Last week, the American Academy of Pediatrics published a clinical report that took a look at safety practices of bed-sharing and rooming in. This wasn’t a policy paper, but instead more of a “this is what a group of Pediatricians think” sort of thing. Headlines have been all over the map on this one, though. Some wise nurse and professionals looked at the publication and took away the advice that hospitals need to have good staffing levels and well-trained competent nurses to make sure patients are safe. Sorry to sound flip, but DUH. I guess there are plenty of places that put profits before patient safety (ahem), but in 10 years of attending births, I’ve only seen poor care of a baby after birth in 2-3 cases.
And then, Elisa Strauss of Slate has her opinion: The paper proves that a Baby-Friendly designation makes a hospital inherently unsafe.
Are you kidding me?
In reality, the paper does mention that aspects of the practices outlined by the Baby Friendly Hospital Initiative need additional guidance for safety– but nothing shows that these hospitals are inherently unsafe. Strauss has a history of writing about studies in a very odd way– in January she tore apart the idea of having a doula based on the most inane logic possible. If you want to see someone hell-bent on espousing experience-based practices, she’s your writer.
How dies she even come to her conclusions?
First, she writes that, “Their [the researchers] first area of concern is the initiative’s requirement for skin-to-skin contact between mother and child directly after birth until the completion of the first feeding, and to encourage skin-to-skin contact throughout the hospital stay. The problem is not the skin-to-skin contact itself, which has documented benefits, but the fact that mother and child are often left unsupervised during this time.” Immediately postpartum, nurse coverage should be 1 to 1– a nurse should have no other patients than the baby and new mother. Yes, complications can develop quickly right after birth, and medical supervision in needed. However, the problem isn’t the skin to skin contact– it’s hospitals that profit from lean staffing levels. Further, Strauss doesn’t present any solutions– does she think these babies should be taken away from the new parents and placed in a nursery with dozens of other babies with only 1 or two nurses to take care of these babies? Or should the babies be left in the warmer in the room for a couple of hours following birth? Or…..what?
The next paragraph is a doozy. Strauss writes,
Other concerns in the JAMA paper include the encouragement for rooming-in, even when the mother is exhausted or sedated. They believe this can lead to unsafe conditions for the newborn, and that parents, thinking that such sleep-arrangements were hospital-approved, may continue sleeping in such a manner once they return home. Also, they question whether supplementation with formula should really be banned, as there is no hard evidence linking early formula use to a decreased likelihood of breastfeeding further down the line. In fact, one study suggests that early formula use might help increase breastfeeding rates by reducing stress among new moms while they wait for their milk to come in.
Where to start?
NO HOSPITAL in their right minds would EVER encourage rooming in when a mother is sedated. The hospitals I have worked at rightly and explicitly disallow rooming in if a mother is unconscious and nobody else is there to attend to the baby’s needs. I want to see proof that this is a practice any place actually follows. I’m also not sure what she means by “these sleeping arrangements”. In reality, current SIDS reduction practices actually encourage parents to have babies sleep within 15 feet of the parents– in the same room. As far as formula supplementation being banned– it’s not. Nothing about Baby Friendly designation bans formula use. It calls for hospitals to pay for the formula (rather than get an unlimited free supply from the formula companies) and it calls for guidance when mothers do supplement. That’s all. This oft-repeated myth is a great tool for formula companies who want to create public panic, but it’s simply a lie. And WHY do otherwise intelligent writers perpetuate the whole nonsense that until a mother’s “milk comes in”, there’s nothing to feed a baby. It’s called colostrum, and it works very well to feed human babies and all other mammals, thankyouverymuch.
Finally, according to Strauss,
They end the paper by arguing that the Office of the Surgeon General should reconsider its call for an acceleration of the implementation of the Baby-Friendly Hospital Initiative in the United States. “If government and accreditation agencies wish to encourage and support breastfeeding, their focus should shift from monitoring Baby-Friendly practices and breastfeeding exclusivity to monitoring breastfeeding initiation rates coupled with evidence of lactation support both during and after the hospital stay. More attention should also be placed on ensuring compliance with established safe sleep programs, emphasizing the need to integrate safe sleep practices with breastfeeding.
The language she quoted does not exist ANYWHERE in the cited publication, and at no point do the authors even come close to encouraging the discontinuation of the 10 steps outlined as Baby-Friendly. Further, she doesn’t even include a citation for this quote, and it could be completely made up for all we know.
In reality, the authors of the AAP paper praise the 10 steps, saying, “The Ten Steps include practices that also improve patient safety and outcomes by supporting a more physiologic transition immediately after delivery; maintaining close contact between the mother and her newborn, which decreases the risk of infection and sepsis; increasing the opportunity for the development of a protective immunologic environment; decreasing stress responses by the mother and her infant; and enhancing sleep patterns in the mother.”
For better or for worse, there will always be a backlash against the movement of hospitals towards the implementation of the 10 steps of the Baby-Friendly hospital designation. However, it would serve all of us better to see this discussion happen in a place without twisting a clinical report to serve one’s preconceived editorial slant.