Anyone going baby friendly?

babyktchr, BSN, RN · Sep 17, 2009

So, it seems that this has gone awry. Everyone is entitled to their opinion. Just agree to disagree.

So......has anyone out there actually gone thru the Baby Friendly 10 steps and achieved Baby Friendly status??? There are only 25 hospitals nationwide that are. Would love to hear about your experience.

Elvish, BSN, DNP, RN, NP · Sep 17, 2009

Please, folks. It's not really necessary to ask people's credentials nor call their license into question. This is the internet, and we really don't know each other here. A lot gets lost in 'translation.' Please give each other a break. And, stick to the topic. :)

Thanks.

Mimi2RN, ASN, RN · Sep 17, 2009

I would like to have a piece of both worlds. I would like to retain the formula bags for the bottlefeeding moms and then develop a pro breast feeding bag for the moms. I just don't think we should have to be in an all or nothing initiative. Intentionally or unintentionally, someone will be offended. I just think the baby friendly title would be offensive to anyone who chose NOT to breastfeed.
There is no easy answer. While promoting breastfeeding is a great idea, I don't believe it should be forced or guilted into it, nor should anyone feel slighted because they chose not to.

This is what we do. We still have formula bags for the bottlefeeding moms, and small diaper bags with a hospital logo for the breastfeeding moms. When you have a mom who says she has to go back to work in 2 weeks, what can you do? It's not always easy to pump at work (and that baby wanted to breast feed). Baby friendly isn't an accurate term.

Marymoomoo · Sep 17, 2009

Mothers can sign up and get all the freebies on their own! :) They don't have to get a free bag from the hospital. Sign-ups are available online, through magazine inserts, etc. There's no shortage of ways to get formula samples, coupons, and freebies.

Personally, I think it's great that hospitals are "banning the bags". :) It's nothing more than free advertising for formula companies. They are already marketing to mothers directly, so IMHO, best to keep hospitals (who are supposed to protect the health of the mother and baby dyad) out of the marketing game.

on the other hand, the bottle fed moms will not get formula to go home with, nor a diaper bag. we have a 60% breastfeeding rate and i just see the bottlefeeding moms having a huge problem with not receiving the bag. even breastfeeding moms like the bags for pete's sake. ultimately i guess it makes no sense to me that we can put things in a bag that have names on them and we are pretty much advertising those products...and formula is a big no no. i just see the fit that is going to be thrown when we say we don't have the bags. i totally agree with the above poster....i am all for being mommy friendly.

Marymoomoo · Sep 17, 2009

Why does breastfeeding friendly have to be so family/baby unfriendly? That smacks of dogmatism.

I wouldn't say that the Baby Friendly initiative is family/baby unfriendly. From my POV, it's quite the opposite.

I completely understand that sometimes mothers (or their babies) can't breastfeed for a wide variety of reasons. I also completely understand that some mothers choose to formula feed also for a wide variety of reasons be it physical, emotional, or lifestyle choice. That being said, there are plenty of reasons to protect and promote breastfeeding. There are also plenty of reasons for hospitals to avoid marketing (promoting) formula.

Although the magnitude of this death and disease is far greater in the developing world, thousands of infants in the United States suffer the ill effects of an infant formula-feeding culture. A decreased risk of diarrhea, respiratory and ear infections, and allergic skin disorders are among the many benefits of breastfeeding to infants in the industrialized world.
In the United States, these benefits could translate into millions of dollars of savings to our health care system through decreased hospitalizations and pediatric clinic visits.

What is the Baby-Friendly Hospital Initiative and why do we need it?

The campaign grew out of efforts in Massachusetts to stop aggressive formula company marketing tactics in hospitals. Multiple studies have shown that formula sales campaigns undermine mothers who choose to breastfeed, and coopt medical professionals to promote expensive brand-name formula.

Ban the Bags

The findings indicate substantial prevalences of maternity practices that are not evidence-based and are known to interfere with breastfeeding. For example, 24% of birth facilities reported supplementing more than half of healthy, full-term, breastfed newborns with something other than breast milk during the postpartum stay, a practice shown to be unnecessary and detrimental to breastfeeding (7,10). In addition, 70% of facilities reported giving breastfeeding mothers gift bags containing infant formula samples. Facilities should consider discontinuing these practices to provide more positive influences on both breastfeeding initiation and duration (5,6,8).

