best to let them work it out. I think you are right and should tell your mom to back off.

      My mother did something similar. She always told me growing up that other family members didn’t like me (because she is a lunatic). Now as an adult and a mother, I realize how completely inappropriate that was. Even if it was true (that my grandmother didn’t like me) it was inappropriate for my mother to tell me that.

    • mabelcruet

      I think your mother is out of line here-its normal for children to make that sort of dramatic statement, they don’t have the experience to verbalise or articulate their feelings differently. At that age, they have little insight into the ‘future’, for them, not speaking to their friend ever again normally means they’ll be back being best friends the next morning. I’m maybe biased, having a toxic narcissist as a mother, but I would definitely ask yours not to make that sort of comment-it could undermine your daughter’s friendships, and it could lead to her not being able to deal with confrontations or upsets. By being so dramatic about a childish squabble, she’s setting your daughter up to potentially having difficulties making friends or being able to navigate relationships with friends. My mother used to tell her oldest granddaughter that the reason her friend fell out with her was because she was too fat (just as she did with me when I was a child) so if she wanted people to like her she had to be thin, and that has cast a very long shadow.

    • rational thinker

      It is pretty normal behavior for a three year old. Normally they say things like i hate you your not my friend anymore and by the next day or an hour later the whole thing is forgotten and they are friends again.

      Kids (especially girls in my experience) start being mean and excluding others about the time they start first grade. That’s when you have to worry. Kids may have it a little better now than I did over 30 years ago because of the anti-bullying movement. When I went to elementary school if someone was picking on you and would not leave you alone you could not even tell the teachers. When someone was bullying you and you told the teacher YOU would be in trouble for being a “tattle tale”, it sucked. This could have been your mothers experience also. So maybe that could be a reason why she says what she says, but this is your child and if you dont want your mom telling her these things then you need sit sit down with your mom and discuss this issue with her. Tell her you are her mother and you would like her to stop telling your child these things. If you dont stop it now it may get worse as she gets older.

    • Mel

      Your kid sounds completely normal and like a nice kid to boot.

      Your mom sounds like she’s got her own issues around female-female relationships.

      My MIL’s mom pretty much instilled in my MIL that female-female relationships are Machiavellian dystopian nightmares that should be handled by scheming and passive-aggressive maneuvers as a first-line of defense. My MIL is not good at scheming, but has an aggressive victim mentality that comes to the forefront when she’s confronted by her female friends about her behaviors.

      And yet, she can’t understand why her daughter and two daughters-in-law have a distant, vaguely cordial relationship with her while turning down most invitations to do anything.

    • Anna

      My daughter says this all the time!!! I think it came from kindy, and probably from older siblings there. My older kids are past that stage. Its hilarious because my daughter says it to people that weren’t really in line for best friend status anyway. She said it to my 13year old son the other day and he was dying with laughter. He wouldn’t get her some M&Ms down for breakfast so she said “thats IT! You’re not my best friend, never again and you’re a poo poo”.

    • Allie

      My daughter has just started doing this and she’ll be 7 in a few weeks, so I’d say your LO is advanced : )
      I think you’ve got it spot on. They quarrel about something silly, likely because they’re tired or hungry, and they make up the next day. I always tell my daughter the same – I’m sure you’ll make up and be friends again, but it’s always nice to have lots of friends. She is starting to understand that she can say to a friend “no thanks, I don’t feel like playing right now,” without being rude. Friendships can ebb and flow, and that’s okay. It’s not a zero sum game.

  • Shawna Mathieu

    They’re still also ignoring another factor in breastfeeding problems – flat or inverted nipples. When I was pregnant with my son, I thought my breasts were fine. I knew they weren’t inverted, so I though as long as they stuck out at the appropriate times they worked.

    And NO medical professional, not even OB-GYNs, had ever said anything to me about it, not even during prenatal exams.. It wasn’t until I put my son to my breast for that magic photogenic moment, and he couldn’t latch, that a nurse gently took my breast, squeezed it, watched the nipple zoop back, and said, “Hmm, flat nipples.”

    All the BFing books talked about inverted and flat nipples as a minor inconvenience that you just have to try a little harder to make it work. All but one of them said to refuse a nipple shield, because it’d interfere with the skin to skin bonding.

    And if you had to, you were supposed to stop using it as soon as the baby started latching. Which apparently would happen if you just kept trying, everything would just pop in place like Lego bricks.

