Breastfeeding Medicine

Physicians blogging about breastfeeding

Rebuttal to Dr. Amy Tuteur regarding Time editorial

with 50 comments

This essay is reposted with permission from CHAMPSBreastfeed.org

Thirty years ago, every newborn infant born in a US hospital was separated from their parents at the time of birth. Rooming-in was not an available option. We know now that that this standard practice was not optimal for the mother or the infant. As a pediatrician, I am concerned by the implications of this article. The image used by Time Magazine depicts an “unsafe” practice: several newborns swaddled in basinets on their sides sleeping. This sleep position carries more the double the risk of SIDS compared to infants sleeping on their backs. In addition, the bassinets are positioned adjacent, in a row, which is a practice that is fraught with risk for nosocomial infections, and has implications for security, and privacy concerns, especially when viewed by the public as is often the case in US delivery hospitals.
feltman-winter rooming in2

Beyond the disturbing photo the subtitle is inaccurate. It is important to note that what is changing among maternity care hospitals is that mothers are now offered the opportunity to allow their newborn to share a room with them. This opportunity is not “forced” but protected, given that rooming-in not only does help breastfeeding, it is safer than sleeping separated from mom. In the past, mothers were forced to separate from their newborn infants and required to have their infants sleep separately in a nursery setting, where they were grouped with other infants. Rooming in is the recommended environment for all mothers regardless of chosen feeding method. The author repeatedly refers to rooming-in as unsafe but with appropriate guidance and monitoring it is not unsafe and is safer than sleeping in a nursery. Both mother and newborn continue to receive the same level of care and supervision. Rooming-in does not mean that the care of the newborn is delegated to the mother, however, rooming-in provides the mother the opportunity to participate in their own newborn’s care. This permits staff to do additional teaching and observation of parenting skills before discharge.

Rooming-in does not mean mothers cannot rest. In fact, studies show that mother’s sleep quality improves when her newborn is nearby, and sleep quantity does not diminish. Rooming-in is not a result of the “breastfeeding industry.” Rooming-in is not intended to promote breastfeeding, but rather to support breastfeeding for a mother who has chosen to breastfeed. Rooming-in does not promote bed-sharing, but breastfeeding often does occur in bed. Mothers are instructed to ask staff for assistance to help transition the newborn to a safe sleep surface, their bassinet, after feeding is complete.

feltman-winter rooming in
It is unfortunate that the author believes Baby-Friendly is “deeply wounding” for those who choose to formula feed. Baby-Friendly offers the best care for mothers and babies irrespective of feeding method. Formula is still available in Baby-Friendly hospitals, but like any other medication it is not accepted as a free product nor distributed for free. Mothers are not given acetaminophen or ibuprofen free to use when they go home, but are likely to use these medications. The sole purpose of infant formula being given to delivery hospitals for free is to establish brand loyalty. Similar to other Pharmaceutical Research and Manufacturers of America (PhRMA) policies that are standard among hospitals, infant formula companies must follow the same set of guidelines. PhRMA code promotes the use of ethical standards, medical knowledge and experience to address individual patient needs and make sure they have access to appropriate medications. As a standard of care, the delivery of infant formula would fall under these PhRMA guidelines.

Regarding the author’s assertion of “What’s wrong with the BFHI?”:

  1. The benefits of breastfeeding and risks of formula feeding are anything but trivial. The establishment of the infant’s immune system and properly functioning microbiome are reliant on an exclusively breastfed diet with profound and lifelong results. Even in first world countries the health outcomes and costs associated with not meeting the recommended timeframe of breastfeeding is estimated to be in the tens of billions of dollars per year for both maternal and childhood illnesses.
  2. There is no “breastfeeding industry.” What we have is persuasive research evidence that mother-baby separation leads to increased supplementation and decreased duration of breastfeeding (for example NJ PRAMS data).
  3. There are safety recommendations to ensure that mothers who are sedated or temporarily disabled due to delivery mode are provided with the assistance and support they need to care for themselves and for their newborns. The best way to think about rooming-in is a semi-private room where the mother and baby are sharing but both provided with skilled and continuous nursing.

Bradley Thach’s paper in the Journal of Perinatology (J Perinatol. 2014 Apr;34(4):275-9) drew attention to the conditions called, sudden unexpected perinatal collapse. While Dr. Tuteur suggests we know why these babies die or have perinatal collapse, we actually don’t know. While some of the deaths may have been related to accidental suffocation, there are no data to confirm or deny this association. Nevertheless, careful monitoring and safety considerations for mothers bringing babies into their beds is common sense. Mothers should be expected to use call bells when sleepy or having trouble transferring the newborn to the bassinet.

Rooming-in, and the BFHI, does not require being “privileged to have a partner” or money to pay for baby-sitting other children. As stated, rooming-in supports the most optimal arrangement for maternal rest and sleep quality.
Finally, the author is incorrect in stating that no one is preventing rooming-in. Indeed, most hospitals in the US do exactly that. They have routines that require babies are monitored for arbitrary yet mandated periods of time during some “transition” period. Rooming-in serves the needs of mothers and babies, regardless of feeding method, not the “breastfeeding industry” and does not lead to staff layoffs or reassignment of baby care to the mother.

