Baby-Friendly Hospital Initiative

To attain Baby-friendly designation status, a hospital must implement and follow two guidelines set forth by the WHO and UNICEF, these are:

• Ten Steps to Successful Breastfeeding, a series of activities that medical studies have shown increase rates of breastfeeding around the world. In the United States, new mothers exposed to at least six of the ten steps were 13 times more likely to continue breastfeeding six weeks after birth as compared to mothers who had not been exposed to any of the ten steps during their hospital stay after birth.
• The International Code of Marketing of Breast-milk Substitutes, a framework that defines how hospitals and birthing centers may obtain formula. They may not receive free or discounted products from manufacturers to ensure that infant-feeding practices and education are not impacted by commercial interests.

Additionally, the hospital staff must undergo many hours of training to support these steps.

Brigham and Women’s Hospital began working toward Baby-friendly status in 2013. Achieving this status in January 2019 reflects our commitment to create an environment that encourages breastfeeding among new mothers. The Brigham is one of approximately 550 hospitals and birthing centers nationwide that have received this distinguished designation.

Our Baby-friendly team includes nurses, midwives, lactation consultants, obstetricians and pediatricians who work closely to implement Baby-friendly policies at the Brigham. Studies have shown that the types of changes we have made during the process of earning Baby-friendly hospital designation improve breastfeeding success and support mother-baby bonding regardless of feeding method. At the Brigham we have implemented the following practices to help mothers successfully breastfeed: rooming-in, skin-to-skin contact and limiting pacifier use.

We are encouraging mothers to maximize time spent with their newborns. Prolonged separation of a mother and newborn is associated with a lower likelihood of establishing successful breastfeeding. Keeping your baby in your room also provides the following benefits for you and your baby:

• Babies who stay in the room with their mothers cry less often, sleep more, breastfeed better and longer, gain more weight each day, and are less likely to become jaundiced.
• When your baby stays in your room with you all the time, you will learn how to understand your baby’s cues more quickly.

At the Brigham we work with each expectant mother on her birth plan, including care for her newborn. While we encourage breastfeeding for optimal nutrition, we respect each mother’s choice and needs on infant feeding. While the designation is Baby-friendly, the Brigham is equally devoted to being mother-friendly. Also, our new moms will continue to have our newborn nursery available to them and their babies as needed.

With skin-to-skin contact, your baby will be placed directly against your chest. Skin-to-skin contact should be practiced immediately after birth for at least one hour and then as frequently as possible thereafter. Skin-to-skin contact is also possible and should be done after a cesarean delivery. Babies who have skin-to-skin contact generally have better breastfeeding success. They may also be calmer, have better blood sugar levels, improved respiratory rates and healthier body temperatures than babies who do not receive skin-to-skin contact. Your partner can do skin-to-skin contact as well.

While Brigham and Women’s Hospital does not routinely provide pacifiers for breastfeeding newborns, parents that choose to use a pacifier for their baby may ask for one.

Recommendations from the American Academy of Pediatrics (AAP) regarding pacifier use are listed below:

• For breastfed infants, delay pacifier introduction until breastfeeding has been firmly established, usually by 3-4 weeks of age
• Pacifiers should not be hung around an infant’s neck. Pacifiers that are not attached to infant clothing should not be used with sleeping infants
• Objects such as stuffed toys, which might present a suffocation or choking risk, should not be attached to pacifiers
• The pacifier should be used when placing the infant down for sleep and not reinserted once the infant falls asleep. If the infant refuses the pacifier, he or she should not be forced to take it.

The Brigham has always encouraged breastfeeding and other policies that promote bonding between mothers and babies. To ensure that breastfeeding begins as soon as possible, we are now promoting skin-to-skin contact during the first hour of life. This means that certain newborn evaluations and treatments, such as measuring a baby’s weight or giving vitamin K injection and eye drops, are done later. We have found that these evaluations and treatments can be safely postponed until a mother has time to hold and bond with her baby during skin-to-skin contact. Skin–to-skin contact lessens babies crying, reduces stress and increases ability to fight infection. It also promotes relaxation and helps you respond to your baby’s feeding cue’s easily.

Once you leave the delivery room you will go to your “Family Room” on the Postpartum Unit. Babies that stay with their mothers are more likely to be more successful with breastfeeding. The more time you spend with your baby the better you can learn your baby’s needs and feel more confident going home.

Returning mothers may also notice that we now only provide complimentary pacifiers if there is a medical reason, for breastfeeding babies. These changes have been scientifically proven to help increase breastfeeding success.

Many Baby-friendly practices, like skin-to-skin contact and rooming-in, are beneficial to all babies and moms, not just those who breastfeed. Our goal is to help new mothers achieve their personal goals. If a new mother is not planning to breastfeed, we will make sure she feels confident about safe formula feeding before leaving the hospital.

We understand each mother makes many informed choices about the care of her newborn, and we respect and support these individual decisions.

An exclusive breastfeeding plan means your baby is receiving your breast milk and nothing else. The American Academy of Pediatrics recommends exclusive breastfeeding for about the first six months. If there is a medical reason for supplementation, expressing your own milk first would be best. If your milk is not available, pasteurized human donor milk would be recommended, then formula. Your nurse will help you learn how to express your milk.

Early introduction of bottles and pacifiers should be avoided because it can keep you from establishing a good milk supply. Your baby’s suckling in the first few weeks should be entirely at your breast.

Parents will receive more information about breastfeeding support in their community before discharge from the Brigham. You can also check with your pediatrician or obstetrician to see if they have a lactation consultant in their practice. Also, organizations like zipmilk.org provide information about local breastfeeding resources.