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Breast politics and the Baby Friendly Hospital Initiative

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F.E.B.E

We have just published an article by Tara Moss which is a response to an article Mia Freedman wrote over the weekend in regards to 'lactavism'.

Do you support the Baby Friendly Hospiotal Initiative or birth in a baby friendly hospital?

 

Author Tara Moss felt compelled to address the issue of 'baby friendly' accredited hospitals today following an article on breast politics published in News Limited papers on the weekend. Moss is a patron for The Baby Friendly Health Initiative in Australia.

 

Dear Mia Freedman,

 

Firstly, congratulations on your ongoing role as one of the leading voices of women in Australia, and on your ability to bring important women’s issues into the public eye. I have read many of your articles published at Mamamia.com.au and in the weekend newspapers, and of course we have met and communicated numerous times over the years. Yesterday I came across your piece titled ‘Time to get a grasp on reality and stop making colossal boobs of ourselves over breast politics’ and I felt I should contact you to address some important issues.

 

I am unaware of any ‘Breast Feeding Association’ that gives accreditation to hospitals, as mentioned in your article. There is a volunteer group called the Australian Breastfeeding Association that provides breastfeeding classes and a 24 hour hotline (1800 mum 2 mum) to help women with breastfeeding problems, with the phone lines manned - ‘womaned’ actually - by volunteers who have earned qualifications to help women struggling with breastfeeding related issues, milk supply, attachment problems, etc. They generously provide a free and helpful service but do not provide accreditation to hospitals. The Baby Friendly Health Initiative, or BFHI (previously named the Baby Friendly Hospital Initiative), developed by the World Health Organisation and UNICEF in 1991 and implemented in over 150 countries worldwide, does provide accreditation for hospitals globally. I think this may be the program you are referring to in your article, and as I am patron for BFHI in Australia I thought I should address some of the issues you raised.

 

The Baby Friendly Health Initiative, and their ‘10 Steps To Successful Breastfeeding’ have been very successful in raising breastfeeding rates in countries with Baby Friendly accredited hospitals. To give one example, after only two years of BFHI implementation in China exclusive breastfeeding rates in that country doubled in rural areas and increased from 10 per cent to 47 per cent in urban areas.

Full story here:

http://www.essentialbaby.com.au/baby/breas...0227-1tyco.html

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Blondiebear

I was so disappointed with Mia's article, particularly the false claims made about the so-called 'Breast Feeding Association' which Tara so eloquently refuted. I get the point that Mia was trying to make but it's unfortunate she had to use inaccurate anecdata to make it. I am 100% Team Tara, yes I do support the Baby Friendly Hospital Initiative and yes I birthed in a Baby Friendly Hospital.

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Melidia
It is for these reasons that formula is not displayed in BFHI accredited hospitals, however it can be readily accessed for medical reasons or if the mother wishes

 

This statement is misleading. It makes it sound as though mothers who need access to formula can get it easily, which is just not true.

 

The way mothers who request formula are treated in some of the 'breastfeeding friendly' hospitals is nothing short of disgusting and discriminatory. I agree with Mia when she says the pendulum has swung too far the other way.

 

 

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Blondiebear
The way mothers who request formula are treated in some of the 'breastfeeding friendly' hospitals is nothing short of disgusting and discriminatory.

That's a big call, RoxieRouge, care to explain? (and by the way, the hospitals are 'baby friendly', not 'breastfeeding friendly')

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Datrys

I didn't birth in a "baby friendly" hospital. It simply wasn't on my radar when choosing a hospital.

 

That said, as far as I can tell, my hospital had implemented 8 of the 10 steps listed, and one of the ones they did not implement was not giving an artificial teat. Since they helped me to express and bottle feed when my nipples had blistered, I considered this a good thing!

 

I think it's possibly true that for some women in some situations the pendulum might have gone too far the other way, but I couldn't say that of my hospital. I felt that my decision to attempt breastfeeding was mostly supported very well, without me being given a hard time when I was struggling (which is more than can be said for others I turned to for help after being discharged).

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*mylittleprince*

Great response

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Love_Evie

100% Team Tara, I'm surprised a great journalist like Mia wouldn't have done her research properly?

 

I find it very strange, even upsetting that a mother would not set out to breast feed her baby. Deal with any feeding issues when they are met.

 

If there was a genuine health reason not to breast feed, these Baby Friendly hospitals would have the formula and bottles ready to go. Unfortunately many of the reasons some women choose not to breast feed are a little pathetic.

 

I know many women who have tried hard to breast feed one baby and have not succeeded. I also know that with their next child they will try again because breast milk is best.

 

 

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Phascogale
This statement is misleading. It makes it sound as though mothers who need access to formula can get it easily, which is just not true.
All the hospitals I've been in that have been to, you get formula pretty easily. Sign a consent form and it's normally brought straight to you. But you will get as much help as possible to breastfeed your baby unless you really don't want to

 

The way mothers who request formula are treated in some of the 'breastfeeding friendly' hospitals is nothing short of disgusting and discriminatory
Did this happen to you? Pretty much every midwife I've met has been pretty pragmatic when it comes to formula (including lactation consultants) and are baby friendly, not that breastfeeding is the be all and end all of everything.

