The Role of Hospitals in the Promotion of Breastfeeding

We know those first days of life are extremely important in developing your breastfeeding relationship with your baby. So, what happens when most of that time is spent recuperating inside a hospital? What is the hospital’s role in the promotion of breastfeeding? Are hospitals doing enough or are some hospitals going too far to promote breastfeeding?

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The Boob Group
The Role of Hospitals in the Promotion of Breastfeeding
Episode 170, August 17th, 2016

[00:00:00]
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
SUNNY GAULT: Thanks to our friends are Rumina Nursingwear for sponsoring today’s episode. Their hands free products make nursing and pumping simple, comfortable and convenient. Use promo code BOOBGROUP20 and save 20% of your order at www.pumpandnurse.com.
[Theme Music]
SUNNY GAULT: We know those first days of life are extremely important in developing your breastfeeding relationship with your baby. So, what happens when most of that time is spent recuperating inside a hospital? What is the hospital’s role in the promotion of breastfeeding? Are hospitals doing enough or are some hospitals going too far to promote breastfeeding? We are The Boob Group.
[Intro/Theme Music]
SUNNY GAULT: Welcome to The Boob Group, we're here to support all moms who want to give their baby’s breast milk and to respect the choices of moms who want to feed their babies in other ways. I'm Sunny Gault, thanks so much to all of our loyal listeners, we do love creating this show for you week after week, so please let us know what topic you want to learn more about, we'll look into it and we'll see if we can explore it on a future show.

Our show is available on a bunch of different platforms including iTunes, Stitcher, Spreaker, TuneIn and Google Play Music, and also don’t forget our free apps. Wherever you listen please take a moment to comment and rate and review our show, it’s so important for us, this is the main way other moms find out about our show. So if you can star us and leave a brief comment that would be awesome. 

So let’s meet the moms that are joining our conversation today, ladies, tell us a little bit about yourself, your family, and also let us know where your kids were born, as far as, you know, were they all born in hospitals, did anyone do any home birth, what about birthing centers and all that good stuff? Pria let’s start with you.
 
PRIYA NEMBHARD: Sure, so my name is Priya, and I’m a mom of three, my oldest is 14 and I have a 12-year-old and an eight-year-old. So I breastfed, breast-pumped, supplemented for all of them and I also gave birth in a hospital for each one of them, and the first two were born in Saint John's Episcopal here in New York, and the third one, he was born in Jacks Memorial in Miami, and they were all great experiences, all sort of different. I'm also the co-founder of the Moms Pump Here Nurse locator App that helps moms find, rate and share nursing locations around the world. 
 
SUNNY GAULT: Awesome. Thanks for being with us, and Moon, tell us a little bit about yourself.
 
AFRICAN MOON: Greetings everyone, I'm African Moon, I have three children. My eldest two were born in hospitals and I had my latest child at home.
 
SUNNY GAULT: Oh, a home birth. Awesome, yay. Alright and Leslie, why don’t you tell us a little bit about yourself. 
 
LESLIE NIDEL: Sure, I'm Leslie Nidel, I have two daughters, Rebecca is five and Lila will be two in September, and we live in Hoboken, New Jersey and they were both born in hospitals nearby in New York City. 
 
SUNNY GAULT: Let's see, Alicia tell us more about yourself. 
 
ALICIA: Hello, I am Alicia, I just very recently gave birth to my first daughter. Her name is Cadence and we did do a hospital birth which was an incredible experience at the hospital that I was able to deliver at here in Nashville, Tennessee, and just kind of figuring everything out, breastfeeding wise, but we're doing pretty good so far. Happy to be here.
 
SUNNY GAULT: Alright, yeah, within the last month you gave birth, so this is a very squishy fresh baby that you're probably holding right now as you're recording this with us right?
 
ALICIA: That’s right, she’s sleeping nice and cozy.
 
SUNNY GAULT: That’s awesome, and for me, so I have four kids, all were born in a hospital and my first baby was a vaginal birth and then I had a lot of complications after that which resulted in my other kids being delivered via cesarean. So I have a lot of experience with hospitals and staying in there recuperating from the C-section, so probably even staying a little bit longer than what, you know, some moms are able to get out there pretty quick after a vaginal birth, but yeah. So I can definitely share my experiences as far as what kind of hospitals I delivered at. I did deliver at two different hospitals for the three delivery experiences that I had and one, I think only one, was deemed baby friendly, which I know we're going to talk about a little bit later on, so, that's me.
 
[Theme Music]
 
SUNNY GAULT: So before we dive into our topic today, there’s a photo that’s going around and it is just, its heartbreaking, it’s beautiful at the same time and so it's what we're going to talk about as part of our news headlines today. It’s beautiful because it’s a mom breastfeeding her baby, I actually can’t see much of the mom its mainly a picture of the baby, but the big deal is that this baby was born with cancer and so, born with cancer, yeah, like I mean totally horrid kind of situation.

But this mom, I mean apparently this baby just loves to breastfeed and this is just, you know, one of these, you know, the main way that this mom can really help her baby and provide for her baby and she actually, this photo was taken while the baby was receiving chemo treatment and so you can only imagine, you know, what that mom is experiencing, what that baby is experiencing and I just think it just shows the beauty of the connection between mom and baby and what mom can do, like, you know, in the toughest of times, to carry her baby through it.

It says that this relationship that they have, their breastfeeding relationship, is proving to be a huge comfort for both of them, which of course I think everyone here on our call can relate to, and that people are just really commenting on this and just sharing their love and support. It's just a heartbreaking kind of situation but the baby was born with stage three brain cancer. It's just, it's so sad but it's beautiful at the same time. So I wanted to get everyone's reaction to it, see what you thought.

So I know everyone, everyone's so sad note, I really kicked this off on a really sad note didn’t I? Moon I wanted to get your take on this. 
 
AFRICAN MOON: I didn’t click on the link, I can’t deal right now, so I don’t want to see that, the photo, I don’t know, like right now I’m ready to cry, so. 
 
PRIYA NEMBHARD: The photo's not bad, the photo's not bad.
 
AFRICAN MOON: I'm just super emotional, I’m super emotional lately so, yeah, just, just hearing the story, it's a bit much for me right this second. I don’t even know what the question was. Sorry.
 