    I know some women have fantastic results with nipple shields.
    Me, I could never get them to stay on, and I tried everything. It made everything ten times more complicated.

    In the medical center waiting to see the doctor, I sat there fumbling with my coat and sweater (it was December) and bra, trying to keep them up while I positioned the shield with one hand and get my son in place with the other, oh, and trying to keep the receiving blanket over us in place, which didn’t happen, it kept falling, and people gave me dirty looks.

    My LC told me “Stop giving in, he’ll latch if he’s hungry enough.” tut-tutting me after I guiltily admitted that I fed him breast milk in a bottle after we’d both spent an hour crying and screaming trying to latch.

    She knew I had flat nipples. She thought if I starved my son, they’d magically fix themselves? I’m so damn glad I didn’t listen.

    Later I found out that flat nipples are fairly common, just no one talks about them. My MIL had planned to BF her kids, she had oodles of milk but couldn’t get the kids to latch, she felt like a failure. It wasn’t until I started trying to breastfeed that we realized she had the same thing and it wasn’t her fault at all.. In the past, it wasn’t recognized as a thing, so there’s probably billions of babies in the past who died because they couldn’t physically get to the milk that was right there.

    I actually saw something in a BFing site or journal saying that flat and inverted nipples weren’t a thing in the past, breasts were perfect milk machines then, they’re a modern problem – and blamed it on formula. The “logic” went something like, babies that would have starved b/c of mom’s weird nipples in the past were living because formula’s now a thing, so they passed the genes for abnormal nipples, more moms with abnormal nipples using formula to feed babies, who’ll pass on the bad nipple genes, therefore formula’s to blame Q.E.D.

    • Pevensie

      Straight up eugenics. Wow.

      • Shawna Mathieu

        Anyone know why my post got marked as spam? I swear, I didn’t spam about flat nipples.

        • alongpursuit

          It happens sometimes if the post is long-ish. It happened to me before.

        • rational thinker

          its just a disqus thing it happens but I see its back up now

    • mabelcruet

      The gene idea, whilst its been garbled as a result of passing through an LC brain, is actually not far off. Inverted nipples can be genetic, generally because the lactiferous ducts are a bit short. But inverted nipples aren’t increasing in incidence-if babies were starved in past generations because of inverted nipples, but are now surviving because of formula, and they are growing up into inverted nippled womanhood, you’d expect the incidence to be rising, and its not. The prevalence is about 10%.

      You’d think nipple shield manufacturers would have cottoned onto the inverted nipple market-there are loads of fancy adhesive bras around with sticky silicone bits to stick them to your boob without needing straps or a band, so why can’t they make adhesive nipple shields?

      • Mel

        I suspect the adhesive nipple shield issue is multifaceted. The adhesive would need to be non-toxic, hypoallergenic, resistant to the oily-water mix of breastmilk, able to resist fairly high shear forces during nursing AND still be removable after nursing WITHOUT removing much of the epidermis or whatever ceramide mixture is moisturizing the nipple. Oh, and you’d need to be able to remove and adhere the adhesive to the same spot like 8-12 times a day with a newborn’s feeding schedule.

        • mabelcruet

          Lactivists are happy to lather their nipples with Dr Newman’s nipple ointment (containing bactroban, betamethasone, miconazole and ibuprofen) so a few extra chemicals won’t be a problem, but the peeling nipple skin sounds very painful!

        • AnnaPDE

          Why would you have to take it off? I can totally see an around-nipple solution, to apply once and stick for days, washing-resistant, almost skin-soft. Basically like the adhesive dressing on my CS incision, which stayed on for 6 weeks and looked pretty good at removal. (And the scar underneath – dreamy, it looks better than some of the minor cuts I had.)

    • swbarnes2

      babies that would have starved b/c of mom’s weird nipples

      Except most humans live in communities and families, and no one just lets a baby who can’t suck starve to death. Other lactating women share, or you get the baby on milk substitutes.

      And it’s very creepy to say that babies surviving when they previously would not have is a problem

  • Griffin

    “Baby Friendly USA is backpedaling as fast as they can”

    I am SO very happy to read this title on the Skeptical Ob finally. The Baby Friendly Initiative is horrifically cruel to babies and their mothers, it should be slam dunked into the dustbin of history where it belongs. BYEEE and GOOD RIDDANCE!

    And chapeau to you, Dr Tuteur, for your unflagging heroic efforts against this pernicious, vicious, and disastrous policy!

