What does it mean to be a Baby-Friendly hospital or birth center?

“You should give birth in a Baby-Friendly hospital.” You may have heard this when you shared the news that you were pregnant, and planning to breastfeed. You may have wondered what exactly it meant. You may have googled it. If your research brought you to this page, you have come to the right place. Your research may have led you to some articles that were very critical of hospitals that are Baby-Friendly. I will talk about that as well.

In the USA, an officially designated Baby-Friendly hospital or birth-center must go through a rigorous evaluation by Baby-Friendly USA, including a site visit, confirming that not only are you walking the walk, but talking the talk. 

Blah, blah, blah. You don’t want to know about the boring stuff. You want to know, what does it mean?

Being a Baby-Friendly designated hospital means that a hospital follows the Ten Steps to successful breastfeeding. Research shows moms who give birth at a Baby-Friendly hospital will be more likely to initiate breastfeeding and breastfeed exclusively.

What are the Ten Steps?

  1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff.
  2. Train all healthcare staff in the 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 breast-milk, unless medically indicated.
  7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  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 birth center

 A Baby-Friendly hospital has to follow these guidelines at least 80% of the time. Let’s face it, nobody is perfect.

The term Baby-Friendly was chosen, instead of something like Breastfeeding Friendly because it was easy to translate into the most number of languages.

As I researched this article, I found a shocking amount of Baby-Friendly bashing. If a mom had a bad experience, or a person just doesn’t like the thought of it, they want to write about it. I will discuss that too.

 Those Ten Steps don’t look so hard for a hospital to implement. You might be wondering why a whole organization is dedicated to certifying hospitals to make sure they are following them. What exactly does each step mean? I don’t want to start a “blah, blah, blah” section here. Let’s look at each one.

  • Step 1 – Have a written breastfeeding policy that is routinely communicated to all health care staff. The policy must address the implementation of each step. 
  • Step 2 – Train all health care staff in the skills necessary to implement this policy. Nurses must have at least 20 hours of breastfeeding education, including time to demonstrate they can help moms with position, latch and hand expression. Docs have to have 3 hours of breastfeeding education. The time difference reflects the amount of time that nurses vs. docs actually will spend with moms, helping them breastfeed.
  • Step 3 – Inform all women about the benefits and management of breastfeeding. This step is implemented during pregnancy. Topics should be discussed throughout pregnancy. It only applies to hospitals that are considered to be affiliated. The definition of affiliated is very broad.
  • Step 4 – Help mothers initiate breastfeeding within one hour of breastfeeding. This one is pretty self-explanatory. It’s about giving your baby access to the breast. The emphasis is on getting your baby skin-to-skin immediately after birth and keeping you together until your baby has breastfed. If a medical reason requires a separation, you should start skin-to-skin as soon as it is possible.
  • Step 5 – Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. The nursing staff should show you how to correctly position and latch your baby. If you can’t be with your baby, they should show you how to use a breast pump to provide stimulation to bring in and maintain your milk supply until your baby can breastfeed.
  • Step 6 – Give infants no food or drink other than breast-milk, unless medically indicated. Giving a baby formula or water or sugar-water can have an adverse effect on breastfeeding frequency. It will change your baby’s gut pH and bacteria colonization. It may decrease your confidence about breastfeeding being enough for your baby.
  • Step 7 – Practice rooming-in – allow mothers and infants to remain together 24 hours a day. Rooming-in enables you to learn your baby’s hunger cues and get him to the breast at the first signs of hunger. If your baby gets to the point of crying, he may be in a disorganized state and have a harder time latching on. Your baby should not go to the nursery or nurse’s station. Ideally, parents are educated on normal breastfeeding patterns and taught coping mechanisms that they can use when needed. Learning coping techniques in the hospital will also be helpful when you go home. Research has shown that mothers do not get more sleep if their baby goes to the nursery, compared to baby’s who stay in the room with their moms.
  • Step – 8 – Encourage breastfeeding on demand. Babies should be allowed to feed as often and as long as they want to. Newborns can breastfeed very, very frequently in the first few days. Frequent feeding helps bring the milk in sooner and stimulates an abundant milk supply.
  • Step 9 – Give no pacifiers or artificial nipples to breastfeeding infants. If your baby wants to suck, he should go to breast. If a baby has a pacifier in his mouth, you will miss his cues that he is hungry. You should be offered alternatives to artificial bottle nipples because they may affect the way your baby sucks on your nipple when he goes to the breast.
  • Step 10 – Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center. Having a network of groups and lactation consultants helps a mom get the help that can make the difference between meeting her breastfeeding goals, or whether she has a good experience.

