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When I was pregnant with my oldest, there was so much to learn, and there were so many questions to ask. I was comfortable with my OBGYN practice and confident in my healthcare professional there, so my husband and I didn\u2019t look too closely at the practices of our chosen hospital. My pregnancy was low-risk, and we knew many others who had good experiences delivering there.\u00a0<\/p>\n\n\n\n
Naive to the world of labor, delivery, and postpartum, I was under the impression that low-intervention labor and support for breastfeeding would be everyone\u2019s priority. After all, it was easy enough for me<\/em> to understand the benefits of natural childbirth<\/a> and breastfeeding<\/a>, and I wasn\u2019t even a medical professional.<\/p>\n\n\n\n The birth of our oldest was a cascade of interventions; not at all what I had hoped. My breastfeeding journey was equally misleading and frustrating. After appointments with the hospital lactation consultants, attempt after attempt to help our oldest latch and transfer milk, and so many tears, my husband and I agreed that bottle feeding expressed breast milk was best.<\/p>\n\n\n\n With our second child, we did our research, hired a doula<\/a>, wrote and discussed a detailed birth plan with our healthcare professional, and felt more confident. Our second\u2019s birth story was much better, but our breastfeeding journey found us back at bottle feeding expressed breast milk. After 26 months of pumping to bottle feed expressed breast milk, my husband and I agreed that the breastfeeding journey with our third baby needed to look different.<\/p>\n\n\n\n Halfway through my third pregnancy we moved, which required searching for a new healthcare professional and choosing a new hospital for delivery. With only two hospitals to consider, I began doing my research and settled on the hospital where my prenatal care could be through a midwife and where the facility maintained a Baby-Friendly designation. <\/p>\n\n\n\n Prior to my third pregnancy, I had not heard of a Baby-Friendly Hospital Initiative (BFHI) facility. However, in recent years, Baby-Friendly designations have climbed to approximately 600 certified facilities in the United States and more than 20,000 maternity facilities worldwide<\/a>.<\/p>\n\n\n\n The Baby-Friendly designation by the BFHI refers to the policy and procedure after a baby is delivered, directed towards a successful breastfeeding journey for mothers and babies. BFHI is a global effort through UNICEF and the World Health Organization (WHO) to designate facilities that are implementing practices they believe protect, promote, and support breastfeeding. Baby-Friendly USA<\/a> recognizes United States birthing facilities that have achieved the Baby-Friendly status outlined by global BFHI standards and the USA specific standards. <\/p>\n\n\n\n The Baby-Friendly designation by the Baby Friendly Hospital Initiative refers to the policy and procedure after a baby is delivered, directed towards a successful breastfeeding journey for mothers and babies. BFHI is a global effort through UNICEF and the World Health Organization (WHO) to designate facilities that are implementing practices they believe protect, promote, and support breastfeeding.<\/p><\/blockquote><\/figure>\n\n\n\n Baby-Friendly USA has outlined Ten Steps to Successful Breastfeeding<\/a>, which are the ten steps hospitals and birthing facilities must adhere to to receive and retain a Baby-Friendly designation in the initial 5-year designation cycle, and thereafter in a 2-year redesignation process<\/a>. The Ten Steps, reproduced below, include two critical management procedures, and eight key clinical practices:<\/p>\n\n\n\n Surprisingly, these Ten Steps do not<\/em> require certified lactation consultants to be on staff; instead, 80% of all labor and delivery, postpartum and\/or newborn direct care providers must be competent in several facets of helping mothers in the nourishing and nurturing of their babies. These include:<\/p>\n\n\n\n Common misunderstandings<\/a> of Baby-Friendly designated facilities tend to center around thinking the facility requires breastfeeding, does not allow pacifiers, or demonizes formula. In truth, Baby-Friendly facilities have policies and protocols in place to ensure mothers have the education and resources available to make an informed decision about how to nurture and nourish their baby without<\/em> the interference of commercial marketing and product placement that frequently occur in hospitals due to formula industry influence.