MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

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Part 1: Consumer Advocacy & Evidence-Based Infant Feeding Practices

Here’s the first “installment” for my upcoming presentation at the March 2-3 Breastfeeding Coalition 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.

This installment covers introductory info, background on me and why thinking of women as consumers rather than patients can be productive. The next installment will go into consumer demand, the Baby Friendly Hospital Initiative and the increasing support for Baby Friendly at all levels of government and among accrediting bodies.

The Role of Consumer Advocacy in Increasing Evidence-Based Infant Feeding Practice

“Mothers are acutely aware of and devoted to their responsibilities when it comes to feeding their children, but the responsibilities of others must be identified so that all mothers can obtain the information, help, and support they deserve when they breastfeed their infants.” (Surgeon 2011: v)

Good morning. My name is Katharine Gallagher. I have been invited to speak with you today about the role consumer advocacy plays in increasing evidence-based infant feeding practice. My objective is to outline how responding to consumer demand and encouraging and engaging consumer advocacy encourages hospitals and providers toward practices that effectively support women in making sound infant feeding decisions.

The framework for this year’s annual meeting is the Surgeon General’s 2011 Call to Action to Support Breastfeeding. The fundamental assertion made in this call to action is that a woman’s ability to initiate and sustain breastfeeding is influenced by a host of variables and factors. These include an individual woman, her partner, extended family, healthcare providers and employer. Public health and social service agencies as well as community-based programs also influence breastfeeding decisions as do schools, child care centers, houses of worship, business and industry, and, let’s not forget…the media.

In other words, decisions and outcomes related to infant feeding occur in a multi-layered and dynamic environment. The manner in which these multiple factors support or thwart a woman’s ability to make and follow through on infant-care decisions has a very fast-acting and mostly permanent impact on the trajectory of decisions to breastfeed.

Each of us comes to this meeting with a particular role to play in curbing the discord of the aforementioned factors that influence individual-level decisions. We are here to develop meaningful social supports to ensure women can follow through on the decision to breastfeed their babies. My focus this morning is on the inter-play between women as the consumers of infant feeding services and health care facilities – hospitals – and  providers.

Responding to demand and partnering with consumers fosters improved maternity care. It moves us closer to a model that consistently educates and supports women, families and communities to make choices supported by sound scientific research, good judgment and individual preferences and values. Once engaged, consumers provide an invaluable feedback loop to support and inform policy, practice and outcome analysis. As system users, consumers have a unique perspective. They know from experience how well a particular system is or is not working. Frequently, they know what is needed.  When this information is regularly sought and acted upon, we have a culture of consumer engagement.

About Me

Before getting started, I’d like to share a little about myself and how I came to be involved with maternity care reform as a consumer advocate.

I am the mother of two boys – ages four and six. My professional background is in public policy. My experiences over the past six years with both evidence-based and non-evidence-based maternity care have profoundly influenced me as a person, a mother and a citizen. The result is a deeply-held conviction that we must transform maternity care in this country. This is not solely a women’s issue. We are talking about reforming policies and practices as well as behaviors and decision-making approaches with major physical, emotional, social and financial implications for the economic health and security of this generation and those to come. This is an “everyone” issue.

My first pregnancy was a healthy, low-risk experience that resulted unexpectedly in what I believe to have been an unnecessary and entirely avoidable cesarean section. Hindsight is 20/20. Only in retrospect could I see the signs pointing to and hinting at the impatience and aggressive management my Ob/Gyn employed during my labor and birth. My postpartum trajectory continued south as my son and I had extreme difficulties establishing breastfeeding. However, because he was such a determined latcher, we were considered to be doing fine and encouraged to skip our lactation consultation before discharge from the hospital. This decision was made despite the telltale signs of chewing on my nipples and my too-shyly stated observations that “things didn’t feel right.” At home with a chomper-latch baby and reeling from the shock of an unanticipated surgery, hazy from painkillers, things got worse and worse still.

