MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

Part 2: Consumer Advocacy & Evidence-Based Infant Feeding Practices

Here’s the second “installment” for my upcoming presentation at the March 2-3 Breastfeeding Coalition of Oregon’s 5h Annual Meeting. Blue text indicates information that will be placed on PowerPoint slides, black text indicates what will be said. I’d love your feedback either here or via email at motherbabynetwork@gmail.com. Read the first installment

This installment covers consumer demand, consensus spanning breastfeeding research, accountability organizations and national and state governments, and the new Joint Commission “Speak Up!”campaign.

What does consumer demand by the numbers look like?

Click on chart to enlarge

These statistics, taken from the CDC 2011 Breastfeeding Report beautifully illustrate the strong consumer demand on the part of women to breastfeed. Oregon has exceeded the Healthy People 2020 goal for 81.9% initiation of breastfeeding. What this tells us is that most women today plan to breastfeed – more than 91% initiate breastfeeding. This is great news. But within six months we see a dramatic drop-off, especially when we consider breastfeeding exclusivity. Why is this?

Behind these declining rates are the potholes and gaps of an inadequate infrastructure entirely incapable of meeting and supporting women and families in their infant feeding decision to breastfeed. Soon after or right along with the first latch, mothers and babies face multiple threats to breastfeeding from several angles that hound, hobble and thwart them all along the way. Behind these numbers lurk the stories of women and families who are forced into a choice they initially rejected – formula feeding. Who among us doesn’t know first or second hand the details of these unanticipated transitions to formula and the associated loss of maternal and child health benefits?

What these numbers also fail to illustrate are the social and ethnic inequities perpetuated via barriers to breastfeeding. Unacceptable disparities in breastfeeding persist by race/ethnicity, socioeconomic characteristics, and geography. Here in Oregon, only 25% of African-American mothers and babies are breastfeeding at six months, compared to the 62% of Oregonians. (ICTC Black Birth Survey)

Important as data collection is, standard metrics do not capture the emotions, frustrations and isolation women and families experience when faced with the unanticipated and multiple barriers that threaten and frequently succeed in separating babies and mothers from breastfeeding.

In sum, our maternity care system falls woefully short of meeting consumer demand for effective breastfeeding services. Fortunately, consumers (mothers) are beginning to connect the contradictory advice they receive from physicians, nurses, lactation consultants, nurses’ aids and housekeeping staff with the poor outcomes they experience. More women are beginning to see how gaps in standard hospital practice undermine them before they ever go home to struggle alone. The actions and activities of innumerable local and national groups sprouting up are giving voice to the dissatisfaction women and families feel with the standard of care.

Consumers are not alone in connecting the dots…..

Click on chart to enlarge

In the big picture, women are no longer alone in their search for meaningful support. The time for big change in maternity care is here.

Research

  • Health benefits. We are beyond debating the pros and cons of biologically normative infant feeding. Multiple short- and long-term health benefits of breastfeeding for mothers and babies have been firmly established.
  • Hospital practice. Research conclusively demonstrates that evidence-based hospital practices positively influence breastfeeding duration and exclusivity.
  • Cost savings. Thanks to Bartick et al’s 2009 cost analysis (The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis), we also have clear documentation of the massive projected savings in dollars and lives that come with exclusive breastfeeding.
  • SIDS. 2011 research confirms breastfeeding is associated with reduced rates of SIDS. The effect is stronger when breastfeeding is exclusive. This finding has special significance for my community of Lane County. Between July 2007 and June 2010, 23.5% of 85 fetal-infant mortalities are among post-neonates (babies one month or older). Breastfeeding reduces the risk of SIDS.
  • Childhood obesity. Breastfeeding is associated with reduced odds of obesity throughout the life span with greater benefits conferred with exclusive breastfeeding. Breastfeeding promotion and childhood obesity risk reduction go together.

Accountability

Consumer voices and research findings are increasingly making their way to the top of the agenda for major actors in the development and implementation of health care policies. As these bodies move beyond signaling interest to taking action, forward-thinking hospitals will take action to be in position for a time when reimbursement dollars will be tied to breastfeeding outcomes. Action means adopting evidence-based practice for infant feeding.

  • CDC mPINC. A national survey of hospitals to measure infant feeding policies and practices. Facilities receive private analyses outlining their strengths and areas that need improvement. Unfortunately, consumers are not permitted access to facility-level reports.
  • Joint Commission. The nation’s most important hospital-accrediting body recently included exclusive breast milk feeding in its new perinatal core measure set.
  • US Surgeon General Call to Action and Healthy People 2020. Both documents guide national, state and local health policy making. Increasing the number of breastfed infants is a key public health goal.

