Are "Baby Friendly" hospitals dishonoring cultural diversity

babyktchr, BSN, RN · Nov 8, 2009

That would be a very interesting question to pose to the baby friendly creators. Their rules are very strict and formula is ONLY to be used for medicinal purposes with documentation to prove it. We are beginning our trek down the baby friendly trail, and I am just not a big fan of the process. While I do agree that breastfeeding is best, I do not think that the name promotes breastfeeding and may in fact discriminate against those who choose not to breastfeed or those with cultural factors. I think I may ask my lactation consultant this very thing in the morning and see what she says about it.

mamamerlee, LPN · Nov 8, 2009

I am confused. Is there really a group of people who have denied their babies any sustenance for 2 or 3 days while waiting for the 'milk' to come in?!! Keep in mind that formula and bottles became the WHITE AMERICAN norm barely 60 years ago! It took another 2 decades for the 'westernized' cultures to slowly adopt this, and still there is a wide, wide world out there that have no inkling that formula is good for healthy, full-term infants.

Our breast-revering culture has forsaken the infant's well-being for the adult's egos. What would the indigenous people of other cultures do if mommy simply didn't 'want' to breast-feed?

Now that I've stated all that, I actually believe that moms should have a choice, but our 'culture' bears no pressure on moms to do the right thing. Please find me 10 moms who did not want to breast-feed, who were encouraged to, and after a few weeks thought they made a mistake and/or regretted it?

At the very least, we should encourage more skin-to-skin contact between moms and babes.

If the hospital is the only one in a large geographic area, I don't think they should be able to 'force' moms to breastfeed.

Again I ask, which cultures discourage breastfeeding?

CEG · Nov 8, 2009

Sort of a chicken or egg question.

They are cultural practices but they are only recent cultural practices that have come about due to the influence of medical "culture" on their practices. What was done before commercial formula? Was baby always supplemented until lactogenesis or was it a result of pressure to use formula while in the hospital? If supplementing was still done was it with milk or something totally different? And is that still available?

I don't think we can really look at formula supplementation as a cultural practice due to the fact that it hasn't existed that long. If we looked at it that way then we would have to respect the choice of many of our moms to formula feed as a "cultural choice" and not introduce breastfeeding as a possibility.

I recently relocated to a midsize city in the south and formula feeding is as culturally ingrained as possible- most moms of all cultural backgrounds don't even consider breastfeeding and I don't feel as though I am stepping on their toes to discuss it.

HeartsOpenWide, RN · Nov 8, 2009

I am confused. Is there really a group of people who have denied their babies any sustenance for 2 or 3 days while waiting for the 'milk' to come in?!!

Babies can do just fine on colostrum alone until the milk comes in.

They are cultural practices but they are only recent cultural practices that have come about due to the influence of medical "culture" on their practices. What was done before commercial formula? Was baby always supplemented until lactogenesis or was it a result of pressure to use formula while in the hospital? If supplementing was still done was it with milk or something totally different? And is that still available?
I don't think we can really look at formula supplementation as a cultural practice due to the fact that it hasn't existed that long. If we looked at it that way then we would have to respect the choice of many of our moms to formula feed as a "cultural choice" and not introduce breastfeeding as a possibility.

My mom was born in the early 50s. She had whole milk in her bottle from day one. Cows have been around since the beginning of time. Whether it is formula cow's milk, goat's milk, or rice milk; cultures have various views on breastfeeding which often involves supplementation; and has before the advent of formula. Are you seriously going to use "we can't respect their cultural practices because they are too new to count"? Regardless of whether the practice is 1,000 years old or 100; we need to respect culture practice as long as it is not harmful. If we can respect a family that cups and coins their children, we can certainly respect their cultural belief to supplement.

catshowlady · Nov 8, 2009

Not an OB nurse here, but IIRC, historically "wet nurses" were used to nurse babies if mom couldn't or wouldn't. Again, IIRC, most upper class/royalty did not breastfeed their own children. They had a wet nurse to do that.

:paw:

mamamerlee, LPN · Nov 8, 2009

Yes there were, and still may be 'wet nurses'. But it is still BREAST MILK. My own grandmother was a 'wet nurse' to her niece when her own sister died. My bubby was nursing her own child at the time, and added her sister's child.

My comment about denying sustenance refers to the OP's comment about some American Indians' (HER words, not mine) believing that colostrum was bad for the baby.

In the late 40's - early 50's (post WW II) 'formula' feeding was suggested by American MD's as more 'scientific', and although cow's milk was the base, there were frequent additives such as Karo syrup.

And I wasn't referring to supplementing, but totally supplanting colostrum or breastmilk. Any baby might need supplemental feeding - that would include using a wet nurse!

rn/writer, RN · Nov 8, 2009

Formal use of wet nurses was generally restricted to the upper classes, but informal feeding of another woman's baby was fairly common. Supplementation of one form or another had to take place when a mother died soon after the birth or was too ill from blood loss or the ever-popular childbed fever to be able to nurse her own baby. Some infants were cup fed or were given a milk-saturated cloth to suck, but back when most women had kids every couple of years, there was usually someone around who was lactating and happy to share the wealth. This was especially true in any kind of clan or tribal society where the entire group functioned like an extended family.

