Women across the country are shaking heads and raising their hands in outrage over future hospital policy changes - specifically The Baby Friendly Hospital Initiative, BFHI for short. A system that is optional and hospitals are choosing to participate. The World Health Organization (WHO) and UNICEF have been at the helm of this, worldwide, hospital reform for over five years as a part of their Worldwide Breastfeeding Initiative. The reason the BFHI is suddenly rising blood pressures among exceptant mothers here in the US is that more and more American Hospitals are jumping on board.
As a woman, and a mother I understand, without a moment's hesitation, why my tribe is upset. How can they do this - just remove our option for a service? How can they dictate how we choose to mother our children? You may not intend on breastfeeding, for one of the many personal reasons women have, and now the hospital is exasperating "the choosing not to breastfeed" choice that you have. It feels judgemental, and it doesn't feel fair. I hear you, and I genuinely understand the place from which you are coming.
As a Certified Lactation Counselor (CLC) however, I could not be more pleased about the trend among hospitals in our country! I respect that we all have choices as parents. And, I respect those choices - even those that don't include breastfeeding. However, current statistics tell us that over 85% of women in the US walk into the hospital wanting to breastfeed their babies, exclusively, for three or more months. More so, this number climbs yearly. Albeit only 32.4% of those women reach their breastfeeding goals. What does this tell us?
It says that as a country, we do a fantastic job of telling our mothers how important breastfeeding is for Mom and baby. They are educated about the most nutritious food source for their children and walk into that hospital excited to nurse their future newborns, yet we're not there to support them postpartum. That is a problem, folks! So while it seems like the BFHI is alienating women in their choices, the opposite is true. We are trying to create environments that fully support what the majority of women want. And I think that's a beautiful thing!
I can't tell you how many problematic breastfeeding situations I help solve that are the result of poor, or no, breastfeeding guidance in the critical first 48 hours of the baby's life. Under The BFHI systems, hospital staff is highly trained and prepared to support a new mother so she may have an easier time breastfeeding. As mentioned, the first 48 postpartum are critical to the breastfeeding relationship and provide the only window of opportunity to prime the body, hormonally, for maximum milk volume throughout breastfeeding.
It's imperative for mom and baby to nurse as much as possible during this time, and that means that they need to be together. Enter the "Rooming In" policy. It's this portion of the system, the removal of the opportunity to send your baby to the nursery, that is raising a lot of eyebrows. I promise you, it's not a plan based on judgment, but one founded in science.
Women, we should be celebrating that hospitals are making movements toward evidence-based maternity care, which has long been in issue in American Hospitals. Breastfeeding has become a societal four letter word and ignites passions, but science tells us, a vast body of science says that breastmilk provides the human baby with optimal nutrition (especially in those early weeks!). It's also safest for baby. Did you know that hospitals only serve liquid, pre-mixed formula, due to the high risk of bacteria found in powdered formulas? We hear about the benefits of breastfeeding all the time - we rarely hear about the risks of formula for a newborn.
Hospitals are moving toward the healthiest, and safest decision for their mothers and babies and we should praise that. But yes we, as free, adult, women should have the choice to make decisions about how we choose to nourish our baby and where they should sleep for the night. So let's talk about how you can still have the birth experience you want under the BFHI.
1. Construct a Birth Team
It takes a village, ladies. Put that community to work, ASAP. You are not in this alone just because the nursery is not available to you. I don't blame anyone for not being comfortable to spend the night alone with a baby, you just met, especially if it's your first. Talk to your partner, friends, and family and assign roles. Maybe your partner wants to go home and get some sleep, and you can have a family member or friend stay with you overnight. Just like you would line up someone to care for other children you might have during this transitional time, line someone up to be with you in the room overnight and care for the baby, or offer you help.
Consider hiring a postpartum doula, or better yet hire a doula who specializes in both birth and postpartum support. Doulas are trained and certified to provide support and assistance to mothers. They are an educated, and passionate group of women who want to mother you so that you can mother your baby. Ask your OBGYN/Midwife if they can recommend anyone, or check out www.doulamatch.net.
If a hiring a doula is not possible, I suggest attending a Happiest Baby on The Block class or watch the DVD. Indeed, this does not completely solve the possible rooming in, but it will equip you with fantastic infant soothing skills. You might feel more comfortable with rooming in if you feel more prepared to soothe your baby. Lastly, remember that although hospital staff will no longer take your baby to the nursery in a BFHI Hosptial, they are still available to you as a resource. - All you have to do is hit your call button.
2. Consider Delaying Epidurals
One of the biggest concerns I am hearing from women is that labor is, well, labor! They want to rest and be at 100% at discharge. Or we have women who have had a c-section or other significant interventions and aren't physically mobile enough to get up and move around for a baby. These are legitimate concerns. Let's talk about some ways that you can be proactive about how you might feel in the first hours after delivery. Epidurals, and specifically epidurals administered early in labor are correlated to longer, slower labors with more interventions.
If you can postpone (or do without) the epidural you run a lower risk of being temporarily physically immobilized due to interventions (such as a c-section). You also have a better chance at having a quicker less challenging labor and therefore more energy following delivery. Trust me; I know the elation one feels once that epidural is in place, and that clicker is in your hand - squelch it, and use it sparingly. The more you click it, the number you will be for longer - leaving you unable to care for your baby easily. It can also make pushing difficult because you lack the sensation needed to know when you should push and work with contractions, rather than pushing ineffectively, which leads to more interventions such as c-sections or episiotomies.
3. Own Your Choice & Your Voice
You are entitled to your choice to breastfeed or not to breastfeed. Do not be afraid to be firm. Many women feel powerless in hospitals, as if the second the doors close behind you, you lose your autonomy. Your voice and your choice matter, but you have to speak up, and you may have to be firm. If you feel too out of it, or too uncomfortable to have your baby in your room call a nurse and explain that you need assistance. They may not be able to whisk your newborn away, but you will get support, and if you don't continue up the chain of command.
You have the right to be heard, and the right to ask again. If you don't want to breastfeed, say so. However, understand that you may get push back. That further conversation about breastfeeding is not judgment (it shouldn't be!) about your decisions as a mother but simply a care provider suggesting what they know to be evidence-based optimal baby care.
Of course the most important thing, you can do to have the best birth experience possible, BFHI Hospital or not, is to keep an open mind. Your labor and delivery will probably not go according to your birth plan. And being at peace with this possibility is half the battle.
I love talking about labor and delivery and how they affect breastfeeding and would like to answer any questions you might have. Just fill out the form below.