Baby Friendly Initiative Hospital Experience

I delivered Melody at Madison Hospital in Madison, AL. Madison Hospital is currently pursuing the "Baby Friendly" designation. The practice that I use only delivers at two hospitals locally. Both hospitals are pursuing this designation. We did tour both hospitals, and we were made aware of the hospital's goals at achieving this rare designation. During our tours, we really were not that concerned with this. One reason being that we had no choice. With both hospitals doing this, it really had no impact on which hospital we decided to deliver Melody in. The second reason is honestly, we did not realize the impact this would have on us (more about that below).

What does Baby Friendly mean?

Baby Friendly is a fairly new concept here in North Alabama. I say that because I have had friends who delivered babies in the last 3 years or so that did not have this same experience. There are many articles on the internet that can give a much better explanation of Baby Friendly (Wikipedia, Baby Friendly USA, and al.com). However, here is my interpretation in a nutshell. The goal of the hospital is that your baby is in your room for 24 hours a day. As soon as you deliver your baby (whether it be vaginally or via c-section), skin-to-skin contact is immediately performed between baby and mom if possible. They want this to last at least an hour. All the tests that need to be performed in this first hour are performed with the baby on mom when possible. I believe it is even the goal for breastfeeding to start within this first hour (if breastfeeding is the plan). After skin-to-skin, the baby still stays in the room with mom and dad. The bath, check ups, and all remaining tests are performed in room. From my understanding, the only thing that is required to be performed in the nursery is circumcisions.

Immediate skin-to-skin contact after delivery

The nursery is not what it used to be. While there are beds and a window for people to peek in to the nursery, babies are not kept there. Babies are always in your room. There is a bassinet that is kept in your room. It is on wheels, so if the baby does need to be transported somewhere outside of your room, it does so in the bassinet. Every time I ever passed the nursery (whether on a tour or while in the hospital), the beds were empty and the lights were dim. In the movies and tv shows, you always see people standing outside of the nursery windows staring in at all the newborn babies. That is not the baby friendly way!

It is my understanding that the hospitals are doing this as a way to start the bond between mom and baby sooner and to better establish that bond. By the baby never leaving the room, the parents can continuously bond with baby. It also supposedly allows you to learn your baby and their cues. You can learn the baby's cries and learn its needs. You will be better prepared when you leave the hospital with this newborn baby. At least this is what they tell you...

Our Story

I have already wrote in detail about Melody's birth story. Her birth story dramatically impacts the experience we had with the baby friendly hospital. If you don't want to read all the intense details about her birth story, I will summarize it for you.

I had a rough labor. My epidural wore off during labor and everything the doctors tried to do to help with the pain would cause Melody to go into distress. Therefore, I had to deliver epidural-free (this was definitely not my birth plan). After delivery, I started having postpartum hemorrhaging. I had to have surgery to stop the hemorrhaging. The surgery caused Brad to take the lead with Melody. I was unable to walk for almost 36 hours or more. He had to solely take care of Melody until I was out of surgery. This meant feeding, diapering, and just taking care of her. My parents were able to come help him during my surgery, but after the surgery he still had to take on most responsibility due to my lack of mobility. That is enough background to understand our experience as I describe it below.

Our Experience - Feeding

One of the first things you are asked when you are admitted into the hospital for labor and delivery is your plans for feeding your newborn. Brad and I already had a plan. I wanted to breastfeed but via a bottle. I did not want to breastfeed directly from the breast. This was our choice regardless of reasoning. I told the staff this from the beginning. My ultimate plan was/is to pump and feed from bottles. I already knew Melody's pediatrician approved of this method, so I really did not care what the hospital's view was because I knew what we wanted to do. The nurse who admitted us was accepting of this plan.

Because of my postpartum hemorrhaging, I was unable to attempt breastfeeding directly after Melody's birth. Brad had to feed Melody himself using formula while I was in surgery. I did not attempt feeding Melody until the morning after she was born. I reminded the new nurse what our intentions were regarding pumping and breastfeeding. The nurse proceeded to question my intentions. She wanted to know why this was our plan, and when I attempted to explain it to her in my anemic and pained state, she wanted to argue about how I was wrong and they do not recommend my method of feeding Melody. I caved to the nurse primarily because I did not have the energy to argue. Looking back, Brad wishes he would have stepped in, but he really had no way of knowing I caved due to my lack of wanting to argue. He wanted it to be my decision.

So I attempted to breastfeed Melody directly from my breast. Breastfeeding was extremely hard and uncomfortable. First, she did not latch immediately. The nurse provided me with a nipple shield to use to help her latch. She latched to the nipple shield without issue. Then I struggled to find a position to hold her to feed her due to all of my IVs. I could only get her to latch to my right breast with the nipple shield. She would not latch to my left breast. The nurse provided me with a pump to attempt to pump from the left breast, but I was unable to get anything when I pumped. I questioned whether Melody was getting anything when she latched to my right breast, but the nurse assured me she was.

Notice the awkward placement of the IV lines which made breastfeeding difficult.

On Friday, I was able to get Melody to latch to my breast directly but still only my right breast. The lactation consultant reviewed our chart where we noted her diapers. We also voiced concern regarding her intake and whether she was truly getting anything. She gave us permission to use a formula supplement, but we had to give it to her via syringe. This was so that we did not cause nipple confusion. So Brad and I worked together to give her the formula via syringe.

