Many Australian maternity hospitals are now accredited under the Baby-Friendly Health Initiative (BFHI), which encourages women to breastfeed after the birth of their baby.

While the BFHI is a joint initiative of UNICEF and the World Health Organisation (WHO) to promote the health of newborns, does it adequately support the health of mothers?

What is the BFHI?

The BFHI comprises ten steps that nurses and midwives follow, including ‘Do not provide breastfed newborns with any food or fluids other than breast milk, unless medically indicated,’ and, ‘Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.’

Angela Jade experienced post-natal depression, which she believes was a result of the intense pressure to breastfeed following an emergency c-section birth.

“I was pushed and expected to breastfeed. I wasn’t allowed to choose to use formula to be able to leave the hospital.”

Women depend on medical professionals to provide advice, said Ms Jade, but aren’t always in control of their bodies after they give birth.

“We depend on the experts to tell us what we need to do.

“For me, I felt like I had no other options, and I was alone and trapped in the hospital.

“My midwives were not going to let me go home until I had successfully breastfed my baby.

“I was beyond exhausted, in so much pain, and this continued for ten days.

“My health didn’t seem important to anyone.”

The decision to formula feed should have been an option, said Ms Jade.

“When I left the hospital, I felt ashamed and like a failure for not being able to continue feeding my baby through breast.”

Fortunately, Lexi Crouch didn’t have the same negative experience with formula feeding after the birth of her premature baby, which resulted in low milk supply.

“The midwives were amazing and supportive; using the phrase ‘fed is best.’

“It built my confidence to do what was best for my baby and my health.

“It’s what I remember most about my birth experience - the support of the midwives around formula feeding, where judgement was cast from others.”

Midwife Belinda Joyce said women should feel empowered to make an informed choice on how to feed and the BFHI is not always mother or family-friendly. 

“I’ve met many mothers who have tried hard to breastfeed their first baby and then suffered mental health problems and decided to start with formula with their second.

“I feel this is a good decision for them.

“Breastfeeding is not best for all mothers and babies for a variety of reasons.”

Breastfeeding alone should not be the goal, explained Ms Joyce, the emphasis should be on ensuring a healthy mother and baby.

“There is always formula available at a hospital that has a maternity unit. This is mainly used for medical reasons, and a paediatrician or doctor orders it.”

The formula should also be available to mothers who request it, said Ms Joyce, following an informative discussion on the impact on breastfeeding, such as a reduction in milk supply.

While breastfeeding should be encouraged due to a large body of evidence supporting its health benefits, it does not come naturally to many mothers and babies.

“In the early days and weeks, it requires learning and practice. Most mothers will have some challenges, and this is normal.

“Midwives, lactation consultants and child health nurses can support women with breastfeeding.”

When is breast not best?


• Previous breast surgery such as a reduction or augmentation
• Medical conditions for mother or baby
• Medication required for the mother is not safe for the baby
• Low milk supply
• Pain and damage to the nipples not improving with support
• Some women feel that their breasts are purely sexual and therefore feel uncomfortable with breastfeeding
• Attempts to breastfeed with a previous baby were unsuccessful and caused emotional problems


The BFHI is improving breastfeeding rates worldwide by implementing the ten steps which include: hospital policies that are supportive of breastfeeding as the norm, removing free formula samples, babies’ rooming-in’ with their mother and not using dummies and bottles.

“These are all supportive of breastfeeding but are they mother-friendly? It depends on how these ten steps are implemented as well as the culture of the staff.

“For a mother that has made the decision not to breastfeed, for whatever reason, these ‘rules’ can then make her feel judged and unsupported.

“I have cared for mothers who have confessed to me that they breastfed while in hospital and discharged more quickly so that they could start feeding their baby with formula.

“They did not feel safe doing this in the hospital due to judgment.

“This is not only unkind, but these mothers are then not educated on safe preparation and storage of infant formula, which is very important to their baby’s health.”
  
Feeding a baby is a personal decision, explained Ms Joyce, and it should be informed and free of judgement and pressure.

“Mothers already feel judged in so many areas of parenting. We need to empower women and families to set them up for success in this new parenting role.

“We want them to reach their full potential so that they can enjoy caring for their baby.

“By being respectful and empowering of mothers and families, they will come to us in future when they need it.

“Mother, baby and family-friendly are what we should be aspiring to. When mothers are well supported in their own informed parenting choices, they do so much better.”