Booby Traps Series: Only half of hospitals help moms initiate breastfeeding in the first hour

This post is the 17th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

For the last few months I’ve been writing about the Booby Traps in pregnancy and birth.

But now it’s time to move on to the newborn period.  And I’m afraid that, while progress is being made, there are still Booby Traps around every corner.

Let’s start with our babies’ very first feeding.  Research from as far back as the 1970’s has shown that timing of the initiation of breastfeeding is important.  Initiating breastfeeding in the first hour is strongly correlated with breastfeeding both in the early days and even at 2 and 3 months.  It’s such a special time that some have dubbed it The Magical Hour.

The evidence is strong enough that initiation of breastfeeding in the first hour* was made one of the Ten Steps to Successful Breastfeeding.  The Ten Steps, created by UNICEF and the World Health Organization, form the foundation of the Baby Friendly Hospital Initiative.

With all this evidence you’d think that all hospitals would make this their standard practice, right?

Unfortunately that isn’t yet the case.  In CDC surveys filled out by hospitals for 2009, only 51% reported that “≥90% of healthy full-term breastfed infants initiate breastfeeding within one hour of uncomplicated vaginal birth.”  This is up from 44% in 2007, but the current percentage – only half – shows that we have a long, long way to go.

The worst rates were in the Southeast and Southwest regions of the country, with rates of 39% and 43%, respectively.  The West had the best rate, at 59%.

Wondering what the Ten Steps say about the timing of initiation of breastfeeding after a cesarean birth?  To comply with this step in the case of a cesarean birth, babies are to be placed skin-to-skin, in their mothers’ arms, within a half an hour of their mothers’ ability to respond to them.  The rate of compliance with this practice is not measured by the CDC surveys.

Was your hospital one of the half that does routinely help moms initiate breastfeeding in the first hour, or one of the other half?

* The Baby Friendly Hospital Initiative criterion is that breastfeeding should be initiated in the first half hour.  In the U.S., the criterion is initiation within the first hour.

10 thoughts on “Booby Traps Series: Only half of hospitals help moms initiate breastfeeding in the first hour

  1. My friend just delivered her baby girl 4 weeks early. I had my first 4 weeks early and understand the need to make sure that baby is breathing well before anything else. Once my friend’s baby was given a clean bill of health, she was allowed to nurse, however, the nurses REFUSED to call the IBCLC.

    For her entire 48 hour stay, the nurses insisted that LC’s just have extra letters after their names that mean nothing and that they can help just as well. This poor mama had formula fed her first because of lack of support and has been determined to nurse this little one.

    It is crucial for a first time breastfeeding mom to get professional help to get started! Her little one wasn’t latching well and wasn’t transferring well and was extra sleepy due to jaundice. It took a call to a hospital supervisor to get the nurses to call the IBCLC who ran over and was fantastic.

    No mom should have to fight that hard just to get the help she needs.


  2. The lactation consultant at Fort Carson hospital was on leave the day my daughter was born and did not return to work until the following Tuesday. Also she only worked M-F 8 – 5 so I guess if your baby was born at other times you were screwed! We did not succeed at BF even after hiring our own consultant – we tried but I wonder if we had help that first day much less that first hour we might have done better.


  3. With my first birth, they placed my daughter immediately in my arms and to the breast. She latched on right away and I did not have any trouble getting her to latch during my hospital stay. I continued to nurse her exclusively until 14 months.
    With my second birth, although natural without any complications like my first, the staff took her and insisted on bathing her and completing her paperwork (I believe it was a shift change). While I was able to hold her and nurse her for a minute, they quickly asked that I “feed her after they were done with her”. Hindsight, I should have advocated for myself and for her! She ended up going into shock from what was suspected to be low blood sugar.
    I feel as though I relied on the staff assisting me and took their suggestions. PLEASE be a better advocate and take the time to BF and bond. Although I am continuing to BF her, we have had many more complications that I did with my first daughter and, although I know every child is different, I would be remiss to say that maybe the magical hour that was taken from us might have something to do with it.


  4. I planned a homebirth, but a persistent complete placenta previa meant a scheduled cesarean birth. I was terrified of a number of complications, not the least of which was interference with successful breastfeeding immediately and long term.

    Fortunately, I advocated like mad for myself. Worked with my midwife to find a supportive physician and worked up a nice birth plan.

    It certainly could have gone better/there is always room for improvement, but I was insisting on big changes at that hospital so had to take baby steps. So, although I would have loved to have scrubbed up myself and been guided to catch my own baby, I figured skin to skin immediately was a more “valid but still pushing the envelope for them” goal. What I was able to get was staff checking her out at the warmer for 1 minute while my husband supervised. He made sure they kept her as wonderfully wet as possible and didn’t swaddle her up. After her 1 minute apgar (8! Yay!), he carried her over to me just supported in a big blanket and put her skin to skin with me. We had prepared by having the CRNA place monitor leads off my chest, and my circulating nurse came over while he was with our daughter to uncover me and make sure all was set for her to be on me.

