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Baby-Friendly to WHO?

How Hospitals Are Setting Up New Moms for Postpartum Depression

The Baby-Friendly Initiative (BFI) was launched in 1991, in an effort to “implement practices that promote and support breastfeeding.” A noble initiative indeed, but as Marilynne Robison said, “Kindly intentioned, but not considerate.”

Why would she say that, you may ask, especially with the undeniable success of the initiative? In 2015, over 83% of infants born in Baby-Friendly Health Centers in the U.S. left the hospital breastfeeding.  But at what cost? I see more and more women in my clinic deep in despair because they feel have failed – failed at the one thing we tell them every woman can and should do  – breastfeed.

When a woman arrives at the hospital to deliver, especially in BFI hospitals, the presumption is that she will breastfeed. Very seldom do I hear the nurses ask if the mom has taken a breastfeeding class, or what her knowledge around breastfeeding is. And when moms are asked how they plan to feed their baby, the question is often framed, “…you’re planning on breastfeeding, right?” making any answer other than an enthusiastic “YES!” absurd.

This is the problem I have with the BFI – anything other than breastfeeding is deemed unacceptable and a failure.  And, in an effort to create an environment that promotes exclusively breastfeeding, we have taken away a mother’s right to choose how she feeds her infant. We have created an environment that shames women who do not want to or cannot breastfeed.

I’ve had new moms tell me they don’t want to leave the house because they don’t want their friends to know they are bottle feeding.  Ashamed. For. Feeding. Their. Child. The problem with the Baby-Friendly Initiative is in the name.  It only takes into account one of the two involved parties, the baby. But what about mom? When will the Mom-friendly initiative begin?

Breastfeeding initiatives should NOT start in labor and delivery. They should begin in schools, discussed at dinner tables, and by creating a society that genuinely embraces women who breastfeed in the open. We have nine months to educate women on breastfeeding, to give them all the information and support they need to establish a successful breastfeeding relationship. Why wait until they are in labor to educate them about the choice they don’t have?

I Propose a Mom-friendly Initiative. 

Prenatal Consult and Exam
Schedule a prenatal breastfeeding consult and breast exam for all expectant moms. There is nothing more devastating to a new mom than finding out, after days of agonising over breastfeeding, that she will unlikely be able to produce enough milk due to a hormonal imbalance or insufficient breast tissue. Conditions which we could have identified during the first two trimesters. Allowing the mom time to process, grieve and set realistic expectations.

Prenatal Breastfeeding Classes
Provide breastfeeding classes to all expecting women and create an atmosphere that allows women to freely and openly share any fears, anxieties and reservations about breastfeeding. Classes aimed at providing relatable and culturally-sensitive, evidence-based information that allows women to them to make an informed decision about how they want to feed their infant. Win women over with facts not guilt. Then, and most importantly, RESPECT their choices.

Surveillance During Pregnancy
Make assessment and documentation of breast changes throughout the pregnancy part of the prenatal visits. As providers we should be referring moms with abnormal findings or no breast changes at all, for a lactation consult prior to and immediately after deliver.

Staff for Success
Increase staffing hours and the availability of lactation support in the hospital. It’s great that BFI facilities have nurses trained to help with breastfeeding, but in my experience it takes more than 5-10 minutes to teach a deliriously tired mom how to breastfeed and assess her technique. All moms who desire to breastfeed should be seen prior to discharge for a full lactation consult and have ALL their questions and concerns addressed.

Reassess Certain BFI Policies
Let’s reconsider BFI policies that shame women for using formula. Currently, in most BFI hospitals formula can ONLY be given with a doctor’s order, and women are made to sign a release form to feed their babies formula.

I breastfed my first son until he was 3 years old and my second child, who is almost 3, is still on the boob. I have been breastfeeding for the better part of 6 years. I own and run a clinic dedicated to helping women establish a healthy and happy breastfeeding relationship. I am a nurse practitioner and International Board Certified Lactation Consultant. I am a true advocate for breastfeeding. BUT I AM TIRED of seeing women in the immediate postpartum period who feel they have no other choice. A period most women enter ill-equipped to manage the challenges of breastfeeding. Where women are being robbed of the joy of the newborn phase, utterly consumed by the belief that anything other than breastfeeding is considered a FAILURE.

Could this be the real reason postpartum depression is on the rise? Asking for a friend…

The Boob Boss

Rue Khosa, AKA The Boob Boss, is a Family Nurse Practitioner and Board Certified Lactation Consultant. She’s also the founder and owner of The Perfect Push a Lactation and Parenting Wellness Clinic in Redmond, WA.

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