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The First Year of Parenting

Breast-Feeding and Baby-Friendly Hospitals

Not so long ago, it didn’t seem likely that Boston Medical Center (BMC) would ever become an internationally recognized site for breast- feeding excellence. At the cash-strapped inner-city hospital with a maternity ward that treats mostly poor women of color, it seemed that time and money would be better spent on things other than increasing breast-feeding initiation rates.

“Everyone said BMC was an unlikely place for this to happen,” says Bobbi Philipp, MD, a BMC pediatrician and one of three cochairs for the hospital’s breast-feeding task force. “It was outside attitudes that made us want to prove to the world that our mothers and babies deserved to breast- feed just as much as anyone else.”

Convinced of nursing’s health benefits, BMC’s breast-feeding task force began the process of becoming an internationally recognized “Baby-Friendly” hospital, a designation created by the World Health Organization and the United Nations’ International Children’s Emergency Fund to acknowledge hospitals that take the Ten Steps to Successful Breastfeeding. The steps are:

  1. Maintain a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.

  3. Inform all pregnant women about the benefits and management of breastfeeding.

  4. Help mothers initiate breastfeeding within one hour of birth.

  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

  6. Give infants no food or drink other than breast milk, unless medically indicated.

  7. Practice “rooming in”—allow mothers and infants to remain together 24 hours a day.

  8. Encourage unrestricted breastfeeding.

  9. Give no pacifiers or artificial nipples to breastfeeding infants.

  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.10

In December 1999, BMC earned a Baby-Friendly designation, making it just the twenty-second hospital in the United States with such an accreditation. In the years since, the number of Baby-Friendly hospitals in the United States has grown, but not much. As of December 2006, only 55 hospitals in the United States were considered officially Baby-Friendly, though the designation has been awarded to more than 19,000 hospitals in other parts of the world—including 6,500 in China alone.

The campaign at BMC has paid off in hospital-wide breast-feeding initiation rates that range between 82 and 88 percent, according to Philipp, who adds that these numbers are remarkable because poor African-American mothers—who make up more than half of the women giving birth at the hospital—generally have very low breast-feeding rates.

“One of our proudest achievements is that we’ve been able to take what was once a formula-feeding culture and turn it into a breast-feeding culture,” Philipp says. “Our moms are behind this change, too. We’re busting stereotypes here; we’re all proud of that.”

End of excerpt.


10. Baby- Friendly USA, “The Ten Steps to Successful Breastfeeding,” accessed at www.babyfriendlyusa.org/eng/10steps.html on February 20, 2007.  [back to text]

Excerpted from Chapter 15: Feeding Your Baby in Our Bodies, Ourselves: Pregnancy and Birth  © 2008 Boston Women's Health Book Collective.

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