On Monday, I attended and participated in a panel discussion at the Moving Communities Toward Evidence Based Breastfeeding at St. Charles Hospital in Bend. The conference was the result of a productive collaboration between Oregon WIC, the Central Oregon Breastfeeding Coalition and St. Charles. Dr. Marianne Neifert was the conference speaker.
Moving Communities Toward Evidence Based Breastfeeding reflects growing awareness among consumers, healthcare providers and government agencies of the need to implement breastfeeding practices inside hospitals that effectively support women and infants to initiate breastfeeding. Ineffective practices including failure to assess proper latch, formula supplementation and inadequate follow up after birth undermine the long-term prospects for women and infants to establish an adequate milk supply. In other word, the days of “you can breastfeed when you go home” must end.
Kudos to Desiree Nelson, WIC Project Coordinator for the Improvement of Maternity Care Practices, for organizing the conference and to St. Charles for making it possible by hosting. I had hoped this conference would be held in the Eugene/Springfield areas as there is considerable buzz “on the street” that Sacred Heart Medical Center is seriously considering becoming a designated Baby-Friendly facility.
The panel discussion in which I participated included consumers (myself and another woman from Bend), doctors, a hospital administrator and a WIC employee. The composition of the panel modeled the kind of stakeholders conversation needed throughout the state to encourage the adoption of sound breastfeeding practices. (Many thanks for including consumers in the discussion.) As consumers, we described the long-term effects receiving non-evidence based care had on initiating breastfeeding. We described the enormous difficulties of accessing lactation expertise inside and outside the hospital as well as the difficulties of being encouraged repeatedly to formula feed despite making the preference for breast milk known. Like so many other women, our expectations for breastfeeding support were not matched by the services provided.
Three great terms
Three particularly descriptive terms were used during the conference. They describe the difficulties proponents for better mother- and baby-care must contend.
CEO Hurdles. These hurdles refer to business concerns that can conflict with optimal health care for women and babies. For example, designated Baby-Friendly hospitals do not accept free formula. Convincing management that this is not only the correct decision but also one that will not compromise market share is, to put it mildly, challenging. Perhaps as increasingly savvy consumers and government agencies come to see and describe free formula as cheap swag, this hurdle can be cleared.
Block Party. This refers to the trend toward having large numbers of family and friends in the delivery room who are unfamiliar with how breastfeeding is most well supported. In the absence of this information, the clamors to see and hold a new baby frequently trump mother and baby skin-to-skin contact. Nurses and lactation specialists commented on how hard it is for them to protect the mother-baby window for bonding. In the absence of prenatal education about the role of skin-to-skin contact for breastfeeding, nurses have a hard time diplomatically helping make this happen. After all, who’s going to tell grandma she can’t hold the baby just yet?
Mamatoto. This is a Swahili word for the mother-baby unit. Keeping mothers and infants together is the best way to encourage a good start for breastfeeding. We don’t have this word in English but we need one. My answer is to make it happen by putting “mother” and “baby” together to make “motherbaby.”
Moving Forward from the Middle
Moving Communities’ strength was in its devotion to equipping participants with the knowledge and encouragement to move their respective organizations toward sound breastfeeding practices even in as they contend with CEO hurdles on one end and grandmas who likely did not breastfeed and have yet to have a chance to learn how to be supportive at the other end. It’s a tall order.
Dr. Neifert spent a great deal of time describing the development and implementation of Colorado’s Can Do 5 program. This program serves as a useful tool for moving healthcare facilities and providers toward evidence based breastfeeding practices. Can Do 5 is useful because:
- It’s an intermediate subset of steps on the way to becoming Baby-Friendly. (Many administrators and staff see Baby-Friendly designation as a daunting starting objective, especially in light of CEO hurdles.)
- It represents incremental changes fundamental to positively promoting long-term breastfeeding success for families.
- It generates momentum among management and staff as positive outcomes and familiarity with new practices increase. With these steps accomplished, it is much easier to take the additional Baby-Friendly step of refusing free formula from manufacturers.
So, what is Colorado’s Can Do 5?
The “Can Do 5” program is the result of analyzed data from the 2002 and 2003 Colorado PRAMS surveys having been presented to hospital staffs and administrators. The PRAMS survey is a population-based surveillance system for identifying and monitoring behaviors and experiences of women before, during and after pregnancy. Questions regarding hospital breastfeeding practices were added in 2002. These “yes” or “no” questions roughly mirrored the Baby-Friendly Ten Steps:
- Hospital staff gave me information about breastfeeding
- My baby stayed in the same room with me at the hospital
- I breastfed my baby in the hospital
- I breastfed my baby in the first hour after my baby was born
- Hospital staff helped me learn how to breastfeed
- My baby was fed only breast milk in the hospital
- Hospital staff told me to breastfeed whenever my baby wanted
- The hospital gave me a gift pack with formula
- The hospital gave me a telephone number to call for help with breastfeeding
- My baby used a pacifier in the hospital
The survey response rate was at least 70% each year and results were weighted accurately to reflect all Colorado mothers.
Colorado found that five specific hospital practices were significantly associated with longer durations of breastfeeding:
- Baby breastfed in first hour (72%)
- Baby stayed in mother’s room (93%)
- Baby fed only breast milk (46%)
- No pacifier use in hospital (46%)
- Given phone number to call for help (84%)
The average number of practices reported was 2.8 and less than half of babies left the hospital without being supplemented or given a pacifier. Just one in five mothers reported experiencing all five of these supportive practices. But what a difference this made for these mothers and babies! Two-thirds (68%) of this group were still breastfeeding at 16 weeks, compared with half (53%) of those who did not get all five practices. Of particular interest? Breastfeeding rates for this group were consistently higher for women below, at and above the poverty level – EVERYONE benefited.
||2 months (wk 9)
||4 months (wk 17)
||yes = 80%, no = 64%
||yes = 63%, no = 48%
||yes = 66%, no = 47%
||yes = 47%, no = 35%
|High Socioeconomic Status
||yes = 90%, no = 78%
||yes = 78%, no = 61%
Yes = got all 5 practices
No = did not get all 5 practices
See the 2007 published findings at www.cdphe.state.co.us/ps/mch/gettingitright.pdf