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Where should a baby sleep after delivery?
Many hospitals across the country have received designation as “Baby Friendly”; many other hospitals are in the process of seeking this designation. In order to be Baby Friendly, a hospital or birth center must prove they have implemented a set of 10 rules to encourage breastfeeding. As Baby Friendly USA puts it in their byline, it has become the gold standard of care.
Importantly, Baby Friendly fails to recognize that there is another equally crucial participant in any childbirth experience—the woman. Although childbirth is natural and usually healthy, it is not easy. Women commonly lose up to 1 L of blood during childbirth.1 Labor can take 18 to 24 hours for a first-timer and about 12 to 18 hours for an encore performance, often disrupting at least1 entire night of sleep. The minimally invasive cesarean delivery continues to elude us, and women undergoing cesarean delivery must contend with a sizable incision and the additional pain and associated recovery.
Hospitals adopting the Baby Friendly rules must not allow formula, must prohibit pacifier use, and must go to great lengths to encourage rooming-in. Rooming-in means that the baby shares the same room as the new mother around-the-clock, which is reported to help the new mother distinguish sounds that indicate “feed me” from those that indicate a cool breeze. Rooming-in has been shown to be associated with a modest increase in breastfeeding2; however, women who are committed to breastfeeding likely room-in more often than women less committed to breastfeeding. Whether or not forcing the woman who is less committed to breastfeeding or the woman highly committed to breastfeeding who just wants a good night’s rest to room-in with her baby has a meaningful impact on breastfeeding remains unknown.
- Have written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within 1 hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if separated from their infants.
- Give infants no food or drink other than breast milk, unless medically indicated.
- Practice rooming in--allow mothers and infants to remain together 24 hours per day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge.
Reference
- The ten steps to successful breastfeeding. Baby Friendly USA website. https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps. Accessed September 14, 2017.
Are we violating ethics rules?
When hospitals adopt the Baby Friendly rules—policies that limit women’s choices for themselves and for their baby—we violate medical ethics principles regarding respect for autonomy, beneficence, and truthfulness. For instance, women are told that if they breastfeed their babies will be smarter, healthier, and have stronger emotional bonds. However, when research studies control for factors such as mothers’ education level or the amount of time spent talking to the baby, the effect of breastfeeding on intelligence “washes out.”3 Babies who are formula-fed but cuddled experience the same degree of bonding with their mothers as breast-fed babies.4,5
Although breast is best, the reported benefits that underlie Baby Friendly are overblown and oversold. When we explain to a woman why her newborn cannot spend a few hours in the nursery or why we cannot allow a pacifier, we are denying her the right to parent and make choices for herself and her baby, not acting in the best interest of the woman. We are in fact misrepresenting the truth. We are also acting paternalistic, propagating the long tradition of telling women that we know better about their reproductive health and choices.
Related article:
Women’s Preventive Services Initiative Guidelines provide consensus for practicing ObGyns
Breastfeeding still not fully accepted outside the hospital
The Baby Friendly rules restrict autonomy and prod women to breastfeed for the few days that they remain in the hospital postpartum. However, these women go home to societal and institutional systems that are deeply unsupportive of breastfeeding. In addition to being the birthplace for 98% of babies born in the United States, the health care industry is the single largest employer of US women.6,7 There are 5 academic hospitals in the Boston area. After contacting the human resources department at each, I found that only 1 has a policy for their breastfeeding employees.
Women should not be forced to choose between breastfeeding and working, between taking a longer maternity leave (often unpaid and professionally detrimental) and shelving the breast pump. What we invest in reveals our values. When we require women to room-in without respecting their choices or needs, and when workplaces fail to provide reasonable flexibility and private space for breast-pumping employees, our values as a society are revealed.
Women and men, hospital users and hospital employees, need to insist that the principles of autonomy, respect for persons, truthfulness, and justice guide breastfeeding policy both within our hospitals and within our workplaces. We need to respect women and the choices that they make for themselves and their families. We need to allow women to decide to recover from their delivery without their baby constantly in arms’ reach. We need to ensure that our counseling and our policies are rooted in sound science and not influenced by passionate but biased perspectives.
Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.
