You would think squeezing an enormous human baby out of your body — whether painfully via your once-delicate vagine or painfully via major abdominal surgery — would entitle a lady to a little bit of R&R. Handing your beloved infant to trained professionals while you focus on healing seems completely reasonable. Or at least preserving the option to send baby to a secure and safe nursery while you fall unconscious, so as to let your body sort out where all that fluid is supposed to go. But as TODAY reported in 2016, around 1 in every 4 births were occurring in a hospital certified as "baby-friendly," and therefore absent a baby nursery.
From the bottom of my heart to the top of my lungs: absolutely not. This is a mistake. Nurseries in maternity wards should be a given.
I'll head you off at the pass, partner. I know some people like having their newborn right next to them at all times. I'm not judging those people. I was those people. I appreciate the rooming-in model of postpartum care as a necessary option, not only to support breastfeeding success but for the well-being and peace of mind of new moms. Some of us aren't quite ready to have our babies out of arm's reach when we've spent the past nine months in far closer quarters.
But some of us had a four-day-long labor that ended in an emergency C-section and we're exhausted from lack of sleep, intense pain, and heavy medication, and we don't have the physical, mental, or emotional means to effectively help this infant, and what do you mean there's no nursery in here?!
They say road to hell is paved with good intentions, and the Baby Friendly Hospital Initiative (BFHI) is a classic of the genre. In 1991, concerned with low breastfeeding rates and the influence of formula companies in hospitals, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) established 10 protocols to encourage and support breastfeeding in the first days of life, including bullet points like beginning breastfeeding within an hour of birth, no formula unless "medically necessary," and practicing "rooming in," aka keeping mom and baby together 24 hours a day aka no nurseries (for acute health issues, sick babies go to the NICU).
Surely there is a way for hospitals promote and support moms' breastfeeding goals without asking them to unerringly follow universal guidelines that just might not be right for them.
According to Baby-Friendly USA, the number of BFHI accredited hospitals has risen exponentially in the last decade, from fewer than 100 in 2010 to more than 500 today, accounting for 1 in 6 American hospitals and 24% of births. This means nearly a quarter of new moms are presented with one way to care for their child in those crucial first days, which is sort of like learning to walk on a balance beam as the hospital staff screams "THE FLOOR IS LAVA! MY GOD IT'S ALL LAVA!!"
The floor is not lava, people. Again: if you want to keep your infant with you at all times — if you're comfortable on that metaphorical balance beam — that's cool. It should absolutely be an option. But when all other options are stripped away, it's essentially a mandate that boils down to "Successful breastfeeding is more important than literally anything, including your well-being, personal preferences, and in some cases the immediate safety of your baby. So please enjoy going straight from labor and delivery to caring for your new child, without significant help or reprieve, for the duration of your stay. We know you're new to this and that your hormones levels have plummeted, and you're tired, and still in pain: but what could possibly go wrong?! #BabyFriendlyyyyyyyy!"
The worst part? Well, the worst part is that we're doing an enormous disservice to mothers by telling them their needs don't matter. But the kicker is that all this doesn't even appear to work. A recent study published in the Journal of Pediatrics found that BFHI hospitals actually produce lower rates of successful breastfeeding than hospitals without the designation.
Surely — surely — there is a way for hospitals promote and support moms' breastfeeding goals without asking them to unerringly follow universal guidelines that just might not be right for them. A way to make new parents aware of the BFHI guidelines, to make those recommendations available to those who want them, without pressuring those who don't. A policy that can adapt to new research (for example, research that indicates that supplementing with formula can actually support breastfeeding goals). A policy that acknowledges that best practice is one that is family-friendly.
Being a mom is hard, and one of the hardest parts of the gig to learn and practice is balance.
I know it's possible because I experienced it — at two different hospitals, in two different states. I had access to help from nurses and lactation consultants and was given the opportunity to breastfeed within an hour of delivery. I had the opportunity to keep my baby with me at all times. But these were not inflexible hospital policies: they were all, each one, my choice. I never did use the nursery, but knowing I could have, that I had agency in how I was caring for my babies and that I wasn't alone in it, was crucial to my well-being.
Being a mom is hard, and one of the hardest parts of the gig to learn and practice is balance. Balance between your needs and your baby's; between your relationship with your new family and your existing social structures and supports; between work and home. It will remain elusive for the rest of your life, even under the best of circumstances. And when the best of circumstances is contingent on a nurse interpreting hospital-wide guidelines with the right amount of leeway (say, I'm on magnesium, or baby isn't nursing right, or I look like I'm already asleep, we're hoping I have a nurse who knows formula is OK, or the baby maybe could do with a chill-out down at the nurses' station), we make it hard for moms to start this new journey on the right foot.
You cannot support a child without also supporting their mother — if it's not "mom-friendly, it's not truly "baby-friendly," is it — and sometimes mama needs you to take this baby to the nursery so she can get even two hours of uninterrupted sleep. Thank you for coming to my TED talk.
Morain, S., Barnhill, A. (2018) Do Infant Formula Giveaways Undermine or Support Women’s Choices? AMA Journal of Ethics, https://journalofethics.ama-assn.org/article/do-infant-formula-giveaways-undermine-or-support-womens-choices/2018-10
Flaherman, V., Narayan, N., Hartigan-O'Connor, D., Cabana, M., McCulloch, C., Paul, I. (2018) The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial. Journal of Pediatrics, https://www.ncbi.nlm.nih.gov/pubmed/29550235
Bass, J., Gartley, T., Kleinman, R. (2019) Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications. The Journal of Pediatrics, https://www.jpeds.com/article/S0022-3476(19)31122-9/fulltext
Feldman-Winter, L., Goldsmith, J. (2016) Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics, https://pediatrics.aappublications.org/content/138/3/e20161889