Updated: 3 days ago
Update, published September 16, 2021: The original article was published on September 2, 2021. After receiving feedback and reviewing updates to the Baby Friendly Hospital Initiative (BFHI) guidelines, we recognize that the original language in the article didn’t capture the nuance of BIOMILQ’s beliefs, and didn’t incorporate BFHI’s updated recommendations released on July 21, 2021.
BIOMILQ appreciates the evolution of BFHI’s approach to promoting breastfeeding by now incorporating greater consideration for a family’s individual experience and circumstances. New guidelines emphasize the importance of empathy, evidence-based information, cultural humility, provider competency through more rigorous training, and creating a non-judgmental environment. The BIOMILQ team applauds how these updates encourage a more nurturing and holistic approach, which is exactly the direction our original article was advocating for! While policy may sometimes be different from practice, we do recognize that the actions of individual clinicians certainly don’t speak on behalf of all clinicians. Similarly, no infant feeding journeys are identical. The article was inspired by our Co-Founder Leila Strickland’s personal experience during both of her feeding journeys in 2009 and 2013 at baby-friendly hospitals in Northern California and North Carolina.
Because one of BIOMILQ’s core values is transparency, we’ve decided as a team to leave the original article as is. Our Co-Founder and CEO Michelle Egger often encourages the team to lean into learning in public. Feedback on this article has prompted greater internal discussions of BIOMILQ’s views and how we can ensure that future messaging is well-informed and genuinely reflects BIOMILQ’s beliefs. Thanks for latching on to our journey.
We’ve said it before and we’ll say it again: breastfeeding is hard and gaslighting a mom’s experience needs to stop. It’s crying over spilled milk hard. It’s thinking you’ve failed motherhood when you’re only a few weeks in hard. It’s heading to the lab to see if milk can be made outside the body hard. It’s starting a mammary biotechnology company to increase feeding options hard.
It’s about damn time to think critically about what lactation education looks like, how it contributes to reinforcing shame and guilt, and how new parents can be better supported: holistically and empathetically.
Leila with her son Levi, 7 weeks old
Implemented in 150 countries, the Baby Friendly Hospital Initiative (BFHI) is the world’s gold standard for breastfeeding support and endorsed by the CDC, AAP, WHO, WIC, and countless other public health bodies. The initiative has every good intention: to increase breastfeeding initiation and continuation, to provide babies with the benefits of breastmilk, to educate moms on all things breastfeeding, to facilitate more bonding time between mom and baby, to encourage moms to attend breastfeeding support groups after they leave the hospital. But, policy is different from practice.
Our co-founder Leila’s lactation education was founded upon the principles of BFHI. She was spent every minute pumping or *trying* to get son to latch. But, when her son Levi, who’s now 11 and proud to be the reason BIOMILQ exists, dropped weight dramatically during the first three weeks of his life, she realized that parenting classes didn’t empower her with the wealth of knowledge she needed. Leila was only ever told: “you’re doing great, just keep trying.” But she knew she was not doing great at all. She was blindsided by the reality of breastfeeding — while it’s natural, it doesn’t always come naturally.
BFHI’s 10 steps to successful breastfeeding may strive to be baby-friendly but they aren’t always mom-friendly too.
Babies are supposed to stay with their moms for 24-hours a day to promote skin-to-skin, which means babies don’t go to the hospital nursery and moms can’t get much-needed breaks.
Hospital staff are supposed to tell moms about the risks of pacifiers and artificial nipples — new evidence (2) challenges the notion that pacifiers reduce breastfeeding rates. With the intention of protecting mothers from commercial interests, BFHI hospitals must follow the ‘International Code of Marketing of Breastmilk Substitutes’ (WHO Code), which was adopted by the WHO in 1981 as a reaction to the formula industry’s aggressive marketing campaigns. While we agree that extreme marketing is problematic, we’d argue that the other extreme, not educating parents on all infant feeding options, is problematic and harmful too.
Babies aren’t supposed to be given supplemental nutrition until their weight drops to less than 10% of their newborn weight. Supplemental nutrition may be needed before this black-and-white benchmark to prevent unnecessary severe dehydration (4). This would be like waiting to tell your teenager about safe sex until after they’ve gotten pregnant.
BFHI seems to prioritize exclusive breastfeeding over everything else: over a baby’s physical health, over a mom’s postpartum recovery, over a mom’s mental health. It perpetuates the idea that a mom’s inadequate lactation performance means she’s failed motherhood — Leila was far from alone in feeling ashamed of her ill-performing mammary glands. It’s time to revise BFHI to be mom-friendly too, setting realistic expectations for infant feeding and prioritizing everyone’s wellbeing, not just the baby’s.
Leila’s children, Violet and Levi
The status quo isn’t working: interventions need to use a holistic and gentle approach that considers the nuance of each mother’s experience (geographic context, socioeconomic status, education level, maternal age, cultural perceptions of breastfeeding, etc.) (2). A 2016 study found that a flexible and family-centered approach to implementing BFHI’s 10 steps reduced maternal guilt and shame (3).
“You’re doing great, just keep trying” is quite possibly the least helpful piece of breastfeeding advice, if you can even call it that.
As if sheer willpower and dedication could simply be enough to produce more milk. As if moms have total control over their postpartum hormonal changes. As if moms are supposed to sacrifice every ounce of their already limited energy to feed their babies (who will do just fine on infant formula, by the way). Trying harder and longer isn’t the solution, but a more neutral and nurturing approach might be.
Baby Friendly USA. 2012–2021. “10 Steps and International Code.” Accessed online: August 31, 2021.
Gomez-Pomar, Enrique, and Robert Blubaugh. 2018. “The baby friendly hospital initiative and the ten steps for successful breastfeeding. a critical review of the literature.” Journal of Perinatology 38, (6) (06): 623–632.
Groleau, Danielle, et al. 2016. “Empowering women to breastfeed: Does the Baby Friendly Initiative make a difference?” Maternal and Child Nutrition.
Zhao et al. 2021. “Effect of Early Supplemental Formula Intervention on Body Weight and Hyperbilirubinemia in Neonates During 72 h After Birth.” Frontiers in Pediatrics.