Baby Friendly Hospitals…the inside scoop from a postpartum nurse

If you’re expecting a baby and are planning for or have researched a hospital birth, then you might have come across the term “baby friendly” in your search. It seems obvious that a place that cares for families and welcomes new babies into the world would be “friendly” to those newborns, right? RIGHT?! In theory, yes, but there is more than one way to care for a mother and baby dyad, and different hospitals do this in different ways (for better or worse). That’s not to say other facilities are “un-friendly”, but the differences are worth noting.

Baby Friendly USA is the accrediting body in the United States for the Baby Friendly Hospital Initiative (an international program) that conducts the activities necessary for a hospital to earn a Baby-Friendly designation. As of 2019, there were 600 Baby Friendly designated facilities found in all fifty states, Washington D.C, and Puerto Rico. One of the major influences this designation has had in hospitals is reducing the enormous influence outside companies, specifically formula manufacturers, have on the feeding practices recommended to families. Evidence-based care that is free from marketing and commercial interests is top priority.

So, what can you expect from a Baby Friendly Facility that is different from other hospitals? We’ve had experience working in them as well as preparing for redesignation, so we’ll tell ya! The basic tenets of the Baby Friendly philosophy (which can be found in more detail on their website) are :

1.  Human milk fed through direct breastfeeding is the optimal way for human infants to be nurtured and nourished.

2.  The precious first days in the birth facility should be protected as a time of bonding and support not influenced by commercial interests.

3.  Every mother should be informed about the importance of breastfeeding and respected to make her own decision.

Ok, so we’ve got the basic gist of this. Breastfeeding is important and nobody is going to try to gift me a care package of formula on my way out the door. But what does this mean, practically speaking? It means a couple of things are going to be the default setting in these facilities. Those things are breastfeeding, skin to skin contact, and rooming-in. When breastfeeding is part of your baby-feeding plan, these facilities often have more extensive lactation support available to make sure you are as successful as possible. It also means things like pacifiers and other artificial nipples aren’t offered too often and alternative soothing and feeding methods come first. Next, that skin to skin with your baby applies to Golden Hour (learn more about it in our blog post here) and other procedures and assessments. Read more about skin to skin benefits here. Nurses and providers who practice in Baby Friendly facilities are often more skilled and comfortable performing basic tasks like vital signs and even blood draws while a baby is latched or sleeping on your chest. At the very least, many of these things can be done in your baby’s bassinet right at your bedside without having to wheel them away to a closed off nursery. Finally, rooming-in is an expectation, meaning that your baby’s bassinet would stay in your hospital room with you throughout the night, rather than going to a nursery to be looked after by hospital staff. The reason for this is to support more responsive, on-demand feeding habits while you learn the hunger cues of this new little person.

Having worked in facilities with this designation as well as places that do not operate this way, we can say that there are definite pros and cons to both. In a Baby Friendly facility, as mentioned above, you often find a wealth of lactation support including IBCLCs and specially trained nurses. It is the culture that providers visit you at your bedside to provide care to your baby. Highly specific birth and postpartum plans are often more accepted. On the flip side, parents can often feel more pressured in these facilities to feed their baby with their bodies even though it was not part of their plan. They also can sometimes feel isolated in their rooms and afraid to ask for time to sleep or help from their night nurses during that dreaded second night (read about it here). Make no mistake, things like formula, pacifiers, and some alone time with baby in the nursery are not necessarily unavailable to you, but they’re not as overtly advertised.

In non Baby Friendly facilities, breastfeeding support can be significantly less than optimal, if there is any at all. Nurses may have less education on current guidelines and evidence-based practice. Babies often spend longer amounts of time in the nursery for exams and procedures away from the gaze of their parents. Many parents do, however, feel like their choice to combo or formula feed their baby is more acceptable in these facilities. Additionally, their desire to sleep and ask staff to care for their baby is also more accepted. Again, this doesn’t mean the option to have interventions performed at your bedside, keep your baby with you all night, and breastfeed successfully are not possible in these places, they just might not be the cultural norm.

Want to find out which hospitals in your area have this designation? You can search your zip code here.

Our postpartum prep workshop, Taking Back Your Fourth Trimester, covers this topic extensively. Why? Because we believe that information is power. The Baby Friendly designation can potentially change a lot about the way your hospital postpartum experience pans out, and we believe you should know ahead of time. Not because we believe you should or shouldn’t seek out these facilities, but because knowing which way your facility leans before you get there allows you to think about your own preferences for yourself and your baby. Do we think you should consider switching your facility from one to the other? Not necessarily, unless you feel strongly about it. You can find great care (and not so great care) in both Baby Friendly and non Baby Friendly hospitals. We simply encourage you to know what you want and advocate for it. We say it often: YOU are the most powerful person in your hospital room. How do you envision your postpartum experience? Depending on the answer, we can help you know what to ask for, how to use your voice, and what to expect from your chosen place of birth.

If you have specific questions about your situation and making a postpartum plan that works for your family, you can book a 1:1 call with us and we’d be happy to help you formulate a plan that brings you peace.

 *This post is in no way sponsored by Baby Friendly USA or any other organization. Opinions are entirely our own and do not reflect the views of our employers.