Baby-Friendly Bashing

I mentioned the many articles critical of Baby-Friendly practices. Because of this, some hospitals have decided that they will not seek this designation. They may say instead that they are family-friendly, or mother-friendly. The implication is that a Baby-Friendly hospital is not.   I don’t believe this is a competition, one instead of the other. One of the problems with these terms that they are just words. There is not any certification or designation process to be a family or mother-friendly hospital. It doesn’t assure you of anything. Any hospital can use this term.

Baby-Friendly Misrepresentation

Baby-Friendly is a registered certification and may be used only by hospitals that have obtained that certification through an organization that is approved to provide that designation. In the USA that iBaby-Friendly USA.

Myths about a Baby-Friendly hospital

Some people have misinterpreted a hospital designated as Baby-Friendly as being one that will pressure mothers to breastfeed, whether they want to or not. While we are all urged to do things that are healthy, ideally a Baby-Friendly hospital provides education and support so that mom can be successful with breastfeeding. 

A Baby-friendly hospital is not supposed to:

  • Tell you that you have to breastfeed.
    • They should educate you about the value of breastfeeding
  • Refuse to take your baby out of your room if you request it.
    • They should explain the advantages of why it is good to keep your baby in your room.
    • They should offer alternatives, such as someone else, like your partner or another support person holding the baby for a bit so you can nap, or take a shower. Grandmas make great baby rockers. The other parent can take the opportunity to do skin-to-skin, which is good for both of them
    • After being educated and given alternatives, if you say that you still want the baby taken out for a while, they should take him.
    • He should be brought  back if he is showing any feeding cues
    •  If it is not safe for you to keep your baby, because of exhaustion or medication that would make you unable to attend to your baby, he should go to the nursery or nurse’s station.
    • They should not offer to take your baby if you have not requested it
  • Refuse to give you a pacifier.
    • Most hospitals have them for NICU babies and painful procedures, such as circumcisions. If one is used, for this reason, it should be discarded after the procedure.
    • If you want to use one, they should explain how this can interfere with successfully establishing breastfeeding
    • They should give you one if, after having been educated, you still want one
  • Refuse to provide you with formula if you have requested it.
    • They should explain how this can affect your baby’s gut and breastfeeding. It can lead to engorgement or worsen it if your milk has come in
    • If you still want it, they should give it to you
    • They should give you enough for one use, as opposed to several bottles.
    • They should educate you on the appropriate amounts to offer
    • They should encourage you to pump, which may minimize the disruption in normal feeding frequency
  • They should document any requests and education provided
  • Photo credit: l4anyrat via Visual hunt / CC BY-ND

    • Baby-Friendly is about support for breastfeeding. It is not about pressure, judging or mother shaming. Moms do the best they can with the information they receive. It should be the goal of a Baby-Friendly hospital to give you the best education to make decisions.

You drive the bus

It is your baby, and you drive the bus. You are ultimately the one who makes the final decisions. Some nurses and doctors do a better job than others with providing education and support to help you make choices that will help with successfully establish breastfeeding.

I have found that requests to take a baby in the middle of the night decreased when parents are told why rooming-in is recommended, and what normal newborn breastfeeding patterns are. Newborns breastfeed, a lot! Especially at night. Afternoon naps are a new mom’s best friend.

If you can’t find a Baby-Friendly hospital, remember, you drive the bus. You can request almost every single thing on the Ten Steps list. I have seen that when a mom is assertive, then she will get what she asks for.

 The hospital staff may roll their eyes. They may talk about you at the nurse’s station. They may make obnoxious comments directly to you. Who cares? It’s not the last time someone will question or criticize your parenting decisions and choices. IT’S YOUR BABY!

Someone can only make you feel guilty or question yourself is if you allow them to.

You drive the bus.

Photo credit: VinothChandar via Visualhunt.com / CC BY

You can find a Baby-friendly hospital in the US here: https://www.babyfriendlyusa.org/find-facilities

If you are giving birth in Canada, check here:   http://www.breastfeedingcanada.ca/BFI.aspx

One Last Thought

I helped the hospital where I work to become a Baby-friendly designated hospital. It was a team effort for three years, but a personal goal of mine for 20 years. It was one of the best days of my life when I got that call that we had passed our site assessment. I look at our plaque stating our Baby-Friendly status every day that I go to work. It makes me feel proud of myself and proud of the people I work with. It also makes me very happy for our families, to know that they are getting such awesome breastfeeding support.

Next Time

Breastfeeding and drugs, alcohol and diet. Get ready for those holiday celebrations!