Not all the ‘baby friendly’ rules are rooted in science

As last week’s story in the Washington Post describes, more and more hospitals in the United States are clamoring for the designation of “baby friendly.” When I first heard about this movement, I thought that goal should be something that goes without saying. Not only that, hospitals should be friendly to all of their inhabitants, not just sweet little babies. So why are these hospitals bragging about their kindly feelings toward infants?

At its root, the Baby Friendly Hospital Initiative is all about encouraging mothers to breastfeed. A “baby friendly” hospital agrees to 10 steps that include things like forgoing formula, pacifiers and nurseries — all of which may interfere with breastfeeding — and helping new moms breastfeed within the first hour of birth.

Going “baby friendly” works: Hospitals that implement the guidelines are more likely to send home women who breastfeed their babies. Many women have embraced these changes and are grateful for the breastfeeding support. I know that I thankfully received any help I could get. For such a supposedly natural thing to do, breastfeeding can be unbelievably hard. But some women haven’t been thrilled with the new initiative. One new mother, profiled in the Post story, was put off by the zealous hospital staff’s attempts to help her breastfeed, a choice she didn’t make, she said.

Just minutes after her daughter was born, health care workers were ripping open her gown and setting the baby up to nurse, she told the Post. If that was the case, then these people clearly overstepped. A new mother is still the boss of her own self and gets to make her own health care decisions, even if those decisions run counter to a hospital’s recommendations.

That’s not to say that I don’t support hospitals’ decisions to promote breastfeeding. The evidence for the benefits of breastfeeding is quite strong, and I think it would be fantastic if all new parents get the information, encouragement and support they want.

But as someone who spends my days translating scientific findings into tidy messages that still capture important caveats and nuances, I wonder about the science behind those 10 guidelines. What’s the evidence that a pacifier or a few hours in a nursery actually reduces breastfeeding rates, for instance?

To answer those questions, I’d like to see a giant, randomized study that investigates whether babies denied pacifiers early in life go on to breastfeed longer. I haven’t found that study yet, but I did find this assessment of several pacifier studies. The conclusion: In mothers motivated to breastfeed, pacifiers seemed to have no effect on how long the baby nursed.

It’s possible that in some cases, handing out pacifiers like candy in the hospital could cause problems, say, if a mother always stuck a pacifier in a hungry baby’s mouth instead of nursing. But it’s also possible that denying pacifiers, and the comfort they provide to babies, comes with its own unintended harm that’s delivered in the form of a cranky, sleep-deprived family.  

My point here isn’t to fight back against the anti-pacifier establishment. (Baby V wanted nothing to do with pacifiers, but in full disclosure, I would have been delighted had she found comfort in one.) And some of the baby-friendly recommendations are backed up by good evidence: It’s probably better to breastfeed a baby whenever he’s hungry, as opposed to a rigid schedule, for instance. Stopping the flow of freebie formula to new parents has also been linked with higher breastfeeding rates.

So while some of these baby-friendly steps make sense, it’s important to be aware that the leap from scientific studies to policies is often riddled with trouble. Some of these recommendations may be noble attempts to do something good for babies, but that doesn’t mean they’re sacrosanct.

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