What’s the big deal with the Baby Friendly Hospital Initiative program?

The Baby Friendly Hospital Initiative is a program that was developed by the World Health Organization and UNICEF in the late 1990s to encourage breastfeeding globally, beginning with labor and delivery. BFHI, as it is called, consists of 10 steps that communities can do to improve their rates of breastfeeding and has shown statistical success in many parts of the world were breastfeeding rates were low. Many of these steps begin in the hospital or birthing center. One of them has become very controversial — rooming in.

Rooming in means that mother and baby are together from delivery through discharge unless the health of one or the other dictates otherwise. When done well, rooming in allows mother and child to bond, to experience ample skin-to-skin time, and to nurse on demand. Nurses are trained to care for both the mother, as she recovers from birth, and the newborn, as he or she transitions to life outside the womb. In addition, breastfeeding support is readily available throughout the hospital stay.

In my own experience, rooming in was great. After each “easy” delivery, I was able to have my baby close and to nurse on demand. I had family present to help bring baby back and forth to my bed for feedings and to change diapers more quickly than my sore body would allow. The controversy arises when rooming in is the only option, meaning the traditional nursery is eliminated. In those hospitals, the baby remains with mom only. One cannot request a break to sleep, or shower, for that matter, without the baby in the room. For women, including a fair number of doctors, this is upsetting.

Personally, I enjoyed having the nursery as an option. I remember the amazing nurse I had the second night after delivery. She worked with me on and off helping my son nurse, giving me tips and gentle suggestions. Sometime after 2 a.m., she peeked into the room. I was awake, as was my baby, and she knew I had not rested yet. “Let me take him,” she said, “and when you hear the door open again, know that it’s just me bringing you back a sleeping baby … no need to open your eyes.” The next two hours were the best sleep I’d had in days, and I was grateful.

The Boston Globe recently ran an article where the author stated that BFHI is not ideal for many families. In an article for TIME, Dr. Amy Tuteur outlines what she sees as specific complaints against the BFHI including possible safety concerns with mothers who have undergone traumatic vaginal or surgical deliveries caring for newborns without adequate support. Some of the hospitals converting to rooming in are being accused of eliminating nurseries due to cost and not what is best for families.

The Baby Friendly Hospital Initiative is clearly intended to improve, not hinder, the health and well being of mothers and babies, but has a lot of people arguing about what is truly best for families.

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About Dr. Sara Connolly, Board Certified Pediatrician

Sara Connolly, MD, FAAP, is a Board Certified Pediatrician who practices in Palm Beach County, Florida. She has a passion for child advocacy and has worked on the local, state, and national level to increase access to care for children. Her interests include nutrition, breastfeeding, and parenting skills.


  1. The cost motive is interesting… And I hadn’t thought about moms with traumatic deliveries. I went with my daughter to the nursery for some testing (I didn’t want her to leave my sight and did not have a traumatic delivery, thank goodness) and was shocked at the number of babies in the nursery overnight. I was also shocked to see that several moms on the floor didn’t see their babies much at all and used to opportunity to get rest. I wondered if this was the norm.

    1. There are many variables to consider. Babies up for adoption also typically room in the nursery until they are ready to go home with adoptive parents as well (unless the adoptive parents are able to room in…a possibility in some hospitals).


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