“Breastfeeding is a vital component of realizing every child’s right to the highest attainable standard of health, while respecting every mother’s right to make an informed decision about how to feed her baby, based on complete, evidence-based information, free from commercial interests, and the necessary support to enable her to carry out her decision.” – World Health Organization, Baby-Friendly Hospital Initiative Philosophy

Maternity healthcare providers agree: breast really is best when it comes to providing the perfect food for newborn babies. Not only is breastmilk loaded with everything a baby needs, breastfeeding immediately after giving birth encourages close, skin-to-skin contact between mom and her baby, with powerful benefits for both.

The Baby-Friendly Hospital Initiative (BFHI) was created to encourage hospitals and healthcare providers to embrace this simple truth by empowering mothers to make informed decisions about feeding and childcare. Launched in 1991 as a partnership between the World Health Organization (WHO) and the United Nations Children Fund (UNICEF), the BFHI is represented in the United States by Baby Friendly USA. By 2018, more than 500 facilities in the U.S. had earned Baby Friendly designation, covering about one quarter of all births in the country. Baby-Friendly hospitals can be found in every state and the District of Columbia.[1]

Earning the Baby-Friendly designation is a milestone for any facility. At The Wellness Network, we recognize how complex and difficult it can be to fully implement Baby-Friendly guidelines, or as Baby-Friendly USA puts it, “The process will compel your leaders and staff to examine, challenge and modify long-standing policies and procedures, and in some cases, deeply held views. This is never easy.”[2]

Because of the sheer challenge involved in earning the Baby-Friendly designation, it’s only natural to worry about introducing anything into your maternity environment that might jeopardize your designation. Questions like, “Is it OK to have a poster on the wall showing a pacifier?” or, “Will offering educational videos on how to use formula cost us our designation?” take on extra significance when it could mean the difference between keeping Baby-Friendly designation and losing it.

These concerns have been magnified by “sensational headlines and scary messages” in the media concerning breastfeeding and the BFHI, according to Baby-Friendly USA CEO Trish MacEnroe, BS.[3] In the popular media, Baby-Friendly initiatives are sometimes blamed for newborns being denied formula even when it’s medically necessary, or moms feeling pressured by well-meaning lactation consultants to avoid formula and not really feeling like they had a choice in how they feed and care for their newborns.[4] Unfortunately, these misunderstandings can have real-world consequences, especially when it comes to making sure that new mothers are getting the education they need to make informed decisions.

Understanding What Baby-Friendly Is (And Isn’t)

Baby-Friendly is dedicated to resolving these misconceptions and continuing to change the way new mothers and healthcare providers view the precious minutes and hours after a baby is born. As Baby-Friendly’s MacEnroe notes, “For decades, maternity-care practices were built around a culture of formula-feeding as the norm, and breastfeeding was rarely encouraged.” [5] This meant that new moms were typically provided with free formula shortly after giving birth and often told it was a superior alternative to breastmilk, even as their newborn babies were wheeled away to a remote nursery and deprived of direct skin-to-skin contact. Practically speaking, formula marketing had managed to work its way into one of the most sacred spaces in a family’s life: the labor and delivery ward.

Baby-Friendly is intent on changing that—but not at the cost of newborn health. According to MacEnroe, Baby-Friendly Guidelines and Evaluation Criteria (GEC) “support individualized care and appropriate clinical decision-making, not inflexibility or rigid adherence at all costs. While the BFHI envisions exclusive breastfeeding as the norm, it is a misunderstanding to say that it does not allow formula supplementation or that it discourages it when medical indications are present. Safe breastfeeding management includes knowing and understanding conditions that require supplementation.” [6]

In fact, BFHI is intentionally designed to be a flexible approach to breastfeeding management that empowers new moms to make their own evidence-based decisions about what’s best for their babies, while also giving clinicians freedom to make medically necessary decisions for the newborns in their care.

