New dad Sam Baker swaddles Hera after his wife, Mandeep Virk-Baker, breastfed their three-day-old baby girl in their hospital room at Shady Grove Adventist Hospital on Sept. 5. (Evelyn Hockstein/For The Washington Post)

At the growing number of hospitals in the United States that are certified as “baby-friendly,” the naked, often unbathed infant is put on the mother’s bare chest within the first hour of birth. Mothers are to nurse “on demand” whenever babies are hungry. No pacifiers are available. Formula may be provided, but only on request, and only after, in some instances, mothers sign a waiver acknowledging that using a bottle could impede breast-feeding. Lactation consultants roam the floor.

And healthy babies, if possible, are rarely, if ever, taken to the nursery. If a mom wants to send her newborn, staff members often have to ask why and then fill out paperwork explaining the reason.

The number of U.S. hospitals applying for the baby-friendly certification has gained momentum since 2010, when the U.S. Department of Health and Human Services incorporated the practices into federal goals. And the hospital measures are in keeping with the latest research about the significant health benefits of breast-feeding.

But for some mothers, this new push to breast-feed feels a lot like the old one of decades ago, when zealous “lactivists” were accused of trying to guilt other women into abandoning the bottle.

[10 things to do to be a “baby-friendly” hospital]

At least that’s the impression Lisa Stone got after delivering her daughter in December at Inova Alexandria Hospital. She had decided not to breast-feed because of frequent travel for her job with an education nonprofit group.

“Yet right after my daughter was born, they were ripping open my gown and trying to set the baby up to breast-feed. It was really uncomfortable,” the 30-year-old said.

So much so that Stone asked to be released a day early. “I certainly think if you want to have your baby next to you all night, and that makes you feel better, you should have that choice,” she said. “My problem was feeling like I was forced into that position.”

Emotional debate

So far, 197 U.S. hospitals, of more than 3,000, have been certified as baby-friendly, said Trish Macenroe, executive director of Baby-Friendly USA. In the Washington area, MedStar Georgetown University Hospital, Fort Belvoir Community Hospital and Shady Grove Adventist Hospital are accredited baby-friendly hospitals. An additional 700 hospitals nationally are implementing the standards — although not always smoothly.

In an emotional debate carried out recently on a parent e-mail discussion group in Alexandria, some mothers said they loved Inova’s emphasis on and help with breast-feeding, while others said they felt unduly pressured by staff members. Officials with Inova said they will discuss the complaints at upcoming staff meetings.

“The staff and physicians here have taken great pride at being advocates for mothers who want to breast-feed,” said Patricia Schmehl, vice president and administrator of Inova’s Women’s Hospital. “People are very passionate about this. Does it move from passionate to overzealous? It may have.”

The U.S. push toward encouraging breast-feeding at hospitals is an outgrowth of the global Baby-Friendly Hospital Initiative, launched in 1991 by the World Health Organization and UNICEF in response to research showing the health benefits of breast-feeding. Breast-fed babies have lower rates of diabetes, childhood leukemia, sudden infant death syndrome and other illnesses. The WHO maintains that breast-feeding will help cut child deaths from malnutrition, which is now responsible for nearly half of all deaths of children younger than 5.

New mom Mandeep Virk-Baker holds three-day-old Hera in their hospital room at Shady Grove Adventist Hospital on Sept. 5. (Evelyn Hockstein/For The Washington Post)

To become certified, a hospital must adopt 10 practices that research has shown to promote breast-feeding, including skin-to-skin contact between mother and infant within the first hour of life and rooming in — 23 out of 24 hours a day.

“It’s a myth that moms sleep better when the baby’s in the nursery,” said Macenroe, whose organization has been designated by WHO to certify U.S. hospitals. “Research shows that moms sleep better when babies are closer to them.” (Some moms involved in the debate beg to differ.)

The U.S. government’s goal is to have 80 percent of new moms breast-feeding initially, 60 percent of moms continuing to breast-feed at six months and 34 percent breast-feeding for a year — the recommendation of the American Academy of Pediatrics.

The guidelines also call for decreasing the share of newborns who receive formula within the first two days of life from 24 percent in 2006 to 14 percent in 2020.

In 2011, the Centers for Disease Control and Prevention reports, 79 percent of all moms began to breast-feed, but that 49 percent continued nursing at six months and only 27 percent after a year. The biggest disparities fall along socioeconomic lines, with higher-income mothers exclusively breast-feeding.

Macenroe said her work is slow going. “We’re trying to change a hospital culture that’s been in place for many, many decades,” Macenroe said. As late as 2011, the CDC reported that 78 percent of U.S. hospitals still gave non-breast milk to healthy, breast-feeding infants. Many still send new mothers home with goodie bags filled with bottles and formula.

Although the baby-friendly movement has been growing, in 2007, barely 2.9 percent of all U.S. births were in baby-friendly facilities, HHS reports. Its goal is 8.1 percent by 2020.

Execution is key

New mothers’ acceptance of the practices appears to depend on the hospitals’ execution — for example, how well new mothers are educated about the health benefits and how smoothly staff members are able to guide the women in attempting to breast-feed, without appearing to push.

Some mothers who were unhappy with the baby-friendly practices at Inova Alexandria said they felt blindsided. Some had given birth in the past few years and didn’t understand how or why hospital procedures were changing. Other hospitals making the transition to becoming baby-friendly have had similar missteps.

At Shady Grove, to avoid that misunderstanding, the hospital does intensive education and outreach not only with staff members but also with the community, so that everyone knows what to expect, said Carol Chornock, the lactation consultant and coordinator there.

The new procedures have boosted breast-feeding rates when mothers leave the hospital from 30 percent in 2010 to 90 percent today, the highest percentage in Maryland, Chornock said. Where possible, nurses no longer take the babies to the nursery to do testing, weighing, measuring and bathing. Instead, they do it all in the parents’ rooms.

Beth Groves, interim clinical nurse manager of the Mother Baby Unit, said that despite the focus on breast-feeding, staff members are taught to respect mothers’ choices. And many of the same practices that promote breast-feeding also promote bonding.

“Our aim is not to make anyone feel guilty,” Groves said. “There is no right or wrong in motherhood.”

Mandeep K. Virk-Baker, 33, said that without the baby-friendly procedures at Shady Grove, she’s convinced that she would never have been able to start breast-feeding. As a PhD nutrition scientist at the National Institutes of Health, she desperately wanted to adopt the practice.

“I had all the book knowledge in the world, but no practical knowledge, and at first, it was really frustrating,” said Virk-
Baker, who gave birth to her daughter, Hera, on Sept. 3. “We had to learn together.”

What helped was not only having the baby in the room, which she described as “very important,” but the hours of education she had at the hospital before the birth and the time that nurses spent with her one-on-one afterward, helping and encouraging her.

Although she wanted to have the baby placed skin-to-skin on her chest right after delivery, Virk-Baker said she was being sutured after a difficult 140-hour labor. So nurses gave the naked infant to her husband, Sam. Sitting near her, the man who never goes shirtless at the beach took his shirt off to snuggle with their newborn. His body heat, not a warming tray, kept Hera’s body temperature regulated.

“I just can’t see any other type of hospital where we would have had this beautiful an experience,” Sam Virk-Baker said.