How the push for breastfeeding emptied hospital nurseries

Listen 13:57
A nurse bottle feeds a newborn baby.  (AP Photo/Fernando Antonio)

A nurse bottle feeds a newborn baby. (AP Photo/Fernando Antonio)

Little Calla wasted no time coming into the world.

“Basically, I went from 4 to 10 centimeters in a half-hour, and she was born very, very fast — kind of unexpected,” said Maria McCorry, holding her newborn daughter.

Her husband is a colleague. The family invited us to the hospital in Philadelphia.

After Maria delivered, her baby was weighed in the same room and the pair were wheeled into the recovery room together.

“She’s been in here ever since. So she hasn’t left at all,” Maria said.

It’s a comfort keeping her daughter close, she says.

“It’s definitely exhausting, but I’m glad she’s here. I’m breastfeeding her, so it’s nice to be able just to have her right here with me,” Maria said. “I also can have that paranoid-new-mom thing, even though she’s our third, where I make sure she’s breathing constantly.”

Keeping mom and baby together instead of using the nursery is part of the Baby-Friendly Hospital Initiative,  an international program that promotes breastfeeding. It’s been adopted by hundreds of American birthing hospitals over the past decade.

Maria McCorry and her husband Kevin with their newborn, Calla, plus Dylan, 2, and Carver, 4. (Photo courtesy of the McCorry family)

For the McCorrys, it was a blessing. But it’s not as blissful for everyone.

Julie Ksleman became mom a few months ago. She was almost at her due date, but her blood pressure was dangerously high. So doctors tried to induce labor.

“I was stuck on my back in this windowless hospital room, just kind of suffering through the induction. I waited and waited,” she said. “After 48 hours, they realize that, no, I was not going to go into labor on my own.”

She ended up getting a cesarean section. Her baby was healthy, but mom wasn’t.

“I was just incredibly sick. I developed a fever, I was vomiting,” Ksleman said.

And her baby was right there in the room with her.

“So I remember feeling so distraught, because I was just looking at him in the bassinet next to me and I didn’t even have the strength to pick him up and hold him,” she said.

Her husband was there, but he was exhausted too, and couldn’t really move around because of a knee injury. Ksleman said she wanted to be there for her baby, but she also didn’t feel she was physically up to it.

“There were times that I would just start crying uncontrollably,” she said. “And I think those were the moments that I really thought, oh my gosh, I just wish, I wish someone would just take him for an hour. ”

Sending her baby to the nursery didn’t seem like it was even an option, Ksleman said. The hospital she delivered in, like at least one-sixth of all American birthing hospitals, is Baby-Friendly-designated.

Baby-Friendly comes from the the World Health Organization and UNICEF. It’s aimed at increasing exclusive breastfeeding until babies are 6 months old. That means no formula unless medically necessary.

It also calls for rooming-in — keeping moms and their babies together as much as possible. When baby gets hungry, mom is right there to breastfeed.

Ksleman said being together meant staying awake, hour after hour, all night, and all day. A similar story came from another mom, who delivered at a different Baby-Friendly hospital.

“I did the math … and I slept only five hours over, I think, like four days,” this mother said.

She didn’t want us to use her name because she felt humiliated by her experience. Her delivery was a relatively smooth one. But the baby’s father was working in another city, so she was alone with her newborn son.

“I definitely got my second, third and even 10th wind while I was in there because I knew I had to be up and take care of him,” she said.

Any time her baby went in the bassinet, he cried. When he slept with her in the bed, nurses came and woke her, saying sleeping together was dangerous. Staff were coming and going, performing tests on her baby. She wasn’t producing much milk, and wasn’t given any formula.

Basically, she said, she couldn’t catch a break.

“There was one point where I really had to go to the bathroom, but I didn’t know what to do with the baby,” she said. “I’m freaking out, he’s freaking out.”

She ended up relieving herself on the floor.

“And of course, a nurse comes in at the same time and she sees what I did, and I was like … I don’t have enough hands,” she said.

Both women said they couldn’t wait to escape their hospitals  — going home meant finally getting to sleep.

Breastfeeding is important to lots of new moms. And doctors agree breastfeeding is the best thing for the health of both the mother and the baby.

It’s rooming-in that these moms question. Those sleepless nights right after delivery — are they necessary to encourage breastfeeding?

