Baby steps: Baby-Friendly practices promote breast-feeding success

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http://news.nurse.com/article/20111024/NATIONAL01/110240038

Baby steps: Baby-Friendly practices promote breast-feeding success

When Pigford was pregnant with her son , she knew she wanted to give breast-feeding a go. “I really wanted to try breast-feeding because I had heard it was better for them,†Pigford said. “And hearing how much formula costs and how much it would be for a year of it, that was a big expense that I would rather not have paid if I didn’t need to.â€Pigford, who lives in Surf City, N.C., was able to breast-feed for 15 months. But it was difficult at first because had trouble latching on completely, she said. Then when he was about a month old, she developed cellulitis in her breast and was hospitalized and treated with vancomycin. “I figured if I made it through that, there was no reason to stop,†she said.While the American Academy of Pediatrics recommends infants be breast-fed exclusively until they are 6 months old, not all new mothers have the same success breast-feeding as Pigford.The CDC’s Breastfeeding Report Card 2011, reports 75% of U.S. infants have “ever been†breast-fed but those rates vary from state to state. Oregon leads the pack at 91%, and Louisiana brings up the rear at 49%. The rate of U.S. infants who are breast-fed exclusively at 6 months is just 15%. Many new mothers at Holy Cross Hospital in Chicago never initiated breast-feeding, said Carvalho, FACHE, vice president of strategic planning and business development. Holy Cross began tracking its breast-feeding rates after a Chicago Public Radio story reported the hospital had a breast-feeding initiation rate of 10%. After gathering its own data, the hospital found rates to be higher at about 30%, but staff knew they could do more to promote breast-feeding.“Once we knew the data, it allowed us to streamline the education process and opened up windows of opportunity for us,†said Anita -Karriem, RN, MHA, director of the family birthing center. One of these opportunities was for Holy Cross to become the first Chicago-area hospital to pursue Baby-Friendly designation.International accoladesOverseen by the nonprofit organization Baby-Friendly USA Inc., the national arm of the World Health Organization and UNICEF’s global Baby-Friendly Hospital Initiative, the Baby-Friendly designation recognizes facilities implementing evidence-based care that supports optimal infant feeding and mother-baby bonding, said Baby-Friendly USA’s Executive Director Trish MacEnroe.“The designation gives them bragging rights to say, ‘We’ve been reviewed externally by an objective group that came in and looked at our practices and confirmed that we are implementing properly the 10 steps and we are providing state-of-the-art care for mothers and babies,’†MacEnroe said.The steps MacEnroe referred to are the “Ten Steps to Successful Breastfeeding for Hospitals†as outlined by WHO and UNICEF. They are core components of the BFHI and include practices such as rooming in, breast-feeding on demand, and forgoing the use of artificial nipples, including pacifiers, for breast-feeding infants.“Each of the steps has specific guidelines for implementation and a specific set of evaluation criteria that we [baby-Friendly USA] use to determine if a hospital has implemented the step appropriately,†MacEnroe said.Now in 4-DThere are 119 Baby-Friendly facilities in the U.S. The process begins with the discovery phase of the “4-D Pathway,†in which the hospital registers with Baby-Friendly USA and learns what it means to become Baby-Friendly. “During the discovery phase, we encourage people to learn as much as they can about the 10 steps of successful breast-feeding and the international code of marketing of breast-milk substitutes,†MacEnroe said. She also suggested drumming up facility support for the BFHI journey at this time and completing BFHI’s self-appraisal tool. “The purpose of that is for them to establish for themselves what they’re doing well and what they need to improve on,†MacEnroe said.Each subsequent phase costs about $2,000 for 500-bed plus hospitals, and $1,200 for those with fewer than 500 beds. After paying the development phase application fee, the hospital receives a package of tools, including planning documents with model action plans for each of the 10 steps. Facilities also receive a feeding policy check-off tool, templates for staff-training and prenatal and postpartum teaching plans, and a data collection plan.After the plans are created, they are submitted to Baby-Friendly USA for review and feedback. The plans are rolled out during the dissemination phase and assessed by hospital staff using auditing tools from Baby-Friendly USA. “They use the audit tools in conjunction with their data collection plans to evaluate that they are achieving what they’re hoping to achieve,†MacEnroe said.Finally, the hospital moves into the designation phase, during which a team from Baby-Friendly USA does an on-site assessment to verify the steps have been fully implemented.Growth and developmentBreast-feeding has many benefits, including preventing infection and promoting