Finally, a step in the right direction!
After several years of mounting evidence that the Baby Friendly Hospital Initiative (BFHI), designed to promote breastfeeding, leads to preventable deaths of babies being smothered in or falling from their mothers hospital beds, the American Academy of Pediatrics has finally weighed in. Their Clinical Report, written by members of the AAP’s Committee on Fetus and Newborn, Task Force on Sudden Infant Death, is entitled Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There is no evidence that promoting breastfeeding saves the lives of term infants. Therefore it makes no sense to risk the lives of term infants to promote breastfeeding.[/pullquote]
Buried within the oh-so-careful language and grossly exaggerated benefits of breastfeeding is a simple truth:
The Baby Friendly Hospital Initiative mandates practices that kill babies.
And that’s before we address the further deadly impact of restrictions on formula supplementation.
Two of the tenets of the BFHI, the encouragement of long periods of skin to skin contact (SSC) between mothers and babies, and the virtual mandate on 24 hour rooming in are in direct violation of everything we know about infant suffocation and death.
The biggest risk to babies appears to be the risk of smothering. We know that there are multiple modifiable risks for infant suffocation: co-sleeping, prone position, soft bedding, and maternal impairment by opiates. Despite this, the BFHI encourages mothers to co-sleep amid soft bedding and during maternal impairment by opiates, as well as placing babies in the prone position during skin to skin contact.
Why are such obviously deadly behaviors encouraged? It is a misguided effort to promote breastfeeding. The evidence that skin to skin contact and rooming in promote breastfeeding is weak to non-existent. Yet even the AAP cannot resist false claims:
SCC has been researched extensively as a method to provide improved physiologic stability for newborns and potential benefits for mothers. SSC immediately after birth stabilizes the newborn body temperature and can help prevent hypothermia. SSC also helps stabilize blood glucose concentrations, decreases crying, and provides cardiorespiratory stability, especially in late preterm newborns. SSC has been shown in numerous studies as a method to decrease pain in newborns being held by mothers and fathers. In preterm infants, SSC has been shown to result in improved autonomic and neurobehavioral maturation and gastrointestinal adaptation, more restful sleep patterns, less crying, and better growth. Although not specifically studied in full-term infants, it is likely that these infants also benefit in similar ways. (my emphasis)
Of the eleven papers cited in support of this claim, NOT EVEN ONE demonstrates SCC causes benefits for term infants. That’s hardly surprising since the needs of preterm infants are dramatically different than those of term infants and there is NO REASON to suppose that both benefit from SSC in similar ways.
The purported benefits of SSC for mothers are even more tenuous, and based on papers from less rigorous nursing, midwifery and lactation journals.
Even worse, the AAP unforgivably repeats a favorite lactivist canard:
Rooming-in … may avoid newborn abductions …
Really AAP, how could you support such crackpot nonsense?
The truth is that claim that SSC leads improved increased breastfeeding is based on the same “evidence” that vaccines “cause” autism: temporal association, observation and wishful thinking. The rest of the Hill criteria for causation are not fulfilled, especially the mechanism of action and the utter lack of consideration of alternative explanations for the observations.
The sad reality is that tenets of the BFHI are not based on science; they reflect the preferences of lactivists elevated to requirements for other mothers.
This insistence on invoking spurious benefits of SSC and rooming in prevents the American Academy of Pediatrics from recommending the obvious: stop promoting extended skin to skin contact and stop mandating 24 hour rooming in.
Instead the AAP recommends steps that are entirely incompatible with the functioning of contemporary postpartum wards.
… [H]ave no more than 3 dyads assigned to 1 nurse to avoid situations in which nursing staff are not immediately available and able to regularly monitor the mother-infant dyads throughout the postpartum period.
But it takes two nurses per shift to staff a well baby nursery of 30 babies or more, and hospitals are abandoning well baby nurseries in order to save money on those two nurses’ salaries. It defies common sense to imagine that the same hospital is going to double or triple the number of postpartum floor nurses per shift in order to intensively monitor babies in mothers’ rooms.
Reality check:
There is NO EVIDENCE that promoting breastfeeding saves the lives of term infants. Therefore it makes NO SENSE to risk the lives of term infants to promote breastfeeding.
The AAP has taken a long overdue first step in acknowledging that the tenets of the BFHI lead to preventable infant deaths … But they still have a long way to go in explaining why a punitive program designed by lactivists to force other women to mirror their own choices back to them has any place in a facility devoted to promoting infant and maternal health.