Some doctors are starting to worry about how safe all this is. Could an exhausted mom fall asleep and accidently smother a baby, or drop one?

“One of the requirements is that 80% of the babies need to be at least 23 hours of the day with the mom,” said neonatologist Enrique Gomez Pomar. He said he was struck by how strict Baby-Friendly’s policies seemed when it came to his hospital system in Meridian, Mississippi, in 2016.

“The problem with this comes when you have a mother that had a C-section or when you have a mother that was laboring for two days and is exhausted,” he said.

Like the two moms mentioned earlier, and others. Finding them was no trouble, basically just a matter of posting on neighborhood Facebook groups, looking for recent delivery experiences.

Such stories are common, Pomar said, because giving moms a break — taking healthy babies to the nursery — is a “ding” against the Baby-Friendly designation.

“They’re very strict about their numbers,” he said. “Say the mom says that she wants to rest, then you take the baby to the nursery. That baby,  that case, actually dings the hospital.”

Baby-Friendly USA

Baby-Friendly USA is the nonprofit in charge of implementing the program in the United States. The international Baby-Friendly Hospital Initiative trains hospital personnel in the “Ten Steps to Successful Breastfeeding.” Certification takes about three years and costs about $12,000.

A Baby-Friendly USA team goes to a hospital and makes sure it’s having babies room-in with their moms. The team makes sure the hospital isn’t advertising commercial formula and, in general, is really promoting the benefits of breastfeeding. It ascertains moms are being taught breastfeeding techniques. There’s annual recertification.

“You know, old practices die hard,” said Trish MacEnroe, CEO of Baby-Friendly USA. “So, even in facilities that have gone through our process and have made the transformation, we ask them to continue to monitor their practices so that they don’t backslide.”

What about those moms and how badly they just wanted to sleep, and the doctor’s concerns? Why not just offer up the nursery more, make it a feel more like an OK choice?

“With the reality of mothers and babies being exhausted, the best answer may not always be separation of mothers and babies. That might be one solution. And that certainly should be used if necessary,” she said. “[But] sometimes, it is inviting the mother to have a support person alongside of her to help, and if the mom nods off, that support person can, you know, gently take the baby and put it back into a bassinet. So there’s many, many different solutions.”

Important bonding happens in those first hours after delivery, MacEnroe said. Moms start learning how to be moms, how to listen to feeding cues from their babies. If a baby doesn’t try to breastfeed, the mother might not be able to produce milk later.

If you just whisk away the baby and give formula while mom sleeps, they miss out on all that. There’s also anxiety — lots of new moms dread being separated from their babies.

“I’ve talked to mothers who said, ‘I felt like I rested better because … I knew my baby was by my side in the hospital. Staff were checking on my baby,’ ” MacEnroe said.  “There are mothers that have reported that when their babies were in the nursery, they’d hear crying down the hall, and they wondered if it was their baby.”

She says Baby-Friendly is about empowering moms, makings sure they don’t miss out on breastfeeding. Formula can run up to $30 a week, while breast milk is free,  and always at the right temperature. Breastfeeding can even help moms lose the baby weight.

Breastfeeding ‘wasn’t even really a choice’

But this focus on breastfeeding is actually a complete 180 from how things were just a few decades ago. Babies were just taken away and checked into the nursery automatically. No one asked moms what they wanted, and formula seemed like a gift from science.

A Good Start formula commercial from a couple decades ago proclaimed: “Formulated for brain and eye development, with comfort proteins that are broken down for digestion.”

Compared to that, breastfeeding was considered almost backward.

“For a lot of women, it wasn’t even really a choice,” said Jessica Martucci, a researcher at the Science History Institute in Philadelphia and the author of “Back to Breast,”  about how breastfeeding has made a comeback in the United States.

“It was just, sort of, you have your baby in the hospital, and then the nurses take it away to the nursery, they give it a bottle of formula,” she said.

Newborn babies in the nursery ward at City Hospital in St. Louis, Mo. (AP Photo)

Martucci tracks Baby-Friendly’s origins to the 1950s, and a group called La Leche League, a grassroots movement of moms that pushed back against formula.