    • Cartman36

      And the worst part is…..hospitals are paying BF USA five figures a year for the privilege.

      • Griffin

        Yes, just insane. In my view, BFHI is a case of regulatory capture – all those societies and bodies (eg WHO) etc got infiltrated by people making money/power from this poisonous policy, and the rest of the members (mostly) got dragged along (or went along with it happily). They were profiting from playing on the bodies of women and babies. Disgusting.

    • Pevensie

      I mean, they’re backpedaling but not really. They’re gaslighting. Insisting they were misunderstood. It’s basically several articles worth of “I’m sorry if you were offended.”

  • alongpursuit

    I’m curious about what is implied by this:

    “Delayed lactogenesis is actually increasingly common because the risk factors for it are potentially increasing,” Dr. Rosen-Carole says.

    What risk factors? How are they increasing? I had no idea this could happen (until it happened to me) and all the BFHI propaganda made it seem like if I didn’t breastfeed it was my (bad) choice not to. It wasn’t a choice – I just didn’t make anywhere near enough milk to feed a baby.

    • MelJor

      There are a list of risk factors (here is one such list https://academic.oup.com/ajcn/article/92/3/574/4597439#110785562, Fed is Best also has a nice worksheet highlighting the risks of excessive weight loss which is similar) and many of the risk factors seem to come down to being older, and being a first time mom. Women today are also more likely to have had breast surgery or some kind (biopsy, enhancement, reduction, etc) and more likely to have a higher BMI (though that doesn’t seem to consistently be a risk factor, it appears to be for first time mothers). I also seem to see medical interventions during childbirth (c section, excess blood loss) listed, and those are perhaps more common, especially in light of our older more medically complex demographic having children. I myself has a wonderful elective c section, but my milk did not really “come in” until day 5, so without supplementation I am sure we would have been in a a bad place by then. As it was I had milk coming out of my ears and a sleepy baby who didn’t nurse well on engorged breasts, so it still took a good RN IBLC, my ped, a nipple shield, and a pump to get us through days 5-7.

    • Leading Zero

      Funny how those risk factors were previously unknown/unacknowledged, isn’t it?

    • rational thinker

      I think that particular comment really says “its not our fault, YOU must be doing something wrong, lets see what YOU not US did wrong” thats what I got from it.

      • Tempera

        That’s interesting. I believe one of the reasons why BFHI has been ”tolerated” for so long, is the feeling of guilt. Guilt of not succeeding in breastfeeding and thus not being a good mom, or guilt of not realizing that the baby is not nourished. Personally, we had a sad episode with a ”baby friendly” hospital when our newborn was sent to NICU due to complications from insufficient milk intake on his second day of life, after we had repeateadly asked for supplementation (which was naturally perceived as a hysteric reaction of first time parents). Afterwards I still had an overwhelming feeling of guilt: how stupid could I have been, not realizing how serious the situation was. Why didn’t I fight harder, or just bring my own formula, when there was plenty of food around us and my little baby was starving? I can just imagine the self accusations if we would have played along their tune all the time… Not to mention parents who are sent home with bad breastfeeding advice and are alone responsible for the well being of their child.

        • NoLongerCrunching

          I think it’s also because people have difficulty advocating for themselves when they’re vulnerable and dependent on others for their care. They don’t want to rock the boat and risk not getting taken good care of.

    • Mel

      In no particular order – moms today are more likely to be older, heavier, able to reproduce after surviving complicated medical issues that would have killed/prevented reproduction previously and able to reproduce thanks to reproductive technologies.

      It’s kind of like the hand-wringing about the fact that women are ‘choosing’ to delay having babies into their 30’s rather than popping the kids out in their late teens and early 20’s. The implication is that women are being selfish and/or blase about having babies – but really, that’s backwards if you think about it. Women often used to have their first baby much, much younger – but that was as much a consequence of crappy birth control methods and no access to safe abortions.

      • HailieJade

        Also that C-sections mean women are actually quite literally evolving narrower pelvises because the babies and women who 200 years ago would have died in childbirth, are now surviving to pass on their genes. I have actually seen people get upset about this online, no joke. “Those selfish women and their unwillingness to die so that “Survival of the Fittest” can continue to reign supreme amongst homo sapiens, and only those worthiest of wide-hipped women can survive to pass on their Superior Genes!” is basically what these repulsive people are saying. Makes me sick.