SUNNY GAULT: I'm sorry, I didn’t mean to bring you down Moon. Priya’s right, the photo isn't bad. Pria what are your thoughts on this?
 
Pria: So, my son was born with a kidney defect and so it's not, obviously this is a really extreme situation and it's breaking my heart just thinking about the fact that this mom has to go through this, but it's the breastfeeding was so important for me when my son was going through all of the kidney tests, and then he had a surgery at eight months. He, I had to breastfeed, and it was the one way that I felt I could bond with him and support him and make him healthy because he was under medication.

So I'm imagining she’s feeling the same way that this, you know, it's one thing she feels she could do physically and directly for the baby to help the baby with the cancer, you know, whereas she's getting all these tests and stuff from the hospital and the chemo.
 
SUNNY GAULT: I know. Alicia I know, this isn't fair that I toss it to you because, you know, you just had a baby and I'm sure all this is just so fresh in your mind. The baby looks pretty, pretty young, I guess she is six months old. What are your, what are your thoughts on this?
 
ALICIA: Well, I actually had a cousin who, I think, her baby, it was actually my aunt, that’s right, it was my aunt who her baby was six months old and he did have brain cancer and so I, having that in my family personally and seeing how that affected their situation and then knowing just, you know, very recently, how much the comfort breastfeeding can be for my little girl, I know it’s got to be, I can’t even imagine the kind of emotions that she's got going through but again being able to have that physical, direct help that she, she can give to her baby and having that comfort and that bonding even though that they're going through this really really difficult situation.
 
SUNNY GAULT: Right

LESLIE NIDEL: I mean, I think it’s obviously a heartbreaking situation but any steps that the mother can take to make her child feel better, of course she would take them and it's amazing that they can have this breastfeeding bond and it can be the thing that connects them during such a difficult time. I've heard that, from so many people, that when their child goes through something traumatic they do want to breastfeed, you know, that becomes their comfort, that’s what they know as what is good for them. So it's amazing that she can provide that for her and obviously I wish them the best and hope that everything turns out to be on the upswing as it says. 
 
SUNNY GAULT: And I should mention too, and at the bottom of the article it does talk about this, but they do have a GoFundMe site, so if this is, is really kind of tugging on your heartstrings and, and you want, you feel compelled to do something about it, you know, we'll post this link to our Facebook page, but you can also just google it. This article is actually posted on scarymommy.com but I think that there’s probably a lot of people picking this up but if you kind of google, you know, mom breastfeeding chemo baby kind of thing, you'll probably find it. So kudos to this mom for doing everything that she can to help her baby, that’s what we do right? As moms. 
 
[Theme Music]
 
SUNNY GAULT: Alright, so today we're talking about hospitals and the role they play at encouraging moms to breastfeed and a term that you're going to hear us talk about a lot, in fact I think I mentioned it in the beginning, is the term baby-friendly. So real quickly I just kind of wanted to define this. So if you haven’t heard of this yet, it is a distinction or designation hospitals are given after they complete a series of ten steps that are designed to make them more breastfeeding friendly okay?

And we'll talk about those steps in the second half of our conversation, but moms before us kind of dive into all that I really wanted to get your take, we've all delivered in hospitals here, and I wanted to get your take on how that experience was as far as how these hospitals encouraged you to breastfeed? What role they had in the process? And I know a lot of us, actually besides Alicia you're on your first kid, but the rest of us have a bunch of kids so we may have some different stories. So Priya let’s start with you, what would you say, and feel free to break it down per kid, but, we'll be here forever right, if we all do this. But what was your experience?
 
PRIYA NEMBHARD: So, It's funny, because you know this breastfeeding-friendly thing, this baby-friendly thing, I don’t know, when did it first come out? Because I didn’t hear about it when I was pregnant and had my babies, and if it’s been around for a while obviously the hospitals that I gave birth in never made any mention of it, so I’m assuming they weren't baby-friendly back then, but after I gave birth I knew that a lactation consultant was going to go on to the, come into the room, well actually at the first child you already know the rounds, you know, what’s going to happen, you know, how long you're going to be there, all that stuff.

So I knew on the last day I was going to get a lactation consultant but I did know on the first day that I was going to breastfeed so I did do that and I breastfed and, but it’s funny because there was no strong emphasis on breastfeeding, you know, I knew I had to do it but when, on the last day, when I was about to leave I got the info-mil bag. It was a pretty blue and yellow bag and I had it until my third child because it was sentimental and it had the big info-mil label on the front and I had like two three cans in there, info-mail plus coupons and all this stuff and I didn’t think anything was wrong with that, you know, I thought it was just part of the process, you know, and although my parents, you know, we're all from south America.

They grew up differently breastfeeding and all that stuff there wasn’t a lot of formula that they had to resort to but nobody said to me you have to breastfeed, don’t use this formula, but it was just an organic thing, like I just started using it eventually, you know, after, you know, I weaned my son off and all that stuff and I knew it was there and I thought it was okay. I believed it was okay, and it was okay for him. So my first son, yeah, I went through those emotions and, you know, I thought it was normal, I got the bag and my, my daughter, I only breastfed her for two weeks, I pumped afterwards but I supplemented with formula and I thought it was okay.

I had the same experience in the hospital, you know, the lactation consultant comes in, talks about, you know, decent things you should do, I fill up paperwork and then I left after three days because of the insurance, and then my third child, his experience was a little bit different because, well first of all the labor was different because I wanted to do it without medication but of course that didn’t happen, it's so sad, that’s another story, and when he was born they actually were telling me you can stay a couple of days longer if you wanted to and I don’t know if it had to do with insurance or whatever and my OBGYN did not, was not the one in the labor room with me, it was a bunch of nurses.

But they were all, you know, for the breastfeeding I remember having conversations with them, before the lactation consultant came in, so they were all great experiences, slightly different in its own way, but there was no over emphasis of breastfeeding, it was more organic in the last birth and I, you know, it was just, you know, for me it was normal.
 
