It’s great to have breastfeeding in the news. The mere fact that we are discussing the importance and challenges of this critical public health issue is encouraging, even if the attention is not always positive.
The most intriguing thing to me in the recent discourse is the erroneous assertion among some that breastfeeding supporters seek to limit a mother’s choice of how to feed her newborn. In fact, after years of commercial interests pulling us in the opposite direction, we have made great strides to restore breastfeeding as a viable option for new mothers.
Mass-production of infant formulas beginning just a few decades ago, combined with aggressive marketing to convince the public that formula was the optimal infant feeding method for the modern mom, resulted in nearly an entire generation being persuaded not to breastfeed in favor of formula. This aggressive marketing also influenced care practices in maternity wards across the country where it was common to take newborns away from their mothers immediately after birth, formula feed them in the nursery for much of the hospital stay, and send the mom home with a free gift bag of formula and related goods.
The decision of how to feed her newborn was literally taken out of the mother’s hands. She essentially had no choice as breastfeeding was often not presented or considered as an option for mothers. Even if a woman insisted on breastfeeding, the care practices in place at the time often interfered with it. Hospital maternity wards unwittingly served as marketing channels for the increasingly influential infant formula companies. As irrefutable scientific evidence mounted that breastfeeding has many significant health benefits for mothers and babies, decisive action was necessary to push back this alarming trend.
The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI) in 1991 to remove commercial influence (e.g., free formula or promotional packages) from the birth facility and optimize mother-baby bonding and support through practices such as “skin-to-skin” (baby is placed on mother’s chest immediately after birth), “rooming-in” (mothers and infants sharing a hospital room), and training staff and new parents about breastfeeding benefits and best practices in service of informed decisions.
Earlier this month, the BFHI achieved an important and amazing milestone when Baby-Friendly USA (BFUSA) announced that more than one million babies are now born each year in Baby-Friendly designated facilities in the US. That’s more than the total number of babies born each year in many other major countries – including Argentina, Australia, Germany, Italy, France, and Saudi Arabia.
I am thrilled that we as a nation have achieved this important milestone. In an industry that is typically slow to shift its deeply-embedded practices, we have seen massive change in a few short years. Baby-Friendly practices are now standard care in maternity wards across the country, even for many facilities that are not officially designated as Baby-Friendly institutions.
I’m proud that the BFHI and BFUSA have played pivotal roles in making that happen. But mostly, I’m happy for the more than one million mothers and babies each year whose precious first days together will occur in environments that uphold the highest standards of infant feeding care. Commercial interests are now banned from most maternity settings and breastfeeding is once again a viable option for new moms. Even our most ardent critics must recognize and celebrate this major accomplishment.
At the same time, I recognize that we have room for improvement and would like to use this milestone as a moment for some reflection. We have tried to be clear that our guidelines support all feeding methods, that we understand each situation and parent-infant relationship is unique, and that we respect every mother’s individual informed decision of how she wants to feed her baby. We must strive even more to reinforce this more inclusive message and ensure that families feel supported, not pressured by the very systems and providers who are there to assist and champion their success.
In that spirit, I would like to underscore several key principles behind Baby-Friendly practices which should continue to guide us as we push ahead to the next milestones in our journey.
Baby-Friendly protocols are designed to support individualized care and appropriate clinical decision-making, not inflexibility or rigid adherence at all cost. Healthcare professionals are responsible for making clinical judgments on a case-by-case basis about when supplementation or other deviation from Baby-Friendly protocol is appropriate.
Individualized care requires health professionals to recognize conditions that merit further assessment and close follow-up with the mother, infant, or both. Ideally most situations are resolved through increased lactation support. This also includes situations in which the baby would benefit from – or critically needs – supplementation, which might be temporary and serve as a bridge back to breastfeeding or, in some cases, result in continued supplementation. This is a delicate matter and practitioners must carefully weigh the risks and benefits of this decision. Our guidelines call for this kind of judgment by clearly stating that “additional individualized assistance should be provided to high risk and special needs mothers and infants and to mothers who have breastfeeding problems.”
Respect Mother’s Informed Decision
While the BFHI certainly emphasizes the health benefits of breastfeeding, Baby-Friendly guidelines support all feeding methods and our practices respect the mother’s right to decide how to feed her baby.
We understand that exclusive breastfeeding is not the right decision in some circumstances and that some mothers will decide to formula feed their infant or need to supplement even if their plan is to breastfeed. A nurse or lactation consultant should engage in a collaborative discussion with every family about their individual circumstances and preferences for infant feeding. We recognize these conversations can be very delicate as some mothers will respond positively to additional encouragement and support while others will not. The BFHI strives to support each mother in fully understanding her options and weighing the pros and cons of each method. Ultimately, the mother’s informed decision should be fully respected.
Supporting Mothers Through Caring Conversations
Baby-Friendly practices are designed to help families understand their options and achieve their infant feeding goals, regardless of their selected feeding method. Every new life is precious and no mother should be made to feel guilt or shame for her infant feeding decisions.
In implementing BFHI guidelines, we all need to be acutely aware that our enthusiasm for breastfeeding along with our ethical responsibilities to inform mothers of the evidence, can send overt or subtle negative or judgmental messages to families who decide to formula feed their baby. It is the responsibility of every Baby-Friendly practitioner and facility to engage in educational, helpful, supportive, caring, and non-judgmental conversations with all families.
Just as expecting parents have a lot to think about as their big day approaches, we at BFUSA and everyone else in the breastfeeding community have a lot to think about as we now work toward new milestones. We should celebrate the fact that, for moms across the United States, the decision of how to feed their child is now entirely their own to make. Yet I know our work is not done. We all have much to do every day to continue optimizing our support for all families in one of the most precious times of their lives.