- American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care, 8th ed. AAP; Washington, DC: American College of Obstetricians and Gynecologists; 2017:272.
- Jaafar SH, Ho JJ, Lee KS. Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding. Cochrane Database Syst Rev. 2016;(8):CD006641.
- Jain A, Concato J, Leventhal JM. How good is the evidence linking breastfeeding and intelligence? Pediatrics. 2002;109(6):1044-1053.
- Britton JR, Britton HL, Gronwaldt V. Breastfeeding, sensitivity, and attachment. Pediatrics. 2006;118(5):e1436-e1443.
- Jansen J, de Weerth C, Riksen-Walraven JM. Breastfeeding and the mother-infant relationship--a review. Dev Rev. 2008;28(4):503-521.
- MacDorman MF, Mathews TJ, Declercq E. Trends in out-of-hospital births in the United States, 1990-2012. CDC National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db144.htm. Published March 4, 2014. Accessed September 11, 2017.
- US Bureau of Labor Statistics. Women in the labor force: a databook. BLS Reports. https://www.bls.gov/opub/reports/womens-databook/2016/home.htm. Published April 2017. Accessed September 11, 2017.
Dr. Baecher-Lind is Director, Division of General Obstetrics & Gynecology, Tufts Medical Center, and Clerkship Director, Obstetrics & Gynecology Clerkship, Tufts University School of Medicine.
The author reports no financial relationships relevant to this article.
Dr. Baecher-Lind is Director, Division of General Obstetrics & Gynecology, Tufts Medical Center, and Clerkship Director, Obstetrics & Gynecology Clerkship, Tufts University School of Medicine.
The author reports no financial relationships relevant to this article.
Dr. Baecher-Lind is Director, Division of General Obstetrics & Gynecology, Tufts Medical Center, and Clerkship Director, Obstetrics & Gynecology Clerkship, Tufts University School of Medicine.
The author reports no financial relationships relevant to this article.
Many hospitals across the country have received designation as “Baby Friendly”; many other hospitals are in the process of seeking this designation. In order to be Baby Friendly, a hospital or birth center must prove they have implemented a set of 10 rules to encourage breastfeeding. As Baby Friendly USA puts it in their byline, it has become the gold standard of care.
Importantly, Baby Friendly fails to recognize that there is another equally crucial participant in any childbirth experience—the woman. Although childbirth is natural and usually healthy, it is not easy. Women commonly lose up to 1 L of blood during childbirth.1 Labor can take 18 to 24 hours for a first-timer and about 12 to 18 hours for an encore performance, often disrupting at least1 entire night of sleep. The minimally invasive cesarean delivery continues to elude us, and women undergoing cesarean delivery must contend with a sizable incision and the additional pain and associated recovery.
Hospitals adopting the Baby Friendly rules must not allow formula, must prohibit pacifier use, and must go to great lengths to encourage rooming-in. Rooming-in means that the baby shares the same room as the new mother around-the-clock, which is reported to help the new mother distinguish sounds that indicate “feed me” from those that indicate a cool breeze. Rooming-in has been shown to be associated with a modest increase in breastfeeding2; however, women who are committed to breastfeeding likely room-in more often than women less committed to breastfeeding. Whether or not forcing the woman who is less committed to breastfeeding or the woman highly committed to breastfeeding who just wants a good night’s rest to room-in with her baby has a meaningful impact on breastfeeding remains unknown.
- Have written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within 1 hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if separated from their infants.
- Give infants no food or drink other than breast milk, unless medically indicated.
- Practice rooming in--allow mothers and infants to remain together 24 hours per day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge.
Reference
- The ten steps to successful breastfeeding. Baby Friendly USA website. https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps. Accessed September 14, 2017.
Are we violating ethics rules?