SUNNY GAULT: Right, and you did ask, you asked when this started, and I was looking up information on that, so 1991, and this is actually, it says it was launched by the world health organization and the united nations children’s fund which is unique, to encourage and recognize hospitals and birthing centers that offer an optimum level of care for infant feeding and mother baby bonding. So, 1991. So Moon, tell us a little bit about your experience and how you felt, you know, with the hospitals and whether they supported your breastfeeding. 
 
AFRICAN MOON: So I’ll start off by saying I had my third child at home, so I think that sort of talks a little bit about my experiences in the hospital, but I, you know, I want to say that I think the word baby-friendly is sort of a chicken statement, like I really want to voice that because they want for hospitals to focus on breastfeeding so why are we so afraid to say that? Why is it that we're so afraid to say that we're breastfeeding-friendly? We're a breastfeeding-friendly hospital that bothers me that people tiptoe around those words. 
 
SUNNY GAULT: I was just going to say, I, it’s an interesting take that you have on that, I actually viewed it a little differently, I didn’t view them as not wanting to say the word breast or to be very obvious about what the goal was. I actually think, and I have no proof of this, but I actually think that it’s a marketing tactic, because if you say baby-friendly, okay what hospital doesn’t want to be labelled as baby-friendly? For me it kind of rubs me the wrong way because it indicates that if you're not breastfeeding your baby, that you're not baby-friendly and, man, I think that that could really hurt a lot of moms that have chosen not to breastfeed. 
 
ALICIA: I 100% agree, I think that feeding a baby is baby-friendly, keeping a baby happy and changing its diaper is baby-friendly. I think, everything that goes into taking care of a baby no matter how it happens is baby friendly, so telling someone who doesn’t want to breastfeed, for whatever their reason is, or someone who's having a difficult journey, for whatever that reason is, that they are not being baby-friendly, is just like a dagger through my heart, I mean that would have been so painful for me to hear. So I’m glad I had my babies before that was a thing because it’s really, its mother shaming before they've even left the hospital, quite honestly. 
 
SUNNY GAULT: Yeah and that’s a really good point to make, but Moon I know we kind of got interrupted with your story so continue, tell us more about your experience, it sounds like your first two, not so great experiences in hospitals?
 
AFRICAN MOON: Well my first child, I was approached by a lactation consultant maybe an hour or so after she was born. I was really already starting to have problems because she was sleeping, but she was on my breast, but she wasn’t nursing and when the, and when, you know. I was waiting for the lactation consultant to come in so I can ask her like is this, is she sleeping because she’s new? Like, you know, what’s going on here? And when she walked in the room she looked at me and she says, ugh I am so tired of you young girls. 
 
PRIYA NEMBHARD: What? 
 
SUNNY GAULT: What?
 
AFRICAN MOON: Let’s get this titty in this baby’s mouth!
 
PRIYA NEMBHARD: What?
 
AFRICAN MOON: And I’m like whoa okay!
 
SUNNY GAULT: What? 
 
AFRICAN MOON: I need for you to leave.
 
ALICIA: What hospital was that?
 
AFRICAN MOON: I was at Mutzel hospital in Detroit, okay? Because I can’t stand that hospital, I want everybody to know I hate that hospital, but I'm like first of all I’m 30, you know, so thanks for calling me young but no not so much. Second, like are you kidding me right now? I need you.
 
PRIYA NEMBHARD: She walked in with an insult instantly
 
AFRICAN MOON: Yes, like, I, now I can’t hear anything you're saying because you came at me so wrong, you know, so I asked her to leave, I need you to get out of here, like, you're putting me in a bad space, but the way she approached me .... Where I was struggling for weeks afterwards trying to get my daughter to breastfeed until I found this amazing woman at one of the wick offices that came to help me.

But she, the hospital, it seemed like they wanted me to feel in labor, they put me in this room and the first thing that I walk in the room and there's like 40 bottles of formula around. My baby's not even born yet, you know, it just seemed like they were sabotaging me left and right. I mean, the whole thing was completely ridiculous and so because of that we, we seriously had a lot of problems. I spent the first few weeks completely miserable and thinking that I was putting my daughter in danger because I was refusing to use formula. It's like no! I gave birth to this child, I should be able to breastfeed her, and if the hospital had been more for me or more for my child and not so much for the formula companies, that would have helped a bit, you know. 
 
PRIYA NEMBHARD: And it’s like that woman sabotaged you mentally.
 
AFRICAN MOON: Absolutely, absolutely with that, you know, and even if I was 12 like you don’t talk to anyone that way if you're supposed to be helpful. My birth experience with my second child was amazing, but then we come to what would happen afterwards. So when the lactation consultant came in, she came in with that same vibe, now by then I had breastfed my daughter for three years, so I knew what I was doing.
 
SUNNY GAULT: Yeah.
 
AFRICAN MOON: So when she came at me like, ugh so are you going to breastfeed this one or are you just going to give up? And I'm like, you know what? You can get out because we already got this, we got
 
PRIYA NEMBHARD: Was it the same lady?
 
AFRICAN MOON: It wasn’t the same lady, it was not the same lady, but it was the same attitude. 
 
PRIYA NEMBHARD: So it's the culture in the hospital, they're not
 
AFRICAN MOON: Absolutely!
 
PRIYA NEMBHARD: They're miserable 
 
AFRICAN MOON: They're horrible people, you know, and I seriously was like, you can just go, I’ve been doing this for three years, like, I’m a pro by now, you know, so you can get out. 
 
SUNNY GAULT: That's really interesting, now, I mean, as you were talking, Moon, I’m thinking, wow we have a lot of diversity on this call as far as where we're all located. Moon you're in the Detroit area, and Priya you're in the New York City area, and then Alicia you're in Tennessee right? And then I’m in San Diego, and I think what we're going to see here is, like as we all share our stories, I think this will be really interesting to see how it varies in the locations that you're at and how, you know, because I mean, just like anything, like how this stuff spreads. You know, it will start in one area and it kind of grows from there and it may be that just our areas, our own experiences, are obviously going to be tainted by what we see in our day to day lives.

I think it’s going to be really interesting to kind of have that kind of unfold in this conversation because it sounds like it’s going to be different based on where we're from. Alright, and Leslie for your birth experience, what do you remember, do you remember the hospital being, you know, breastfeeding-friendly or, you know, what did they do for you?
 
