Baby-friendly ho$pital$

Not so friendly for parents

Author’s note: This newsletter takes a while to get to the tech tie-in, but I promise it’s there. This is an issue that’s super important to me these days.

When I went to my first check-up for the baby I just had, while I sat in the smaller waiting room, I saw a sign saying that the office, in conjunction with my hospital, had just been certified as “baby-friendly.”

On the sign was a pregnant, glowing woman, smiling a thousand-watt smile.

“Baby-friendly” wasn’t something I’d heard about with my last pregnancy, so I was curious about what it meant. I heard it several more times in consequent appointments. Every time it was brought up, it was framed as “a way for mothers and babies to bond.” But, it wasn’t until I talked to other moms who recently had babies and did some internet sleuthing that I discovered what the philosophy is all about.

What it means is that hospitals are now getting rid of nurseries that are currently a part of maternity wards. These nurseries are where babies who are just born go for a short amount of time. Usually, in these nurseries the babies are weighed, observed, given baths, and kept for a couple hours (until they wake up to feed) so exhausted moms can get some rest.

Instead, “baby-friendly” means that hospitals are now encouraging “rooming in”, where babies are always with the parents in the hospital room, ostensibly so babies can bond better and moms can breastfeed easier:

For a hospital to achieve accreditation from Baby-Friendly USA, it must adhere to the 10 tenets and strive to meet certain goals. The org wants at least 80 percent of breast-feeding women who are able (i.e., who don’t have a justifiable reason not to, such as they’re recovering from a C-section and on painkillers) to room-in with their babies 23 out of 24 hours a day and eschew formula and pacifiers.

In order to understand what is being taken away here, let me paint a picture of the days immediately following childbirth.

Usually, what happens once you deliver a baby, be it by c-section or traditional birth, you are a sweaty mess, physically torn up, and extremely tired. Hormones are surging through you. You’re wheeled from the operating room where you give birth into a regular hospital room. The baby is placed next to you in a small plexiglass bassinet that’s higher than the hospital bed.

The baby needs something every ten minutes for the next five billion years, or until they graduate college. Either the baby is cold, or crying, or she needs to eat, or you want to hold her, or she needs a diaper change.

Since your insides feel like they’ve been pulverized with a mortar and pestle, and the plexiglass bassinet is high up, this usually means having someone come, bringing the baby to you, and putting the baby back in the bassinet, over and over again, through throngs of visitors, and through hours when you would kill someone for a ten-minute nap.

The hospital becomes quieter at night, but your baby doesn’t. He still needs to eat every couple hours, and, in between, makes all kinds of new baby noises that are impossible to sleep through. He also needs diaper changes, re-swaddling, and a million other small adjustments. During all this time, you as a new mom (and partner, if they stay overnight on the impossibly hard and small hospital chairs) are full of hormones and completely attuned to every sound, every cry, every sigh that your baby makes. You are, physically and mentally, a complete wreck, particularly if you’re a first-time parent.

Previously, to help with this, you could request that a nurse take the baby to the nursery for 2-3 hours between feedings, and have them be brought back when they cried and it was time to eat again. For me personally, the ability to send my baby away saved my life that first night with my daughter. I finally got at least a little sleep. I knew she was in solid hands - even better than mine as an inexperienced parent at that point - and I knew that, very soon, she would be right back with me to continue to learn the messy, complicated tango between mom and newborn child.

Learning that my hospital was moving to “baby-friendly” hospitals and realizing that those couple of hours of crucial rest would be taken away from me for my second baby was an enormous disappointment for me. It also came out of nowhere. One year my hospital was normal, and all of a sudden, at my first ob/gyn pregnancy visit, it was baby-friendly.

So, I started investigating into why American hospitals were suddenly moving in this direction, and it all started to make a lot of sense.

The TL;DR is that increasingly cash-strapped hospitals are looking for things to drive driving costs, and baby-friendly hospitals are a PR-friendly way to show new moms that hospitals care about them, while at the same time cutting expenses.

To be fair, the original baby-friendly movement started with good intentions for moms and babies.

The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990. The initiative is a global effort to implement practices that protect, promote and support breastfeeding.

This initiative, when rolled out in developing countries, resulted in decreased child mortality rates, particularly when coupled with education for the mom.