Friday night Melody would NOT stop crying. She literally cried ALL night. My assumption was that she was hungry, so I fed her. I fed her almost once an hour that night. All I did was cry the entire time too. It was SO painful. I was still unable to produce anything via pumping, and since she was only latching to one breast, it started to bleed. It was the most painful thing. I was literally at a point of wanting to breakdown and quit. No one provided any support or help. The nurses said this was part of breastfeeding and continued to tell me that she was getting what she needed.

On Saturday, I saw a different lactation consultant. She encouraged us to "prime the pump". This meant Brad would use the syringe to insert the formula into the nipple shield. This would allow Melody to get fed, but also continue to learn to latch. This consultant told us that there was a good chance that due to my hemorrhaging I was not yet producing milk or colostrum. It would take me longer than others for my supply to build, and I would need to use formula supplement until I started producing.

By Sunday, Melody was down one pound from her birth weight...ONE POUND. I solely blame this baby friendly craze as to why my baby lost so much weight. The staff was so focused on forcing me to breastfeed, that they forgot the bigger purpose. My baby needs to be fed. I know she cried and cried on Friday night because she was starving. I mean she lost 14% of her birth weight in 3 1/2 days. The hospital pushes breastfeeding to an extreme. It is so unfair that my baby (and other babies) have to suffer because of this.

To make matters worse, even after we were discharged, the lactation consultant still pushed us to use that nipple shield to feed Melody formula. When I told her I wanted to bottle feed breastmilk, all she kept saying was it would cause nipple confusion. Well I have no desire for her to attach to my nipple, so what does it matter? Secondly, how is using a nipple shield any different than using a bottle in terms of nipple confusion? That's right, there isn't.

I am happy to say we are now feeding Melody via a bottle using exclusively breastmilk. She has been off formula since she was a week old. It took us longer to get on the plan we originally wanted, but we finally were able to achieve it. I think every mom should be able to decide what she wants to do about feeding her baby and the hospital should respect that and help the mom fulfill her plan. If a mom wants to formula feed, she should not feel bad for that. If a mom wants to breastfeed but can't, the baby should not starve because they want to push breastfeeding so much. This causes so much more pain to the mom than is necessary. I think it actually has a negative impact on the mom and will cause her to give up on breastfeeding altogether. Again, my stance is that the mom should get to do what she wants and the hospital should respect that!

Our Experience - Nursery

During my surgery, Brad and my parents took care of Melody. I got out of surgery extremely early Thursday morning. When I got back to the room, we were ALL exhausted. It had been well over 24 hours since Brad had slept. My only sleep came in the form of anesthesia. My dad and mom were also working on very little sleep. Brad asked our nightshift nurse if she could take Melody to the nursery so that we could all get a few hours of sleep. Without question, that nurse agreed to our request and whisked Melody away.

Brad is finally getting some sleep after our long labor and delivery (and surgery).

Around 8:30 a.m., the nurse returned with Melody so that I could feed her. Melody stayed in our room all day Thursday. This was really hard on Brad. I could not walk at all on Thursday. Anytime she needed anything, he had to take care of it. He had to change every diaper, he had to clean up every spit up, and he had to bring her to me anytime I wanted to hold or needed to feed her. He literally had to do everything because I was useless.

Thursday night, Brad requested Melody be sent to the nursery again. He asked the nursery nurse instead of my nurse because that was who was in our room. She was not happy about this request, but she took her anyway. She was sure to bring Melody to me to "attempt" feeding her. They only kept her for a few hours, and the nurse was very rude and unhappy about it.

Friday night was the worst. We were transferred from LD&R to a mother/baby room earlier Friday evening. We were assigned different, less attentive staff. This was the night Melody decided to cry ALL night. As I stated before, I assumed she was hungry and continued to try to breastfeed. It hurt, I cried, she cried, we all cried. It was awful. My nurse walked in at some point in the middle of the night to take some blood for my lab work, and she heard all the crying. Brad asked the nurse if we could send Melody to the nursery for a few hours so we could get some sleep. The nurse literally looked at Brad, ignored his request, and looked back at me to continue my blood work. It was so rude and unnecessary. She later told us all Melody wanted was to suck on something and to put our finger in her mouth. So we sat with a finger in her mouth all night to appease her. We finally got a nurse that would at least give us a pacifier, but she had to read us a statement about how a pacifier could negatively impact breastfeeding and we had to agree to the risks before she could give it to us.

One nurse's solution instead of a pacifier

All of this is because of the baby friendly initiative. The nurses don't want to take babies to the nursery because it negatively impacts their attempt at getting the baby friendly designation. It also causes someone to have to actually be in the nursery with the babies. I think the rooming-in aspect is positive for most, but I don't think it should be required or forced upon parents. I think parents should have the option to send their babies to the nursery if they want. In our case, I had to recover and this put the sole responsibility on Brad. That isn't entirely fair to him. On top of that, it is hard to recover when I can't sleep because I am constantly checking on the baby or the baby is crying.

Overall

I think the baby friendly initiative has a lot of positive aspects, but I do not think it should be enforced on every mom and baby. I think parents should still have the options they once had prior to this initiative. This initiative also impacts more than just the mom, dad, and baby. Pediatricians, Obstetricians, and Nurses are also dealing with the pros and cons of this change. Pediatricians are now having to go room to room to visit each baby instead of just going to the nursery and seeing them all at once. Obstetricians are now having to make sure they are not bothering the mom when the pediatricians are in the room. And now there is not a need for as many nurses to be in the nursery which impacts jobs. I am not saying this initiative is bad or is unwarranted, but again, I think it should not be forced onto every patient.