Lori Feldman-Winter, M.D., MPH, is Professor of Pediatrics at Cooper Medical School of Rowan University and the Division Head of Adolescent Medicine at The Children’s Regional Hospital at Cooper University Healthcare in Camden, NJ.

Renée Boynton-Jarrett is a practicing primary care pediatrician at Boston Medical Center, a social epidemiologist and the founding director of the Vital Village Community Engagement Network.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by winterlb

March 8, 2016 at 11:03 am

50 Responses

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  1. The anit nursery article was written by Amy Tutuer. Enough said. She will only be happy if women are not informed as to their (all their) options – risks and advantages – for maternity care, birth and breastfeeding. It is scary to read what she has to say on these issues.

    Jeanne Batacan

    March 8, 2016 at 12:53 pm

  2. “Studies show” that rooming in doesn’t diminish mother’s sleep.

    Fine, but you don’t link to such a study, or even an article on such a study. Does that article focus on babies who are merely hours old, or babies up to a year old? Does it study mothers who just underwent surgery? Or hours long labor? Who knows? Who cares? Bottom line, both I and my husband are exhausted for days after birth, and we were denied use of the nursery. There was no nursery for us to use because we were tired. Yes, women are being forced to room in.

    Christina

    March 8, 2016 at 1:06 pm

    • Please help me understand why is it someone else’s responsibility to take care of your newborn? Other than for cesarean section, you shouldn’t be at the hospital for more than a few hours postpartum anyway. Obstetrician/hospital-managed labor & delivery is NOT the standard of care. You don’t know that because we don’t have it in the United States.
      You can start with Dr. McKenna’s research on sleeping http://cosleeping.nd.edu/
      And then you can take a look at the following: https://www.rcog.org.uk/globalassets/documents/guidelines/maternitystandardsdatabase0608.pdf

      Rachel Bell

      March 13, 2016 at 12:04 pm

      • Exactly Rachel. Thank you for your reply/question. The vast majority of babies born in the world are cared for and stay with their mothers and other close retaliative(s). And what do mothers who choose to birth at home or birth centers do??? Stay with their babies!!
        It would be a good thing for this group to understand the evolution of centralized nursery care……drugs in labor and $$$$$.
        You saved me the trouble of providing a research link to this group. Although Dr. McKenna is not the only researcher that has looked at this issue, his solid research is very well done and replicated.

        In this day and age, it is amazing that anyone has to ask for research citations.

        But here is another link…. https://scholar.google.com/scholar?q=mother+infant+sleep&hl=en&as_sdt=0&as_vis=1&oi=scholart&sa=X&ved=0ahUKEwjPh9KG58rLAhXCwiYKHfU-A04QgQMIPTAA

        Jeanne Batacan

        March 18, 2016 at 12:56 pm

      • Of course it is someone else’s responsibility to take care of a brand-new baby! No traditional culture I’m aware of, other than ours, expected a new mother to take care of her newborn alone just a few hours after birth. Other relatives would come and help out, often for weeks. Here in the USA, we do not have strong extended families, and so hospitals need to operate on the assumption that help may not be available, and provide new mothers with a little bit of real sleep before going home.

        Forget “should.” Concentrate on “is.” The way it is, brand new mothers need a tiny bit of help, and you are arguing that the help should be taken away, so that none of them have access to it.

        Brooke Orosz

        March 20, 2016 at 1:16 am

      • Thank you for your thoughtful and considerate reply Brooke. Compassion like this should be shown to new mothers more often.

        Jimso

        March 20, 2016 at 2:27 am

      • Are you for real? It’s because the post-partum mother is also a patient. Do you also get tetchy if mothers don’t bring their infants while recover from gallbladder surgery?

        Liz

        March 20, 2016 at 7:00 am

      • I’m sorry I don’t understand your question? I’m not tetchy. I’m a mother who had a personal bad experience and appreciate Brooke’s kind words.

        Jimso

        March 20, 2016 at 11:22 am

      • Ah sorry on re-reading I’m not sure you are replying to my comment. Thank you

        Jimso

        March 20, 2016 at 11:27 am

    • EVERY new parent is exhausted after birth regardless of where the baby rooms! Not only for “days”, but for weeks.
      The biological norm – since mammalian life began, is for mothers to stay close to their infants from the get go. “Westernized” maternity care (which is NOT the Gold Standard) is the ONLY instance where babies have been separated from their mothers.

      Jeanne Batacan

      June 1, 2016 at 12:50 pm

  3. If you had asked me after the birth of my first child, I would have completely agreed with this article. The birth of my second child has taught me a valuable lesson in perspective, however. While the BFHI is not intended to force rooming-in, that is what happens in practice where the nursery has been shut down. My delivery was straight forward so I did not qualify for extra assistance from the midwives. After 8 months of hyperemesis though and subsequent undiagnosed near anaemia, I was in no shape to be caring alone for a baby. Further, there absolutely is a breastfeeding industry. I have spent thousands of dollars trying to establish breastfeeding – consultants, doctors, blood tests, at-breast supplementers and pumps sold at hugely inflated prices in the country I’m in. I would have been far better off financially and emotionally had I chosen to formula feed from the beginning. The only reason I am persisting with partial breastfeeding at five months pp is because my family has a history of digestive disease and breastfeeding may offer theoretical benefits to the gut biome. But I am disheartened when I read research suggesting these benefits are probably only carried over by exclusive breastfeeding. And then I wonder, well whose biome is my baby inheriting? My shoddy one. And will all my efforts come to nought the first timevmy child receives antibiotics? Or would it be better to pin my hopes on fecal transplant in future? The BFHI did not take into account any of my personal circumstances and I will never give birth in another BFHI hospital again as a result.