By the late ‘70s, La Leche League was a well-respected, internationally known organization. Formula was still king in the wealthy countries, but then major companies started marketing it in the developing world. That raised red flags.

“If an area doesn’t have access to clean water, for example … is it ethical to ask people to buy formula that you need to mix with water that could then make their babies sick?” Martucci explained.

Minor infections, diarrhea, then as now, were major drivers of infant mortality in places such as sub-Saharan Africa. Using only breast milk would save hundreds of thousands of lives.

Martucci said UNICEF and the World Health Organization had meetings to draft guidelines to promote breastfeeding over infant formula. La Leche League was there to advise.

The result was “10 Steps To Successful Breastfeeding,” the basis of the Baby-Friendly Hospital Initiative. It officially launched in 1991 and spread across the world. But it didn’t catch on in the U.S. at first.

Obesity, chronic disease, and breastfeeding

“I would say that things really started to take off … around 2010,” said MacEnroe, Baby-Friendly’s CEO.  “That really came about because there was a recognition about the relationship between breastfeeding and childhood-obesity prevention.”

After that, Martucci said, Baby-Friendly grew. One hospital system started using it, then another followed its lead. Eventually, insurers start asking about it.

“Of course you’re going to follow the guidelines to get the certification because why would you not do it that way?” said Martucci. “By creating this system it’s just kind of self-perpetuating, and it doesn’t have within it a sort of system of checks and balances for evaluating what it’s actually doing,”

When asked why exclusive six-month breastfeeding is so important in the U.S., officials at the WHO and UNICEF also brought up its long-term benefits.

Dozens of studies have shown breastfeeding is linked to lower rates of obesity and a wide-range of diseases (diabetes, cancer and asthma), and allergies. Some have even said breast milk makes kids smarter and better behaved.

Hear enough about the studies, and breast milk begins to seem magical. However, they don’t have a true control group.  You can’t take a group of moms and randomly tell some to breastfeed and others not to.

Without the control, you don’t know whether it’s the breast milk that’s behind the benefits or what researchers call “confounders.”

“Things like mother’s education and family income, the race of the infant,” said Cynthia Colen, a population-health researcher at Ohio State University. She said scientists try to control for such differences.

To minimize their effects, her team looked for sibling pairs, where one child was breast-fed and the other wasn’t.  They found nearly 1,800 cases.

In this Saturday, Jan. 5, 2019, photo different kinds of baby formula line the shelf in the Cambria Gallery during Feeding Every Baby Formula Shelf’s monthly distribution event in Mankato, Minn. (Jackson Forderer/The Free Press via AP)

“What we found is that the protective effects of breastfeeding really went away,” Colen said. There was no real difference between breast and formula-fed when the kids were in the same family.

Social epidemiologist Michael Kramer has been working on a massive breastfeeding study in Eastern Europe.

Known as the PROBIT study, researchers randomized 31 hospitals. At some, they implemented Baby-Friendly protocols; the others, they left alone.

Initial breastfeeding rates were already high, but at the Baby-Friendly hospitals, exclusive breastfeeding continued at seven times the rate of the control hospitals. More moms were breastfeeding and for much longer.

The study continued for two decades, tracking these babies as they became teenagers.

Here’s what it found — or, rather, what it didn’t find.

“We did not find any protective effect against obesity. We found no protective effect against allergic disease,” said Kramer. “We found no protective effect against high blood pressure or any … metabolic indicators which might be considered as precursors of type 2 diabetes.”

So what explains the benefits all the other studies found? Well, no one knows for sure.

But both researchers say something else must be at play when it comes to breastfeeding that isn’t understood yet. Maybe something more than what’s in the milk.

Every mother interviewed for this story, even those opposed to Baby-Friendly, had one thing in common: All of them breastfed.

Whether they believed breast milk was magic or only marginally better than formula, they said they breastfed because they wanted to provide the absolute best for their babies.

One mother,  the one who didn’t want her name used, said that didn’t mean she wasn’t going to use formula here and there.

“One of the nurse practitioners at the OB-GYN’s said to me, ‘Formula-fed babies go to college, too,’ ” she said.  “So, you know, I’m alright with it.”

Want a digest of WHYY’s programs, events & stories? Sign up for our weekly newsletter.

It will take 126,000 members this year for great news and programs to thrive. Help us get to 100% of the goal.