LESLIE NIDEL: They were definitely breastfeeding-friendly, there was lactation support throughout my stay, but I think I am in the minority because when my daughter was born she was eight pounds eight and a half ounces, and I was attempting to breastfeed immediately and they told me that they had checked her blood sugar, she had low blood sugar, and they had to give her formula right away. That even whatever I could give she wasn’t enough, so they took her, I want to say, within a couple of hours of being born, and gave her formula.

So it was part of my experience right from the beginning, whether that’s baby-friendly or not remains to be seen. But it was part of our experience; it was just having that formula around because they said she was so big that whatever I was producing wasn’t enough. I mean I've heard since then, I mean obviously this was my first baby I had no experience, I did not know who to believe, or what to believe, I've heard since then that that's impossible, that your body produces exactly what your baby needs and you know, people have told me that that's crazy but that was my experience, you know. I let them take her and then continued on with, I think, the nurse set bottles, pretty often right from the beginning just because the breastfeeding didn’t come naturally to us, so her latch wasn’t that great. It just wasn’t the relationship we were meant to have and so yeah, we did formula starting very early. 
 
SUNNY GAULT: And how old is your daughter now? Like how long ago was this?
 
LESLIE NIDEL: That was in 2011, January of 2011 so now she’s five, and she’s fine, formula did fine. I did attempt to, I mean I took, it was about two weeks where I was really giving it the good college try to breastfeed, but it just didn’t work for a multitude of reasons. There were so many factors into that, and it was a painful decision to stop but not really because since the beginning she had been getting formula so I knew that that was an option, you know, it wasn’t just, I don’t know. 
 
SUNNY GAULT: Yeah, and in, did she start gaining weight right away after the introduction of formula, did it get better after that point?
 
LESLIE NIDEL: Yes, I think she had always been gaining, I mean I think she lost the normal amount that they do in the hospital. We were never fearful of her not gaining enough weight; it was just the stress that it was putting on me and the state of my body that could not maintain the breastfeeding. She was just colicky and reflux and I was, you know, I had a bit of postpartum depression quite early on so it was just not the way we were meant to go. So formula let me rest, and it let her have the sustenance she needed because she was a bigger baby, you know, she’s not massive by any means- in terms of when she was born, but, you know, she was bigger and she ate well, so the formula was able to give us that piece of mind.
 
SUNNY GAULT: So I can share with you guys a little bit about my experience. So I mentioned I've had three labor and deliveries even though I have four kids right? Because I've got the twins, and my first child was a Singleton baby and he, you know, the hospital I delivered at was really interesting because I actually was with a different medical care provider but they were more in downtown San Diego, and for me to get to downtown San Diego it's like over 40 minutes depending on the, you know, commute time and stuff like that. So they had a partnership with a hospital that’s like literally like five minutes away from me, where they had people on rotation, you know, from my medical care provider up at this hospital up here that’s closer to me. So you could deliver even though you had the care of the medical care provider that was down the San Diego area.

So I ended up, for my first baby, delivering right here that this hospital is like five minutes away and they are not baby-friendly, they still aren’t, I’m looking at the list now, which by the way we'll post this link to the episode page so you guys can kind of check out what hospitals are considered baby-friendly. The hospitals on this list, by the way, have gone through the whole process, it does take a while to become certified or have this distinction, right?

And so, hospitals can be in the process of becoming baby-friendly for years, so just because a hospital isn’t, or birthing center, isn’t on this list, doesn’t mean they're not taking steps to becoming, quote-on-quote, baby-friendly, it just means they haven’t completed the process yet. So anyway, so the first hospital that I delivered at was not baby friendly, and Priya, just like you, you know, I remember, you know, getting that formula bag, you know, going home.

The other thing I noticed with it too, and I don’t know if this was because they weren’t baby-friendly or, you know, if it was just happened to be the person that came in, I believe she was a lactation consultant, but I had just had a baby and my mind was elsewhere. I wasn’t really checking credentials, but this woman came in, and I was trying to breastfeed my son and she looked, she took one look at me and him and said, oh you need a nipple shield. I’m like I don’t even know what a nipple shield is, what are you talking about? And then she went out the room and then she came back a little bit later and she’s like, oh yeah you have flat nipples, you have to, you know, use this nipple shield.

I mean, seriously, I just thought this was the craziest little device but I put it on and my son was able to breastfeed through it, and I don’t know if that would have happened in a baby-friendly hospital but I will say that I think there was not much education about what is this device, what am I using here, how long am I supposed to use it for, and I really believe, no one, no one ever told me that nipple shields were supposed to be temporary.

So I thought every time I breastfed my baby, I had to use this nipple shield, and it caused so much, if anyone’s had to use a nipple shield, its, its fine until you don’t have it, and they're clear right? So they're hard to find if you lose them and, or they tear or something like that. So I really think that because no one ever told me I was supposed to transition off of this, that, first of all it was given to me prematurely because I never had to use it with any of my other kids. But, and then no one told me I, you know, I need to wean off of it, that it became a hindrance for my breastfeeding experience with my first son.

I only ended up breastfeeding him for four months and I was really upset by that because, I mean, he, he, he got to the point where he would not latch, he would not have it if I did not have that nipple shield, and it was just a nightmare. So was that because it wasn’t a baby-friendly hospital? I don’t know, I mean, but I can definitely say that that hospital I delivered at wasn’t baby-friendly and it still isn’t baby-friendly.

Now on the other hand, because I had to have cesareans with my other two labor and deliver experiences, I had to go to where my medical provider actually was, I couldn’t go to this hospital that was closer to me that they had this partnership with. So I know, I’m not sure about the first, I think, both times that I delivered down there my C-sections, I think they did have the distinction of being baby-friendly. In fact I’m looking on the website now and it says they were first certified in 2010 and so that would have been after my first son was born but before my second son and my twins were born. I did notice a very big difference in how everything was done, and definitely, you know, the bags, you know, were different and they changed all of that up.