    Jimso

    March 8, 2016 at 1:14 pm

  4. Could I please have some references for the following statement?

    “The establishment of the infant’s immune system and properly functioning microbiome are reliant on an exclusively breastfed diet.”

    Are you saying it is impossible to have a functioning immune system and gut biome without exclusive breastfeeding? I find this a bit far fetched. Believe it or not, there are quite a few non EBF people out there whose immune and GI systems work just fine.

    Anne Risch

    March 8, 2016 at 1:59 pm

  5. Nine years ago when I had my daughter I didn’t even think that nurseries were still a thing, I wrongly assumed they’d been phased out years ago. I only found out that my hospital still offered them and how common they were when my friend who is a nurse in the maternity unit came to visit us. When my son was born 6 months ago the hospital had phased them out and I was happy that I he didn’t leave the room during our hospital stay even though I was mostly on my own this time. We were not given a formula bag either which was great because last time our family ended up giving my daughter formula without even asking me from that bag. Great rebuttal.

    vgnsocjust

    March 8, 2016 at 7:27 pm

  6. In what sense is formula is a medication?

    Liz

    March 8, 2016 at 8:01 pm

    • Formula is similar to a medication because it is only needed when and if the body, mothers’ or babys’ fails to function properly in the most drastic way. In those rare cases, it IS a medication and a welcome one (aside from donated human milk, which may be a good choice for the rare percentage of mothers who are unable to produce a sufficient quantity of milk.)

      As for the elimination of the Central Nursery in BFHI hospitals: it is mostly for the good. Nurseries are for sick babies who need medical care. “Tired parents” come with the territory of being parents. Being “tired” isn’t a medical condition in new parents. (If that were the case, mother, her partner and the baby would need to be hospitalized for the first 5 years, at least, of the baby’s life!)

      With my last birth, which was a C Section, I was offered the use of the Special Care Nursery, but demurred and kept my child with me. My baby was a bit preterm, but healthy, I was a bit “tired” but, despite a quadruple high risk pregnancy and delivery (including several medical conditions, an android pelvis, preterm labor for 2/3s of the pregnancy and a repeat C Section) I was able to care for my baby. The only thing I could not do was to put my baby back into the “salad bin’ provided by the hospital. No matter, she slept in my arms, at my breast, nursing almost constant for my entire hospital stay. She screamed when placed into the “salad bin” by my partner,by one of my older children (I had a bunch of those, too) or by any of the nurses. The only place my just-short-of-5-lb-baby was happy and secure was in my arms. A few times, while I was eating, one of the nurses would take her “for a walk” (despite hospital policy against babies being carried while in the hospital) or when she was taken to Special Care to weigh her.

      As an IBCLC lactation consultant I work with post partum moms all the time. Despite most of them having their babies at BFHI hospitals or those striving for BFHI certification, I have not heard any complaints about the lack of a Central Nursery. About 5% of my clients have their babies at home (“*gasp!*” I’m sure Ms. Tueter would say) and they, also, do not have the use of a Central Nursery at all. No complaints there, either. On the rare occasion that the mother is unable to care for her child immediately after birth the BFHI hospitals and those working on certification will use the Special Care Nursery if the mother is truly handicapped in caring for her newborn. Of course, if these mothers continue to feel unable to care for their babies alone after the 1-3 days in hospital, if no family or friends are willing or available, there are myriad doula and home nurse agencies to help them out.

      As for the claim that in traditional societies women have a barrage of help from family and other women in the community, this is often true. BFHI hospitals do not restrict family, friends or even a paid or volunteer doula from helping a new mother who may need help or assistance with her newborn immediately after birth.

      The age of the “Newborn Nursery” along with “viewing window” for the public’s amusement is a long gone, gratefully, outgrown thing. Newborn Nurseries were along with entire Maternity floors, in fact, often designed by formula companies to keep newborns as far away from their babies as possible, making it more “efficient and convenient” for Nursery nurses to formula feed, instead of bringing babies to their mother to learn to breastfeed. The addition to often requiring mother to don masks, gloves and even requiring the use of an alcohol wipe on the nipples before attempting to breastfeed, along with rigidly scheduled feedings, were all a part of this dark age of infant “care” that has, thankfully run out of steam and been shown to be nothing but detrimental to the baby, the mother, the family and society as a whole.

      Central Nurseries are not needed. We have NICU for the sickest babies, who need round the clock, intensive care, we have Special Care Nurseries for babies who are not quite as sick or small, but may need to be monitored medically, but putting otherwise completely healthy babies all together in a room, away from their mothers, fed on schedules and only allowed visiting hours with their own parents are gratefully a thing of the past in most progressive areas.

      As for formula, it is, of course needed in some instances. (With donated human milk being a wiser choice when available) I’m glad we have it for those rare cases where it is necessary. But,the key word is “necessary.” Necessity of something outside the norm, in a hospital setting is either a medication or a treatment. Formula is both.