CDC: Breastfeeding-Related Maternity Practices at Hospitals and Birth Centers --- United States, 2007

Add to the above that breastmilk is the biologically normal food for newborn humans and there are many, many constituents of human milk that science simply cannot duplicate. There are too many health advantages for both baby and mother that cannot be ignored (if anyone wants to be pointed in the direction of some specific journal articles, LMK). There are risks to formula feeding based on the product itself (possible microbial contamination, allergy, etc) and from the lack of breastfeeding. Parents deserve to know all the facts so that they can truly make an informed choice. When formula marketing in health care settings is taken out of the equation, it's easier to for parents to make an informed choice.

ducknurse · Sep 17, 2009

Has anyone looked at the other models out there? Texas and Colorado have both developed their own program b/c the baby friendly steps were too restrictive.

geekgolightly, BSN, RN · Sep 17, 2009

Marymoomoo

As you can see from my other posts in this thread I am VERY pro breastfeeding. I bf my son until he was 3. I am one of those nuts you see at lactation feed-ins. So please I do not need quotes and articles explaining how great bf is. I know!

But I also think that being dogmatic and shunning people who choose not to breastfeed for whatever reason will have more of a negative impact on the advancement of the acceptance of breastfeeding as the norm. Women need to support each other. If a woman has read the information and chooses not to bf, then give her formula and a bag and wish her the best. She needs to be supported and cared for just as much as breastfeeding moms.

You aren't coercing women to take home formula and threatening to destroy a breastfeeding relationship when you tell her there is a nice bag for formula feeders and a nice bag for breastfeeding moms. I can see how your information/research would apply when there is only one choice. Moms want to take home a nice bag. even I did. I had a preemie who was given formula in the hospital, I was told by the neonatologist that I needed to formula feed my preemie because breastmilk wouldn't support him, I was only given a bag that supported formula. It took me six weeks to get him to the breast because he was bottle fed in hospital. They told me there was no other option. With that kind of pressure from the hospital, I should have caved. Most women would have. I didn't only because I read a ton of information, which I know most women don't do.

That's the sort of pressure that should be taken away. Absolutely. But there should always be support provided for a woman's informed choice.

Marymoomoo · Sep 17, 2009

As you can see from my other posts in this thread I am VERY pro breastfeeding. I bf my son until he was 3. I am one of those nuts you see at lactation feed-ins. So please I do not need quotes and articles explaining how great bf is. I know!

I was attempting to share why the BFHI is what it is. I was responding to a variety of questions surrounding BFHI, so I really shouldn't have quoted your post. I apologize for making it appear that I was attempting to single you out as that wasn't my intent. Your post summed up the concerns others had shared very well, which is why I quoted it. :)

The issues raised here are interesting to ponder. I totally understand the POV of not wanting anyone to feel unsupported. There are a few things I don't understand, though, and I'd love to hear more perspectives.

How is not providing a free diaper bag with formula samples causing mothers who choose to, or need to, feed formula feel unsupported? How is not providing formula samples unsupportive of a woman's informed choice?

Why do mothers expect a free diaper bag (yes, I expected one myself!)? Is it ingrained in our society that new mothers should expect to go home with bags of swag? Do other hospital patients expect to go home with similar bags? Would other pharmaceutical companies even be allowed to mass market to patients that way?

What about the issue of brand recognition? Studies have shown that mothers tend to stick to whatever brand/type of formula they received in the hospital, which is why formula companies want to market to mothers before they leave the hospital. Oftentimes, the freebie is the most expensive of the manufacturer's line and families end up spending more money on their baby's nutritional needs than is necessary. Not to mention that formula is regulated and store brands contain the same levels of nutrients at a much lower cost. Name brand formula costs so much more partially because of the "freebies" that manufacturers give to mothers through hospitals, clinics, and postal mail.

What about the issue of health? Would hospitals hand out any other product that does not promote optimal health?

What about product contamination and liability? One serious example is that powdered formula has been contaminated with E. sakazakii, a bacteria that can cause fatal infections.

dscrn · Sep 17, 2009

Good questions, Marymoo. As far as a "goodie bag" just seems that they are important to most. Years age. bags were not in cmmon, and everyone go a bag of coupons, booklets, etc. Truh is, those gift bags were so poorly marketed that I only look in them months later, before discarding...

Rhee · Sep 17, 2009

What? I'd have smacked a nurse if they tried to "supplement" formula to my breastfed newborn because she was "hungry." Seriously, I would have smacked her.

As a postpartum nurse, I do not supplement breastfed babies with formula unless the parents request for the baby to be supplemented. I kind of take offense to the above statement. We don't go around just giving formula to breastfed babies. I have given formula after a baby had extremely low blood sugars, I hope that mother didn't want to "smack" me.