When hospitals adopt the Baby Friendly rules—policies that limit women’s choices for themselves and for their baby—we violate medical ethics principles regarding respect for autonomy, beneficence, and truthfulness. For instance, women are told that if they breastfeed their babies will be smarter, healthier, and have stronger emotional bonds. However, when research studies control for factors such as mothers’ education level or the amount of time spent talking to the baby, the effect of breastfeeding on intelligence “washes out.”3 Babies who are formula-fed but cuddled experience the same degree of bonding with their mothers as breast-fed babies.4,5
Although breast is best, the reported benefits that underlie Baby Friendly are overblown and oversold. When we explain to a woman why her newborn cannot spend a few hours in the nursery or why we cannot allow a pacifier, we are denying her the right to parent and make choices for herself and her baby, not acting in the best interest of the woman. We are in fact misrepresenting the truth. We are also acting paternalistic, propagating the long tradition of telling women that we know better about their reproductive health and choices.
Related article:
Women’s Preventive Services Initiative Guidelines provide consensus for practicing ObGyns
Breastfeeding still not fully accepted outside the hospital
The Baby Friendly rules restrict autonomy and prod women to breastfeed for the few days that they remain in the hospital postpartum. However, these women go home to societal and institutional systems that are deeply unsupportive of breastfeeding. In addition to being the birthplace for 98% of babies born in the United States, the health care industry is the single largest employer of US women.6,7 There are 5 academic hospitals in the Boston area. After contacting the human resources department at each, I found that only 1 has a policy for their breastfeeding employees.
Women should not be forced to choose between breastfeeding and working, between taking a longer maternity leave (often unpaid and professionally detrimental) and shelving the breast pump. What we invest in reveals our values. When we require women to room-in without respecting their choices or needs, and when workplaces fail to provide reasonable flexibility and private space for breast-pumping employees, our values as a society are revealed.
Women and men, hospital users and hospital employees, need to insist that the principles of autonomy, respect for persons, truthfulness, and justice guide breastfeeding policy both within our hospitals and within our workplaces. We need to respect women and the choices that they make for themselves and their families. We need to allow women to decide to recover from their delivery without their baby constantly in arms’ reach. We need to ensure that our counseling and our policies are rooted in sound science and not influenced by passionate but biased perspectives.
Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.
Many hospitals across the country have received designation as “Baby Friendly”; many other hospitals are in the process of seeking this designation. In order to be Baby Friendly, a hospital or birth center must prove they have implemented a set of 10 rules to encourage breastfeeding. As Baby Friendly USA puts it in their byline, it has become the gold standard of care.
Importantly, Baby Friendly fails to recognize that there is another equally crucial participant in any childbirth experience—the woman. Although childbirth is natural and usually healthy, it is not easy. Women commonly lose up to 1 L of blood during childbirth.1 Labor can take 18 to 24 hours for a first-timer and about 12 to 18 hours for an encore performance, often disrupting at least1 entire night of sleep. The minimally invasive cesarean delivery continues to elude us, and women undergoing cesarean delivery must contend with a sizable incision and the additional pain and associated recovery.
Hospitals adopting the Baby Friendly rules must not allow formula, must prohibit pacifier use, and must go to great lengths to encourage rooming-in. Rooming-in means that the baby shares the same room as the new mother around-the-clock, which is reported to help the new mother distinguish sounds that indicate “feed me” from those that indicate a cool breeze. Rooming-in has been shown to be associated with a modest increase in breastfeeding2; however, women who are committed to breastfeeding likely room-in more often than women less committed to breastfeeding. Whether or not forcing the woman who is less committed to breastfeeding or the woman highly committed to breastfeeding who just wants a good night’s rest to room-in with her baby has a meaningful impact on breastfeeding remains unknown.
- Have written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within 1 hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if separated from their infants.
- Give infants no food or drink other than breast milk, unless medically indicated.
- Practice rooming in--allow mothers and infants to remain together 24 hours per day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge.
Reference
- The ten steps to successful breastfeeding. Baby Friendly USA website. https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps. Accessed September 14, 2017.
Are we violating ethics rules?
