Frequently Asked Questions: The Baby-Friendly Hospital Initiative

Q: What is the Baby-Friendly Hospital Initiative?

A: In 1991, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI) to ensure that all birthing hospitals and centers support new mothers as they begin to breastfeed. In order to attain the Baby-Friendly designation, a hospital must implement the Ten Steps to Successful Breastfeeding and comply with the International Code of Marketing of Breast-milk Substitutes.

Baby-Friendly USA is the designating body for the Baby-Friendly Hospital Initiative in the United States. In order to receive the Baby-Friendly designation, hospitals must undergo a rigorous auditing and evaluation process to ensure that they provide the best possible breastfeeding care to all patients. At present, 15% of births in the United States occur in Baby-Friendly-designated facilities. We are proud that Mass General has joined this elite group of hospitals as of November 25, 2015. 

Q: Why is breastfeeding so important?

A: Breast milk is the ideal food for newborns and infants. It changes over time to meet the changing needs of a growing baby and contains immune factors and antibodies that help protect babies from infections. Babies who are breastfed have lower rates of ear infections, pneumonia and diarrheal illnesses. Breastfeeding also decreases the risk of SIDS (Sudden Infant Death Syndrome), type I diabetes and obesity.

For moms, breastfeeding decreases the risk of breast and ovarian cancers, type 2 diabetes and cardiovascular disease. Breastfeeding also burns around 500 calories a day.

Q: Why is Mass General involved in the initiative?

A: Helping all new moms get the best start possible with breastfeeding is very important to us, and we are dedicated to helping all women meet their personal breastfeeding goals. So in 2011, Mass General began the process of earning the Baby-Friendly Hospital designation. Our Baby-Friendly team includes nurses, midwives, lactation consultants, obstetricians and pediatricians who work closely to implement Baby-Friendly policies at Mass General.

The changes we have made during the Baby-Friendly journey have been shown in medical studies to help improve breastfeeding success. Baby-Friendly reflects our commitment to creating the best environment possible for breastfeeding.

Q: What changes are being made at Mass General as part of the Baby-Friendly initiative?

A: At Mass General, we are implementing changes to help new mothers meet their breastfeeding goals. These include rooming-in, using pacifiers only for medical reasons and practicing skin-to-skin mother-baby bonding.

One of the changes I’m most proud of is our skin-to-skin initiative. Skin-to-skin means that after birth, the baby is placed directly on mom’s chest. Baby is warmed by his or her mother’s body heat and comforted by her familiar heartbeat and voice.

Babies who are placed skin-to-skin immediately after birth generally have better breastfeeding success, but there are other reasons for this practice, as well. Babies placed skin-to-skin as soon as possible after birth are calmer, have better blood sugar levels, improved respiratory rates and healthier body temperatures.

Q: Is skin to skin just done following a vaginal birth?

A: No. We facilitate skin-to-skin bonding in the operating room for mothers who have Cesarean deliveries. For many women, this improves their experience during Cesarean birth. Mothers feel better and tend to tolerate the discomforts of Cesarean delivery better when their baby is placed skin-to-skin. Nothing beats the positive endorphins that come from your first cuddle with the little one you’ve waited so long to meet.

Q: What changes will a patient notice if she gave birth at Mass General before the Baby-Friendly initiative?

A: Mass General has always encouraged breastfeeding and other policies that promote mom and baby’s health and bonding. We now work to ensure that breastfeeding is begun within the first hour of life and we prioritize skin-to-skin bonding during that important time. This means that certain newborn evaluations and treatments, such as measuring baby’s weight or giving vitamin K injection and eye drops, are done later. We have found that these tasks can wait because baby’s first hug and cuddle with his or her mother is so much more important. We also encourage rooming-in, meaning baby and mother stay in the same room during their time in the hospital. Studies have shown that mothers actually sleep better when their babies are nearby. This also allows parents to learn early hunger cues that will help make breastfeeding more successful. Returning mothers may also notice that we now only provide complimentary pacifiers if there is a medical reason, as pacifiers in the first few weeks can negatively affect breastfeeding.

All of these changes have been scientifically proven to help increase breastfeeding success. Our goal is to help our new mothers and their babies have the best chance to reach their breastfeeding goals.

Q: What are the Baby-Friendly "Ten Steps to Successful Breastfeeding," and why are they important?

A: The Baby-Friendly Ten Steps are 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 10 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 birth hospitalization. Another benefit seen in medical studies is that when U.S. hospitals adhere to the 10 steps, it helps to reduce racial, ethnic and socio-cultural disparities in breastfeeding rates.

Read more about the benefits of breastfeeding from Baby-Friendly USA.

Q: How will the Baby-Friendly initiative at Mass General affect mothers who are unable or choose not to breastfeed?

A: Many Baby-Friendly initiative changes, like skin-to-skin bonding 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 cannot or chooses not to breastfeed, we will make sure she feels confident about safe formula feeding before leaving the hospital.

Q: Where can mothers find more breastfeeding information and support after discharge from the hospital?

A: Supporting new mothers once they leave the hospital is an important part of the Baby-Friendly initiative. At Mass General, we offer a drop-in mother’s group attended by a lactation consultant to help mothers have success with breastfeeding once they leave the hospital. In addition, for more complex medical lactation issues, we offer a lactation clinic to assist new mothers. Please speak with your health care provider for more information.

Parents will receive more information about community breastfeeding support before discharge from the hospital, Organizations like ZipMilk provide information about local breastfeeding resources.