Are "Baby Friendly" hospitals dishonoring cultural diversity

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I am in totally agreement that breast is best. But also am a big fan of cultural competence. 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. But what about respecting different cultures? A large majority of Hispanic women breast and bottle feed. Some American Indians believe that colostrum is dangerous to baby and will bottle feed until milk comes in, there are many other cultures that have different beliefs on breastfeeding than what Baby Friendly hospitals would "allow" (http://www.cdph.ca.gov/programs/BreastFeeding/Documents/MO-EthnicDescriptions.pdf). How do Baby Friendly hospitals honor other cultures?

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Some American Indians believe that colostrum is dangerous to baby and will bottle feed until milk comes in

*** Enabling such false beliefs is not being cultraly competent, it's promoting ignorance. The cure for this particular ingnorance is educating the mom, not enabling.

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. But what about respecting different cultures? A large majority of Hispanic women breast and bottle feed. Some American Indians believe that colostrum is dangerous to baby and will bottle feed until milk comes in, there are many other cultures that have different beliefs on breastfeeding than what Baby Friendly hospitals would "allow" (http://www.cdph.ca.gov/programs/BreastFeeding/Documents/MO-EthnicDescriptions.pdf). How do Baby Friendly hospitals honor other cultures?

I totally agree that we all should be striving to be understanding of and accomodating towards one another's cultures. I must say, though, that I found the information provided in the link borderline offensive. There are hundreds of different cultures within the classification of "American Indian" , dozens or more within "Hispanic" or "Asian", etc., and not one set of ideals fits all. I would guess that the information could be helpful to someone who was unknowlegeable of the range of beliefs one might find in other cultures, but I don't think the document is by any means an accurate representation of the variety of ideals and beliefs you are likely to find within any one racial group.

The BFHI rules aren't so rigid as to not allow room for mothers who have cultural beliefs about breastfeeding in the early days, or who choose to formula feed for personal reasons. To qualify for BF status, you need at least 75% of all mothers exclusively breastfeeding OR formula feeding for medical reasons at discharge. There is certainly room there for mothers who will formula feed by choice (including cultural beliefs). BFHI rules don't allow for formula advertising, formula "freebies", or anything that might influence mothers to use formula. Mothers that choose to feed formula are educated about the risks and benefits of various feeding options, and are educated about what is affordable, feasible, accessable, sustainable, and safe in the own unique situations. ALL mothers that formula feed (regardless of reason) are educated about how to properly and safely mix, feed, and store formula.

You can read more about the BFHI guidelines here:

http://www.who.int/nutrition/publications/infantfeeding/9789241594998_s4/en/index.html (open the PDF for detailed info)

http://www.who.int/nutrition/topics/bfhi/en/index.html (info from WHO)

http://www.babyfriendlyusa.org/

All that being said, I would think that even if a mother is choosing formula for cultural reasons, she should be given accurate information so that she can truly make an informed decision. It doesn't seem right to avoid giving a woman information that could benefit her child (and herself!) for ANY reason. All women deserve to be able to make informed choices about their own care and the care of their babies.

Specializes in OB, Occupational Health.

My OB unit is designated "baby-friendly" and I don't think that we practice any differently than any other OB unit. The 10 steps that designate a "baby-friendly" facility 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.

We don't withhold or discourage formula feeding. It's more about giving women the tools and support they need to breastfeed.

Specializes in L&D/postpartum.

My main issue with the baby friendly hospital concept is that the decision to breast or bottle feed is something that one should be formulating during their entire pregnancy, not just their time in the hospital. Until we have a baby friendly society and baby friendly OB docs who encourage breastfeeding and make it a priority, having a baby friendly hospital isn't making the intended impact.

Specializes in Nurse Manager, Labor and Delivery.
My main issue with the baby friendly hospital concept is that the decision to breast or bottle feed is something that one should be formulating during their entire pregnancy, not just their time in the hospital. Until we have a baby friendly society and baby friendly OB docs who encourage breastfeeding and make it a priority, having a baby friendly hospital isn't making the intended impact.

AMEN sister!!!!!!!

My main issue with the baby friendly hospital concept is that the decision to breast or bottle feed is something that one should be formulating during their entire pregnancy, not just their time in the hospital. Until we have a baby friendly society and baby friendly OB docs who encourage breastfeeding and make it a priority, having a baby friendly hospital isn't making the intended impact.

I couldn't agree more!

The time for a woman to be considering her options and making a decision (and a commitment) is during the pregnancy when there is time for education and support from her doc and all the other staff members at the office or clinic where she is receiving care. It is NOT during the middle of the night after hours of pushing or a c-section (or for some poor women, both!) when she is exhausted, and the baby is starving and won't latch easily.

