Childbirth, Postpartum Care, and Breastfeeding in a “Baby-Friendly” Hospital

The hospital where the twins were born is a “baby-friendly” hospital. According to Baby-Friendly USA, that means:

The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. The BFHI assists hospitals in giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.

Our hospital takes pride in having recently achieved “baby-friendly” status, and we heard a lot about it during our childbirth class and hospital tour. The goals of the initiative are admirable, and it leads to a lot of what I saw as benefits in terms of how the mother and baby are cared for in the hospital. Of course, no system is perfect, and the baby-friendly approach has a few problems that I found not conducive to good care, at least as I see it.

I thought I would share my thoughts, based purely on my own personal experience giving birth to twins at my local, baby-friendly hospital, in December of 2015. Of course, my experience may or may not be representative of the baby-friendly initiative over all, and mostly, I assume, reflects the care provided by the specific hospital in question and by their staff in particular.

That said, here are what I saw as the pros and cons of giving birth in a baby-friendly hospital:

PROS:
Skin-to-skin as soon as possible. This is one of the best things that happened in my delivery experience. I had an unplanned C-section, and one of my biggest concerns about having a C-section before the fact was that I might not be able to hold the babies and do skin-to-skin contact immediately after the birth. In the operating room, they did have to give L oxygen immediately after his birth and the surgical team had to sew me up, but immediately after that we were in recovery, holding the babies, doing skin-to-skin, and breastfeeding. That time was really wonderful and will probably always be one of my best memories of the experience.

Quiet time for parents and baby immediately after birth. In the hour or two immediately following the birth, the hospital does not allow anyone into the room other than the mother, baby, and partner/support person. It’s meant to be a quiet time for family bonding before any other visitors are allowed in. In our case, we didn’t have any eager family members out in the waiting room ready for their chance to get their paws on the babies — but if we had? I would have been VERY GRATEFUL for the nurses who would have kept them away during these early hours.

Daily quiet time. Every afternoon there is a two-hour stretch of designated quiet time during which no visitors are allowed in the rooms. Again, visitors weren’t an issue for us (our family lives out of state and came to visit after we were home; we didn’t invite local friends to come to the hospital). This policy was still very appreciated, though, because it turned out that this also meant hospital staff would not come in the room during this time. Sometimes, these two hours were the only respite we got from the unrelenting stream of hospital staff coming in and out of our room. More on that later.

Lactation counselors always on staff. We were really grateful for the help these women gave when it came to nursing, pumping, and eventually formula supplementation. Our current nursing-bottle feeding-pumping regimen was devised by one of these LCs and it has worked out well for us. We were also grateful for the opportunity to check in with the LCs two days after discharge to weigh the babies and revisit our feeding plan.

Babies’ care (tests, bath, shots, etc.) takes place in the room; babies “room in” with mothers/parents. It was really nice not to have to have the babies taken away to the nursery for their standard care. Hospital staff would only take the babies to the nursery if they needed special care, for example, if ours had needed feeding tubes or respiratory help. Healthy babies stay in the room with parents. In our case, E and L were healthy enough to stay in the room with us 24/7, with a couple of exceptions when the nursery staff needed to check E’s lungs for suspected fluid (she was fine).

CONS:

No pacifiers. With the focus on breastfeeding and the fears of nipple confusion, the hospital is anti-pacifier. They will not give out pacifiers, as far as I know, for any reason. During the nights when the babies were going crazy with hunger because my milk had not come in and I couldn’t cluster feed them for any longer, we needed pacifiers. Luckily, we had brought a couple with us — but we basically felt like criminals giving them to the babies! Whenever a nurse or LC would come into the room, I would whisk the pacifiers into my pajama pocket so she wouldn’t see. It doesn’t seem like a great idea to deny parents a tool that might be needed, or to make them feel guilty for employing it. See immediately below for more on this theme.

No formula. Again, due to the emphasis on exclusive breastfeeding, the hospital is anti-formula. We knew this going in, especially after the breastfeeding class we had taken, during which the LC essentially said that feeding a baby formula would turn the baby into an obese, stupid, maladjusted sociopath. (Not much of an exaggeration.) Clearly, breastfeeding is an important ideology here and formula is seen as the enemy.