The Ten Steps to Successful Breastfeeding

Here at The Wellness Network, all of our patient education undergoes a careful medical review to ensure that our videos are compliant with Baby-Friendly guidelines. Our criteria for offering education—both internally created and videos offered from partners, including the Office of Women’s Health—is based on the Ten Steps for Successful Breastfeeding, which forms the core of the Baby-Friendly program. Below we’ve listed the steps, with recommendations for educational videos that support each step:

  • Step One: Hospitals should not promote infant formula, bottles, or teats. Facilities should have a written breastfeeding policy. Videos we offer to support this step include:
    • Breastfeeding: Overcoming the Challenges of Breastfeeding
  • Step Two: Staff should be trained to support breastfeeding.
    • Secrets to Breastfeeding Success
    • Helpful Strategies for Successful Breastfeeding
  • Step Three: New moms should be educated on the importance of breastfeeding and prepared to be successful. Videos we offer to support successful breastfeeding include:
    • Breastfeeding: Breast Milk Production and Benefits
    • Breastfeeding Your Newborn
    • Helpful Strategies for Successful Breastfeeding
    • Uncovering Breastfeeding Misconceptions
  • Step Four: Skin-to-skin contact is encouraged, and new mothers are encouraged to put their baby to the breast as soon as possible after birth, preferable within the first half-hour after delivery. Videos we offer to support skin-to-skin contact include:
    • Newborn Care: The Benefits of Skin to Skin Contact
  • Step Five: New mothers should receive practical support to initiate and maintain breastfeeding, including coaching on how to express breast milk. Videos we offer to support hand expression and practical steps to breastfeeding include:
    • Hand Expression in Breastfeeding
    • Common Breastfeeding Positions
    • Building a Breastfeeding Support Network
  • Step Six: Mothers should be discouraged from providing food or fluids other than breast milk, unless it’s medically indicated.
    • Breastfeeding: Breast Milk Production and Benefits
    • Breastfeeding Your Newborn
  • Step Seven: Rooming-in with newborns is encouraged, so mothers and their babies can spend time together throughout the day and night. This may not apply, however, in circumstances where infants require specialized medical care. Videos we offer to support rooming in include:
    • Rooming In With Your Baby
  • Step Eight: Mothers are encouraged to practice responsive feeding and coached on how to recognize cues for feeding, closeness, and comfort.
    • Breastfeeding Your Newborn
  • Step Nine: Education should be provided on feeding bottles, teats and pacifiers. Unless medically indicated, artificial teats or pacifiers should not be given to breastfed infants. If expressed breast milk or another food is medically indicated, it should be provided with cups, spoons, or feeding bottles or teats. Videos we offer to support medically indicated bottle feeding include:
    •  Newborn Care: Formula and Bottle Feeding
  • Step Ten: Breastfeeding support for mothers is encouraged after discharge, including referrals to breastfeeding support groups.[7] Videos we offer to help support mothers after discharge include:
    • Handling Stress Over Breastfeeding
    • Breastfeeding and Back to Work
    • Breastfeeding in Public for New Moms

Helpful References

If you have additional questions about how our patient education supports the Baby-Friendly Hospital Initiative, or about core elements of the initiative itself, the following resources can be helpful:

  1. Write or call The Wellness Network. We will be happy to provide a demonstration of our maternity patient education and provide guidance on how we support BFHI.
  2. Visit Baby-Friendly USA. This is the U.S.-based organization supporting the global BFHI. Baby-Friendly USA provides BFHI designation to domestic hospitals.
  3. Access Implementation Guidance for the Baby-Friendly Hospital Initiative. This document provides updated implementation guidance on BFHI.
  4. Access the International Code of Marketing of Breast-Milk Substitutes. This document provides detail on the first BFHI principal ensuring that mothers can make decisions without commercial pressure.


[1] Baby-Friendly USA. The Baby-Friendly Hospital Initiative.

[2] Baby-Friendly USA. Why Seek Designation?

[3] Clinical Lactation. Debunking the Misunderstandings of the Baby-Friendly Hospital Initiative and Designation Requirements. Clinical Lactation, 2018, 9(4), http://dx.doi.org/10.1891/2158-0782.9.4.208.

[4] The Atlantic. Breastfeeding at Any Cost?

[5] Clinical Lactation. Debunking the Misunderstandings of the Baby-Friendly Hospital Initiative and Designation Requirements. Clinical Lactation, 2018, 9(4), http://dx.doi.org/10.1891/2158-0782.9.4.208.

[6] Clinical Lactation. Debunking the Misunderstandings of the Baby-Friendly Hospital Initiative and Designation Requirements. Clinical Lactation, 2018, 9(4), http://dx.doi.org/10.1891/2158-0782.9.4.208.

[7] Baby-Friendly Hospital Initiative. Implementation Guidance.