I also think that my whole attitude towards it was different, because I was hell bent on breastfeeding my second child for longer than I did my first and in trying to overcome it, and I really didn’t want to have to use a nipple shield. No one ever suggested a nipple shield to me that was not on the table, they just kind of showed me, you know, how to position the baby a little bit better how to kind of put the nipple in the mouth, and my son was breastfeeding right out the gate. So again, I don’t really know what to chalk that up as, but I definitely had more support in the baby-friendly hospital. So moms what do you think some of the benefits are of hospitals becoming more proactive and involved in the breastfeeding experience?
AFRICAN MOON:  I think one of the benefits would simply be putting moms in the mindset where they can do it. It sends a message, the fact that you may fail when you walk into a room and you're already introduced to baby formula before you are introduced to your child. But I really think that we need to start saying that I’m breastfeeding-friendly, I’m breastfeeding-friendly, I’m breastfeeding-friendly, so mothers will say like, you know, this whole hospital is going to work on helping make sure that I get to where I need to go.
I think we need to stop being so scared of offending someone who may not want to breastfeed and start focusing more on those who really do want to do it, but they have some kind of apprehension, they have the family that’s not supporting them, whatever their case is. We need to keep saying those words so people won’t be afraid to say, no I really want to breastfeed and I need you to help me.
SUNNY GAULT: Yeah, I mean, I think that’s, you know, the whole point with the whole baby-friendly initiative is, you know, when moms come in to a hospital, you really don’t know their background, you don’t know, you know, did their mom breastfeed, you know, have they, you know, have they ever seen someone nursing in public, like you don’t know where they start off. So the idea is, listen, let’s give them the basic foundation so that they know the health benefits and everything to breastfeeding. I think the question is, can we take it too far?
LESLIE NIDEL: Right, and I think it’s following the moms lead. I have friends that were die hard wanted to breastfeed no matter what, and I have friends that went in knowing they would not even try. So every woman, just like they go in with a birth plan, which I think those should be thrown out the window and never discussed again, I think the same thing goes for breastfeeding plan. Mine was, if it works great, if it doesn’t, oh well, and that ended up being the best plan I could have had because it didn’t, you know, and I didn’t let myself fall apart over it, it just wasn’t meant to be.
So some moms, if they're having troubles or if they've gone through a traumatic birth or if they're under immense pressure and they don’t want to breastfeed, I think pushing them to do it too much is just detrimental on top of things that are already hurting them.
SUNNY GAULT: Right, because that’s all we want to do, is help our babies in the beginning and then you're like, oh so I can’t breastfeed so I’m, I’m not helping my baby? Like 
PRIYA NEMBHARD: Yeah, that’s not right to do that.
SUNNY GAULT: Right
PRIYA NEMBHARD: Because so many women that are in situations, you know, preemies, look at preemies, moms cant breastfeed right away, and they have to maybe use donated milk or supplement with formula and its, you hurt women and you give them that, that complex when you do that.
SUNNY GAULT: Which is sad because that’s not the intention, you know, I mean that’s not why the baby-friendly initiative was created, you know what I mean? Like that we want to make sure, like I said, that everyone is starting out on the same playing field as much as possible, you know, and it does make sense to do that, you know, right after the baby is born, right? I mean we're so influenced by a bunch of different things in the beginning and all you have to do, if you're in the hospital in the beginning, all you do is rest and take care of your baby, so that’s a perfect time to kind of foster this relationship.
I just think that it, you know, we just have to be careful, you know what I mean? We don’t want to give people a bad impression of what it means to breastfeed, or that if they just can’t do it, or they just don’t want to do it, I mean this, you know, we still live in a free country right? I mean, even if something isn’t the best thing for our baby, we still have the right to make that decision, you know, I mean regardless of what the statistics say, and I think that that needs to be respected as well. So, you know, it’s definitely a fine line. Alright so we're going to take a quick break, when we come back we're going to briefly break down those 10 steps that I was talking about. I just want to get everyone’s reaction to what’s on this list, as far as hospitals getting this baby-friendly designation. So we'll be right back.
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SUNNY GAULT: Alright, so welcome back everyone. We're continuing our discussion about hospitals and what their role is in the promotion of breastfeeding and in this second half we're going to break down these 10 steps to getting this baby-friendly designation, this is what the hospitals need to do, and like I said it can take a while to complete this process. I know hospitals that have been in the process of becoming baby-friendly for three years or more. So right now, according to the baby-friendly website, there are 355 hospitals and birthing centres across the US that are currently considered baby-friendly. So they have that distinction, they've gone, you know, all the way and completed these 10 steps.
So let’s go through these steps. The first one, have a written breastfeeding policy that is routinely communicated to all healthcare staff. I think that makes a lot of sense, I don’t know that any of us would really disagree with that. Anyone have any take on that? 
PRIYA NEMBHARD: Yeah that seems like an automatic
SUNNY GAULT: Yeah, right, you got to, yeah, you got to have a policy. The second one is to train all healthcare staff in the skills necessary to implement this policy. I think Moon that would have definitely helped you, I think that woman needed some training. 
AFRICAN MOON: Yes.
SUNNY GAULT: And the benefits of breastfeeding. Number three here, inform all pregnant woman about the benefits and management of breastfeeding. I think it’s interesting, and I’m sure they break this down on some level, how do you do that? I mean, is it simply, you know, lactation consultant coming in and, you know, right after babies born and, you know, talking about the benefits of it, you know, are you planning to breastfeed your baby? You know, well if you're not planning, you know, I just want to let you know what some of the benefits are to that. Again I think that could be taken too far, really depends on how far they want to push this. Anyone have any comment on that?
ALICIA: For me, like I said, I was already planning on it, so they just asked me, hey what are your plans, and I said yes and then it wasn’t really, they just kind of assumed, they guessed that I’ve had my educated decision so they didn’t really push it that far after.
SUNNY GAULT: Yeah, yeah I think if you already said yes we're going to be, I am going to breastfeed my baby, they wouldn’t have any need to push it so. Alright, number four, help mothers initiate breastfeeding within one hour of birth. And I think, Moon, didn’t you mention that it was about an hour before you were able to breastfeed your baby?
