There has been pushback against "baby-friendly" hospital initiatives (BFHI) in recent weeks, after a new set of data from the CDC found that breastfeeding rates were actually lower in hospitals following "baby-friendly" protocols designed to boost adoption of breastfeeding behaviors.
While many mothers had positive experiences in hospitals with the BFHI designation, others responded to a Romper article by Danielle Braff with tales of exhaustion, worries they would drop their baby, disbelief that there was no nursery, and stress over the pressure to breastfeed. "I delivered at a baby-friendly hospital and the pressure one nurse put on me to breastfeed was incredibly stressful," wrote one mother. "I would have loved for a nurse to take my baby for just a few hours so that I could have rested but that was highly discouraged," wrote another.
What people agreed on was the need for hospitals to put protocols in place that prioritize the mother's wellbeing as well as that of the baby. So what would a "mom-friendly" hospital look like, if that was an actual classification? We asked a range of experts, each with a different vantage on birth and recovery. Here's what they said.
What Pediatricians Want To See
Dr. Harvey Karp, CEO of Happiest Baby and author of The Happiest Baby on the Block, believes having a dedicated, specialist support staff for new parents is crucial in the early days. “More important than a fancy suite is the level of care mothers are provided,” says Karp.
He calls for additional support in terms of lactation consultants, child care educators, social workers, and mental-health professionals. “[These individuals] are tremendously valuable, especially for a mother with a traumatic birth experience or any infant abnormality,” says Karp.
Sleep-in rooms for partners, reasonable parking, mini toiletries, flexible visiting hours, and ADA-friendly accommodations.
A “mom-friendly/family-friendly” hospital is “one that makes all members of the family feel comfortable,” says Dr. Sandra Elizabeth Ford, a pediatrician, and head of the DeKalb County Board of Health This could entail everything from sleep-in rooms for partners, reasonable parking, mini toiletries, flexible visiting hours, and ADA-friendly accommodations, to translation services and activities for young visitors.
What OB-GYNs Want To See
“In my mind, mom-friendly hospitals are those that help support and guide women to make decisions that are best for them,” says Dr. Kameelah Phillips, an OB-GYN at Lennox Hill Hospital.
Phillips would like to see more individuation of care over adherence to "best practices." Hospitals "operate within a culturally sensitive paradigm" she says, and staff need to recognize "the importance of culture, language, and community influences," as well as the standard procedures during and after birth.
Chief of Obstetrics at the University of Texas’ Medical Branch in Galveston, Dr. George Saade, says mom-friendly protocols cover everything from allowing families to stay together in those first postpartum days, as well as providing the parents educational and counseling resources after discharge.
Saade, who is also a professor of obstetrics and gynecology at UTMB, as well as the director of their maternal-fetal medicine division, would like to see patient navigators offered in hospitals, to help advocate for patients, coordinate care, deal with paperwork, assist with financial questions, and help patients learn about their conditions and options. Traditionally, patient navigators have worked with individuals with cancer and other difficult illnesses, but they are also proving to be effective for new parents.
A fancy lobby and goody bags are nice, but they don't replace a respected and empowered experience.
What Doulas Want To See
“A fancy lobby and goody bags are nice, but they don't replace a respected and empowered experience,” says Mary Catherine Hamelin, a doula, licensed midwife, and certified lactation counselor based in Tampa, Florida. Hamelin wants hospitals to offer postpartum and breastfeeding support groups, welcome family members and doulas into birthing rooms, and listen openly to a family’s birth preferences.
Hamelin advises hospitals to ask new parents about their goals and expectations for the “fourth trimester” with questions like, “Who will help out at home if they are recovering from a cesarean or traumatic birth?”
"We cannot talk about being mom/family-friendly without talking about racism and maternal mortality,” says doula Danellia Arechiga, who co-owns La Fuente: Birth, Postpartum, y Mas, a community space in Long Beach for new parents. Arechiga would like to see anti-racism training for staff, citing the disparity in maternal mortality between white women, and black women, who are four times more likely to die in pregnancy and childbirth than any other race group.
“Consent is a huge issue in hospitals, so trauma-informed training and implementation would lessen and prevent routine procedures that cause some families to feel abused in their care,” she adds. The Long Beach-based doula also recommends hospitals adopt inclusive language. “They should not assume everyone is ‘mommy and daddy’ or ‘she and he.’ Asking what the family's preferred pronouns are upon intake would be a huge step in the right direction,” she says.
“Hospitals should keep themselves accountable by asking families for feedback, reviewing their data and keeping up to date with the most evidence-based practices," says Lindsay McCoy, a birth doula and childbirth educator in Minneapolis, Minnesota, who would like to see ongoing training for hospital staff on birth trauma as well as topics like informed consent, racism in maternity care, and supporting survivors of sexual abuse.
McCoy also recommends that hospitals who want to be considered mom-friendly/parent friendly work toward less unnecessary disruptions for parents by delaying procedures that can be done later, especially during the first postpartum hour.
Lisa Gould Rubin, co-author of The Birth That’s Right for You and a virtual doula, feels that a mom-friendly/family-friendly hospital focuses on "supporting birthing people in their agency to make choices that fit them, not fitting them into the hospital system.”