In our case, we fully intended to breastfeed, exclusively if possible. But we had premature twins who didn’t weigh much to begin with and were rapidly losing weight because my milk had not come in. Three days after their birth, they’d already lost more than 10% of their birth weights. E had gone from 6lbs 12oz to 5lbs 15oz, and tiny L had gone from 5lbs 3oz to just 4lbs 11oz. We were already worried, but we thought we were going to be discharged and planned to give them formula at home until my milk came in. At least they’ll have something to eat when we get home, we said. The hospital had other ideas.

They told us they would not discharge the babies due to their weight loss, and they wanted us to stay for at least another day until they stopped losing weight. But! My milk had not come in! There was no food for them to eat if we stayed in the hospital! How could this possibly make sense?! We knew the hospital did not feed formula and at no time was any formula offered to us.

Finally, as the super-condescending pediatrician (who was refusing to discharge us) was busy mansplaining that my milk should come in “any day now,” my husband interrupted him to ask if feeding formula was something we could do in the meantime. “Well,” said the pediatrician, gesturing at both of us with disapproval, “if that’s something you want to do, the two of you can have that conversation. You can talk about formula and decide if that’s something you want to do.” At this point I had heard enough of his condescension and (I had been crying throughout this conversation) I tearily jumped in and said “We would like to do that. DO YOU HAVE any formula HERE that we can give them NOW?”

At this point the nurse who had also been in the room left without a word and came back with formula for us a few minutes later. So, they DO have formula in the hospital. INTERESTING.

I mean, OF COURSE they have formula in the hospital. Many babies need it for a medical reason. (And in this hospital, it is apparently only given out for medical reasons.) The hospital just hadn’t considered our babies to need it, so they weren’t going to offer it or give it unless we specifically asked. But no one told us we could ask. I basically had to have an emotional breakdown because my babies were starving in order to get desperate enough to demand it.

When the nurse returned with the formula, she quietly told me, “I’m glad you said that. If you hadn’t asked about the formula, I would have told you it was time.” She had the air of sharing a confidence when she said this, as if it was something she wouldn’t have said in front of the doctor or other staff.

Needless to say, this part of the experience really colored my impression of the baby-friendly initiative. Worried parents shouldn’t have to fear that they are starving their babies and be made to feel guilty for asking for food.

Healthy twins gave the impression we needed less help. This is sort of an aspect of the above item, and isn’t specifically tied to baby-friendly policies, but I feel the need to mention it. The hospital had five sets of twins born over the weekend while we were there — a remarkable number for our small town, for sure. All the staff kept mentioning it with wonder. From what I gathered, I think our twins were maybe the only set (or one of two sets?) healthy enough to room in with their parents as opposed to being sent to the special care nursery for extra medical help. I think that because the other twins on the floor needed more help in comparison, and because ours were breastfeeding (even if only colostrum), the staff didn’t think we needed as much help as we really did.

Three patients in the same room. Because the babies room in with parents in a baby-friendly hospital (which is great!), we had three patients in the same room (me and both babies). This led to constant staff intrusions. Nurses, techs, lactation counselors, pediatricians, OBs, cleaning staff, and food delivery people were coming in and out of our room at all times for various tasks. It was insane. The morning we thought we were going to be discharged but weren’t, we had people in our room at all times from 7:00 AM to 2:00 PM, the time when quiet hours began. We never had the room to ourselves for more than 5-10 minutes at a time during those hours. I couldn’t even get dressed after a shower without having to hide from a nurse when she walked in on me while I was naked*. What I learned (too late) was that we could ask staff to coordinate better to avoid so many separate interruptions. If you find yourself in a similar situation, Reader, please ask your nurse to coordinate with the other personnel to minimize the number of separate staff visits.

In general, my impression of the baby-friendly initiative (as represented by my specific experience at my specific hospital) is that it would be better termed “breastfeeding-friendly.” It did not seem particularly friendly to babies and certainly not to parents.

