This post is the 24th in a series on Booby Traps made possible by the generous support of Motherlove Herbal Company.
For several years I taught breastfeeding classes at area hospitals. At one class, in addition to about ten expecting couples, there was a nurse from the childbirth center in attendance. This was part of an effort to try to make our messages about breastfeeding consistent from prenatal class through postpartum care.
When I got to the issue of pacifiers I explained, “Pacifiers can cause breastfeeding problems, particularly in the early days when a baby is learning now to suck. The American Academy of Pediatrics recommends: For breastfed infants, delay pacifier introduction until breastfeeding has been firmly established, usually by 3 to 4 weeks of age.'”*
As I finished explaining this, I saw the nurse’s hand go up. I was surprised, since the idea was that she was there to observe, not to participate. But I called on her to speak.
She said, “You know what I find is really helpful? Using a pacifier that first night after a baby is born. It really seems to calm them down and keep them happier, and it allows the moms to get some sleep. I’d really recommend that.”
Needless to say, I was disturbed by this comment, both because it completely contradicted what I had just said, and because it was the opposite of what the evidence has shown. So I said, “I’m sorry, but I’m going to have to disagree with you.” I then explained the ways in which the early introduction of a pacifier can harm breastfeeding. As I did so, I heard a dad in the class say, “Oooooooh.” I suddenly felt like I was back in seventh grade.
Thinking back on that moment, I think that this experience probably gave the families a realistic picture of the contradictions they were about to encounter on this and other issues related to breastfeeding. One person says pacifiers are bad, another says they’re great. Chances are this wasn’t the only confusing message they were going to receive.
National data confirm that pacifiers are still a commonly used item in our hospitals. The CDC reports that only 30% of hospitals limit the use of pacifiers so that less than 10% of healthy full-term breastfed infants are given pacifiers by maternity care staff members. This, despite the fact that “giving no artificial teats or pacifiers to breastfeeding infants” is one of the evidence-based Ten Steps to Successful Breastfeeding, and the AAP in their breastfeeding policy, says: “Pacifier use is best avoided during the initiation of breastfeeding and used only after breastfeeding is well established.”
Some of this pacifier use is driven by uninformed views like the one voiced by the nurse sitting in on my class, but some is undoubtedly a result of maternal request. Here again, as we’ve discussed before on the issues of early elective birth and formula supplements in the hospital, health care providers have a responsibility to explain to mothers that pacifier use can get in the way of their goal of breastfeeding. Not explaining this deprives moms of their informed consent.
I recently heard of one way in which some hospitals which are working toward Baby Friendly status deal with the pacifier issue: they inform moms prenatally that the hospital where they are going to deliver simply does not stock pacifiers. Think that sparks a discussion about pacifiers and breastfeeding? I’m sure it does!
Did your hospital push pacifiers? Discourage them?
* The AAP encourages the use of pacifiers as a means of preventing Sudden Infant Death Syndrome (SIDS) once breastfeeding is established.