A long story short, my pleas for help from the medical practice I was using and a willingness to pay out of pocket failed to secure the assistance we needed. In serious need of help, during an appointment for my baby, I asked the pediatrician to look at my breasts to confirm that I had a problem. He would not, and no referral was made. A desperate late-night call to La Leche League and another pediatrician’s gentle support resulted in our finally finding someone to help. We found an independent lactation consultant who works outside the healthcare system.

By this point, all of us were in pretty wretched shape. My nipples were chewed to shreds, my son was far from content and my husband was worried. Getting back on track required weeks of pumping and syringe feeding until my breasts healed. We then slowly re-introduced my baby to the breast. This was a team effort. My husband and I both took unpaid maternity leave and my mother moved in and  took care of all of us. Weeks of perseverance paid off and eventually we were where we needed to be to continue breastfeeding. Clearly this experience is and would be the exception, not the rule for most women and families.

Pregnant again and much better informed the second time, I knew I wanted to have a different birth and postpartum experience – one that would allow me to hold and hug my two-year old and tend to a newborn without the physical and emotional challenges of cesarean recovery. I selected the Baby-Friendly designated PeaceHealth Nurse Midwifery Birth Center for my care. My prenatal experience exhibited the hallmarks of optimal healthcare – individualized care, personal responsibility, shared decision making and informed consent. Attended by a midwife at the hospital, I had an un-medicated VBAC. My second son was born content and alert and eased peacefully into life outside the womb beginning with the glorious and inordinately important but yet to be fully understood skin-to-skin time. My delight and amazement in seeing a baby so alert and present was shared by the many Labor and Delivery nurses who came in to see an “un-medicated baby.”

Consistent with Baby Friendly, I had been counseled and educated prenatally about breastfeeding. I had the knowledge and support to confidently continue nursing my first son through my second pregnancy. Per my wishes, I was also able to tandem nurse until my oldest son weaned at 3 yrs old. Furthermore, along the way I connected with other new mothers using the Nurse Midwifery Birth Center. These women became an invaluable source of support for breastfeeding and just about everything else – pumping, returning to work, not returning to work, how to take a shower, the best places in town to change diapers and the lists goes on.

Tops on our personal lists for breastfeeding success? The weekly drop-in baby clinic and 24-hour phone support for lactation. We had a  lactation safety net and while many of us had not realized it would so critical before birth, we soon discovered how necessary it is to getting breastfeeding started and maintained. We did not yet know this lactation support was the outcome of evidence-based practice or that it had a name –the Baby Friendly Hospital Initiative. What we did know was that it worked. This was a most welcome change from my first breastfeeding experience and I was continually struck by the way in which new mothers were seamlessly supported in learning to breastfeed and to solve problems and overcome challenges that are part of life with a new baby.

Consumer or Patient?

“Empowered, informed, engaged consumers, individually or collectively, can be effective at overcoming barriers to safe, effective care.” (Romano, 53) 

Just as communities, healthcare systems, government and employers must re-tool or re-orient themselves to support evidence-based infant feeding decision making, so too must those who consume maternity services – women. Seeing oneself as a consumer rather than as a patient can provoke a radically different set of perspectives and actions that positively influence individual and system-wide care.

Pregnancy is a gateway experience into the health care system for many women. For most, pregnancy is a time of health, discovery and a renewed commitment to well-being. Women’s experience shapes their behaviors and expectations for future interactions with healthcare throughout the life cycle. Add to this that women frequently take the lead in heath care decision making for nuclear and extended family members and their initial experiences via maternity care have multiple ripple effects. Accordingly, the manner in and degree to which they participate in decision making during pregnancy, birth and the postpartum period has significant social, health and economic implications in the lives of women, families and communities that reach well beyond today’s topic of infant feeding.

Re-conceiving of the users of the maternity care system as consumers rather than patients promotes productive ideas and behaviors by providers and users. Consumers are associated with:

  • Knowledge
  • Choice
  • Purchasing Power
  • Autonomy
  • Responsibility

As a consumer advocate and childbirth educator, I encourage women to take an active role in their care. I encourage them to use their purchasing power and autonomy to shop around and ask questions in order to identify facilities and practices with the best reputations for thorough lactation support with excellent post-birth outcomes. I remind them that it is okay to change hospitals, birth centers and providers, too.