When hospitals adopt the Baby Friendly rules—policies that limit women’s choices for themselves and for their baby—we violate medical ethics principles regarding respect for autonomy, beneficence, and truthfulness. For instance, women are told that if they breastfeed their babies will be smarter, healthier, and have stronger emotional bonds. However, when research studies control for factors such as mothers’ education level or the amount of time spent talking to the baby, the effect of breastfeeding on intelligence “washes out.”3 Babies who are formula-fed but cuddled experience the same degree of bonding with their mothers as breast-fed babies.4,5
Although breast is best, the reported benefits that underlie Baby Friendly are overblown and oversold. When we explain to a woman why her newborn cannot spend a few hours in the nursery or why we cannot allow a pacifier, we are denying her the right to parent and make choices for herself and her baby, not acting in the best interest of the woman. We are in fact misrepresenting the truth. We are also acting paternalistic, propagating the long tradition of telling women that we know better about their reproductive health and choices.
Related article:
Women’s Preventive Services Initiative Guidelines provide consensus for practicing ObGyns
Breastfeeding still not fully accepted outside the hospital
The Baby Friendly rules restrict autonomy and prod women to breastfeed for the few days that they remain in the hospital postpartum. However, these women go home to societal and institutional systems that are deeply unsupportive of breastfeeding. In addition to being the birthplace for 98% of babies born in the United States, the health care industry is the single largest employer of US women.6,7 There are 5 academic hospitals in the Boston area. After contacting the human resources department at each, I found that only 1 has a policy for their breastfeeding employees.
Women should not be forced to choose between breastfeeding and working, between taking a longer maternity leave (often unpaid and professionally detrimental) and shelving the breast pump. What we invest in reveals our values. When we require women to room-in without respecting their choices or needs, and when workplaces fail to provide reasonable flexibility and private space for breast-pumping employees, our values as a society are revealed.
Women and men, hospital users and hospital employees, need to insist that the principles of autonomy, respect for persons, truthfulness, and justice guide breastfeeding policy both within our hospitals and within our workplaces. We need to respect women and the choices that they make for themselves and their families. We need to allow women to decide to recover from their delivery without their baby constantly in arms’ reach. We need to ensure that our counseling and our policies are rooted in sound science and not influenced by passionate but biased perspectives.
Share your thoughts! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.
- American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care, 8th ed. AAP; Washington, DC: American College of Obstetricians and Gynecologists; 2017:272.
- Jaafar SH, Ho JJ, Lee KS. Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding. Cochrane Database Syst Rev. 2016;(8):CD006641.
- Jain A, Concato J, Leventhal JM. How good is the evidence linking breastfeeding and intelligence? Pediatrics. 2002;109(6):1044-1053.
- Britton JR, Britton HL, Gronwaldt V. Breastfeeding, sensitivity, and attachment. Pediatrics. 2006;118(5):e1436-e1443.
- Jansen J, de Weerth C, Riksen-Walraven JM. Breastfeeding and the mother-infant relationship--a review. Dev Rev. 2008;28(4):503-521.
- MacDorman MF, Mathews TJ, Declercq E. Trends in out-of-hospital births in the United States, 1990-2012. CDC National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db144.htm. Published March 4, 2014. Accessed September 11, 2017.
- US Bureau of Labor Statistics. Women in the labor force: a databook. BLS Reports. https://www.bls.gov/opub/reports/womens-databook/2016/home.htm. Published April 2017. Accessed September 11, 2017.
- American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care, 8th ed. AAP; Washington, DC: American College of Obstetricians and Gynecologists; 2017:272.
- Jaafar SH, Ho JJ, Lee KS. Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding. Cochrane Database Syst Rev. 2016;(8):CD006641.
- Jain A, Concato J, Leventhal JM. How good is the evidence linking breastfeeding and intelligence? Pediatrics. 2002;109(6):1044-1053.
- Britton JR, Britton HL, Gronwaldt V. Breastfeeding, sensitivity, and attachment. Pediatrics. 2006;118(5):e1436-e1443.
- Jansen J, de Weerth C, Riksen-Walraven JM. Breastfeeding and the mother-infant relationship--a review. Dev Rev. 2008;28(4):503-521.
- MacDorman MF, Mathews TJ, Declercq E. Trends in out-of-hospital births in the United States, 1990-2012. CDC National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db144.htm. Published March 4, 2014. Accessed September 11, 2017.
- US Bureau of Labor Statistics. Women in the labor force: a databook. BLS Reports. https://www.bls.gov/opub/reports/womens-databook/2016/home.htm. Published April 2017. Accessed September 11, 2017.
