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.