When women are seen as and view themselves as consumers with the attributes of knowledge, choice, purchasing power and autonomy, it is much easier to develop and benefit from the resulting personal responsibility, mutuality, partnership, collaboration and trust when they engage care in a particular setting. This beginning orientation lays the groundwork for developing the expectation for and demand for consistent evidence-based practices. It lays the anticipatory groundwork on the part of the user for share decision making and informed consent across the life cycle.

These assertions have yet to be borne out by research. The majority of current maternal and child health research focuses on interventions fully within the realm of providers with little to no consumer participation. Cesarean surgical techniques or intensive care treatments are examples of “provider realm” interventions. Research into consumer-realm interventions would invert institutional paradigms to elevate women receiving care to the position of  a “positive” and “powerful” actor capable of moving maternal and child health outcomes in a positive direction. In this era of health reform in which we appear to be searching for meaningful ways to move toward a preventive model with the associated reduced costs, increased positive outcomes and great consumer satisfaction, this type of inquiry is much needed.

We are seeing hints of this forward-thinking inversion here in Oregon. During the last legislative session, a law was passed directing the Oregon Health Authority to investigate how doulas (labor companions) improve birth outcomes for women at disproportionate risk. Doulas provide emotional, non-medical support associated with positive outcomes. Doulas are a well documented evidence based and non-medical intervention with a proven track record for positively influencing the social, physical and emotional outcomes of the perinatal period. Rep. Tina Kotek (D-N and NE Portland) and Rep. Lew Frederick (D-NE Portland) sponsored the bill. Portland-based International Center for Traditional Childbearing played a critical role in the introduction of the bill.

Fortunately, there is one very important “consumer realm” intervention for infant feeding services that has already clearly demonstrated massive maternal and child health benefits.. It is the Baby Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding. From start to finish, consumers are educated, engaged in decision making with the necessary evidence-based information about infant feeding and provided with full-spectrum perinatal support for making breastfeeding work. This intervention can be summarized in two words: “It works!” It works for mothers, families, employers, communities, economies and, well, everyone. Baby Friendly figures greatly into any discussion, including this one, of policy development and implementation for heeding the Surgeon General’s Call to Action to Support Breastfeeding.

End of installment #1…..

Will Oregon hospitals close the breastfeeding care gap?

Evidence-based infant feeding care is the future for hospitals in the United States. Oregon is at a critical juncture: will it lead by building on the unique, forward-thinking approach for which it is known? Or, will it wait for other regions or states to lead? Waiting might make sense for some states but not for Oregon – the home of several cutting-edge leaders, thinkers and organizations where infant feeding is concerned.

Last week, representatives from 35 of Oregon’s 52 maternity hospitals participated in a day-long summit devoted to evidence-based infant nutrition. Provided with resources, expertise and mentoring, hospital teams developed action plans for closing the gap between current infant feeding practices and evidence-based mother-baby care. For background on the infant feeding gap, read “Closing the Quality Gap: Promoting Evidence-Based Breastfeeding Care in the Hospital.”

Prevalent non-evidence-based mother-baby practices include routine supplemental feedings of formula, repeat separation of mother and baby beginning with the first minutes of life and pervasive distribution of formula company marketing samples to breastfeeding mothers. Optimal care following birth includes skin-to-skin time, keeping mother and baby together and care from trained and educated staff. Optimal care occurs in a commercial-free environment.

The summit marked the half-way point in the year-long Oregon Hospitals Partnering for Evidence-based Infant Nutrition – a project of the Breastfeeding Coalition of Oregon, one of five community coalitions supported by the Oregon Public Health Institute. (See The Lund Report’s coverage) Amelia Psmythe, director of the Breastfeeding Coalition of Oregon, provided much of the vision, creative energy and sheer determination necessary to make this potentially-transformative opportunity available to Oregon hospitals. Because of her uniquely collaborative approach to the summit, teams returned to their respective hospitals prepared to begin the work of aligning infant feeding care with the high expectations mothers, families, communities, employers and governments at all levels have for them.

