What is the Baby Friendly Initiative?
Recently, our hospital has written an agreement to work toward a Baby Friendly Initiative (BFI) designation. The Baby Friendly Initiative was started by the World Health Organization (WHO) and UNICEF in 1991 to counteract the effects of formula company marketing on breastfeeding rates. This world-renowned designation is no easy feat to accomplish by hospitals, but the number of countries involved has grown to include 152 world-wide.
While I do feel that the WHO Baby Friendly Initiative has both the mothers and infants interest in mind, it has a bad reputation for pressuring moms to breastfeed and shaming moms who use formula. For this reason I had entered this BFI training a skeptic, but on the whole I was pleasantly surprised at how inclusive it appears to be.
However, if we do reach this much sought after designation, there will be changes to how we treat our moms and babies. I really feel that having a heads up to current practices prior to admission would make a world of difference to how a moms postpartum care is perceived!
Changes That A Postpartum Mom May Notice
Breast is Best
Nurses within a Baby Friendly Initiative designated hospital should know the benefits of breastfeeding and the risks of formula feeding. It is the nurses job to make sure all moms are capable of informed decision-making when it comes to infant feeding choices.
One benefit of a Baby Friendly Initiative hospital is that all nursing staff will receive the same training. Therefore, the information provided to new moms should both be accurate and consistent. There are many misconceptions about breastfeeding, and hopefully teaching new moms will help spread the word and ultimately increase exclusive breastfeeding rates worldwide.
However, it can be very difficult for nurses to provide this information without appearing too pushy or judgmental. There is a risk that if this topic is not approached correctly, it could lead to a lack of trust, the mom becoming guarded if there is a breastfeeding concern, and the mom deciding to make the switch to formula once out of the hospital.
This can be a concern as the nurse won’t have a chance to discuss formula feeding with the mom while in hospital, as we are not to give out information on formula feeding unless a mom requests.
Breast Expression and Cup-Feeding
I love this part about the Baby Friendly Initiative. In their training, the Baby Friendly Initiative recommends teaching all new moms how to manually express their breasts. Not only does the extra stimulation post-feed help a moms milk come in, but also gives baby something to eat while mom and baby are still trying to figure out the latch. Breast expression and cup-feeding puts less stress on obtaining the perfect latch, and more on mom and baby bonding.
Many moms are simply not comfortable manually expressing their breasts, especially with their husband, visitors and even the nursing staff around. Completely understandable, but I have seen many sleepy babies with poor latches and no audible swallowing.
Cup feeding a moms colostrum could prevent the downward spiral of sleepless nights for mom and baby, the need for supplementation with formula, reduced milk supply, and the mommy guilt and feelings of failure.
When a mom manually expresses, she often thinks that she does not have enough milk to satisfy her baby. But she does! A newborn infants stomach is only the size of a chickpea, so the few drops you see in a medicine cup or spoon is all your baby needs.
If your nurse wants to teach you how to manually express and cup feed, try it! While you’re at it, you can express your milk post-feeds, apply it to your nipples and allow to air dry to help prevent infection and ease nipple pain.
Every baby that does not need medical intervention at birth should be placed on their mom skin-to-skin, for as long as possible. Not only does this help with mother-infant bonding, but also helps ease a baby’s transition into her new world and does wonders to regulate body temperature.
Skin-to-skin has been a gold standard within labour and delivery for many years, but hospitals with the Baby Friendly Initiative designation will go one step further by having policies and staff education in place to make sure skin-to-skin is advocated for at every opportunity. Right now our hospital is working on a policy to implement skin-to-skin immediately after caesarean sections! Very exciting stuff.
24 Hour Rooming In
While our hospital has not yet reached a Baby Friendly Initiative designation, our moms and babies have been rooming together for much longer than I have been working. The benefits of rooming in to mother-infant bonding are tremendous, but there have been times when I have offered to take a baby out of the room at night for short periods.
Usually I do this when it is 3 am and mom and baby have not slept at all. Baby has cluster fed, moms nipples are sore, and she can barely keep her eyes open let alone care for her newborn baby. Or, a mom who laboured for 24 hours, ended up not progressing and is now recovering from an unplanned cesarean section. These moms are exhausted, and these babies just want to be held. Co-sleeping of course is not recommended due to the risk of SIDS.
I would never, ever, provide formula or pacifier to a newborn at night without her mom knowing, but sometimes if it is quiet on the floor I will rock and hold a baby to sleep so her mom can get some much-needed rest.