The ideal would be for lactation consultants to be meeting with patients several times before delivery. This would be a real boon in connection with low-income clinics where there are many very young moms who may not have the motivation or support they need unless the idea of breastfeeding is started early and encouraged throughout the pregnancy.

Postpartum floor nurses should be the icing on the cake, reinforcing and building on what has taken place in the six months prior. When we are the ones just planting the seed after delivery, it's tremendously unrealistic to expect us to reap a good harvest in the short time we have to work. We try our best, but I'm sure the results would be much better if the education had started months earlier.

Truly baby friendly programs would include an ongoing effort from the first OB appointment through the first three months--or longer--of care. This could start in the OB's office (or with a referral to lactation resources at the hospital) and continue with support groups after the birth.

But the question always ends up being, "Who's going to pay for this?" Unfortunately, we know the answer to who will pay if there are no such services.

Specializes in NICU, previously Mother baby.

I work at a "baby-friendly" hospital, and it's not that mother's can't formula feed, we just have to teach them all the benefits of breastfeeding and explain that research has shown it's the best food for baby. Most mom's at least at our facility plan to breastfeed. Sometimes that doesn't work out, but the nurses don't pressure the mom to do anything she doesn't want to do, and there are different kinds of formula available. Obviously if a mom is dead set on bottle feeding there isn't much you can do. I don't think it has anything to do with cultural competency, just what is best for baby (which is what everyone wants). If a nurse steps over the line somehow, she is responsible for that, not the baby friendly policy.

I'm a big breastfeeding advocate. I unfortunately didn't look into breastfeeding while pregnant but decided at the last minute that I would try it. I quit after 2 days while still in the hospital. The maternity staff and LC were of no help! For the 1st year of my sons life he had nothing but problems due to formula. At the time I of course didn't know to blame it on the formula. So when we started trying for #2, I looked into breastfeeding and then realized the problems my son was having was because of the formula (acid reflux and horrible constipation). I knew I would never give formula to another child. I then went on to nurse my 2nd until she weaned herself at 20 months. With my own personal experience (which is shared by many other moms) and my research on breastmilk vs formula....I personally think hospitals should not be providing formula unless for medical reasons. 3% of the population medically can't breastfeed (producing no milk) and then there's those moms that can't due to taking meds that are harmful, I understand that and formula of course should be provided. But why should the hospital provide formula that can jeopardize a babys health. If a mom chooses to for selfish reasons, then bring your own. I think more education is needed....most times Drs. don't know squat about this topic and it's really sad. I too agree with another poster about WIC. WIC would save a bunch of money if they would quit giving out formula checks. :/ Oh in a perfect world.....

Specializes in OB, Occupational Health.
Specializes in OB, Occupational Health.
But why should the hospital provide formula that can jeopardize a babys health. If a mom chooses to for selfish reasons, then bring your own.

Bring your own, huh? I find this to be a really narrow-minded and rude thing to say. I have worked in OB and I know what the benefits of breastfeeding are, however I chose not to breastfeed. To breast or formula feed is a personal decision and shouldn't be mandated by anyone(ie; withholding formula when a mother chooses to formula feed). We provide food for adults, we have to provide food for infants.

Perhaps the reasons I chose to formula feed may seem selfish to you, but it worked for my lifestyle. I think a happy mom is a better mom, and if a woman is going to be miserable breastfeeding why should she do it?

Everyone's situation is different. If someone wants to breastfeed, great, let's help them. If not, that's ok too.

barkow said:

my main issue with the baby friendly hospital concept is that the decision to breast or bottle feed is something that one should be formulating during their entire pregnancy, not just their time in the hospital. until we have a baby friendly society and baby friendly ob docs who encourage breastfeeding and make it a priority, having a baby friendly hospital isn't making the intended impact.

i totally agree! education should begin with the ob/midwife and wic appointments (if applicable). studies have shown that mothers are most open to education early in the pregnancy and the attitude of her health care provider makes a huge impact on their parenting decisions. during pregnancy is the best time to provide mother with information about feeding her baby (and many other important issues that impact her pregnancy and her baby, of course).

rn/writer said:

the time for a woman to be considering her options and making a decision (and a commitment) is during the pregnancy when there is time for education and support from her doc and all the other staff members at the office or clinic where she is receiving care. it is not during the middle of the night after hours of pushing or a c-section (or for some poor women, both!) when she is exhausted, and the baby is starving and won't latch easily.

the ideal would be for lactation consultants to be meeting with patients several times before delivery. this would be a real boon in connection with low-income clinics where there are many very young moms who may not have the motivation or support they need unless the idea of breastfeeding is started early and encouraged throughout the pregnancy...