AFRICAN MOON: Yes, yeah. Well with my first daughter, I actually started having issues immediately and within, within an hour, hour and a half or so the lactation consultant did come in, so I guess to her credit, she did do that, but she came in with such a funky attitude that the appearance of her was not helpful.
SUNNY GAULT: Okay Moon, so for you that, within that first hour that was really important for you, you knew you wanted to breastfeed. On the flip side, what about moms who aren’t ready to breastfeed at that one hour mark?
LESLIE NIDEL: I mean, if a woman has had a traumatic birth experience or a C-section or anything that has gone a rye and within one hour they're not ready to do this other invasive thing to their body, you know, say what you want but latching a new born baby onto a breast is not the most magical experience, I think if that doesn’t happen within an hour then you're going to deem yourself not baby-friendly and that is also just hurting new moms, it’s not, I think that’s a very prescriptive thing that may not always be possible.
SUNNY GAULT: Alright, well number five on our list here of this 10 steps is, show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
PRIYA NEMBHARD: Does that include breast-pumping then? Cause I would assume so.
SUNNY GAULT: You know what’s interesting, and I don’t know if this happened with just my twins when I delivered my twins, but there was a pump already set up in the room. It was a hospital grade pump and they gave me, you know, the flanges and the tubing and everything so that if I wanted to initiate pumping in the hospital I could and that was a baby-friendly hospital. So I don’t know, I didn’t pump because I was, I was actually trying to latch them and then that didn’t really work and my milk hadn’t quite come in yet. I was still, I had a lot of colostrum which was good because that’s what my twins needed in the beginning, so, but I was just manually expressing in the hospital. Did anyone have any experience, like, you know Alicia you just, well it wasn’t a baby-friendly hospital, but, you know, you just gave birth, do you remember anyone saying anything to you about pumping?
ALICIA: They told me how to get a pump, because I actually still haven’t, and still don’t, have one yet but that’s my own procrastination, anyway, but they did not have one set up in the hospital and they asked if I wanted to but I told them, you know, I’d rather try to focus on getting the latch well, so it, it was offered but it, I didn’t feel the need to try it at that time. So at least, I mean, they did provide the auction.
SUNNY GAULT: Okay, well that’s good. I don’t remember anyone ever really teaching me about manual expression by the time I gave birth to my twins I already knew all about manual expression and so I was already doing it. I know they were kind of surprised by that, they were like, wow this mom knows what she’s doing, I got out those, you know those like little medicine cups that they give you, like if you've got pain, because I had a C-section, so they were giving me pain meds and stuff like every few hours, and I was actually hand expressing colostrum into that cup, and then, because the babies, my babies were preemies they were born at 35 weeks, and so they were having a really hard time latching.
so I was like in there working it, I’m like, I mean I felt like, you know, I was milking myself basically but anyways, so, yeah I had a pump in my room, so I’m not really sure. Maybe it depends on the hospital, I’m not really sure. The next one on our list is, give infants no food or drink other than breast milk unless medically indicated. I think this can be a sticking point because, as we talked about earlier, there may be moms, I’m sure there are, moms that happen to deliver at a baby-friendly hospital because its what’s nearby or that’s, you know, what, you know, their insurance is part of, or whatever the case is, that go in there really not wanting to breastfeed. I would be really interested to hear what happens at that point, you know, how far do they push?
LESLIE NIDEL: I think that sounds completely unbaby-friendly. I think that if medically indicated, of course, those people should get formula, those babies fed no matter what, but what, what constitutes medically indicated? You know, my daughter, low blood sugar, is that a medical indication? Perhaps! Is a baby that’s crying a lot because it’s starving because the mother’s milk obviously hasn't come in yet and maybe the latch isn’t perfect and lactation support hasn’t been as it should be or she just doesn’t want to breastfeed? I, there’s, there’s a multitude of reasons that could go into providing babies with formula, that’s why it exists, and to withhold it like it’s some kind of illegal substances seems quite, I don’t even have words right now, it seems just..
SUNNY GAULT: Wrong.
LESLIE NIDEL: Wrong, wrong, flat out wrong. Yes.
PRIYA NEMBHARD: I wonder if there are any fights break out.
SUNNY GAULT: I know, I know right? I mean, well, I mean at some point, I mean that you can’t ever force a patient to do anything, to receive any kind of care or whatever, you know. But yeah, so I think this is definitely a sticking point if you're going in thinking that you're not going to breastfeed, and I think it could be, you know, just something to consider. If you want to deliver at a, or thinking about delivering at a baby-friendly hospital. The other one, number seven we're at now, practice rooming in, and that means allowing mothers and infants to remain together 24 hours a day, and I personally loved this. I mean the whole idea of a nursery seems very weird to me, like, I just gave birth to this baby and we had this great skin to skin now go take him away, like that just doesn’t really make sense to me.
However, I will say, I’ve read some articles on this too, that sometimes, especially moms who have been through a very traumatic labour, need to rest, they need just, you know, to get some sleep and have a little bit of distance from their babies, and that would be one situation where I’d be like, oh I don’t know maybe it is better for the baby not to be in the room at that particular time. I don’t really know what happens, you know, during, you know, for baby-friendly hospitals, you know, I would imagine that they would try to accommodate the mom, or try to help the mom in other ways. Has anyone heard of situations like this?
PRIYA NEMBHARD: Well, I haven’t heard, but my last child was the only hospital that wheeled, he, they wheeled Liam in right away and he stayed with me most of the time and they weren’t, Jackson Memorial in Miami, I don’t think they're baby-friendly, or were baby-friendly back then, but he spent most of the time I was there he was in the room with me and I loved it. The other two hospitals didn’t do that right away.
LESLIE NIDEL: So this is one of my pet peeves actually. This is what I tried to do with Rebecca, and we kept her in our room the first night and she cried the entire time and I had been up the entire night before, you know, having her. So I was exhausted and I didn’t want to send her to the nursery because I wanted to prove from minute one that I was a, you know, champion mom. But eventually I said can you please take her and just bring her back when it’s time for her next feeding, and I slept and it was magical and quiet. With my second I sent her to the nursery every chance I could because I needed that time to rest and let my body heal and rest is necessary to even have a good breastfeeding experience. You need to sleep and eat and drink and you can’t do all of those things all the time if your baby is in the room and perhaps fussier than other babies, or for whatever reason.
