|Infant feeding method
||“Baby-Friendly forces mothers to breastfeed.”
||Our goal is for hospitals to create a supportive environment and provide optimal infant feeding care for every mother and baby. While health authorities agree that breastfeeding is optimal infant nutrition, we respect that breastfeeding is not possible in certain situations, that supplementation is sometimes medically appropriate, and that some mothers will decide not to breastfeed. Every mother has the right to accurate, evidence-based information, free from commercial interests, so that she can decide what is best for her situation.
||“Baby-Friendly takes away parents’ rights to decide how to feed their infant.”
||Our goal is to ensure mothers are fully informed of the importance of breastfeeding and to facilitate success for mothers who choose to breastfeed. Baby-Friendly designated hospitals are expected to treat all mothers with dignity and respect regardless of their infant feeding decision.
|Use of infant formula
||“Baby-Friendly designated facilities are forbidden to use infant formula.”
||Baby-Friendly designated facilities create an environment that is conducive to successful breastfeeding by offering an optimal level of care for infant feeding and mother/baby bonding. We recognize there will be cases where formula feeding is either preferred or medically required, and formula is available and supported for these situations. Baby-Friendly designated facilities are required to purchase infant formula and feeding supplies at a Fair Market Price.
|Exclusive breastfeeding rates
||“Facilities must meet an exclusive breastfeeding rate threshold to remain Baby-Friendly designated.”
||Exclusive breastfeeding rates are NOT a criterion for Baby-Friendly designation in the US. However, US facilities are expected to monitor their exclusive breastfeeding rates for quality improvement purposes.
||“Baby-Friendly requires non-breastfeeding mothers to sign a waiver.”
||This is not a requirement of the Baby-Friendly Hospital Initiative. “Consent forms” are commonly used by facilities as a way to ensure consistency in the provision and documentation of education on a wide array of topics. Some facilities may have applied this practice to education on infant formula. BFUSA’s Guidelines and Evaluation Criteria require only that a staff member have a conversation with the mother about the potential consequences to the health of her infant and document that conversation and the mother’s infant feeding decision in the patient’s medical record.
||“Mothers are forced to care for their babies every minute of their stay at a Baby-Friendly designated facility.”
||While it is true that rooming-in is the expected practice in Baby-Friendly designated facilities, we recognize some circumstances necessitate mother-baby separation. Staying together as much as possible allows the mother to learn about her baby’s feeding cues and needs under the expert guidance of trained staff. Hospital staff are expected to support mothers while they are rooming-in with their infants, including discussing safety matters and helping her understand how to request help when necessary.
||“Baby-Friendly requires that the newborn nursery be closed.”
||There is no such requirement. BFUSA’s Guidelines and Evaluation Criteria (GEC) require only that rooming-in be the standard of practice, consistent with Step 7 of the Ten Steps to Successful Breastfeeding. It is important to note that the GEC allows for rooming-in to be interrupted or not occur for a medically justifiable reason, safety-related reason or an informed decision. BFUSA’s Interim Guidelines and Evaluation Criteria issued on December , 2019, clarify this issue.
||“Skin-to-skin care throughout the hospital stay leads to unsafe sleep practices.”
||Skin-to-skin care is an important way to sooth an upset infant and it facilitates breastfeeding. As with all protocols, proper implementation and support is critical. Parents should be taught how to safely practice skin-to-skin care. A component of excellent breastfeeding care is to help the mother understand that sleepiness is a normal, hormonally-driven, physiological response to breastfeeding for both the mother and infant. As a component of safe skin-to-skin care and breastfeeding, she should be encouraged to ask for help from hospital staff and, when at home, from her support person, to place the baby on his/her back in the bassinet/crib whenever sleepiness sets in.
||“Baby-Friendly is a one-size-fits-all approach to maternity care.”
||The Baby-Friendly Guidelines and Evaluation Criteria support individualized care and appropriate clinical decision-making, not inflexibility or rigid adherence at all cost. Guideline 5.2 of the 2016 GEC specifically states “Additional individualized assistance should be provided to high risk and special needs mothers and infants and to mothers who have breastfeeding problems or must be separated from their infants.” Healthcare professionals are responsible for making clinical judgments on a case-by-case basis about when a variation from the Baby-Friendly protocol is appropriate.