In this episode of The IBCLC Mentor Podcast, Margaret Salty interviews Eileen Fitzpatrick, CEO of Baby-Friendly USA, about the Baby-Friendly Hospital Initiative (BFHI), its implementation in the U.S., and how political changes are impacting breastfeeding outcomes. They discuss the history of Baby-Friendly, the challenges hospitals face in meeting the designation requirements, and what IBCLCs need to know to support Baby-Friendly practices.

Eileen explains the structure and mission of Baby-Friendly USA, including:

• The difference between Baby-Friendly USA and the global Baby-Friendly Hospital Initiative (BFHI)
• How Baby-Friendly USA is an independent nonprofit that follows WHO/UNICEF guidelines
• The role of Baby-Friendly USA as the accrediting body for hospitals in the U.S.

Eileen highlights how Baby-Friendly programs are structured differently around the world:

• Some countries integrate BFHI into their government health systems
• Other countries operate BFHI under their national UNICEF programs
• The U.S. runs Baby-Friendly USA as an independent organization due to government refusal to adopt the program

Margaret and Eileen discuss the history of the International Code of Marketing of Breastmilk Substitutes and its rejection by the U.S. government:

• The code came before the BFHI and was designed to curb formula industry marketing
• The U.S. never signed onto the code due to commercial interests in infant formula
• Baby-Friendly USA remains the only U.S. organization requiring compliance with the code

Eileen shares key statistics on Baby-Friendly hospitals:

• Approximately 530 Baby-Friendly designated hospitals
• Baby-Friendly facilities account for 25% of all U.S. births
• The impact of maternity care deserts and hospital closures on Baby-Friendly participation

Eileen explains the 4D Pathway, the structured process hospitals follow to earn Baby-Friendly designation:

• Development: Hospitals create policies and train staff
• Dissemination: Implementation of Baby-Friendly practices begins
• Designation: Hospitals undergo an official assessment
• Designation Maintenance: Hospitals submit ongoing quality data and undergo reevaluations

Baby-Friendly hospitals must collect and submit annual data, including:

• Race and Ethnicity Metrics – Ensuring equitable breastfeeding support across all patient populations
• Breastfeeding Initiation Rates – Tracking progress in early lactation support
• Exclusive Breastfeeding Rates – Though not a required benchmark, data helps track trends
• Patient Experience Surveys – New tools to assess how Baby-Friendly practices are perceived

Challenges in data collection include:

• Hospitals struggling to access race and ethnicity data from electronic medical records
• The discontinuation of perinatal core measures by CMS and The Joint Commission, making Baby-Friendly one of the only organizations still tracking exclusivity rates

Hospitals must uphold the 10 Steps to Successful Breastfeeding, which include:

• Having a written infant feeding policy
• Training all healthcare staff in lactation support
• Immediate and uninterrupted skin-to-skin contact after birth
• Rooming-in for 23 out of 24 hours
• Avoiding supplementation unless medically necessary
• Providing families with postpartum lactation support resources

A common misconception is that Baby-Friendly hospitals force breastfeeding. Eileen clarifies:

• Parents always have the right to choose their feeding method
• Hospitals must document informed decision-making, but no parent is required to breastfeed
• The goal is patient-centered care, not rigid enforcement of breastfeeding policies

One of the key Baby-Friendly requirements is that hospitals must:

• Pay at least a fair market price for formula instead of receiving it for free
• Avoid formula company-sponsored training, free samples, or promotional materials
• Store formula and bottles out of public view to remove marketing influence

Eileen explains how formula companies try to undermine Baby-Friendly compliance, including offering early-pay discounts that can lower the cost below the required fair market price.

Significant changes have been made to the staff education requirement:

• The 20-hour lactation training requirement has been removed
• Instead, hospitals must demonstrate staff competency in breastfeeding support
• Hospitals can use their own training systems rather than purchasing external courses
• Baby-Friendly USA provides optional quizzes and templates for hospitals to use

Margaret and Eileen discuss how U.S. political changes could impact Baby-Friendly and breastfeeding promotion, including:

• The withdrawal of the U.S. from the World Health Organization and its impact on global breastfeeding efforts
• The defunding of CDC breastfeeding programs, which could affect data collection and hospital support
• Cuts to Medicaid, which disproportionately impact low-income families in Baby-Friendly hospitals

Eileen shares how IBCLCs can advocate for Baby-Friendly practices, even if they don’t work in a Baby-Friendly facility:

• Join local and state breastfeeding coalitions to push for better policies
• Encourage parents to provide feedback to hospitals through patient surveys
• Educate families prenatally about Baby-Friendly practices and their right to request lactation support
• Report complaints about Baby-Friendly hospitals through Baby-Friendly USA’s official process

Eileen Fitzpatrick is the CEO of Baby-Friendly USA and a public health expert with a background in maternal-infant health. She has worked on statewide breastfeeding initiatives in New York and now leads the accreditation process for Baby-Friendly hospitals in the U.S.

🔗 Find Baby-Friendly USA Online:

🌐 Website: www.babyfriendlyusa.org

📧 General Inquiries: [email protected]

📌 Baby-Friendly Hospital Initiative – Learn more about the 10 Steps: www.babyfriendlyusa.org

📌 March of Dimes Maternity Care Deserts Report – Tracking OB unit closures across the U.S.

📌 CDC Breastfeeding Data – Understanding breastfeeding rates and disparities

Have questions or suggestions for future episodes? Reach out to Margaret at [email protected] or connect on social media:

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty’s IBCLC Community

🎙 Hosted by: Margaret Salty

🎧 Guest: Eileen Fitzpatrick, CEO of Baby-Friendly USA

🎵 Music by: The Magnifiers, My Time Traveling Machine

#IBCLC #BabyFriendly #BreastfeedingSupport #BreastfeedingMedicine #LactationConsultant #BFHI #BreastfeedingEquity #IBCLCMentorPodcast #MargaretSalty

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