She recommends the book, How to Become Mother-Friendly: Policies and Procedures for Hospitals, Birth Centers, and Birth Practices, by Barbara Hotelling and Helen Gordon, as additional resource for hospitals, care providers, and parents-to-be.
While I strongly encourage breastfeeding…[it’s] not always the best choice in some situations.
What Nurses Want To See
“I do think that allowing babies to stay in the room with mom as much is possible is best for both mom and baby in most situations, but not all," says Amanda Lynn McIntosh, who has worked as a labor and delivery, obstetrics, and pediatric nurse for 12 years and says “baby-friendly” hospital initiatives are anything but “mom-friendly.”
"If a mom has had a traumatic delivery, or is just absolutely exhausted, then sometimes having staff care for baby is best for everyone," says McIntosh. "And while I strongly encourage breastfeeding…[it’s] not always the best choice in some situations. Ultimately, the parents need to decide what is best for mom and baby, based on their intimate knowledge of the mother's ability to handle the stresses that come along with new parenthood and breastfeeding,” she says.
McIntosh also says that it’s vital to have NICU-trained personnel on staff, as well as different levels of practitioners for prenatal care, including midwives and high-risk physicians.
Linda Hanna, a nurse with 40 years of clinical experience, would like privacy and comfort to be prioritized. “Coordinate the mom's schedule so that specialists come in at times during the day that make sense and that allow the mother to get adequate rest and recuperation,” says Hanna, who is also the founder of Mahmee — a platform for jointly managing care for moms and babies, including support groups, check-ins, and more.
What Lactation Consultants Want To See
Consistent protocols would help patients dealing with multiple lactation consultants, says Sara Silverstein, a lactation consultant with a private practice in Brooklyn. "Women do need different advice depending on the shape of their breasts and nipples. But... staff should and can be taught a consistent protocol so the women get consistent advice. The staff needs to learn, ‘flat nipples need to be treated this way, short nipples treated this way, and large nipples need this protocol.’ The point is there should be training (which is available),” says Silverstein.
What Mental Health Professionals Would Like To See
Susana Marquez, a licensed marriage and family therapist specializing in maternal mental health, thinks clinicians should visit parents while still in the hospital.
“[Clinicans can] answer questions for them and provide information that discusses perinatal mental health disorders so moms and new parents have the information, but with resources [on hand] to seek if they need them,” says Marquez.
“[A new parent] should have educational materials available but not pushed on her and there should be mental health education and screenings done before discharge,” says reproductive and perinatal psychiatrist Dr. Carly Snyder, who believes new moms and parents can leave the hospital either feeling empowered by the information they’re given during their stay, or scared and full of shame, depending on their experience.
“Fathers with postpartum depression also often have no idea what is going on with their mood and have nowhere to turn, and were never given information or supports during their partner’s stay,” she adds.
Snyder believes hospitals should encourage open dialogue and request feedback during stays and at discharge in order for the hospital to improve its model of care.
Taking care of the mother during labor and helping her not only through childbirth but also afterward.
What Moms Want To See
“Don't harass us over breastfeeding. Don't ignore pain complaints. And please ask if we need help so we can sleep — we're exhausted!” says 45-year-old mom and copywriter Grace Alexander, who has given birth in three different hospitals. Alexander feels hospitals need to give new parents options, respect the mother’s wishes, and give patients a heads up on every procedure.
Thirty-three-year-old writer Irina Gonzalez is currently expecting her first child and recently found a hospital she and her husband feel fits the criteria.
“For me, ‘mom-friendly’ means that there is a great deal of care that goes into taking care of the mother during labor and helping her not only through childbirth but also afterward." She was keen on choosing a hospital that allowed rooming in (some do not).
“Hospitals can and should spend more time addressing the non-essential needs of the mother: checking in with her, asking what else they do, making sure that a new mother's question are answered without judgement, and giving a mother the option of formula feeding,” says Marissa Altunis, a social work supervisor and parent in Islip, New York.
Thirty-six-year-old Jamie Kenney of New Milford, Connecticut, who wrote a followup essay for Romper about baby-friendly protocols, would like hospitals to avoid conducting well-checks when a mom is sleeping. “I know you’re in the middle of a shift or whatever, but it’s 6 a.m. and I just got to sleep for the first time in two days,” says Kenney.
If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.
Dr. Harvey Karp, pediatrian and CEO of Happiest Baby
Dr. Sandra Elizabeth Ford, pediatrician and head of the DeKalb County Board of Health
Dr. Kameelah Phillips, an OB-GYN at Lennox Hill Hospital
Mary Catherine Hamelin, doula, licensed midwife, and certified lactation counselor
Lindsay McCoy, a birth doula and childbirth educator
Lisa Gould Rubin, doula and co-author of The Birth That’s Right for You
Amanda Lynn McIntosh, R.N. labor & delivery, obstetrics, and pediatric nurse
Linda Hanna, R.N., nurse and founder of Mahmee
Sara Silverstein, lactation consultant
Susana Marquez, a licensed marriage and family therapist
Dr. Carly Snyder, reproductive and perinatal psychologist