      People need pain medications after surgical procedures, requiring strong pain medication is beyond the “norm” for people who have not had recent surgery or illness. Despite the fact that both the surgery and the medication necessitate payment by the patient is not questioned by many. So, when formula, or a nursery is required, as these are only necessary in situations beyond the norm, they are to be paid for.

      You don’t get your surgery for free in the US, you don’t get your Norco, Percocet or Ibuprofen post surg, or your IV during or after surgery for free, even when you need these to survive. But, you are still required to pay for them. Why should formula be any different? Necessary? In some cases, yes. “Free” No! Not by a long shot. All that “free formula” given out by formula companies is NOT “free” and does have to be paid for, and the cost of ‘gift bags” filled with “free” formula was then passed on to parents who absolutely needed the substance, often for the survival of their babies.

      When the US gets National Health plus formula and medications are no longer made by For-Profit companies, we can re-visit these situations. There’s no such thing as a Free Lunch and there isn’t and never was such a thing as “Free” formula.

      P'Gell Danielle, IBCLC

      October 1, 2016 at 12:16 pm

      • Thank you Danielle. Sadly, Dr. Amy will still not ‘get it”.
        When we look at normal human behavior – we could say normal animal behavior, it is very abnormal for mothers and babies to be separated and can lead to attachment issues. Every mother has access to a call button to get help from the nurse and the vast majority of mothers have family/friends that are willing and able to help.

        Jeanne Batacan

        November 4, 2016 at 7:25 pm

      • Danielle, I’d like to add here for everyone and Dr. Amy as well – that all major health organizations are now recommending that babies stay-sleep in the mother’s/parent’s room for at least 6 months and ideally 1 year. There is no mention about – once they get out of the hospital. Hospitals with rooming in policies are doing it because it is safer.

        Jeanne Batacan

        November 4, 2016 at 7:37 pm

  7. Apparently the folks at ABM don’t think that mothers can be trusted to make the choice they want them to make. The response is embarrassingly weak, muddled and afflicted by remarkably foolish errors.

    1. False dichotomy.

    The ABM piece starts with the same false choice that preoccupies many apologists for the BFHI:

    “Thirty years ago, every newborn infant born in a US hospital was separated from their parents at the time of birth. Rooming-in was not an available option. We know now that that this standard practice was not optimal for the mother or the infant.”

    But the opposite of forbidding rooming-in is NOT mandating rooming in; it is ALLOWING rooming-in.

    2. Red herring. A red herring is something that misleads or detracts from the issue at hand. The ABM red herring is pathetic in the extreme:

    “The image used by Time Magazine depicts an “unsafe” practice: several newborns swaddled in basinets on their sides sleeping. This sleep position carries more the double the risk of SIDS compared to infants sleeping on their backs.”

    The picture? Seriously, ladies, the picture? The picture is meant to illustrate the piece, not to accurately reflect contemporary well baby nurseries. You must be really desperate to be reduced to criticizing the picture instead of making a reasoned argument.

    3. A whopper:

    “Rooming-in does not mean mothers cannot rest. In fact, studies show that mother’s sleep quality improves when her newborn is nearby, and sleep quantity does not diminish.”

    Studies show? Which ones? Oops, the authors could not manage to cite any of the studies! But worse than the fact that the authors don’t bother to provide citations is the fact that claims like these illustrate the most maddening aspect of the breastfeeding industry: they don’t listen to mothers. Women are complaining bitterly that they can’t rest when they are responsible for infant care 24/7 and they need to rest to heal from the ordeal of birth and any lacerations, stitches or surgery. But the breastfeeding industry couldn’t care less what mothers want; they are only interested in what THEY want.

    4. Casual callousness:

    It is unfortunate that the author believes Baby-Friendly is “deeply wounding” for those who choose to formula feed.

    “No, what’s unfortunate is that the authors don’t believe the MOTHERS who say that the BFHI is deeply wounding. I breastfed my four children. I did not directly experience the shaming and guilt of the BFHI but I don’t doubt the many, many women who have written to to me and commented on my blog telling me that they have experienced the BFHI as shaming. But, as noted above, the breastfeeding industry couldn’t care less how mothers feel; to my knowledge, no breastfeeding researcher has ever asked them.”

    5. Speculation presented as scientific fact:

    “The benefits of breastfeeding and risks of formula feeding are anything but trivial. The establishment of the infant’s immune system and properly functioning microbiome are reliant on an exclusively breastfed diet with profound and lifelong results.”

    The only words in that sentence that are true are “and” and “the.” The rest is wishful thinking on the part of the breastfeeding industry, which routinely substitutes opinion for scientific evidence.

    6. A lie:

    “There is no “breastfeeding industry.”

    Really? The why does a major market research firm publish a 56 page market analysis of the breastfeeding supplies industry? And that doesn’t even count the millions spent on lactation consultants, breastfeeding classes and promoting and implementing the BFHI. It’s an industry that’s so lucrative that market research analysts charge $2500 for the report, reasoning the members of the industry will pay to find out how to sell more goods and services.

    7. Heartless indifference to the deaths of babies who die as a result of mandatory rooming in.

    “Mothers should be expected to use call bells when sleepy or having trouble transferring the newborn to the bassinet.”