<\/p>\n\n\n\n Breastfeeding, while mutually beneficial for moms and babies, is physically, mentally, and emotionally draining in the initial days and weeks postpartum. In communities that may not prioritize or appreciate breastfeeding, it can also cause social stress for both mom and baby. Beyond care provided by Baby-Friendly designated facilities for the first 24-48 hours of a baby\u2019s life, mothers and babies need a supportive community around them for the duration of breastfeeding to make it a possibility.<\/p>\n\n\n\n Follow-up care and support looks different in every community, and while the Baby-Friendly designation requires facilities to link mothers to lactation-support resources in their local community upon discharge, these recommendations<\/a> are based on what support systems exist in your community through \u201cprimary health-care centers, community health workers, home visitors, breastfeeding clinics, nurses\/midwives, lactation consultants, peer counsellors, mother-to-mother support groups, or phone lines (\u201chot lines\u201d).\u201d <\/p>\n\n\n\n While it is a Baby-Friendly designated facility\u2019s goal to ensure a successful breastfeeding journey, mothers birthing at a Baby-Friendly facility are not required to breastfeed nor is the success of their breastfeeding journey guaranteed. <\/p>\n\n\n\n Studies are conflicted on whether or not Baby-Friendly designation actually matters when it comes to the success of a breastfeeding journey and the health of mom and baby. <\/p>\n\n\n\n Recent articles published in Women and Birth<\/em><\/a> <\/em>as well as Journal of Neonatal Nursing<\/em><\/a> note a significant difference in breastfeeding rates and maternal satisfaction among mothers who have experienced the Breastfeeding Hospital Initiative (BFHI) compared to mothers who have not [1][2].<\/p>\n\n\n\n However, the Center for Women’s Mental Health raises the question: Does Baby-Friendly Have to Be Mom-Unfriendly?<\/a> Stating that, \u201cWhile these [BFHI] recommendations are based on solid scientific research and are designed to promote and support breastfeeding, the rigidity and specificity of these guidelines may place undue pressure on new mothers and may be overly demanding\u201d (Center for Women’s Mental Health, 2017)<\/p>\n\n\n\n The Center for Women’s Mental Health raises the question: Does Baby-Friendly Have to Be Mom-Unfriendly? Stating that, \u201cWhile these [BFHI] recommendations are based on solid scientific research and are designed to promote and support breastfeeding, the rigidity and specificity of these guidelines may place undue pressure on new mothers and may be overly demanding.<\/p><\/blockquote><\/figure>\n\n\n\n Massachusetts General Hospital earned its Baby-Friendly designation in 2016, and since earning the designation, the hospital has \u201cheard stories from mothers who have found the new baby-friendly approach to be less than friendly to new moms\u201d (Center for Women’s Mental Health, 2017).<\/p>\n\n\n\n A 2016 publication by JAMA Pediatrics<\/a> concludes that \u201cUnfortunately, there is now emerging evidence that full compliance with the 10 steps of the [Baby Friendly] initiative may inadvertently be promoting potentially hazardous practices and\/or having counterproductive outcomes\u201d [3]\n\n\n\n Lindsay Cantwell of Montana State University agrees after completing a study seeking to improve sleep opportunities in hospitalized postpartum mothers (Cantwell, 2022)<\/a>. Cantwell (2022) accepts \u201cthe Baby-Friendly Hospital Initiative creates many benefits for breastfeeding and mom\/infant bonding, but maternal recovery needs are often not addressed.\u201d<\/p>\n\n\n\n Cantwell (2022) asserts that, \u201cIdeally, this [Baby-Friendly] care model should incorporate intentional nursing strategies to promote rest and recovery for new moms following delivery while maintaining baby-friendly care.