With the Breastfeeding Coalition of Oregon as its principal organizer, the project develops collaborative relationships inside and outside hospitals and provides technical support to assist reform efforts. Funders include:

  • Oregon Public Health Institute
  • Multnomah County Health Department
  • Oregon WIC
  • Oregon Association of Hospitals and Health Systems
  • Legacy Health System
  • Kaiser Permanente
  • Providence Health & Services
  • Oregon Health & Science University
  • Tuality Healthcare
  • Medela, Inc.

Funders as well as community partners attended the summit. Community partners included MotherBaby Network, Northwest Mother’s Milk Bank, the Nursing Mothers Counsel of Oregon, Multnomah County Health Department, Multnomah WIC, the March of Dimes, the Oregon Health Authority and the United States Breastfeeding Committee.

US Sen. Jeff Merkley’s wife Mary Sorteberg, RN presented awards to the state’s five Baby Friendly facilities and to four with formal commitments to become designated. Visit the Breastfeeding Coalition of Oregon’s Facebook page to see photos. The Baby Friendly Hospital Initiative (BFHI) – a global program sponsored by WHO and UNICEF to promote, protect and support breastfeeding – certifies hospitals practicing the Ten Steps for Successful Breastfeeding. Women receiving lactation services at a Baby Friendly facility can be confident of comprehensive evidence-based care.

The Centers for Disease Control is monitoring the project’s trajectory. Its early success engaging and leveraging the interests and resources of multiple constituencies inside and outside of Oregon hospitals warrants this attention. Depending on how the next several months unfold, an effective model for other states could result. Such a model would have national significance in light of the current CDC focus on encouraging exclusive breastfeeding for the first six months of life as the public health intervention with the greatest potential for addressing the skyrocketing rates of childhood obesity.

Lane County

Lane County had a strong showing at the summit. The county is home to the state’s first facilities to earn Baby Friendly status: the PeaceHealth Nurse Midwifery Birth Center and the Cottage Grove Healthcare Community (since closed), both in 1997. The county’s two largest hospitals, Sacred Heart Medical Center and McKenzie Willamette Medical Center, both sent teams. All four facilities were acknowledged during the morning award’s ceremony. Lane County could be on the path toward evidence-based infant feeding as a community standard.

Lane County’s Desiree Nelson works on behalf of the project. Nelson led Cottage Grove’s hospital to become a designated facility in 1997 and, until recently, worked at the PeaceHealth Nurse Midwifery Birth Center. She is also co-founder, along with Debbie Jenson of Sacred Heart, of Baby Connection, a phenomenally successful grassroots demonstration project of evidence-based, drop-in breastfeeding support groups. The existence of post-discharge groups satisfies Baby Friendly step 10. Baby Connection serves all women and families.

What did hospital teams do?

Throughout the day, hospital teams developed facility-specific action plans. Team members included physicians, labor and delivery managers, family birth center managers, charge nurses, lactation consultants, childbirth educators and quality improvement staff. 

As a condition of participation, hospital teams arrived having reviewed the latest CDC 2009 benchmark data for their facility. This data is captured in the CDC Maternity Practices in Infant Nutrition and Care (mPINC) reports. Teams updated their benchmarks to reflect 2011. These advance team-based activities were intended to ensure familiarity with current practices and policies.

Aggregate state-level mPINC data will soon be available. Facility-specific results are currently anonymous. Anonymity is considered key to participation. Download a Sample Benchmark Report. mPINC reports for other states’ facilities are being printed now. The CDC expedited shipping to support the work of the summit.

