Take away pacifiers in a hospital… and breastfeeding rates drop?

by Tara Haelle 

We all have those things we said we’d never do when we had a baby which, once we actually had a baby, kinda went out the window. For me, one of those was pacifier use. Now, the more I learn about pacifiers, including what a recent study in Pediatrics shows, the more I support their use during a baby’s first year.

Before having my baby, I shared my mother’s belief that pacifiers were a lazy soothing method that may introduce bad habits. I didn’t have any actual data on my belief, and I’m not even sure what the “bad habits” were I had in mind – like many of these beliefs, it was just stuff I’d heard or read somewhere. I also worried that a pacifier could cause nipple confusion for my son, who I planned to exclusively breastfeed. I even returned the pacifiers I had been given at baby showers.

Then I actually had my son. I did exclusively breastfeed, but it was very difficult and painful. My milk took a while to come in, and my boy was a hungry, demanding little kiddo, like most are. He was also a lousy sleeper. (Neither those characteristics has changed so far!)

In any case, the nurse offered a pacifier. First, I demurred. Later, a second time, I demurred. Then, finally, I asked them for a pacifier. I gave in (and my mom supported my giving in). He was simply crying too much and not sleeping enough (even as a newborn in the hospital); my breasts couldn’t satisfy him, my pain tolerance was nearly gone, and I absolutely refused to feed him formula.

Happily, the pacifier worked, he experienced no nipple confusion at all, and I soon found Soothies to be one of the greatest inventions on earth. I was also thrilled to learn later that pacifiers are actually linked to lower rates of SIDS, though the mechanism isn’t clear. Looking back, I wonder if I had been less anti-formula, and the hospital had not offered a pacifier, if I, or someone else like me, would have simply given him formula during those times I was at my wit’s end and couldn’t satisfy him on my own.

And that is precisely my anecdotal, unscientific explanation for the findings of a recent study that looked at breastfeeding rates before and after a pacifier restriction policy was put in place at a hospital in Portland. Although this hospital and Oregon in general have very high rates of breastfeeding – 91.2 percent are ever breastfed compared to the nationwide average of 74.6 percent – the hospital instituted a new policy that corresponds to one of the ten steps to becoming a Baby Friendly hospital. Baby Friendly hospitals receive this designation for their pro-breastfeeding practices and policies.

In December 2010, the hospital stopped routinely distributing pacifiers. They were not restricted completely – parents could bring them from home – but they were not passed out by hospital staff. At the same time, formula was discouraged, but it was not restricted. Parents asking for formula were given it even if it was not deemed a medical necessity.

In the five months before the pacifier restriction was introduced, from July through November, the exclusive breastfeeding rate was 79 percent (out of 812 babies). After the new policy’s implementation, the rate dropped to 68 percent (out of 1,278 babies).

Likewise, the exclusive formula feeding rate increased, from 1.8 percent to 3.4 percent, and the breastfeeding plus supplemental formula feeding rates increased from 18 percent to 28 percent.

The researchers were baffled by this result. The babies’ and mothers’ demographics were similar before and after the intervention, and the researchers could not determine what might explain the change in breastfeeding rates after the policy.

To which I ask: Are any of the researchers mothers? Again, my explanation is only an untested hypothesis. A randomized controlled trial would need to be done to determine if there is even a cause-and-effect relationship here at all, much less what the nature of it might be.

However, speaking from my own experience, if I’m exhausted, and breastfeeding is difficult and painful (as it was for me), and my child appears satiated in terms of hunger but simply is not sleeping or is constantly crying, I want to do something. I would rather that “something” be a pacifier than formula for my own personal reasons, but if I or another mom didn’t have that bias against formula and no pacifier was in sight, I’d probably stick a bottle of formula in the baby’s mouth to calm him down.

I’m surprised the authors did not consider this possibility in their discussion of the findings, and it leads me to wonder about what the evidence says about individual components of the ten-step Baby Friendly initiative.

One last thing – I am not saying that mothers *should* or *should not* use a pacifier in the first few weeks of a baby’s life. I’m saying I have a theory about why taking away pacifiers might have affected exclusive breastfeeding rates in this hospital (if cause-and-effect is at play here). There is, however, evidence for nipple confusion, though it’s not evidence I have evaluated. If the evidence relating to nipple confusion is valid, there is the possibility that using pacifiers early on can cause difficulties if moms are planning to exclusively breastfeed. I prefer La Leche League’s stance: it’s a personal decision of the parents.

This post originally appeared at Red Wine & Apple Sauce. Photo by “yenhoon.”