Booby Traps Series: 4 out of 5 hospitals supplement breastfed babies when it’s not medically necessary. Whose fault is that?

This post is the 19th in a series on Booby Traps made possible by the generous support of Motherlove Herbal Company.

Today I’m writing about one of the biggest Booby Traps, the non-medically necessary supplementation of breastfed babies with formula, glucose water, or water, during the hospital stay.

Supplementation is a problem for a number of reasons, including the damage it can do to a mother’s developing milk supply and the confusion it can cause a baby who is learning to suckle at the breast.  It’s strongly correlated with shortened breastfeeding duration, or what we would call, in Best for Babes vernacular, moms not meeting their personal breastfeeding goals.

As I’ve been ticking off the many Booby Traps lurking on maternity wards I’ve been relying on recent CDC data on maternity care practices.  It’s called the mPINC survey.  Hospitals complete this survey two years, and the response rate for the over 2,600 hospitals and birth centers was a remarkable 82% in 2007 and 2009.

Hospitals are assessed on their compliance with the Ten Steps to Successful Breastfeeding – evidence-based policies known to increase breastfeeding rates.  One of the key steps, or course, is not giving formula or other supplements unless it’s medically necessary.

The CDC judged adherence to this policy based on the number of hospitals reporting that “<10% of healthy full-term breastfed infants are supplemented with formula, glucose water, or water.”

And what percentage of hospitals met this threshold in 2009?  21%.

Why does this happen?  Some of it probably has to do with babies being separated from their mothers.  As I wrote previously, only one third of hospitals report that 90% or more of their mothers and babies are “rooming in.”  As you know, breasts don’t stretch down hallways and under doors.  So if babies are in nurseries it’s more challenging for mothers to exclusively breastfeed them.  Unless a mother is very clear that she is to be called in to feed her baby, hospital staff often interpret a baby being sent the nursery as a green light to give the baby a bottle.  And even when the instructions are to call mothers in to breastfeed, this doesn’t always happen.  So lack of compliance with one of the Ten Steps leads to problems with another of the Ten Steps.  Put differently, one Booby Trap leads to another.

Another reason for all this supplementation is maternal request – meaning that mothers request that their babies get formula during their hospital stay.  We moms, especially first time ones, are often scared that their babies aren’t getting enough milk.  Or we want to sleep.  Or we have nipple pain because we haven’t gotten skilled help getting our babies latching well, and we want a break.

Here again, it’s easy to blame mothers, isn’t it?  Certainly, we have to take responsibility for our actions when we’ve been informed of the risks.  But many mothers don’t know what it can mean to breastfeeding to supplement – in hospital terms, they don’t have “informed consent.”

And even when moms do know the risks, hospital staff need to stand up for what is going to make the mother much more likely to succeed with breastfeeding.  This means that they need to have adopted evidence-based policies to support breastfeeding, and have providers who do their very best to uphold them, even when a mother requests otherwise.  In other words, as Jennifer Block said in a post on early elective births, “It is physicians’ and midwives’ responsibility to practice good, evidence-based medicine and to educate their patients.”

So what does that mean practically?  It means that if a mother asks for formula to feed her baby, a nurse or other provider has to be able to stand behind a policy and, after asking why the mother wants to give her baby formula, explain:

“You know, hon, you’ve told us that you want to breastfeed, and we want to help you be successful with that.  Giving your beautiful baby formula can make it really difficult for you to produce enough milk.  That’s why at this hospital we don’t give formula to breastfed babies.  She’s doing great on your milk, and I know you can do this.

And then, depending upon the mom’s expressed concern:

“Oh, you’re worried she’s not getting enough milk.  Want to see how small her tummy is now?  (cue belly balls or some other teaching tool).”

“It hurts?  Let me help you get a better latch.”

“I’ll bet you’re tired!  Let me show you how to nurse her and rest at the same time.  Let’s also put a sign on the door asking that you not be interrupted when you take your next nap.”

There are lots of possible variations on these responses, but you get the idea.

The alternative, which I have to believe is what happens most of the time, is:

“You want a bottle?  Okay, be right back.”

And that, to me, is just not good enough.

Did your baby get supplemented against your wishes?  Did your baby get supplements because you requested it?

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29 Comments | Last revised on 09/28/2011

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