optimal infant growth and nutrition said Stellwagen, MD, FAAP, medical director of the newborn service at University of California-San Diego Medical Center.Stellwagen points to the PROBIT trial, a 1996 study of 17,046 mother-infant pairs in the Republic of Belarus that examined the outcome of implementation of the Ten Steps to Successful Breastfeeding, as an example of what Baby-Friendly practices can do for breast-feeding rates. According to the trial results, infants born at sites where the steps were used were more likely than infants born at non-Baby-Friendly sites to be breast-fed exclusively at 3 months (43.3% vs. 6.4%) and 6 months (7.9% vs. 0.6%). UC-San Diego also reports high rates of breast-feeding, with 94% of mothers on the well-baby unit breast-feeding upon discharge, Stellwagen said. Terry Lawson, RN, IBCLC, NICU lactation consultant, has been at UC-San Diego since 1979 and has seen breast-feeding promotion practices evolve over the years. “When I started here as a nurse, we just knew that we needed more help with breast-feeding,†she said.Lawson recalled a time when breast-feeding for five minutes on each side and having a central nursery for well babies was the norm. But the unit began practices such as rooming in, couplet care and phasing out a centralized well-baby nursery. Now mothers have constant access to their babies and to breast-feeding support, which is achieved by providing lactation training to all their RNs as part of their annual competency hours. Even though UC-San Diego had incorporated practices aligned with the BFHI’s 10 steps for years, achieving Baby-Friendly designation was no cakewalk. “Education was the hardest piece to do,†said Stellwagen, who had to educate a staff of about 600 people to earn Baby-Friendly status. The education component also presented a challenge for the staff at Holy Cross. “We were already doing the majority of the steps to successful breast-feeding,†-Karriem said. “However, there is a component we struggled with, and that was the financial component to be able to educate all of our nurses at the bedside to be lactation counselors.â€Holy Cross is a safety-net hospital serving Chicago’s Marquette Park neighborhood, an area with its share of socioeconomic challenges. About one-third of Holy Cross’s patients are uninsured, one-third receive Medicare and one-third receive Medicaid, Carvalho said. So funding for staff training can be hard to come by. But with the help of the nonprofit HealthConnect One and the Chicago Department of Public Health, -Karriem will be able to provide education for all her primary care bedside nurses beginning this month. She also has incorporated breast-feeding education in the unit’s new hire orientation with the goal of giving all RNs the skills to support breast-feeding mothers. Holy Cross is in the development phase of Baby-Friendly designation, has started reviewing its breast-feeding policies and setting goals and desired outcomes. “We know that breast-feeding is the best method to feed your baby,†-Karriem said, “and we want to service our community the best way we can.â€In 2009, 70 hospitals were going through the designation process. Presently, there are about 300 hospitals that have indicated their intent to become Baby-Friendly. “I really believe they are answering the nation’s call … to make changes to maternity care practices,†MacEnroe said.On Oct. 13, the CDC announced it awarded almost $6 million over three years to the National Initiative for Children’s Healthcare Quality to help U.S. hospitals encourage mothers to breast-feed their babies. The project’s goal is to increase the number of Baby-Friendly hospitals nationwide, according to a news release.But whether a facility chooses to go down the Baby-Friendly path or not, MacEnroe says breast-feeding support is always important. “It’s for the health of our next generation, and for the health of young women today,†she said. “So we all need to rally together and support our sisters and help each other be successful.â€

10 steps to successful breast-feeding1. Have a written breast-feeding policy that is routinely communicated to all healthcare staff.2. Train all healthcare staff in skills necessary to implement this policy.3. Inform all pregnant women about the benefits and management of breast-feeding.4. Help mothers initiate breast-feeding within one hour of birth.5. Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infants.6. Give newborn infants no food or drink other than breast milk, unless medically indicated.7. Practice “rooming in†— allow mothers and infants to remain together 24 hours a day.8. Encourage breast-feeding on demand.9. Give no pacifiers or artificial nipples to breast-feeding infants.10. the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.Source: Baby-Friendly USA Inc.

Thew, RN, BSN, MSJ, is national nurse editor. FOR MORE INFORMATION: www.babyfriendlyusa.org

Gail Neuman RNC BSN CPHW, Notary Publiccertified in high risk OBchildbirth/lactation educator & student nurse practitionerNRP, AHA BLS for Healthcare & Heartsaver Family/Friends instructor Perinatal Nurse AssociatesBaby Your Way Midwifery Associates801 N. Tustin Ave., Suite 305Santa Ana, CA 92705