So I am a huge fan of nurseries, I am a huge fan of keeping your baby in your room if it is what you want to do, I, you know, making your own choices is what I’m a fan of. So this, I, I haven’t heard it worded as nicely as this, allowing mothers and infants to remain together, I have heard it as, there is no nursery to send them to, your baby stays with you, what are you talking about, we don’t take babies. Like, which is just backwards to me, I think the hospital is where you should be able to recover as a mother, as a new mother, who’s just gone through a huge experience, or surgery, or labour and delivery. 
SUNNY GAULT: Trauma, yes.
LESLIE NIDEL: Trauma.
SUNNY GAULT: Major, major surgery. A lot of woman have major surgery.
LESLIE NIDEL: Exactly.
AFRICAN MOON: I wasn’t in a, a breastfeeding-friendly hospital but I’m totally paranoid about anyone touching my children because we don’t vaccinate, so I was super paranoid that if they would take my children out of the room they would go ahead and vaccinate or at least with my second child, because they did so with my first child they vaccinated her without asking, so yeah, I wasn’t allowing my children to get anywhere away from me so I think that could help with people like myself who are not so much trusting.
SUNNY GAULT: Right. The next one on our list, number eight, encourage breastfeeding on demand. You guys feel like that was encouraged at all, and breastfeeding on demand is just hey, you know, instead of like necessarily having a schedule, it’s just hey whenever your baby wants to nurse just put him to breast. Do you feel like that was conveyed at your hospitals? Alicia what do you think?
ALICIA: I mean, yeah definitely, and the one thing that I appreciated and finding out from my hospital is, cause they, they wake you up all the time, you know, to do this and do that and check on you and with Cadence too, sorry she’s trying to latch right now.
SUNNY GAULT: Perfect timing Cadence, perfect timing.
ALICIA: I know, mommy now.
SUNNY GAULT: Breastfeeding on demand at its finest right there.
ALICIA: Right, right in the moment, but whenever, whenever they were having set like I would have a nurse come in and say, okay, you know, and we're going to do this at about this time, and if at that time they came in and she was nursing they would say, okay, no worries, just like page me whenever she's done and I’ll come in and get her and so they were very, like, zero pressure, or at all, you know, they were very much as far as, you know, her eating on her schedule is the most important thing and everything else can wait. 
SUNNY GAULT: Oh good, good I’m glad to hear that. Did anyone else feel like for those first, I don’t know how long you were in the hospital but, on average mine was like two to three days after giving birth, did anyone else feel like you were just shirtless the entire time or is it just me? I mean I literally did not wear a shirt and I didn’t care, like I didn’t care who came in the room, because I was doing skin to skin or whatever and, you know, I was just like whatever, you're going to see it eventually it doesn’t matter.
Alright so number nine on our list, I think, is a little bit controversial. It says, give no pacifiers or artificial nipples to breastfeeding infants. Anyone got a take on that one, because I, I definitely saw a difference between the baby-friendly hospital and the non-baby-friendly hospital in that regard as I mentioned. I think, are nipple shields considered an artificial nipple, does anyone know?
AFRICAN MOON: I don’t know
SUNNY GAULT: I don’t know, I don’t know.
PRIYA NEMBHARD: But you know if there’s going to be a breast pump in the room for moms who are medically, they medically have to use breast-pumps or 
SUNNY GAULT: Yeah
PRIYA NEMBHARD: That’s an artificial nipple, so that’s kind of like, I don’t understand, I’m so confused because they say not to use artificial nipples
SUNNY GAULT: Right
PRIYA NEMBHARD: But you have to use a bottle and an artificial nipple for a breast pump.
SUNNY GAULT: Right, well, and like I said that first hospital I delivered at, she took one look at me and was like, oh artificial nipple or whatever, I mean nipple shield. So I’m thinking that’s an artificial nipple because it kind of fits the description right? And I did not get that at all at the baby-friendly hospital, I mean no mention of it, no need for it, and then I didn’t even tell them my story, they didn’t even suggest it, so I’m thinking that probably falls into it. The other thing though is pacifiers.
LESLIE NIDEL: I am completely against this. Pacifiers, when they're used to do what they are meant to do, which is pacify, which is to make a baby feel better and safe and it just gives them that sucking motion that they're born wanting to do, this allows you again, rest, peace, quiet, I mean a lot of babies will use the mom as their pacifier and that, especially early on in your breastfeeding journey, is just painful as well. So I think that not even having pacifiers as an option, there are parents that would choose not to use them regardless, there are parents that don’t want pacifiers because they can’t imagine having that baby that has it in all the time and then having to take it away, whatever their reason is, there are parents that don’t want them. So give them the choice, there is no reason not to give them the choice, and nipple confusion or whatever that is, is BS. I just think, you know, babies are going to eat when they are hungry and they are going to suck on anything you give them especially in the first few days.
ALICIA: Well that's a good point with the pacifiers specifically because in the take home bag that I got there were diapers, there was, you know, the bulb syringe, few other different things, and it did have a pacifier in there, and that pacifier actually really came in handy because I did bring her to the hospital but just in the flurry of everything, the actual diaper bag that I brought was in the car all the way up until right before we were getting ready to leave, and then I had to send, I had to send Nicholas back to the car to grab it so that we can have an outfit to put her in.
Anyway and I forgot that I had pacifiers in there but when it was time to put her in the car seat, oh she did not like that at all, and the nurse, she said, well do you guys have a pacifier and we gave her the pacifier and then she was completely calm, so we were able to manage getting her in the car. I’m sorry, I’m sorry, I’m trying.
SUNNY GAULT: She’s like, you're not paying attention to me.
ALICIA: Like that's enough.
PRIYA NEMBHARD: You know what's funny, my daughter when I left the hospital, I have a picture of her leaving the hospital with a pacifier in her mouth.
SUNNY GAULT: But did you bring that? Did you bring that or?
PRIYA NEMBHARD: I don’t remember, I, mommy, I don’t remember
SUNNY GAULT: It was a while ago right?
PRIYA NEMBHARD: But I can relate to Alicia because I had the same issue, you know, and it helped a lot. 
SUNNY GAULT: I don’t remember ever getting pacifiers in a hospital, but I will say I only had one binky baby, what I considered to be a binky baby, my first was very much, he had to have his pacifier and it was a very difficult transition when we, you know, when he was older and we needed to get rid of them. But he was my only child out of four of them, the other kids would never take a pacifier. So I remember though, after I came home from the hospital, so this was probably the start of my third day postpartum when I came home after having a vaginal birth, and like I said I had a bunch of complications and stuff.