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FeralProudSwahili

I am 100% supportive of the BFHI.

 

Mia's article is trite rubbish. Nothing new there.

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FeralProudSwahili
The way mothers who request formula are treated in some of the 'breastfeeding friendly' hospitals is nothing short of disgusting and discriminatory.

 

Really? How so?

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WinterIsComing

FFS, now giving a bottle of EBM is putting your baby's health at risk?

 

I think Tara's article is misleading, self righteous and not entirely factual. Yes, formula is not sterile but neither is your breast or nipple, I would bet my house that the amount of germs growing on milk-covered nipple is not insignificant. Besides, the whole sterilisation mania has gone a bit too far.

 

 

And for what it's worth, the use of dummies is recommended by medical professionals as a soothing aid as well as an SIDS-decreasing implement.

 

(I am and plan to exclusively breastfeed until 6 months).

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Autumn_Anonymous

I haven't read the Mia Freedman article, (and am not likely to either).

The Baby Friendly Hospital Initiative provides breastfeeding best practice standards established by the World Health Organisation and UNICEF not only in Australia but around the world.

I think BFHI accreditation is very important, setting high quality guidelines for establishing breastfeeding.

The BFHI has my full, considered, support. It sounds to me like Ms Freedman has little, if any, idea of what she is writing about.

 

 

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CherrySunday
FFS, now giving a bottle of EBM is putting your baby's health at risk?

Wtf? Who said that???

 

FTR, 100% team Tara :D

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FeralProudSwahili
And for what it's worth, the use of dummies is recommended by medical professionals as a soothing aid as well as an SIDS-decreasing implement.

 

(I am and plan to exclusively breastfeed until 6 months).

 

Using a dummy and reduced SIDS risk is inconclusive.

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Datrys
Wtf? Who said that???

 

As I read the requirements for the BFHI, it would mean that a hospital would not be accredited if giving bottles of EBM, since they state that hospitals should "Give no artificial teats."

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purplekitty
Wtf? Who said that???
Tara Moss did.

 

 

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fairymagic

As a midwife I too find that in some hospitals the pendulum has swung too far the other way. Thankfully, our hospital is supportive of our mother's choices be it breastfeeding, bottlefeeding, combination feeding, use of a dummy etc. I have been on placement in BFHI hospitals and was both dismayed and disgusted at the attitude some other midwives portrayed to women who either chose not to breastfeed or wanted to top up their baby's feed with formula. One poor woman who had already had one child and had tried to breastfeed had decided to not breastfeed her second child and made her decision clear to the midwife doing her antenatal appointment. This midwife then proceeded to lecture her on why her decision was selfish, why it would be better to try than not try at all and that she is letting her unborn child down by not at least attempting to breastfeed. Now as awful as that sounds, my version is much more "polite" than how this woman was spoken to. The midwife left the room at some point and even though I was only a student midwife at the time, I could see this woman was close to tears. I comforted her and told her to make the decision that was right for her and be adament about that decision regardless of the attitude of the midwives she may yet come across. The midwife returned to the room armed with brochures on breastfeeding. She had not listened nor taken on board anything this Mum had talked about.

 

Breastfeeding is a difficult skill to learn. I am the first one to explain this to new Mums so that their expectations are realisitic and they don't feel like failures or in some way inadequate in the early days where lots of assistance and encouragement is crucial. There is often lots of tears, pain for those whose babies may not have started breastfeeding from the start with a correct attachment so have caused nipple trauma and damage. This does not mean that as midwives we can't help them through this period of learning by being supportive of how they feel. This may mean taking the baby off the breast and "resting" the nipples for 24 hours and expressing and feeding the baby EBM. It may mean for a mum that has not slept for three or four consecutive nights due to a baby feeding every 1 - 2 hours getting a requested bottle of formula to top their baby up and give them a block of 3 - 4 hours sleep.

 

Women need to feel supported in whatever way they choose to feed their babies. They should not be criticised or condemned if they choose to bottlefeed or top up their babies in the first few days/weeks if supply is not adequate and baby is not settled. If they want their baby to use a dummy, let them use it.

 

Another friend of mine had their baby at a BFHI hospital a few years ago. They actively discouraged use of formula except when absolutely medically necessary. They in fact did not even discuss the use of formula with the Mums there unless their baby needed it while in hospital. My friend had a 36 week baby who to be honest, I am not sure whether she had formula in hospital or not - I would assume so but am not sure. She took her baby home exclusively breastfeeding - after 6 weeks of her baby screaming night and day, attending the hospitals postnatal clinic and having baby weighed where weight gain was either static or very low, she was finally told that she had little to no milk supply. After 6 weeks someone finally gave her the information that she should have been given weeks earlier. She could have been given the option to top her baby up to get through those early weeks where supply is establishing but no, being a BFHI they did not recommend that - only recommended frequent feeding to increase stimulation and increase supply. Well, it didnt' work for her. Her baby was starving and she was hating motherhood. When she finally succumbed and put her baby on bottles, she had a new child. She had a child who was no longer starving but settled between feeds.

