What makes a hospital "baby friendly"?

The hospital where we welcomed our third child began a shift to a “baby friendly” hospital in the time between when we had the twins and our third. While we absolutely love the hospital - enough to go back for our third - and the nurses and other staff there, I’m not sure I’m completely down with the changes we noticed as part of this transition. While I applaud the ability for mothers to chose their preferred methods of bonding with their children and appreciate the support, I actually found a few of the changes to present less choice for parents and it made me worry about how our experience would have differed with the twins had they done it earlier.

The main aspects of a “baby friendly” hospital are support for breastfeeding and rooming in with the baby the majority of the time. These were both actually encouraged during the birth of the twins as well, but not quite as strongly. This time we didn’t even get formula with the other supplies like diapers and wipes while in the room. We explicitly had to ask for it if we wanted it. I felt like this went a little far in that a new parent might think they either couldn’t ask for it, or even if they knew to, wouldn’t want to because having to ask would feel like a failure.

I know my wife had a similar feeling when we had the twins because she wanted to breastfeed, but with twins, it was exceptionally difficult. Getting enough milk to feed two humans is hard enough, but because they were tiny when born, they struggled to even pull enough. We wanted to breastfeed because all the parent blogs talked about how magical it was and how beneficial. We saw formula as a failure of our own parenting abilities. I know this is a huge source of parental anxiety and postpartum stress and depression, so exacerbating it seems highly problematic to me.

I appreciate the additional support theoretically offered for it. Perhaps we got less because we were the “easy” ones on the maternity floor since we were low maintenance and already experienced parents, but we really got no additional breastfeeding advice or support beyond nurses asking twice how it was going. Part of this was that with the Corona Virus keeping staff away, there was no lactation consultant or classes while we were in, but I could imagine a new parent being even more overwhelmed than we had been with the twins.

As a result of relying solely on breastfeeding and not realizing we could easily supplement with formula, then not knowing how much to supplement, we let the twins lose over 10% of their body weight in the first two days, as well as allowing blood sugar levels to drop, resulting in one heading to the NICU for one night. Had we known more deliberately how much to feed them or what was expected for breastfeeding kids like them, we could have easily prevented this. Thankfully there were no long term issues, but it added anxiety during a tough time of parenting. Another of our friends who recently had twins experience the exact same thing even worse. This time we knew that we could and should immediately fall back to formula if needed, though we didn’t need to with one child who was older and more effective at nursing. Still, having that extra support to help us out in the hospital would have been beneficial.

Breastfeeding certainly has benefits, but in my mind, it’s a choice that all parents should get to make based on their own situation. The additional time together for bonding is great for mothers, but I’m actually feeling left out this time compared to with the twins when I spent countless hours bottle feeding them. There may be health benefits especially early on with breast feeding, though even some of these studies are inconclusive, and formula isn’t by any means worse or detrimental. It’s a better option for some situations, and I feel that ignoring it entirely is not right for everyone. It’s fine to encourage and celebrate the benefits of breastfeeding since it can be harder, but that shouldn’t come at the expense of optionality for those that need it.

The other aspect of a “baby friendly” hospital is encouraged and extensive “rooming in”. Rooming in just means that rather than staying in the nursery, babies stay in the room with the parents during almost the entirety of their stay. While the twins had more visits to the nursery for various tests and measurements, it felt like this evolved even further this time to the point where our baby stayed with us in the room completely with only two very short visits to the nursery for blood work. Of the 48+ hours we spent in the hospital, the baby was probably with us for just about 46 of them. This was actually great as it allowed us to get additional bonding time with our baby in realistically the only time we get separate from the twins in his early life.

The final noticeable part of this transition was that pacifiers were no longer provided. We ended up with one after what must have been a noisy visit to the nursery for the 36 hour blood work, so it was unclear if this was intentional or not, but according to “baby friendly” online resources, pacifier use is not recommended or encouraged. With our third child, we really haven’t needed it much at all yet as he seems uninterested in it, but for the twins it was a lifesaver. For their first year and a half of life, it was a big help when they were in difficult tantrums. We also had minimal difficulty getting rid of them at 18 months and haven’t noticed the supposed issues of encouraging thumb sucking or any other dependence. Like breastfeeding, I admire their intention to provide support to reduce this dependency, but it should also be the parents’ choice. Having to explicitly ask for a pacifier can add to parent guilt rather than if it was a clear option. I’d actually like to see them continue to not provide them, but instead of acting like they don’t exist in addition to formula, why not put it as an option for the sake of the environment or other parents on a card like hotels have done for reduced housekeeping? This way the process is the same, but it doesn’t make parents feel as guilty if they need to ask.

I’m not a huge fan of the terminology of a “baby friendly” hospital either. It insinuates that any other choices are not friendly to the baby which is definitively untrue. Reducing the opportunity for choice and discouraging parents from doing what may be best for their families and babies isn’t my definition of friendly. To me, the right priority is to focus on being the most friendly to the whole family and ensuring new parents have the support they need regardless of how they want to or need to raise their children. The first few days with a new baby are the times where parents least need additional stress and anxiety. Suppressing those options for choices can lead to feelings of failure and negative emotions with a new child when it’s supposed to be joyous and amazing. Finding that right balance of support is the best way to be friendly to not only the baby, but the parents as well.