So I came home and I remember that first night my child would not sleep, he was crying incessantly and my mom said give him a pacifier, and I was like, no I can’t give him a pacifier should be, and it wasn’t really a breastfeeding thing for me, it was, I should be able to figure out what’s wrong with my son and not just give him a product to consume right? I really thought that maybe I had done something wrong or something and so the moment my mom put that pacifier in my sons mouth, he was happy as a clam.
I mean he went right to sleep and he didn’t have a, he wasn’t without a pacifier for a year and a half or two years after that and so, you know, I’m so torn on this because when you hear, you know, pacifier use, it’s usually, they usually don’t want you to incorporate pacifiers until you have established a solid breastfeeding relationship and obviously you haven’t had a chance to do that in the hospital yet when your baby is two or three days old. So I think that that’s why this is on the list, and to be completely honest maybe that’s why my relationship, my breastfeeding relationship with my first son really didn’t work out.
I mean I had the nipple shield right there in the beginning right? Causing a barrier between me and my son and then after that maybe he was just so used to, for those first few days, having that plastic thing in his mouth, maybe that led to him wanting a pacifier and then from there him not wanting a nipple because he was so used to, I mean, a real nipple as opposed to an artificial one and that’s something like I’m never really going to know, but I think that’s what lead to these initiatives, is they look at the information and they're like, hey, this could be a result of her not being able to make it to six months of breastfeeding her baby, you know. 
AFRICAN MOON: I totally feel like the pacifier that was given to my daughter in the hospital assisted in the problems that we were already having.
SUNNY GAULT: Yeah. 
AFRICAN MOON: I totally believe that because once I had a lactation consultant truly help us with getting that breastfeeding relationship established, she didn’t use it anymore, but if you look at all of our, because I definitely don’t remember I have mommy brain, but if you look at all of the photos from the first three or four weeks, she always had a pacifier in her mouth. You know, because I didn’t, I’m like I don’t know what this child wants other than this pacifier, and I didn’t know what the heck I was doing with the breastfeeding, but once we really got the breastfeeding relationship started, I turned into a big old pacifier but she didn’t need the, she didn’t need the plastic pacifier anymore.
SUNNY GAULT: Right. Alright and the last one on our list is, foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth centre. So this could have been something too that was even in your bag. I think when I delivered at the baby-friendly hospitals, I think it was more of a diaper bag that they gave me and inside that, instead of the formula which I got from my first birth. It was more pamphlets and information about classes at the hospital that I could be part of and different support groups and, you know, breastfeeding support groups, things of that sort, and like maybe even lactation consultants I could reach out to through the hospital and I know two, like after I delivered my twins, because they were preemies, it was automatically included as part of my care because I knew I wanted to breastfeed them and they were having trouble latching, that up until their actual birth date.
So they were born, what like five weeks early, I saw lactation consultant, I think it was once a week, and then after that point it was up to me, you know, if I wanted to continue it or whatever, well it was always up to me. But you know what I mean, its, they really wanted me to do it up until the baby’s actual birth date was supposed to be, their due date and so, you know, I think that kind of fed into this too, is that kind of support and immediately setting me up with someone from the hospital that could help me in continuing to breastfeed. 
LESLIE NIDEL: Im pro information in any way it can be given, so I, yeah, if it’s a hand out, if it’s another visit from the lactation consultant before you go because things have changed in the next 24 to 48 hours since you've seen the, whatever it may be. Any information that can be given to someone, especially before they leave, if there’s a list of, you know, la leche league meetings or support or lactation consultants, whatever it may be. Another huge thing I hear about all the time that is rarely discussed in the hospital for some reason is tongue tie and lip tie and all these things that make breastfeeding so much harder. I was told that Lila had severe lip tie and tongue tie when she was three days old, four days old, but somehow in the hospital no one even looks for that or checks or talks about it. So I don’t, I don’t know, I wish that the support given was more, less routine and more individualized, you know, I think that would be a great thing. 
SUNNY GAULT: Alright ladies, thanks so much for being part of today’s show. If you are a member of The Boob Group club then be sure to check out our bonus content for this episode. We're going to talk more about those gift bags you heard us talk about it throughout this episode, but we're going to talk about more, about the bags that moms get when they leave the hospital. That changed drastically with this baby-friendly initiative and we're just going to talk about how it’s changed over the years. So for more information about our club you can visit the members section of our website. 
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SUNNY GAULT: Alright so we have a question from one of our listeners, this comes from Ginger and she posted it on our Facebook page. Ginger says, how I can relocate, I just stopped nursing and pumping a couple weeks ago. 
Michelle Stulberger: Hi Ginger, this is Michelle Stulberger an IBCLC in the Washington DC area with metropolitan breastfeeding. Great question about relactating. The short answer is that yes, you can relactate, however, without having a consultation and getting a full history from you, the best advice I can give is to begin pumping frequently as you need to tell your body that milk production is needed. Depending on where you are in the process though, it's important to work closely with a qualified IBCLC or physician as there are several medical protocols that can be followed to assist with this. One of these protocols is the Newman Goldfarb protocol. That's N E W M A N, goldfarb, G O L D F A R B protocol, and you can find that online through google search. Good luck! 
SUNNY GAULT: That wraps up our show for today. I know it was a longer one. Thanks so much for hanging in there with me.

Don’t forget to check out our sister shows:
∞ Preggie Pals for expecting parents
∞ Newbies for newly postpartum moms
∞ Parent Savers for moms and dads with toddlers and
∞ Twin Talks for parents with multiples.

This is The Boob Group where moms know breast!
[Disclaimer]
This has been a New Mommy Media production. The information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. While such information and materials are believed to be accurate, it is not intended to replace or substitute for professional, medical advice or care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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