Hopefully with manual expression and cup feeding, these sleepless nights will be fewer between for our moms and babies. Unfortunately we will no longer be able to offer taking a baby out of the room to give the mom a break.
Formula Only if Medically Indicated
I have heard a lot of moms at my local mom group mention that their night nurses would suggest a bit of formula to top their babies off when they were fussy, and most often moms regretted doing it.
I can say that without a doubt, that these night nurses were not out to get anyone. They probably wanted you and baby to get some rest. With a starving baby with a poor latch and an exhausted mom, everyone will just keep spinning their wheels.
However, giving formula to a baby whose mom has chosen to breastfeed is not the answer, unless it has gone too far. If a baby is too sleepy, her sugars are too low, her weight has dropped below the recommended loss, or mom is taking a medication in which breastfeeding is contraindicated (which doesn’t happen very often), your baby may need to be supplemented with formula.
If your hospital has a Baby Friendly Initiative designation and has a formula free policy, you may need to go out and buy your own formula while in hospital, or they may provide small amounts at a time in a label-free bottle. I have heard of cases where moms must sign a waiver or sign out formula each time they give it to their baby.
While many moms (and even nurses) may see these requirements as formula shaming tactics, in actuality they are in place to ensure that moms and hospital staff are on the same page, and so that no mom feels coerced into formula feeding their baby.
No Bottles or Pacifiers
The use of bottles and pacifiers with breastfed babies is frowned upon within a Baby Friendly Initiative designated hospital. When a bottle is introduced to a baby early, it can be a slippery slope as moms milk supply can dwindle from decreased stimulation, and baby enjoys the ease of use bottle feeding provides.
Pacifiers are not recommended when a moms milk supply is still being established as having your newborn suck on a soother may reduce the time spent at the breast.
Manually expressing/ pumping and then cup feeding your baby can be a great option when a mom is unable to breastfeed for whatever reason. Feeding your baby formula from a cup or spoon, learning paced bottle feeding, feeding small amounts at a time and pumping your breasts during each feed can really help ease the transition back to breastfeeding.
This is very different for a mom who has made an educated decision to formula feed or if a mom is unable to breastfeed her baby. For these babies, bottle feeding will most likely be the easiest option. In addition, research now shows that pacifiers used by formula fed infants can actually decrease the incidence of SIDS and therefore their use is recommended.
No Samples Allowed
One of the main facets of the Baby Friendly Initiative, is that moms should have the ability to be free from baby product advertisements while in hospital. Most hospitals receive free samples from companies to provide to their patients. While many of these are not formula feeding related, they will still need to be removed in order to reach the Baby Friendly Initiative designation.
This means that moms and babies will not receive many of the samples that previously were provided, such as lanolin cream or Johnson & Johnson baby wash, unless the hospital pays for it from their own pocket. The public hospitals in my area have been at a 0% budget increase for the past three years, and the likelihood of having extra cash to give out samples to new moms is very slim.
Please don’t be terribly offended if we don’t have any samples to give you and have to ask that you go get a product from the local pharmacy! If we could give it to you, we would.
Linking Up With Community Resources
Before you are discharged from hospital, as a new mom you should be provided a list of community resources to help you with breastfeeding.
Since hospital stays for postpartum moms and babies range from 24 – 72 hours, there isn’t much time for nurses to make sure feeding is going well. Of course we do our best to help you, but it is nice to know that there are many resources available near you if you hit a speed bump along the way. These may include:
- La Leche League
- The MotHERS Program: Telehealth Ontario has a separate line for breastfeeding moms
- Lactation Consultants and breastfeeding clinics in your area
- In home visits by a public health nurse
Is My Hospital Baby Friendly?
The Baby Friendly Initiative is meant to be just that – baby friendly. It is all about educating families, providing resources, assisting with infant attachment and doing what is best for your baby.
If you want to know if your local hospital has or is trying to obtain a Baby Friendly Initiative designation, feel free to contact your Labour and Delivery ward or ask your obstetrician at your next appointment.
Currently, only three hospitals in Ontario have achieved this designation, including St. Joseph’s Health Care in Hamilton, Grand River in Kitchener, and Toronto East General but many other hospitals are working towards it. You can see the whole list of BFI facilities in Canada HERE and in the United States HERE.
Knowing ahead of time what to expect at your hospital may help you as a mom have the enjoyable experience that you are meant to have with your beautiful new baby. I hope this helps you understand more about the Baby Friendly Initiative designation.
Have you heard of the Baby Friendly Initiative? If you have comments or experiences, please share below!
xo, The Mama Nurse