In the United States, too, baby-friendly hospitals started with good intentions. But when you dig deeper, you find that one of the real primary reasons for baby-friendly terminology is cost savings.

In a PowerPoint presented to hospitals in Colorado in 2013,(PDF) a woman, “Dr. Mom”, gave the following presentation.

It’s clear that improving the hospital’s bottom line is a primary concern:

Sure, there are lots of slides about how breastfeeding, a focus of baby-friendly hospitals, is good for both mother and baby, but these in particular caught my eye (from this study):

Ultimately, why are hospitals pushing baby-friendly and breastfeeding? Because it saves them (and the government, through Medicaid payments) money.

In theory, it sounds great. In reality, baby-friendly hospitals are, in general, a terrible idea for moms, as threads upon threads of recent new moms attest. My own experience the second time around was far from ideal.

These hospitals are also potentially not great for hospital workers. My local Philly area magazine recently did a story about them and they confirm my suspicions:

In early February, I met with two postpartum nurses who work for Main Line Health. (They asked to remain anonymous for fear of getting fired.) They believe in the importance of breast-feeding and take the role they play in a mother’s success at it seriously. But as we sat around my kitchen table, they told me that the reason behind the transition to Keystone 10 — the Baby-Friendly initiative from the Pennsylvania Department of Health — wasn’t explained to the team. “The nursery just has a bunch of empty bassinets in it,” one said. “There’s no one staffed down there.” They say that the changeover still causes tension among the staff: Night-shift nurses want to acquiesce to requests from moms who long to get some sleep, but they have to answer to day-shift colleagues demanding to know the next morning why mom didn’t room-in. “It’s a constant back-and-forth,” said one nurse. “They don’t see these moms at night. I want everyone to come in at three in the morning when these moms are having mental breakdowns.”

But don’t they sound great?

I’m not a healthcare professional, but I’d be interested in knowing how much money losing a nursery saves, versus maybe not paying for things like unnecessary EHR systems.

Atul Gawande, one of my absolute favorite essayists, wrote a recent piece about the elaborate cost of these systems:

On a sunny afternoon in May, 2015, I joined a dozen other surgeons at a downtown Boston office building to begin sixteen hours of mandatory computer training. We sat in three rows, each of us parked behind a desktop computer. In one month, our daily routines would come to depend upon mastery of Epic, the new medical software system on the screens in front of us. The upgrade from our home-built software would cost the hospital system where we worked, Partners HealthCare, a staggering $1.6 billion, but it aimed to keep us technologically up to date.

Trying to shave hundreds of dollars off delivery bills by driving new mothers insane while the other side of the hospital is spending billions on ineffective software is an insane systemic failure, and one I’d be more interested in exploring from the tech side.

(Or at least, it seems that way to me, as a consumer of the healthcare system. If I have readers that have made it this far and are experts in healthcare, get at me!)

In the meantime, the baby-friendly hospital designation is only continuing to grow:

In 2007, less than 3% of United States births occurred in approximately 60 Baby-Friendly designated facilities. In 2018, those numbers rose to more than 25% of births in more than 500 Baby-Friendly designated facilities, and they continue to rise.

Art: Mother Holding Her Child in a Doorway, Adriaen van Ostade , 1667

What I’m Reading lately

  1. Books I recently finished:

    • Born a Crime by Trevor Noah - 110% recommend. This book is very, very, very good, even if you don’t like Trevor Noah on the Daily Show, which I don’t

    • The Egg and I by Betty Macdonald - Unexpectedly funny account of living on a chicken farm in Washington State in the 1920s

    • China in Ten Words by Yu Ha - I didn’t get as much out of the latter set of essays as the first five, but I still think it’s important to learn more about China as stuff heats up. This gave a good personal account of the Cultural Revolution

  2. Siri, Privacy, and trust by someone who is usually a staunch Apple defender

  3. This is a sweet .DS_Store git tip and I wish more tips came with animations

  4. Don’t read this if you’re hungry

  5. Thread:

  6. RIP Thinkgeek:

About the Author and Newsletter

I’m a data scientist in Philadelphia. This newsletter is about issues in tech that I’m not seeing covered in the media or blogs and want to read about. Most of my free time is spent wrangling a preschooler and a newborn, reading, and writing bad tweets. I also have longer opinions on things. Find out more here or follow me on Twitter.

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