GREENFIELD — In the Andis Women and Children’s Unit at Hancock Regional Hospital, the nursery where newborn babies were once kept is sitting empty, with the lights turned off. You won’t see a row of swaddled newborns behind a glass partition, but it’s not because women aren’t giving birth at the hospital. It’s because when they do, their babies stay with them.
Not separating mother and child after birth and allowing for early skin-to-skin contact and breastfeeding are requirements of the baby-friendly hospital initiative. The push to make hospitals “baby-friendly” was launched in 1991 by the World Health Organization and UNICEF. It’s designed primarily to promote and support breastfeeding for all infants.
More than 15,000 hospitals in 134 countries have been designated baby-friendly, according to UNICEF. It’s become more common in recent years for hospitals in the United States to seek the status, and Hancock Regional Hospital was recently certified as baby-friendly.
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Click here to purchase photos from this gallery“You can’t ignore the evidence of healthier moms, healthier babies,” said Becky Fontaine, a lactation consultant at the hospital.
A hospital must meet several requirements to be designated baby-friendly, most centered on making breastfeeding a top priority. Baby-friendly hospitals give all expectant and new mothers information on breastfeeding’s health benefits, encourage a first feeding within 30 minutes of birth and discourage the use of formula feeding unless medically necessary.
They also practice “rooming in,” meaning that infants and mothers are together 24 hours a day whenever possible. Whereas the hospital would have once assigned a nurse to a new mother and a different nurse to her baby, one nurse is now assigned to both.
While those practices have become the norm in some developing countries, like Cuba, there are just over 100 baby-friendly hospitals in the United States. Hancock Regional is the fifth in Indiana to achieve the status.
Katrina Leary, a nurse and lactation consultant, said the process to obtain the baby-friendly certification was a long one. Hospital staff began discussing the idea around 2009, and some, including Leary, formed the Hancock County Breastfeeding Coalition.
“It is challenging to get started because you have to have a culture change,” Leary said. “If things have always been done for years and years a certain way, now you have to change the culture and the thinking of your doctors and your nurses, and your patients.”
Nurses and physicians were required to take official training courses in the baby-friendly method, and the hospital moved through a four-step transition process across several years before being evaluated by a representative of the organization Baby-Friendly USA.
Leary said although the transition took time, it now feels like second nature to the unit’s staff.
“After you’ve done it for a while, it just becomes the new norm,” Leary said. “I think all of our nurses are like, ‘oh, I can’t even imagine doing it the other way now.’”
The program emphasizes that both breastfeeding and other aspects of the baby-friendly approach, like allowing babies skin-to-skin contact with their mothers immediately after birth, have medical benefits. Immediate skin-to-skin touching is now the standard even for infants born by C-section or with health conditions that require specialized care after birth.
“That’s evidence-based care,” Leary said. “When babies are skin-to-skin, they recover faster, they have better heart rates, better temperatures, better blood sugars.”
A systematic review of 38 studies published in the Journal of Human Lactation in 2017, of pre- and post-natal interventions like those used in baby-friendly hospitals, found that they are successful in promoting more, longer and more exclusive breastfeeding. However, the review noted that there was not enough evidence to recommend any single program as the most effective.
Nurses at the hospital said they have seen an increase in breastfeeding rates, especially for babies born by C-section. A lactation support group also offers new moms extra help, both from consultants and more experienced parents.
“We used to do a lot of supplementing that wasn’t necessarily medically necessary, whereas now we don’t do that as often,” Fontaine said. “We have educated our doctors and our staff about appropriate supplementing.”
Leary said exclusive breastfeeding rates at the hospital have increased since the implementation of baby-friendly practices. Leary said implementing protocols that can improve infant health is particularly important in Indiana, which has one of the highest rates of infant mortality in the country. According to the United Health Foundation, 7.4 infant deaths occurred per 1,000 live births in Indiana in 2018, compared to 5.9 infant deaths per 1,000 live births nationwide.
“This is one thing that we can do that can decrease maternal and infant mortality,” Leary said.
But some parents and medical professionals do not see increased rates of exclusive breastfeeding as an unqualified success. The Fed is Best Foundation is an organization dedicated to promoting safe practices for both breast- and bottle-feeding, and its vision of safe practices does not include several of the protocols adopted by baby-friendly hospitals.
The foundation’s co-founder, Dr. Christie del Castillo-Hegyi, of Little Rock, Arkansas, is a physician whose son suffered from jaundice, hypoglycemia and dehydration after birth due to insufficient milk intake. Her son was later diagnosed with a number of developmental disabilities, which she believes are connected to that early malnutrition — something she says would not have happened if she had not been convinced exclusive breastfeeding was the best thing for her baby.