    She was placed directly on my chest and we were left to bask in the joy of being a family while they closed. We explored her, but mostly just let her be and she breastcrawled over to my right breast and latched on all by herself. All within the the first 10-15 minutes!

    We wouldn’t let her go anywhere and kept her naked skin to skin with me for the first 2-3 hours. After that, we kept her diapered only and skin to skin with either myself or my husband. (And swaddled a few times with a couple close family visitors).

    Fortunately, after a 2 week learning period, breastfeeding has been pretty much perfect for us. She is four months old and wonderfully huuuuge! I owe a big part of our success to those first precious minutes and hours where we were left relatively undisturbed. I truly think it made all the difference in the world!


  5. I work as a hospital LC and one thing to consider is the readiness of the baby or challenges in maternal anatomy. My hospital is very supportive of the first feeding – even in bringing stable babies to the recovery room for a first feed. But I have been called to a room post-delivery where a baby has so much head molding, with what seems clearly to be head discomfort. Some of those babies cannot always accomplish that first feed in the first hour. Even when not separated, feeds do not always happen. This does not always mean complications ahead, although it may be a few hours before baby is willing to try again and parents get anxious that it is not happening.

    Life in the “trenches” of the first 1-3 days of breastfeeding finds us trying to assist babies who have clearly not read the book or the policy or about what is “normal” in breastfeeding.


    1. If baby is unable to breastfeed immediately after birth, baby should still be put on mom’s abdomen or between her breasts and allowed to be together. Laid back nursing (Biological Nurturing) would allow this baby to attach without mom touching his head.
      Thanks for sharing.


  6. The hospital I delivered my one and only at had a policy called “Parents First”, where grandparents and other family were strictly not allowed. It was for parents and new baby to bond for that first hour with skin to skin and nursing. I stalled in labor and ended up with an unplanned c-section. Even with that complicating things, my son was never out of my husbands sight, and my doc got me put back together and stapled up in under 20 minutes. I was in a recovery room and had him to breast when he was about 25-30 minutes old. The hospital encouraged rooming in, and respected our no pacifier, no formula wishes. It was never suggested, and I saw 2 different LCs while there (any time I asked to see one, and they checked on me periodically).

    For what it’s worth, we’re still nursing once a day and he turns 3 in another week.


  7. I had my daughter in a birthing tub in my living room with the help of my husband and midwife. She latched on soon after birth and we didn’t really have any problems with breastfeeding. She’s 3.5 months now. From everything I read that initial time after birth is very important for mom and baby. I realize some circumstances may not allow that for some but I’m glad I was able to have that with mine. 😉


  8. I have to admit that I was very nervous about breastfeeding since I am a first time mother. I didn’t even know how to begin or what to do. I wanted to be successful so I was hoping that after delivery everything would fall into place. I feel so blessed to have delivered at Community Medical Center in Missoula, MT where they took my concerns about wanting to make sure my daughter and I knew what we were doing seriously. Not only did one of long time girlfriends who works in labor & delivery get to step in and help get me situated and instructed on breastfeeding within the hour of delivery (what a special time for me to have a trusted friend ease my fears and spend those first special minutes with my husband, daughter and I) but ALL the nurses stepped in during my recovery with encouragement and hands on help to make sure I was successful. I believe that their support for my decision to breastfeed was instrumental. I have been exclusively breastfeeding for 7 months and my daughter and I love our bonding time and I know she is getting all the great nutrition that she needs.


  9. When I had my oldest son he was delivered by c-section so I didn’t get skin-to-skin immediately after birth. From there he went to the nursery and was kept there for TWO HOURS because he has a slightly lower than average temperature. He was almost 3 hours old when I held him for the first time let alone nursing. When I finally could try to breastfeed the nurses pushed formula saying ” he’ll sleep longer” so I decided to try one bottle just for that night and he developed nipple preference and refused to nurse. Within his first week at home I gave up on nursing and pumped. Three months old and he was on formula because I was in pain and overwhelmed. There was support I could have reached out for but I just never did.
    My second son, also born c-section at the same hospital, was in my arms while I recovered. We got hours of skin-to-skin! (I had told the staff before he was born that I was NOT going to be ok with a repeat of my last birth so they helped make it happen)
    I was forced to try and give him some formula because of low blood sugar, but he hated it and refused to take more than 1/2 oz. his sugar came up and I was free to nurse! I had a better idea of what to expect this time and was determined not to give up. I made use of nurses for any questions I had and they were happy to help because I told them my oldest sons story and how I wanted a different breastfeeding outcome this time.

    To overcome the pitfalls and issues that come up you have to let hospital staff know ASAP and repeatedly what YOU want for your baby.
    Have the baby stay in your room instead of the nursery. And most importantly keep your head up! It can be hard, leaky and painful (it was brutal for me for the first few days) but it gets easier!
    Don’t ever be embarrassed to ask for help.


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