    If you accidentally fall asleep with the baby in your bed and the baby dies, it’s your fault you didn’t call the nurse before accidentally falling asleep. That attitude is reprehensible.

    8. Refusal to address the actual issue: lack of respect for women’s autonomy.

    The issue is CHOICE. Are we going to treat women as if they are smart enough and capable enough to decide when they want their babies in the room and when they want to rest? Or are we going to trot out ugly medical paternalism to insist that women can’t be trusted to know what’s good for them and their babies?

    The authors of this rebuttal are really grasping at straws if they have to resort to false dichotomy, a red herring, a whopper, a lie, speculation, casual callousness in response to women’s feelings, heartless indifference to preventable infant deaths, and lack of respect for women’s autonomy.

    The issue is simple; the issue is choice. The breastfeeding industry does not trust women to make the decisions they want them to make so they prefer to restrict their choice.

    Amy Tuteur, MD

    March 8, 2016 at 9:16 pm

    • Before mothers can make an [INFORMED] choice, they have to be given information that includes risks and benefits and the difference between myth and reality. I have been a childbirth and lactation educator as well as a lactation consultant and doula. The vast majority of mothers I work with are extremely misinformed or not informed. Listening to Mothers Surveys I, II and III all back this sad fact up. Have you looked at the results of these nation wide surveys?

      Jeanne Batacan

      March 8, 2016 at 9:51 pm

      • Oh yes, they must be misinformed because they don’t agree with what you want them to agree with. Typical.

        Christie del Castillo-Hegyi, M.D.

        March 9, 2016 at 5:07 am

      • I have looked at those surveys, and they show there is no crisis. Mothers are happy with the ways things are. The BFHI matters to breastfeeding advocates only.

        Liz

        March 9, 2016 at 7:51 am

      • In what ways are women misinformed (or not informed)?

        Anne Risch

        March 9, 2016 at 3:24 pm

      • Ann,
        I have been a childbirth, lactation educator for 35 years – a lactation consultant for 20 years and a doula for 20 years. I worked in OB-GYN for 26 years.
        When I poll my class participants, They do not know that the common “routine” interventions have a cascade effect and can impact breastfeeding in a negative way.
        They do not know that Fentanyl is in epidural anesthesia and that all narcotics DO “get” to the baby (straight to the liver and then to the brain). They do not know that some drugs commonly used in L&D are not approved by the FDA for use in pregnancy, labor or breastfeeding. I have never once heard a mother be told that Misoprostol (Cytotec) effects can not be reversed and has caused death in mothers and babies and that there are safer (reversable) options for inducing labor.
        As a doula, I frequently witness a lack of informed consent given to the laboriing mother. Often she is told of the benefits but not the risks of what ever intervention the nurse/doctor wants to do.
        Most women I have known do not know that they have a legal right to say “No” to a proposed intervention nor do they know they have the right to cross off certain things on a consent form,
        I have witnessed mothers in transition given a consent form to read and sign. This can’t be informed consent because women in transition and in pain are not able to read and comprehend much of anything.
        I have witnessed women being told outrageous things from some nurses and doctors, both in labor and about breastfeeding that are not evidence based. I have witnessed women saying “stop!” “STOP!” to a painful procedure and simply ignored by the caregiver.
        I could go on and on but you get my drift.
        This is not hear-say. These are things I have witnessed over and over.

        Jeanne Batacan

        March 14, 2016 at 6:42 pm

    • And if the mother calls the nurse and tells the nurse she is too sleepy to care for her infant, how will that help in any case? If there is no well-baby nursery, what exactly is the nurse going to do about it?

      liz

      March 9, 2016 at 3:06 pm

      • The nurse, or other caregiver can wrap the baby and put him in his bassinet. Babies sleep in their bassinets in the nursery, they are just as safe in the bassinet in mother’s room while mother sleeps. I have worked shifts where I sat and rocked the baby to sleep in mother’s room and put him in the bassinet. Something that has not been brought up is the fact that the baby is safer in mother’s room… No chance of switching babies, less chance of kidnapping, less exposure to hospital germs. What do you expect moms to do when they get home? Hopefully the baby will be in a bassinet in the parent’s room as recommended by the AAP.

        Lizzie, RN

        September 10, 2016 at 9:28 pm

      • Lizzy, Thank you for your knowledgeable, rational, reasonable and calm reply to this issue. I only wish that Dr. Amy were as informed and rational as she should be on all issues of birth and breastfeeding. Mothers deserve nothing less.

        Jeanne Batacan

        September 28, 2016 at 1:16 pm

      • http://onlinelibrary.wiley.com/doi/10.1111/mcn.12366/full

        How can we persuade Dr. Amy to read research???

        Jeanne Batacan

        September 29, 2016 at 5:49 pm

  8. I’m stunned by the phrase “This opportunity is not “forced” but protected.” If the nursery has been closed, the mother has no choice but to room in. If someone “protected” my opportunity to lose weight by coming into my house and getting rid of any junk food she found, I’d be outraged.

    Taking away a choice is not protecting an opportunity, that’s just not what those words mean.

