Experts explain what giving birth in a Baby-Friendly certified hospital actually means (and doesn’t mean) so you can feel confident in your choice of where to deliver.

By Kristi Pahr
December 16, 2019
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There are a ton of decisions people have to make when they’re pregnant—some big, some small—but they all feel huge when you’re staring at the 40 week estimated due date on the calendar. And when it comes to where you'll actually deliver the baby, there is no shortage of options, which just adds to the pressure of pre-labor decision making.

If you’ve decided to have a hospital birth, you've likely heard the term "baby-friendly" when it comes researching options near you. Baby-Friendly certified hospitals go through rigorous testing that translates to top-notch care for parents and babies. But unfortunately, the internet is rife with misinformation regarding the Baby-Friendly initiative—from forcing nursery closures to formula-shaming—so we decided to set the record straight.

The Baby-Friendly Hospital Initiative

In the 1991, the World Health Organization and UNICEF launched the Baby-Friendly initiative to improve breastfeeding outcomes around the world. Since then the initiative has blasted off, with 597 certified hospitals nationwide (you can find a Baby-Friendly hospital list here), and over 1.1 million births per year which means roughly 28 percent of babies born in the U.S. are born in Baby-Friendly certified facilities.

To become certified, a hospital must implement the Ten Steps To Successful Breastfeeding, which are a series of evidence-based practices that are proven to improve breastfeeding initiation and also increase the time a baby is breastfed.

So what is a Baby-Friendly hospital?

The Baby-Friendly USA website lists those steps as:

  • Have a written breastfeeding policy that is routinely communicated to all health care staff.
  • Train all health care staff in the skills necessary to implement this policy.
  • Inform all pregnant women about the benefits and management of breastfeeding.
  • Help mothers initiate breastfeeding within one hour of birth.
  • Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  • Give infants no food or drink other than breast-milk, unless medically indicated.
  • Practice rooming-in – allow mothers and infants to remain together 24 hours a day.
  • Encourage breastfeeding on demand.
  • Give no pacifiers or artificial nipples to breastfeeding infants.
  • Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

The Baby-Friendly hospital initiative has been a success as evidenced by rising breastfeeding numbers across the nation. Data shows that in the period from 2007 to 2015, the number of births occurring in Baby-Friendly designated hospitals grew from 1.8 percent to 11.5 percent and over that same time period, babies who were “ever breastfed” increased from 75 percent to 83.2 percent. And while no parent should be shamed for choosing formula over breastmilk, the benefits of breastfeeding, even for a short time, are well documented. 

The positive impact of the initiative on marginalized communities has also been noteworthy. In 2006 the CDC published a report that found that 71.5 percent of white babies had ever been breastfed compared to 50.1 percent of African-American babies. A study published in Pediatrics found that in hospitals where the Ten Steps To Successful Breastfeeding were implemented, the number of African-American babies who were ever breastfed increased by almost 10 percentage points.

Baby-Friendly Misinformation

There is a wealth of misinformation regarding the Baby-Friendly initiative and what it means for parents and hospitals. Misconceptions about the initiative can lead to parents being afraid to give birth in a Baby-Friendly facility, believing incorrectly, that Baby-Friendly hospitals are not friendly to mothers. We sat down with Trish MacEnroe, Executive Director of Baby-Friendly USA to help wade through the myths and misinformation so parents can be comfortable deciding to give birth in a Baby-Friendly designated hospital.

Nursery Closings

One of the biggest rumors regarding Baby-Friendly hospitals is that part of the initiative requires facilities to close their nurseries. This is provably false. As part of the Ten Steps To Successful Breastfeeding, parents are encouraged to room-in with their babies—have baby sleep in the same room as the parent—to help encourage on-demand breastfeeding. Many parents find out that their hospital is Baby-Friendly and automatically assume they will not be given an opportunity to rest and recover without their baby in the room. MacEnroe says this is not the case.

 “We do not require hospitals to close their nurseries. Baby-Friendly hospitals not only may have a nursery but in my opinion, should have a nursery,” explains MacEnroe. “If there needs to be a mother-baby separation, there should be a safe place for the baby to go, and it needs to be cared for and supported.” Yes, hospitals are closing their nurseries, but they are not doing it to be Baby-Friendly compliant. 

Formula Shaming

Baby-Friendly hospitals have a commitment to educate parents on the benefits of breastfeeding and empower parents to breastfeed their newborns. As part of the initiative, doctors and nurses must inform parents about the possible breastfeeding complications that may arise from introducing a bottle. That does not translate to denying formula supplementation, especially when there is medical need. Some parents have reported feeling shamed for their decision to supplement with formula or browbeaten into breastfeeding against their will, but MacEnroe says that is totally unacceptable.

“Our guidelines have always allowed for supplementation for a medical indication but if you look at the guidelines, they've also always allowed for informed decision making by the mother,” she explains. “That [refusing to allow bottle-feeding] has never been a requirement of the Baby-Friendly hospital initiative, and for mothers to be made feel guilty or uncomfortable or browbeat is just totally unacceptable.”

“We believe in empowering parents with information, and so we do have a requirement that if a mother request supplementation, the hospital needs to confirm with the mother that she understands the impact of supplementation on the potential success of breastfeeding. They also need to understand that breastmilk and formula are not the same” and that supplementing with formula can impact the potential for breastfeeding success.

The Bottom Line

If you are scheduled to give birth in a Baby-Friendly hospital, you will be empowered and educated about the benefits of breastfeeding and supported while you get the hang of it. (And yes, you will be able to get some rest without your baby if you want!)

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