\u201d <\/p>\n\n\n\n Cantwell\u2019s findings underscore the critical relationship between poor sleep and increased risks of postpartum depression and other adverse health outcomes. Cantwell notes that \u201cThe paradigm practice change in hospitals from nursery-assisted care to Baby-Friendly care has likely contributed to the exacerbation of maternal postpartum sleep disruption due to infant-caregiving duties\u201d and proposes the Baby-Friendly Hospital Initiative continues with the rooming-in protocol and incorporate an offer of quiet time the nurses can offer and chart as offered and accepted, or offered and patient declined (Cantwell, 2022).<\/p>\n\n\n\n The postpartum plans for our second baby\u2014not birthed in a Baby-Friendly designated hospital\u2014included rooming-in and all tests, care, etc. be done in our room or presence. This plan was respected and our newborn was with us for the entirety of our hospital stay. While I do not remember our level of fatigue, I do remember the lack of assistance with latching our newborn. The staff was quick to suggest I pump and bottle feed expressed breastmilk if breastmilk was our plan.<\/p>\n\n\n\n We left that postpartum hospitalization experience feeling respected but not supported.<\/p>\n\n\n\n The postpartum plans for our child birthed in a Baby-Friendly designated hospital also included rooming-in and all tests, care, etc. to be done in our room or presence. This plan was respected; however, when the option to have a test done out of our room was given, we agreed to let the test be done out of my room. With the support of Rachel\u2014the lactation consultant who guaranteed she would walk with me for as long as needed so I would be able to feed this baby at the breast\u2014I nursed our newborn immediately before the brief test. It gave me time to rest and breathe knowing our newborn would be brought back immediately should she show signs of hunger or distress.<\/p>\n\n\n\n Even now, I remember how a short 30 minute \u201cquiet time\u201d (Cantwell, 2022<\/a>) in our 24-hour stay made a significant difference in my well-being.<\/p>\n\n\n\n We left that postpartum hospitalization experience feeling respected, supported, and equipped.<\/p>\n\n\n\n A 2022 publication in Midwifery<\/em><\/a> has the pulse on the benefits and pitfalls of Baby-Friendly designations, summarizing that, while their study results indicate that a BFHI designation improves breastfeeding outcomes, \u201cMaternal perceptions about the impact of BFHI designation are important to consider because mother\u2013infant dyads are at the centre of that support, and their viewpoint may help to assess whether the designation to the BFHI in the unit is successful.\u201d [4]\n\n\n\n What the mom and baby experience in the hospital and how respected, supported, and equipped they feel leaving the hospital matters most.<\/p>\n\n\n\n What the mom and baby experience in the hospital and how respected, supported, and equipped they feel leaving the hospital matters most.<\/p><\/blockquote><\/figure>\n\n\n\n If breastfeeding is your nurturing and nourishing goal and you are birthing in a Baby-Friendly designated facility, their policies, protocols, and resources may increase the success of breastfeeding without adding to your mental load during labor, delivery, and postpartum recovery. Yet, it may still be important to advocate for your rest as a mom to a newborn.<\/p>\n\n\n\n For expectant moms not birthing at a Baby-Friendly designated facility for whom breastfeeding is your nurturing and nourishing goal, it is typical to tour your birth facility around 30 weeks pregnant (for first time moms). Whether touring or simply calling the Labor and Delivery unit, plan to ask about the birthing facility\u2019s policies, particularly around skin-to-skin, lactation support, rooming-in, couplet care, and formula supplementation. This information will aid in helping you craft (and Dad to support) a postpartum plan specific to you and your baby\u2019s nurturing and nourishing goals regardless of the birthing facility\u2019s standard practices.