    Brooke Orosz

    March 8, 2016 at 9:51 pm

    • Every hospital I have been at as a lactation consultant and/or doula – who has “closed” the central nursery has nurses that will bring babies to the nurses station if the mother wants to rest. That said, if a mother’s wish is to breastfeed, these babies need to be brought back to her for feeding. As you know, successful breastfeeding relies on a major law of nature – Supply and Demand.

      Jeanne Batacan

      March 14, 2016 at 6:46 pm

      • So they don’t know the misleading information you are trying to scare them with so they will turn down the interventions you have decided they shouldn’t have? Well, thank goodness for that.

        Liz

        March 14, 2016 at 7:09 pm

  9. Your rebuttal does not address the main point of Dr Tuteur’s argument. She denounced the involuntary practice of rooming-in by taking away nurseries. You repeat many of the thing mothers are already beat over the head with and don’t address the unsafe and unethical practice of taking away the option of nurseries. No one is against rooming-in. But many professionals and mothers are against forced rooming-in because it prevents many mothers from full sleep and recovery. That leads to an unsafe of environment for babies not only in the hospital but at home when their sleep-deprived parents are released to care for a vulnerable newborn unassisted and impaired. Address the real argument, not the invented ones that you put in your article.

    Christie del Castillo-Hegyi, M.D.

    March 9, 2016 at 4:55 am

  10. You know what’s weird about this blog? In my field, there are blogs dedicated to certain topics or subspecialties. But I can’t think of a single blog dedicated to a particular interpretation of that subspecialty. Because that would be unscientific and hard to take seriously. Calling something “breastfeeding medicine” does not elevate advocacy to science.

    Liz

    March 9, 2016 at 7:58 am

    • I agree.. It’s a little odd that the ABM is supposed to be dedicated to the ‘Expansion of knowledge in both breastfeeding science and human lactation”, but none of the members seem to concerned with reading the current research.

      Most of the writers of these blogposts are unwilling cite studies that support claims made (even when asked) or are they willing to discuss recent studies that might not exactly fit with their agenda. As you know, I have many asked for citations and/or discussion of recent research and I am pretty much met with silence.

      Even though the ABM members are medical professionals, it seems as though they are much more concerned with advocacy and promotion than expanding their knowledge base and using the most recent literature and information to create accurate, up-to date statements and protocols (and even blogposts) that will be in the best interests of new families.

      The reason I keep posting on this site is because I hope that the ABM will consider taking the lead and work to make breastfeeding promotion use a little more science and a little less passion and blind faith.

      PLEASE consider taking a good, hard, unbiased look at the evidence for the 10 steps as well as the evidence on the benefits, the ease, and sucess rates of breastfeeding.

      I truly believe that you (ABM members) think you are doing the right thing by promoting exclusive breastfeeding for every woman/baby by any means possible (including lying about the benefits, and encouraging no supplementation) but if you will listen and read what women are saying –even in your own blog —this brand of promotion is unethical to say this least, and does more harm than good.

      I worked for the WIC program for several years and I saw the harms that this one-size fits all breastfeeding promotion can cause… This is why I am so persistent or pesky or whatever you might call it.

      Anne Risch

      March 9, 2016 at 12:58 pm

  11. Really? Because I was born 34 years ago. If my mom and I had not nearly died during my birth, she would have been able to do rooming in. My mother and were actually chatting about that a few weeks ago. She was planning to formula feed, but still wanted to room in. Both hospitals in the area offered rooming in.

    So there goes your unsubstantiated lies that all babies were put in nurseries 30 years ago or more.

    indigosky

    March 9, 2016 at 11:28 am

    • And it doesn’t even matter what they were doing 30 years ago. We’re talking about now. Maybe we know something now that they didn’t 30 years ago….or maybe we have forgotten something we knew.

      liz

      March 9, 2016 at 2:50 pm

  12. “It is important to note that what is changing among maternity care hospitals is that mothers are now offered the opportunity to allow their newborn to share a room with them. This opportunity is not “forced” but protected”

    I don’t know how you can say that with a straight face when you have to know that many (if not most) BFHI hospitals eliminate their well-baby nurseries. What would you call rooming in in those hospitals if not “forced.” If there is no where else for baby to go, even for a few hours respite, yes, women are forced to room in.

    I breastfed all three of my children, without much difficulty, because I was lucky enough to have a body and babies that cooperated with my desires. I still remember with much fondness the nurses who gently suggested that they could take the baby to the nursery for a few hours so I could sleep. I don’t know what studies you are referring to re mom sleeping better with baby close by, but that was not my experience at all. Those 3 hour breaks, when I could sleep without interruption or worry about every sound made by the baby were glorious. And I had short, easy labors every time (longest labor was 4.5 hours, never pushed more than 30 minutes). By 1 a.m. after nursing at least every 3 hours (but in reality more like every 1.5 – 2), I was done. I was tired, in pain, and unable to sleep more than 20 minutes at a time because the baby would make a noise and I’d be instantly awake again. I cannot imagine trying to care for my newborn, alone, after a long labor or c-section, and being told sorry, but no, the nurses could not take the baby to the nursery for a few hours because there is no nursery for baby to go to.

    Were I having more children, I would choose against a hospital that was BFHI certified. Because even as a woman who chose to breastfeed and would choose to try again, recovering in a BFHI hospital sounds hellish.