truly baby friendly programs would include an ongoing effort from the first ob appointment through the first three months--or longer--of care. this could start in the ob's office (or with a referral to lactation resources at the hospital) and continue with support groups after the birth.

baby friendly does include education during pregnancy and referral to support groups after discharge (or that is the way it is supposed to go!). :) baby friendly also includes changing birth practices, especially those which have an impact on breastfeeding.

that being said, let's not discount the impact that hospital staff has on breastfeeding after the fact. the information, education, and support a mother receives in the hospital can make or break a breastfeeding relationship.

crunchymama said:

i personally think hospitals should not be providing formula unless for medical reasons. 3% of the population medically can't breastfeed (producing no milk) and then there's those moms that can't due to taking meds that are harmful, i understand that and formula of course should be provided. but why should the hospital provide formula that can jeopardize a babys health. if a mom chooses to for selfish reasons, then bring your own. i think more education is needed....most times drs. don't know squat about this topic and it's really sad. i too agree with another poster about wic. wic would save a bunch of money if they would quit giving out formula checks. :/

the figure that can't medically breastfeed was proposed to be 5%. spence wrote in 1938 (british medical journal) "there remain a few, less than five per cent, in whom it is physically impossible to establish lactation either because of diseased or malformed nipples, or because the infant cannot suck on account of mental defect or of cleft palate or other physical fault. all women who are not handicapped by these physical defects can breast-feed their infants if they desire to do so and if they are not prevented by an unsuitable environment." he also went on to discuss that if a woman could conceive and maintain pregnancy, she would also be able to lactate.

many women who can get pregnant today, wouldn't have been able to do so in 1938 and some of those issues that can make conceiving difficult can also make maintaining milk production difficult. then there are breast surgeries (reductions, reconstructions, etc) that weren't available then. and let's not forget that more women work outside the home, more women live unsupported by family and friends, more women are experiencing birth interventions that interfere with the initiation and maintance of lactation, and on, and on. while it is still true that relatively few women cannot (medically) breastfeed, there are sill are many, many barriers that must be overcome. until we can truly support mothers, from prenatal appointments to the delivery room to the mother/baby unit and beyond (including lactation rooms, on site day cares, etc.), many women are going to continue to face barriers to breastfeeding. while it may appear that a woman is choosing not to breastfeed for "selfish" reasons, the fact may be that she has barriers that she sees as impossible to overcome. (a good reason why education shouldn't end with a mother saying she chooses formula--sometimes mothers just need to know that they can breastfeed for a few weeks and then stop, combine formula and breast feeding, exclusively pump, have someone to talk to, etc).

yes, doctors need to be educated about breastfeeding. the aap has made a new program for residents, and is hopeful it will make a difference (perhaps, if successful, other associations will create their own education programs):

http://www.aap.org/breastfeeding/curriculum/

nurses need education, too. a recent study showed that a nurse's own personal experience with breastfeeding has an impact on how she educates her patients:

formative infant feeding experiences and education of nicu nurses

i agree that hospitals shouldn't promote, market, or glamourize formula. however, i think that formula should be provided to mothers who are using while they are in the hospital, no matter the reason. i think if a hospital is truly doing a good job of educating their patients about the advantages of bfing/risks of formula feeding in the most matter-of-fact (emotion free) way, then that is the very best they can do. denying access to formula in the hospital isn't going to prevent the mother from using it outside the hospital. it would likely have the opposite effect.

on the topic of wic, the rules have recently changed and there are more substantial benefits for breastfeeding and less formula benefits (so parents will be paying more out of pocket). if our government stopped funding formula today, it wouldn't stop most mothers who use wic for formula benefits from formula feeding. it would likely harm babies, though, because parents would be more likely to dilute formula to make it "stretch" (a dangerous practice), feed cow's milk in place of some formula, or start solids early. in order for formula use to decrease, we have to address the barriers to breastfeeding and we have to be honest with each other about the risks of formula feeding (vs the benefits of bfing). until that happens, no change is going to make a strong impact.

Specializes in L&D/postpartum.

As far as bring your own formula arguments- when people are patients in a hospital in the United States, they are entitled to not only receive food, but to receive food specific to their individual diets. Newborns are also patients in the hospital and are entitled to be fed in their specific diet, which may be formula or breast milk. It would not be vegetarian-friendly to tell someone that the hospital does not prepare food without meat, so tough luck, bring your own. Moms can bring their own formula and be ticked off, but in the end those babies are still being fed formula so nothing has been solved. So much needs to be changed in our culture to make breastfeeding the norm and have moms feel supported, and it's just frustrating how the baby friendly hospitals are not attacking the root of the problem.

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