Nation

  • Healthcare reform. is a major national issue. Promoting and protecting the rights of nursing mothers to pump included in legislation.
  • Let’s Move. The First Lady’s campaign includes breastfeeding as part of the solution to the childhood obesity epidemic.
  • Transforming Maternity Care. Maternity and infant care are the most expensive hospital condition in the United States – $98 billion in 2008. The US spends more than any other industrialized country on maternity and infant care. The outcomes do not support this spending. Any discussion of improving the healthcare delivery service must focus on maternity and infant care.
  • Breastfeeding. Discussion of infant feeding reform thus fits within a larger context spanning the entire perinatal period from conception through an infant’s first birthday.

Oregon

  • WIC. Oregon WIC is one of only 6 states awarded a Breastfeeding Performance Bonus from USDA, tied for the first time to exclusive breastfeeding rates.
  • Oregon Hospitals Partnering for Evidence-based Infant Nutrition. This is a statewide project of the BCO to provide facility-specific technical assistance and encouragement to hospitals adopting evidence-based practices. The May 2011 hospital summit brought hospitals and community groups together to develop plans for next steps. This summit provided my community’s two leading hospitals (McKenzie Willamette Medical Center and Sacred Heart Medical Center) with an opportunity to publicly share their commitment to become Baby Friendly-designated facilities.
  • Oregon Health Insurers Partnering for Prevention (OHIPP). This group of health insurers selected breastfeeding as an evidence-based prevention strategy for reducing obesity. Incentives to hospitals that attain the Baby-Friendly designation are being explored.

The Joint Commission’s message to mothers? Speak Up!

Now that consumers are joined by research scientists and health policy makers at the national and state levels, we are beginning to see efforts to encourage women to seek and insist on excellent infant feeding care. Having recently signaled to US hospitals that exclusive breast milk for infant nutrition is increasingly on the agenda by putting it as an optional perinatal performance measure, the Joint Commission is signaling again. This time, the Joint Commission is speaking directly to consumers. The Joint Commission’s new “Speak Up!” campaign tells mothers they must take action by “speaking up,” if they are to be successful in realizing their preference to breastfeed.

The medium for this latest signal is a brochure. There are several things to like about this campaign’s brochures:

  • It is intended for distribution during the prenatal period when women have the opportunity to think and plan ahead.
  • Breastfeeding, while a biological norm, is presented as a skill to be learned. Learning requires preparation before, during and after birth for mother and baby
  • Women and support people are encouraged to speak up and ADVOCATE for themselves to ensure they are receiving proper, evidence-based care. In other words, being a squeaky wheel is a good thing.
  • Telling women to speak up implies that they ought not assume their hospital’s care is in line with successful outcomes.
  • The information provided is consistent with Baby Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding and, therefore, is evidence based.

Encouraging personal responsibility is laudable. That said, my reservation with this campaign is that it requires a consumer to have a rather deft capacity to read between the lines. The target audience is unlikely to be able to do this, if they are not first informed that the current and common infant feeding support they are likely to encounter is rife with serious deficits. A more straightforward approach would be great.

I suspect, however, the greatest significance of this campaign is the signal it sends to hospitals rather than to consumers. Brochures are a rather passive form of support that may or not be read by consumers. I am confident, however, that the administrators inside hospitals who make decisions about whether or not to pursue the Baby Friendly designation are able to see this campaign in a larger context – one in which an ever-clearer signal is being sent for hospitals to link doing a better job by consumers with accreditation status. Seen in this light, “Speak Up!” is a very positive development.

— End of installment 2, final installment coming soon. Feedback appreciated!

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2 responses to “Part 2: Consumer Advocacy & Evidence-Based Infant Feeding Practices

  1. Sue Scott January 31, 2012 at 10:34 pm

    My favorite section of this presentation is:

    “Transforming Maternity Care. Maternity and infant care are the most expensive hospital condition in the United States – $98 billion in 2008. The US spends more than any other industrialized country on maternity and infant care. The outcomes do not support this spending. Any discussion of improving the healthcare delivery service must focus on maternity and infant care.”

    There need to be maternity/infant care discussions that go beyond following the standard fearful “wisdom” of invasive procedures “just in case” and more money = better care.

    I remember as a girl wondering why moms I knew had to go to the hospital and get cut up to deliver babies when cats and dogs needed no such help. Why did these same moms use bottles? My mom didn’t. Cats and dogs didn’t. Why indeed?

    Great presentation again, Katharine. Thank for your articulate voice.

    Sue

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