    Jennifer

    March 9, 2016 at 12:25 pm

    • Apparently it is a personal feeling. I hated having my babies taken away to the nursery and LOVED rooming in with my last one!
      There have, in the past, been contagious outbreaks of infection that have literally wiped out the babies in centralized nurseries. Keeping healthy babies grouped together away from their mothers has not been the healthiest thing. And for breastfed babies, many got fed formula against the mother’s wishes.
      The other issue is when, after just a day or two, mothers and fathers find themselves at home alone with their new baby without enough experience on how to handle, bathe or sleep near this new addition.
      I work with a lot of new mommies who have had rooming in and have not heard of one complaint yet. Most of the hospitals in Santa Clara County, CA do not have central nurseries any longer.

      Jeanne Batacan

      March 15, 2016 at 7:13 pm

      • Can you cite a source for “contagious outbreaks of infection that have literally wiped out the babies in centralized nurseries”? One from the last, say, 30 years, in a first-world country, that didn’t involve severely premature babies who needed nursery care?

        OK, you haven’t heard complains, but have you asked, in a way that suggested it was OK to say yes? Have you asked a woman who had a difficult delivery, or didn’t have a family member to provide overnight help?

        Brooke Orosz

        March 20, 2016 at 1:09 am

      • Brooke,

        http://www.shea-online.org/Assets/files/Harris_Monday.pdf
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831283/

        Infectious outbreaks in centralized nurseries have been greatly reduced since the start of “rooming-in” in the 1970’s. It is because of these catastrophic outbreaks that rooming-in came about. Not because of breastfeeding as the vast majority of mothers in the 70’s were formula feeding.
        The fact is that now in 2016 the vast majority of mothers desire to breastfeed – and because of an abundance of scientific evidence, the benefits of breastfeeding and risks of formula have been identified all around the world as a public health issue.

        Baby-Friendly designated hospitals are not required to close their newborn nurseries. Rooming-in is an evidenced-based practice that is beneficial to both mothers and infants and is the routine standard of care. Keep in mind that it is very lucrative for hospitals to maintain centralized nurseries as they can then charge the parents or insurance company for any time spent in the nursery. But this is NOT what is considered the “gold standard” of care in the 21st century.

        BFHI came about because, in hospitals, mothers were not getting the care and support they needed to realize their breastfeeding goals. For mothers who choose to formula feed, you may be interested in reading this information about formula feeding in a BFH – https://blogtobabyfriendly.wordpress.com/2012/09/28/choosing-formula-at-a-baby-friendly-hospital/

        Keep in mind Brooke, that many nurses now working in BFH’s formula fed their own babies.

        The way we give birth and the way we feed our babies are very personal decisions that may not be respected by everyone in a given community. But in a hospital or birth center setting, the staff are almost always (I say almost because there are “bad apples” everywhere) respectful of a mothers wishes. It is a nurses obligation and ethical duty to respect every mother she cares for.

        Regarding respect; I have NEVER witnessed a mother who choose to feed formula be forced to try breastfeeding. However I have OFTEN seen a breastfed baby (who is taken to the nursery) be fed formula – against the mothers specific wishes and requests, and I have been working with mothers for over 30 years.

        Jeanne Batacan

        March 20, 2016 at 2:12 pm

  13. Can you share the citation for the study that shows that mothers sleep better with their baby in the room as opposed to in the newborn nursery?

    Primary Care Doc

    March 9, 2016 at 1:19 pm

  14. There are several things I find odd about this article but the most obvious one is that formula is ‘medicine’. While I’m sure it’s true that formula companies provide formula to hospitals for free as a way of developing brand loyalty, why is this a problem? Diaper companies do the same thing – do you want to ban those as well as a way of forcing parents into using cloth ones?
    I chose to room in with my son but I’m also a man and hadn’t given birth – I just watched the labor. Since that involved being up all night (and I’d traveled the day before), I was somewhat tired. A couple of times the nurses were nice enough to take my baby and care for him for a few hours while I got some much needed and appreciated uninterrupted sleep. I very much felt more able to care for him with some good rest.
    I’m not sure what they’d do with me in a baby-friendly hospital – obviously nobody is getting anything to eat from my nipples – they’d probably push me to use donor milk or something – I had a few crunchy friends try to push me in that direction (I ignored them). Any lactavist trying to guilt me that way in the hospital is something I would have found intrusive.
    btw, I did stick with the brand the hospital carried (Similac) because LO took to it with no issues so why change what worked? Not so with the diapers – they had Huggies and they leaked like crazy. I found Pampers worked a lot better so I donated the Huggies to a battered women’s shelter.

    Zornorph

    March 9, 2016 at 9:16 pm

  15. Oh how typical, hilarious-call it whatever you want to call it- that only Dr Amy and her 5 or 6 cronies have bothered to comment on this piece. First, it was how unsafe and awful homebirth was/is but then peer-reviewed data came out showing the safety of planned homebirth. So now let’s go after breastfeeding advocates because it’s just so UNFAIR that mothers and newborns have the best chance to establish exclusive breastfeeding in the first 48 hours postpartum. What a joke. Do you know that women who want to give formula in the hospital ACTUALLY DO and it’s no big deal. The nurses at BFHI hospitals also routinely take newborns away for mothers who want to sleep. What next, Dr Amy…fighting for the rights of every newborn boy to be circumcised just so he can look like dad?! I wouldn’t be surprised since your only angle these days is to make $$$ off of you book and blog. Unlike you, the physicians who wrote this post actual practice at the bedside- something you haven’t done in well over 20 years. Try stepping foot into the hospital one of these days.