When rubber nipples became available, babies took supplements from all manner of bottles. Back in 1934, the internationally famous Dionne quintuplets were 28-week preemies who were fed with medicine droppers because their mouths were too tiny for nipples. Their formula was cow's milk, boiled water, corn syrup, and a couple of drops of rum for a stimulant. They did amazingly well.

It isn't true that women in the "olden days" didn't supplement, as some militant breast-only folks would have us believe. The fact is that they availed themselves of all manner of options, most of which we would not find acceptable now. With those choices--wet nursing; communal breastfeeding; cow, goat or sheep milk with various additives--being neither practical nor desirable, formula is the stand-in of choice.

Formula may not be ideal, but today's versions are much better than most historical alternatives, including early commercial efforts from some of the same manufacturers that are around today. The reality is that supplementation is going to happen for most babies at some point (ranging from brief and occasional to regular and frequent), and formula fills the void left by the disappearance of the other choices. Supplementation isn't a nefarious practice invented in the last fifty years to supplant breastfeeding; it's an ancient practice that the introduction of formula has made much safer.

Would breastfeeding be more prevalent without the existence of formula? No doubt. But so would wet nursing, communal breastfeeding, the use of animal milk at a much younger age, and weird, homemade concoctions with all manner of strange ingredients. Not a pleasant thought.

hope3456, ASN, RN · Nov 8, 2009

I suspect alot more minority, low income and younger mothers would 'think twice' about just sticking the bottle in the babies mouth w/o even attempting to bf (which I have seen alot of) if they were not able to get formula for free from WIC.

I took care of a postpartum mom a few months ago who was having trouble w/ the breast feeding but giving it 110% and would not even allow us to supplement.....she told me she didn't qualify for WIC and didn't want the expense of buying formula.

CEG · Nov 9, 2009

. Are you seriously going to use "we can't respect their cultural practices because they are too new to count"? Regardless of whether the practice is 1,000 years old or 100; we need to respect culture practice as long as it is not harmful. If we can respect a family that cups and coins their children, we can certainly respect their cultural belief to supplement.

I'm not saying that their customs shouldn't be respected. I'm saying that they are not deeply rooted cultural, spiritual ideals. They are the result of American medicine infringing on whatever the actual cultural belief was- whether it was avoiding colostrum and giving cow's milk or whatever. The custom of giving formula was the result of disrespecting cultural practices and didn't happen very long ago. So we could encourage these women to do whatever would have historically been done in their culture in order to respect their heritage. Or if we feel giving formula is a safer alternative to whatever was typically given, then that is a better choice. I am just pointing out that giving commercially manufactured formula to babies is not a cultural custom, unless you count modern western culture from about 1950 on.

Editing because I am not clear:

I think the baby friendly practices probably do make some moms very uncomfortable and infringe upon their cultural beliefs. They are probably very unsettled about being forced to nurse baby at that point and I am sure there is many a grandma clucking her tongue about it.

I was just making the point that the "need" for modern formula is a result of infringing on their culture in the first place. They may have historically used something else for feeding that is not considered safe or practical today so formula is a better choice. I just wanted to say that the practice of giving Enfamil or Similac is not something that is deeply rooted in tradition.

I don't think women should ever be strong armed into breastfeeding, baby friendly or not. I haven't worked in a baby friendly facility (not even close!) so I don't know what the realities are.

nurturing_angel · Nov 9, 2009

I don't work in a "baby-friendly" hospital. We do provide formula for mothers who request it. I am a huge fan of breast feeding and I know that breast is best. But what about mothers that want to bottle feed? What about their rights to choose how they want to feed their babies?

Are these mothers allowed to bring their own formula to the hospital so they can feed their babies? Or if they want to bottle feed, do they just find a alternate hospital to deliver?

Just wondering?

RXtech · Nov 9, 2009

I am not too familiar with baby friendly hospitals, but it is my understanding that they only give formula on very rare occasions such as a sick baby.

That's not how I understand it.

http://www.babyfriendlyusa.org/eng/10steps.html

The Ten Steps To Successful Breastfeeding
The BFHI promotes, protects, and supports breastfeeding through The Ten Steps to Successful Breastfeeding for Hospitals, as outlined by UNICEF/WHO. The steps for the United States are:
1 - Maintain a written breastfeeding policy that is routinely communicated to all health care staff. 2 - Train all health care staff in skills necessary to implement this policy. 3 - Inform all pregnant women about the benefits and management of breastfeeding. 4 - Help mothers initiate breastfeeding within one hour of birth. 5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. 6 - Give infants no food or drink other than breastmilk, unless medically indicated. 7 - Practice "rooming in"-- allow mothers and infants to remain together 24 hours a day. 8 - Encourage unrestricted breastfeeding. 9 - Give no pacifiers or artificial nipples to breastfeeding infants. 10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

I think that it would definitely be indicated if the mother was not breastfeeding. I would imagine that a parent could request it if they were both bottle and breastfeeding. It just would not be routinely stocked in every baby's bed like it is at the hospital I'm doing clinicals in right now. It's my understanding that BFI hospitals still stock formula, but they have to pay for it, rather than getting it gratis from formula companies.