<\/p>\n\n\n\n If breastfeeding is not your plan or you are preparing for a challenging feeding journey (possibly due to your or your baby\u2019s health needs, employment situation, etc.), Baby-Friendly designated facilities have plans to support that journey. These plans<\/a> include teaching about hygienic expression of breast milk or safe preparation of infant formula, as well as safe storage of expressed breast milk and\/ or infant formula. <\/p>\n\n\n\n While the Baby-Friendly hospital experience was a fit for my birth plan, it’s important to look at all the facts. Are the Baby-Friendly clinical practices consistent with your plans for birth and breastfeeding? Do the strengths outweigh the criticism in your estimation? And, very importantly, after visiting with and questioning your local hospital, do you feel safe and supported? Choosing the right facility for your baby\u2019s birth is not always cut and dry\u2013Baby-Friendly facilities may be one option for you as you make a decision.<\/p>\n\n\n\n <\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":"\u0418\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f, \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u0430\u044f \u0434\u043b\u044f \u0432\u0437\u0432\u0435\u0448\u0438\u0432\u0430\u043d\u0438\u044f \u0432\u0441\u0435\u0445 \"\u0437\u0430\" \u0438 \"\u043f\u0440\u043e\u0442\u0438\u0432","protected":false},"author":140,"featured_media":23640,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","csco_singular_sidebar":"","csco_page_header_type":"","csco_page_load_nextpost":"","csco_post_video_location":[],"csco_post_video_url":"","csco_post_video_bg_start_time":0,"csco_post_video_bg_end_time":0,"footnotes":""},"categories":[5336,5378,5185],"tags":[6415,5411],"class_list":{"0":"post-23638","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-breastfeeding","8":"category-labor-delivery","9":"category-pregnancy-childbirth","10":"tag-birth","11":"tag-breastfeeding","12":"cs-entry","13":"cs-video-wrap"},"acf":[],"yoast_head":"\nMy birth and breastfeeding journeys<\/span><\/h2>\n\n\n\n
Baby-Friendly (BFHI) designated facilities<\/span><\/h2>\n\n\n\n
Baby-Friendly USA\u2019s Ten Steps to Successful Breastfeeding<\/span><\/h2>\n\n\n\n
Critical management procedures<\/span><\/h3>\n\n\n\n
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Key clinical practices<\/span><\/h3>\n\n\n\n
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Surprising things the BFHI designation doesn\u2019t<\/em> require<\/span><\/h2>\n\n\n\n
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Do Baby-Friendly facilities require breastfeeding, ban pacifiers, or demonize formula feeding?<\/span><\/h2>\n\n\n\n
Does a Baby-Friendly designation matter?<\/span><\/h2>\n\n\n\n
In our experience<\/span><\/h2>\n\n\n\n
Perception matters<\/span><\/h2>\n\n\n\n
When your goal is to breastfeed<\/span><\/h2>\n\n\n\n
What if you\u2019re not going to breastfeed?<\/span><\/h2>\n\n\n\n
The bottom line: Should you give birth at a Baby Friendly Facility?<\/span><\/h2>\n\n\n\n
References:<\/span><\/h4>\n\n\n\n[1] Wei Fan, Y., Sze Lok Fan, H., Sheung Yu Shing, J., Lam Ip, H., Yee Tak Fong, D., and Yuet Wan Lok, K., March 2025, Impact of baby-friendly hospital initiatives on breastfeeding outcomes: Systematic review and meta-analysis, Women and Birth<\/em>, 8.2, https:\/\/doi.org\/10.1016\/j.wombi.2025.101881<\/a> <\/p>\n\n\n\n[2] Abu El-Shaer, A.R, Harbi, A.S, and Al-Harazneh, R.W., 2024, Impact of baby-friendly hospital initiative on exclusive breastfeeding rates and mother satisfaction, Journal of Neonatal Nursing<\/em>,30.6, 701-706.<\/p>\n\n\n\n[3] Bass, J. L., Gartley, T., & Kleinman, R. (2016). Unintended consequences of current breastfeeding initiatives. JAMA Pediatrics, 170<\/em>(10), 923\u2013924. https:\/\/jamanetwork.com\/journals\/jamapediatrics\/article-abstract\/2546142<\/a><\/p>\n\n\n\n[4] Lojander, J., Axelin, A., Bergman, P., & Niela\u2011Vilen, H. (2022). Maternal perceptions of breastfeeding support in a birth hospital before and after designation to the Baby\u2011Friendly Hospital Initiative: A quasi\u2011experimental study. Midwifery, 110<\/em>, Article\u202f103350. https:\/\/doi.org\/10.1016\/j.midw.2022.103350<\/a><\/p>\n\n\n\n