*And here’s a bonus story about the worst nurse of all time:

This nurse, Jean, was the worst nurse of all time. She was on shift the afternoon/evening immediately following my C-section, and she started on the wrong foot by “not hearing” and/or “forgetting” and/or “losing the order” when I asked for my pain meds. It worked out that my first dose of pain medication didn’t come for about two hours after I initially asked for it. Because I was then “behind the pain,” they had to give me an additional med, D3m3rol, to help alleviate it. It made me so out of it that I couldn’t hold a conversation with anyone and I barely remember the first night with the babies. So Jean was on my shit list for this reason already.

That was a Friday night, and we didn’t see her again until Monday, the day we thought we would be discharged, but weren’t. Nurses over the weekend had all been WONDERFUL, so I was certainly dismayed to see Jean again. She managed to annoy me a thousand different ways during the day. She kept calling my son “Lionel,” for chrissakes. Not his name. At one point, I was in bed nursing one of the babies when she said she had to “check my bleeding” and proceeded to pull down my pants to look at my lady business. Oh…kay then? No other nurse had done that since the night of the C-section, when I was immobilized and had a catheter in.

The final straw came that afternoon, when I was sitting in the recliner where I had been trying to nurse E for about an hour. E was angry and feisty (because she was hungry and there was no milk), so latching on was really difficult. Plus, we’d had a steady stream of people interrupting us for the entire time (taking her vitals, taking my vitals, checking her lo-jack ankle tag, and all manner of other reasons). I was stressed and the baby was screaming and arching and bucking and obviously super hungry but not wanting to latch. And, as I mentioned, this had been going on for an hour.

So Jean comes in to “check my bleeding” again and at this point I was like, NOPE. “I am trying to feed my baby right now. Also, no other nurse has had to check my bleeding that way in the past two days, so I don’t think you need to do that. I’d like to decline.” She was nonplussed, to say the least, and tried to persuade me that checking my bleeding was an essential part of her job. Again, NOPE. I was not having it. I was DONE.

To make a long story short, after this horribly awkward interaction, she became convinced that I was emotionally Not Okay, so she had another nurse come in and talk to me. This gave me the opportunity to tell the other nurse that 1) I was emotionally FINE, thank you very much, and that 2) my only problem was that “I [could] not stand Jean and [did] not want to interact with her ever again.” I actually said this. So Our Nurse Jean thankfully became Not Our Nurse Anymore. Suck it, Jean.

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4 thoughts on “Childbirth, Postpartum Care, and Breastfeeding in a “Baby-Friendly” Hospital

  1. Becca S January 19, 2016 / 2:33 pm

    Ha, suck it Jean!

    We had a wonderful postpartum nurse and a terrible nursery nurse, although not to Jean levels. I mean, it IS their job but also they are working with people and should be compassionate and not a-holes. Ahem.

  2. Joanna January 19, 2016 / 3:24 pm

    This just makes me so twitchy. Why can’t there be a happy medium between breastfeeding and formula feeding? I have three children and they were fed three different ways: I nursed my first for 3 months, nursed my second for 10 days, fed my third baby pumped milk for 6 weeks. Whatever gets the baby fed is the best way. And, I’m sorry that what was supposed to be such a beautiful occasion was tarnished (however lightly) by a hospital with such rigid guidelines.

  3. brunbec123 January 20, 2016 / 1:43 am

    Oh, honey! I can’t believe they didn’t offer you formula sooner! I didn’t have a great recovery bonding experience–my sis and mom had that instead of me. I was a little ticked off to find out they (with the nurses’ support) had already given him a tiny bit of formula before I got there. I was given a ton of breastfeeding support while in the hospital, but was also offered formula for supplementation at every feeding that didn’t go well. (Complications after going home resulted in his still-ongoing breastfeeding strike, though–I’ve reluctantly become an exclusive pumper. It sucks, no pun intended.)

    I ultimately dubbed my hospital “mom-friendly”–I felt like they hit a happy medium between encouraging breastfeeding and my independence and providing much-needed support for me overnight as a single mom whose family left every night but the first for some much-needed sleep. (Funny coincidence: my nurse that first day was also terrible! She was determined to get me up and walking twelve hours after my c-section until I almost threw up all over her. She did redeem herself a few days later, though, after I had recovered a bit!)

    • ravelingoutko February 5, 2016 / 4:20 pm

      OMG that first trip out of bed was the most physically difficult experience of my life. GAHHH.

      I so wish you still lived here so we could discuss all this feeding stuff!

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