Dive Brief:
- Adherence to the Baby-Friendly Hospital Initiative, which places a high maternity ward focus on steps to promote breastfeeding, can inadvertently result in unsafe care practices, a new paper in JAMA Pediatrics suggested.
- The movement has previously been accused of being "mother-unfriendly" and inconclusive in its effectiveness, Slate noted, adding that the new study is taking the strongest opposition stance in questioning its actual safety.
- The researchers conclude with the argument that the Office of the Surgeon General needs to reconsider its position advocating accelerated implementation of the initiative at U.S. hospitals, which currently have a participation level of nearly 17%.
Dive Insight:
The Baby-Friendly Hospital Initiative, which was created by UNICEF and the World Health Organization in 1991 and endorsed by HHS in 2010, asks hospitals to follow 10 rules to promote breastfeeding. The JAMA researchers said having hospitals do so may actually work against their goal, and at worst, put infants at risk.
The rules include having babies room in with their mothers, banning pacifiers, and avoiding formula unless medically necessary.
“Unfortunately, there is now emerging evidence that full compliance with the 10 steps of the initiative may inadvertently be promoting potentially hazardous practices and/or having counterproductive outcomes,” wrote the authors, pediatricians Joel L. Bass, Tina Gartley, and Ronald Kleinman
They argued that leaving infants unsupervised with exhausted or even sedated mothers for the sake of skin-to-skin contact and feeding brings an increased risk of Sudden Unexpected Postnatal Collapse (SUPC), which can require full resuscitation. In addition, there there is no hard evidence that early use of formula decreases breastfeeding later, according to the research, pointing toward some research suggesting it may improve breastfeeding rates by reducing mothers' early stress.
The authors also took on the pacifier ban, pointing out that it has been connected to a reduced risk of sudden infant death syndrome (SIDS), which can often follow SUPCs.
They suggested that rather than the initiative's rigid rules, breastfeeding concerns need to be balanced and integrated with safe sleep practices.