 

I think that while we need to encourage breastfeeding and try and get those rates up higher for those still feeding at 6 months, we also need to be mindful of how we do it. Providing the information that "breast is best" is obviously a start. Recognising and respecting that not all women want to BF or enjoy BF is also important too. Ensuring that women are made to feel supported in their choices will hopefully help those that wish to breastfeed do so for longer and those that choose not to, not made to feel guilty whatever their reasons may be.

 

Breastfeeding friendly workplaces would also be another good staring point. HOw many women return to work when their baby is 6 - 12 months old intending to wean by then since it is too hard to express at work. There is no privacy to do it. Other staff are resentful of time spent away from their desks while they are expressing and the list goes on.

 

BFHI hospitals definitely have their good points. Not all the staff working there are "breastfeeding tyrants" and many are supportive of the choices women make when regarding their method of feeding. At the end of the day though, I would wonder if these hospitals despite all the "criteria" they have to meet to get that accreditation still have a higher breastfeeding rate compared to those hospitals that have not sought the same accreditation?

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WinterIsComing
Wtf? Who said that???

 

FTR, 100% team Tara :D

 

 

Tara Moss did.

 

Thanks Purple Kitty was just coming in to say that.

 

I read Mia's article, I think it sums up the feelings of all rational breastfeeding women everywhere.

 

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ubermum

I read Mia's article today and found it disappointing.

 

I had my first child in a hospital without the accreditation. Within 4 days, they had managed to cause irrepairable damage to our breast feeding relationship. I can't totally blame the hospital, I had no clue either, but I had thought it was something that would just come naturally and the midwives would give you help.

 

Team Tara.

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JAPNII

What annoys me with the 'BFHI' is the name is misleading.

 

Make it breast feeding initiative and it would be more accurate.

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CherrySunday
As I read the requirements for the BFHI, it would mean that a hospital would not be accredited if giving bottles of EBM, since they state that hospitals should "Give no artificial teats."

But not following the BFHI to a T is not necessarily putting a babies health at risk. As in your example, it was better to give EBM than just reach for artificial milk. Surely a hospital can make its own decision as to whether that would be appropriate, rather than just offering it as a first resort.

I imagine that the accreditation guidelines have 'wiggle room' like that...

 

It has been shown that artificial teats CAN (not will) be a barrier to breastfeeding so of course the accreditation criteria would advise against it.

When my DD had BF troubles & would not latch, our midwife tried a medicine cup and many other methods to help get some EBM into her so she'd 'wake up' a little. I believe the hospital where she was born is a fully accredited BFHI hospital.

Edited by tigerfan

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Libster
Unfortunately many of the reasons some women choose not to breast feed are a little pathetic.

 

So what? It's none of your business as to the reasons why a woman chooses not to breastfeed.

 

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Soontobegran
This statement is misleading. It makes it sound as though mothers who need access to formula can get it easily, which is just not true.

 

The way mothers who request formula are treated in some of the 'breastfeeding friendly' hospitals is nothing short of disgusting and discriminatory. I agree with Mia when she says the pendulum has swung too far the other way.

 

When one books into a hospital to deliver their baby they should know it's 'Baby Friendly' status so there should be no surprises when formula is not actively promoted nor supplied unless there is a medical need.

 

Formula is always available for those babies whom are prescribed it by their doctor or when for some reason it is not possible for the baby to be breast fed. Mothers who choose to FF from birth are perfectly able to do so in a BFHI hospital but in most cases they are required to bring their own formula feeding equipment. I honestly can not see how this can be wrong when it is not best practice to advertise formula as an alternative.

 

There are some occasions when a comp feed of formula may be a valid choice but personally I am thrilled to that the option to stuff a crying baby full of formula has been removed. I witnessed 'some' midwives take this option pre the BFHI and then wonder why the baby wouldn't attach happily to the mother's nipple to breast feed :(

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Blondiebear
I read Mia's article, I think it sums up the feelings of all rational breastfeeding women everywhere.

So if it doesn't sum up my feelings I'm irrational?

 

lnteresting that several of you say you (or someone you know) has had difficulty getting access to formula in hospital. I remember having a discussion with my 5 closest mothers group friends, all of whom breastfed our first babies for at least 6 months, and I was the only one who had not consented to give my baby formula top-ups in hospital. I was asked to, but I declined, the others had all had it suggested to them and accepted. Between us we'd been at 3 different hospitals in Melbourne.

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Nobody Cool

I am incredibly grateful for the BFHI. I birthed my first in a Baby Friendly hospital and have no doubt given the issues we experienced that I would not have successfully breastfed my baby without the support of that initiative, so +1 me to those stats. :)

 

Agree with tigerfan on the wiggle room with interpretation of guidelines. My child was fed expressed colostrum through a syringe for the first three days until the LC/midwife offered up a nipple shield on day 4. We went on to breastfeed with the aid of that "artificial teat" for 14 months.

 

There will always be personal experiences - good and bad - related to this initiative but its overall value should not be maligned or diminished.

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