Stories like hers, del Castillo-Hegyi said, show that “there are major, major downsides” to the practices promoted at baby-friendly hospitals.
The Fed is Best Foundation believes supplementing with formula is a better, healthier alternative to exclusive breastfeeding for many newborns, citing data that shows a large percentage of women do not produce breast milk containing adequate nutrients immediately after giving birth.
Del Castillo-Hegyi is particularly concerned about one of the requirements of the baby-friendly hospital initiative, which states “give newborn infants no food or drink other than breast milk, unless medically necessary.” She said this leads to medical professionals ignoring conventional signs of hunger and babies not getting enough nutrients at crucial early stages of life.
Leary and Fontaine said the baby-friendly model has shifted the perception of what makes a “good baby.” Leary said lactation consultants teach mothers to “feed on cue,” meaning as often as necessary, whereas they would once have set a standard that feeding every three to four hours was normal.
“We’re empowering mothers and fathers to learn how to respond to the baby’s cues and to learn how to feed on demand, and just learn that normal babies don’t sleep all night and that that’s OK, that’s an expectation,” Fontaine said.
Critics like del Castillo-Hegyi say that attitude can go too far and lead to signs of hunger — like very long or frequent breastfeeding — to be dismissed, when they should be seen as a need to supplement with formula or donor milk.
“These babies are essentially tortured with hunger for several days until they are at risk of losing brain cells,” del Castillo-Hegyi said.
Indeed, data from the American Hospital Association shows that jaundice and dehydration are among the top reasons infants are readmitted to hospitals.
The medical community has also raised doubts about some aspects of the baby-friendly approach. A paper in the Journal of the American Medical Association found evidence that rooming in can be unsafe for babies when the mother is exhausted or sedated. It called into question other elements as well, such as a ban on pacifiers — whose use has been linked to a decrease in sudden infant death syndrome — and the discouragement of early formula usage. Studies have shown that using formula in the first days of life doesn’t decrease the odds that a baby will be breastfed later on.
Del Castillo-Hegyi said more breastfeeding is not synonymous with more safely fed babies, and that baby-friendly hospitals share information on the benefits of breast milk over formula but not the risks of exclusive breastfeeding immediately after birth.
“That’s the problem when you look at an issue with only one goal in mind, which is to increase breastfeeding,” del Castillo-Hegyi said. “They have become so single-minded in promoting exclusive breastfeeding that they have literally chosen to ignore data.”
And while medical research shows that breastfed infants have better health outcomes, that may not all be down to the benefits of breast milk itself. Moms who breastfeed are generally better educated, wealthier, less likely to smoke and have more access to health care, all of which are other factors with a major impact on a baby’s health. Some studies, including one published in JAMA by members of the McGill University Faculty of Medicine, found that breastfeeding had a limited impact on infant health when controlling for those other factors
Del-Castillo-Hegyi said no matter where they give birth, parents should be prepared to advocate for themselves and their infants.
“Keep your baby fed. That is the number one goal,” she said. “You can still breastfeed, and breastfeed successfully and safely, if you have to supplement.”
Leary said mothers are supported at Hancock Regional no matter what choice they make for their baby’s feeding needs. Every new parent receives a one-on-one consultation with a lactation consultant, whether they plan to breastfeed or bottle-feed, and mothers who use formula for medical or other reasons are welcome in the support group.
“That’s the cool thing about baby-friendly,” she said. “You give the moms education, but you support their decision.”
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According to Baby-Friendly USA, the accrediting body for U.S. baby-friendly hospitals, there are “Ten Steps to Successful Breastfeeding” hospitals must implement that were “developed by a team of global experts and consist of evidence-based practices that have been shown to increase breastfeeding initiation and duration.” The 10 steps are:
- Having a written breastfeeding policy which is communicated to all health care staff
- Training all health care staff to implement that policy
- Informing all pregnant women about the benefits of breastfeeding
- Helping new mothers initiate breastfeeding in the first hour after birth
- Showing mothers how to breastfeed and maintain lactation even if they are separated from their infant
- Giving infants no food or water other than breast milk unless medically necessary
- Practicing “rooming in,” encouraging mothers and babies to remain together 24 hours a day
- Encouraging breastfeeding “on demand,” meaning as frequently as the infant shows signs of hunger
- Not giving pacifiers or artificial bottle nipples to breastfeeding infants
- Creating and referring new mothers to breastfeeding support groups
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