On the other hand, what do you do in the nursery with a breastfed baby whose mother refuses to breastfeed him or her because she wants to sleep, and doesn't want the baby to get any bottles. As an advocate for the baby, who doesn't have a voice, should I just let that baby cry? That definitely is not baby friendly. This happens rather frequently. Or a baby will go out to nurse, and come back in ten or fifteen minutes screaming. Then parents get upset if the baby is brought back out. I suppose the alternative would be to say that breastfed babies must room in, but that would upset many parents too.

Our hospital is going baby friendly right now. We are supposed to try to convince bottle feeding moms to breastfeed. I know that breast is best and there are so many advantages and benefits to breastfeeding, but these moms are adults who can make their own decisions. I will discuss the advantages of breastfeeding and help and encourage my patients so that they have all the info, but the choice is theirs to make.

On the whole breast/bottle/paci issue, I feel that parents have to do what is right for them and what works for their family. There's enough in this world to feel guilty about without anyone creating guilt for a new mom deciding how to feed her own child.

geekgolightly, BSN, RN · Sep 17, 2009

I was attempting to share why the BFHI is what it is. I was responding to a variety of questions surrounding BFHI, so I really shouldn't have quoted your post. I apologize for making it appear that I was attempting to single you out as that wasn't my intent. Your post summed up the concerns others had shared very well, which is why I quoted it. :)

ahhh that makes sense. thanks for the clarification.

How is not providing a free diaper bag with formula samples causing mothers who choose to, or need to, feed formula feel unsupported? How is not providing formula samples unsupportive of a woman's informed choice?

Just as providing only formula bags in hospital, as I experienced, is a way of marginalizing breastfeeders, so is only handing out pro breastfeeding bags. Either there should be both or none.

Why do mothers expect a free diaper bag (yes, I expected one myself!)? Is it ingrained in our society that new mothers should expect to go home with bags of swag? Do other hospital patients expect to go home with similar bags? Would other pharmaceutical companies even be allowed to mass market to patients that way?

From what I understand about hospitals marketing themselves, research indicates that if you get the woman sold on a hospital, you get the entire family to treat. Women who give birth are targets for both the hospital as well as formula companies. Hospitals want to provide freebies as much as women want to feel special and cared for during this big life changing occasion. As far as pharm companies, they market to physicans, so that's pretty much covered. Formula isn't a medication, so I think it's an entirely different category. Do you (does anyone) know if we give out Boost products or similar things upon discharge? Or if Boost is allowed to market in hospital? Maybe they don't need to... the patient will see it on the tray at each meal.

What about the issue of brand recognition? Studies have shown that mothers tend to stick to whatever brand/type of formula they received in the hospital, which is why formula companies want to market to mothers before they leave the hospital. Oftentimes, the freebie is the most expensive of the manufacturer's line and families end up spending more money on their baby's nutritional needs than is necessary. Not to mention that formula is regulated and store brands contain the same levels of nutrients at a much lower cost. Name brand formula costs so much more partially because of the "freebies" that manufacturers give to mothers through hospitals, clinics, and postal mail.

In terms of finance, these are good points.

What about the issue of health? Would hospitals hand out any other product that does not promote optimal health?

The decision has been made. If a women has made an informed choice, and wants to FF, she should be supported and helped to understand what to look for to buy the best formula for her baby. That is supporting optimal health for her baby.

What about product contamination and liability? One serious example is that powdered formula has been contaminated with E. sakazakii, a bacteria that can cause fatal infections.

What about the time a woman was breastfeeding and her child starved to death because she refused to FF and her milk wasn't enough? I'll try and find the article for you. What about introducing bacteria to a baby when a woman gets mastitis. What about thrush? What about mercury levels and other toxins in breastmilk? Bringing up these issues does no good for either party.

Elvish, BSN, DNP, RN, NP · Sep 17, 2009

On the other hand, what do you do in the nursery with a breastfed baby whose mother refuses to breastfeed him or her because she wants to sleep, and doesn't want the baby to get any bottles. As an advocate for the baby, who doesn't have a voice, should I just let that baby cry? That definitely is not baby friendly. This happens rather frequently. Or a baby will go out to nurse, and come back in ten or fifteen minutes screaming. Then parents get upset if the baby is brought back out. I suppose the alternative would be to say that breastfed babies must room in, but that would upset many parents too.

This is the biggest conundrum I find with the whole baby-friendly thing. If you want to breastfeed your baby, breastfeed him. If you are too tired to do it, and your baby is hungry, it is wrong for me to let him starve.