Last week, the Oregon Public Health Division’s Office of Family Health convened a meeting devoted to reforming hospital breastfeeding practices. Most participants were from the Portland metro area though two individuals in addition to me were from Lane County. Both are affiliated with PeaceHealth Sacred Heart Medical Center’s lactation support services.
Much of the meeting focused on the latest information about hospital breastfeeding practices. Following are the key points outlining the need for change:
- A substantial proportion of hospitals use maternity practices that are not evidence-based and are known to interfere with breastfeeding. Read more here.
- Moving toward evidence-based maternity care, the Joint Commission, the nation’s leading hospital-accrediting body, newly requires hospitals to collect data on exclusive breastfeeding. Lack of documentation makes it impossible to identify and address non-medical formula supplementation. Read more here.
- Provision of free formula at discharge implies hospital and staff endorsement, negatively impacting breastfeeding duration and exclusivity. The good news is Lane County’s McKenzie-Willamette Medical Center, PeaceHealth Nurse Midwifery Birth Center and Sacred Heart Medical Center are bag-free.
- Hospitals with comprehensive breastfeeding policies (i.e. Baby Friendly Hospital Initiative or BFHI) have better breastfeeding support services and outcomes. BFHI is well established as the premiere designation. It promotes steady, incremental change broken into ten steps. Meaningful change, beyond verbal commitments and individual commitment, requires paradigm change, reorganization and retraining. Fortunately, each step forward, beginning with the first, improves breastfeeding outcomes.
What’s wrong with formula anyway?
Formula feeding is associated with higher rates of childhood illness including ear infections, asthma, obesity, juvenile diabetes and Sudden Infant Death Syndrome.
Formula feeding denies women the long-term benefits of breastfeeding. Long-term benefits include reduced risks for breast, ovarian and endometrial cancers as well as reduced risks of osteoporosis and bone fracture.
Pushing formula, implicitly or tacitly, deprives entire communities of normal good health outcomes. It misdirects medical dollars and increases sick time putting a drag on local social, health and economic wellbeing.
Breast milk is the most complete form of nutrition for infant health, growth, immunity and development. Oregonians know this as nine in 10 pregnant women plan to breastfeed. Much of this awareness occurs during and as a result of prenatal care and education. Entering the hospital to give birth, women and families understandably assume breastfeeding services will properly support their decision to avoid formula. Sadly, this trust is misplaced. We know this because the data on hospital-based practices and the steep drop-off rates once Oregon women and babies go home tells us so. While many women and families blame themselves, the reality is that they are set up to fail.
Leaders and policymakers are beginning to catch on….
The White House Task Force on Childhood Obesity’s new report includes four breastfeeding-specific recommendations:
- Recommendation 1.3: Hospitals and health care providers should use maternity care practices that empower new mothers to breastfeed, such as the Baby-Friendly hospital standards.
- Recommendation 1.4: Health care providers and insurance companies should provide information to pregnant women and new mothers on breastfeeding, including the availability of educational classes, and connect pregnant women and new mothers to breastfeeding support programs to help them make an informed infant feeding decision.
- Recommendation 1.5: Local health departments and community-based organizations, working with health care providers, insurance companies, and others should develop peer support programs that empower pregnant women and mothers to get the help and support they need from other mothers who have breastfed.
- Recommendation 1.6: Early childhood settings should support breastfeeding.
Recommendation 1.5’s peer support program references Baby-Friendly step 10:
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
Lane County has two weekly peer support programs: baby clinic at the Baby-Friendly-designated PeaceHealth Nurse Midwifery Birth Center and Baby Connection. Baby Connection is a demonstration project providing free, drop-in evidence-based infant feeding education and peer support. Both of these programs operate at capacity every week.
Federal WIC regulations have been updated to prioritize breastfeeding outcomes. Prenatal and postpartum success will depend on the degree to which hospitals become Baby-Friendly. Why? Because the hospital, not the home, is the primary location for formula introduction. This is the most important finding in the recent Oregon WIC Peer Counseling Research Project, a multi-year peer counselor breastfeeding study with 1,695 mothers from diverse regions of the state. One-third of participants introduced formula within the first few days of their baby’s life. Women most frequently reported being given formula because their milk had not come in. Breast milk does not come in immediately, rather women produce colostrum. That woman are encouraged to supplement for “milk not coming in” reflects a critical lack of understanding among many who serve new mothers.
Collaboration, not competition
We have legislation protecting the rights of breastfeeding women to pursue non-formula feeding practices. Now, we need hospitals capable of providing them with a sound foundation from which these rights can be exercised – Lane County hospitals must become Baby-Friendly.
Because all women, families and communities must have access to this level of care, collaboration among hospitals is crucial. Identifying the efficiencies born of collaboration along the 10-step path to becoming Baby-Friendly will make this baseline care available to women and families living anywhere in the county.
States, cities and counties serious about maximizing maternal and community health collaborate. Massachusetts has a collaboration to help hospitals (little, small, rural, urban, for-profit, not-for-profit) become Baby-Friendly. New York and Los Angeles are also working toward having all hospitals become Baby-Friendly. In Oregon, a recent Multnomah County/Community Health Partnership grant provides resources for working with hospitals to become Baby Friendly.
Lane County should be next on this list. It already has one Baby-Friendly facility, the PeaceHealth Nurse Midwifery Birth Center. (Cottage Grove Community Hospital used to be Baby-Friendly.) In other words, we have tremendous social capital in the form of homegrown expert providers as well as women and families able to speak to and support evidence-based breastfeeding services.
Now is the time to pursue Baby-Friendly designations
2010 is going to be a big year nationally and internationally for transitioning to evidence-based breastfeeding services:
- The theme for World Breastfeeding Week in August is “Breastfeeding: Just 10 Steps – the Baby-Friendly way”
- In the fall, the US Breastfeeding Committee will release The Joint Commission Toolkit Part 2: implementing hospital practices to improve breastfeeding rates
- The Healthy People 2020 breastfeeding objectives will be released in the fall
Locally, this is the time for Lane County hospitals to collaborate on becoming Baby-Friendly. The opportunity to invest in the long-term health of women, children, families and communities is too great and too important to miss.