    Voice of reason

    March 10, 2016 at 7:25 am

    • How refreshing! Thank you for your post. I can’t believe how many un-informed, ill-informed defensive people are reacting to this article…… It’s really sad.

      Jeanne Batacan

      March 18, 2016 at 1:47 am

      • It’s because “Dr” Amy has a large contingent of followers and many are actual bullies. They range from housewives who have no medical credentials to other providers who likely bully their patients the way they bully those who disagree with them on the Internet. Apparently support of exclusive breastfeeding is somehow elitist and a crime in “Dr” Amy’s world. I will continue to get my medical advice from practicing providers with an active professional license, thank you very much!

        A voice of reason

        March 23, 2016 at 9:28 pm

  16. “It is unfortunate that the author believes Baby-Friendly is “deeply wounding” for those who choose to formula feed. Baby-Friendly offers the best care for mothers and babies irrespective of feeding method”

    BFHI certainly does not offer the best care for mothers and babies irrespective of feeding method! Not only does it not offer the best care, it has made it far more difficult and distressing for many women who are not breastfeeding! It isn’t unfortunate that the author believes what myself and lots of other formula-feeding mothers have expressed. It’s unfortunate that you don’t believe us. Or maybe you do, and it just doesn’t matter to you. Of course, you would never admit to that, so you’ll just continue to act as though we don’t exist and/or we’re lying to you about our feelings and experiences.

    Emma

    March 12, 2016 at 6:51 pm

  17. I had rooming in with my daughter 30 years ago and it was great. The article you are referring to did not say that rooming in was bad, they said that closing the nurseries so that new mothers were forced to have their babies in the room before they were ready was a bad idea. I don’t see how anyone could disagree with that. Not every new mother has a good support system in the hospital and is ready medically to care for their newborn 24 hours right away. Maybe argueing the actual point of the article would have been better.

    cbarbier985

    May 28, 2016 at 10:47 pm

  18. When I had my first babies, they were taken to the nursery. Three years later when my third came along, I was told that the baby would have to stay with me. That was not a choice, that was a forced decision. I had a painful c section and it was extremely difficult for me to care for my baby. I ended up leaving the hospital early so that I could go home to get help from my husband and I could recover.

    Lora

    May 29, 2016 at 12:57 pm

  19. As a night shift MCH nurse, I can tell you that closing the nursery is a bad idea! When a hospital closes the nursery, how is that not forcing the new Mom to keep her infant with her 24/7? It is not fair, nor is it SAFE!! Many postpartum moms are exhausted after their delivery. Many cannot get up safely to take care of themselves, let alone a newborn. Due to the fact that newborn infants are no longer suctioned after delivery (and I am not refering to the use of bulb-suction), almost all of these infants have large amounts of mucous leftover in their lungs that may take up to 48 hours or longer to bring up on their own. I take care of these infants and I can tell you that when they are basically choking on their mucous while lying on their backs, they need to be tended to immediately!! The risk of aspiration is clearly present. As to the photo of the infants lying on their sides, take a closer look. The infants are on their backs with their heads turned to their side. This is so that when they bring up mucous, breastmilk or formula, it will not be aspirated into their lungs. Even with this positioning, infants are still at risk and need to be monitored by a professional who will not freak out when the infant starts to choke, someone who can get to the infant immediately and keep the infant safe. As to forcing new Moms to “room-in” or to breastfeed, I believe that no one wants to be told or forced to do something. Everyone should have the CHOICE to do what they want. If a new Mom wants to “room-in”, it should be supported. If a new Mom wants to exclusively breastfeed, it should be supported. If a new Mom wants to formula feed, it should be supported. If a new Mom wants to breastfeed and supplement with formula, it should be supported. If a new Mom wants to send her baby to the nursery for the night and get some well deserved rest, it should be supported. All people are different and have their own preferences. It should not be expected that everyone should be treated the same. Hospitals should give women the CHOICE of what they want and healthcare workers should support that choice. End of story.

    Marie Sugrue

    May 30, 2016 at 9:09 am

  20. morristown memorial hospital forces mothers to keep their babies in the room with them. I asked them to take my newborn because I couldnt keep my eyes open. they brought her back in while I was sleeping and actually set her bed on my IV and I couldnt move. it was dark I was confused and fluid started going into my IV. They nurse just left me there. When I got home I was so tired I couldnt put a sentance together. I was lucky I had family at home. There are going to be a alot of tragedies if this practice continues.

    kris

    May 31, 2016 at 10:27 pm

    • It seems that many hospitals, given the comments posted, are adopting policies and practices for rooming-in that are not ideal. The intent for rooming-in is to care for the mother and newborn as though they were sharing a semi-private room with the same level and intensity of care provided by nursing staff as though they were in separate rooms, (post-partum and nursery). The mother should not be assuming the responsibility of care for her newborn, rather the staff should facilitate care plans as a dyad and not expect a recovering mother to be providing all of her newborn’s care.

      winterlb

      June 1, 2016 at 8:40 am


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