At the summit, participants were guided by Carol Melcher, RNC, CLE, MPH – clinical director of San Bernardino’s Perinatal Services Network (PSN). Melcher has led numerous hospitals in San Bernardino county to achieve Baby Friendly designation. PSN instructs hospitals in the SOFT Approach which teaches hospitals to earn designation by building connections that align cultural and procedural priorities with evidence-based care. Needed connections include those between families and staff, between administrators and nurses, between hospitals and between communities and hospitals. These connections place collaboration ahead of competition.

A critical resource for results-oriented learning and facility-level planning was the multiple interactions teams had with small table mentors. Mentors brought expertise in one of three areas: hospital Quality Improvement,  leading a hospital to the Baby-Friendly designation, and large-scale systems change. Hospital teams worked with one of each type of mentor. Mentors volunteered their time at the summit as well as during an advance training session.

To provide an observation-free environment for hospital teams, community partners convened separately following the awards ceremony. They received a briefing on hospital team activities and a presentation by Northwest Mothers Milk Bank.

Why are hospitals ground zero for closing the infant feeding gap?

Hospital-based culture and practices create an environment in which individuals make long-lasting decisions about infant feeding. These first decisions and experiences heavily influence the ultimate role breastfeeding will play in the months to come. Hospital reform is critical for realigning prenatal, birth and postpartum environments to support —rather than thwart— individual feeding decisions that lead to the multiple positive outcomes associated with breastfeeding. Read this consumer survey to learn what women and families have to say about care in a Baby Friendly facility that aligns with their decision to breastfeed.

A well-known recent study reports that 911 deaths, mostly among infants, could be averted and $13 billion per year saved, if 90% of US families breastfeed exclusively for six months. Despite considerable room for improvement, Oregon leads the nation in breastfeeding benchmarks. It starts off with an “A” but quickly plummets to a failing grade by month six. Nine in 10 Oregonian women initiate breastfeeding. At six months, 2 in 10 babies are exclusively breastfed. Even with a failing grade, Oregon is frequently touted as an example for other states.

Like the CDC, the Oregon Health Insurers Partnering for Prevention (OHIPP), another OPHI project, is also monitoring the project. Comprised of health insurers (representing 65% of private insurance and 45% of Medicaid) and public health policy advocates, OHIPP is a collaborative obesity prevention effort. It has selected increasing breastfeeding rates as its first collaborative public health intervention. Imagine the potential for moving Oregon forward were insurers to set a date for implementing different rates of reimbursement depending on a hospital’s Baby Friendly status?

Sorteberg described Sen. Merkley’s state and national legislative efforts to protect and promote the rights of breastfeeding women in the workplace. Her comments highlighted the need to work across barriers so that women will have hospital care that lays the foundation for returning to work with plans to continue breastfeeding intact. Without effective hospital-based support systems, the potential for current legislation is severely undermined.

Effective community connections reach beyond hospitals

Developing opportunities for hospital teams to identify and work with their local community partners is critical to the project’s long-term prospects. The Surgeon General’s 2011 Call to Action to Support Breastfeeding encourages the involvement of multiple groups for the removal of barriers. Families, communities and employers also have an active role in removing barriers. Including these stakeholders in the work of hospital-practice reform is key ingredient for making long-lasting, sustainable change.

Oregon’s strong showing of community partners at the summit points to an inherent and potentially unexamined strength for creating not only a state network of Baby Friendly hospitals but a model of care consistent with current calls to develop patient / consumer engagement in healthcare-decision making models. The SOFT Approach begs to be made Oregonian by actively including the perspectives of local community stakeholders in hospital teams.

What might this look like? Hospital teams can add a healthcare consumer of breastfeeding services to their efforts. Breastfeeding coalitions, La Leche groups, WIC peer counselors and healthy baby coalitions are potential sources for participants with relevant consumer perspectives. As the project moves beyond the summit to develop state-level collaborative frameworks, meaningful inclusion of local community partners should be a priority, too.

Women frequently take the lead in decision making for nuclear and extended family members. The manner and degree in which they participate in healthcare decisions during pregnancy and postpartum have major implications beyond infant feeding. Consumer (or patient) engagement promotes effective partnering for prevention and treatment practices throughout the life cycle. Including consumer perspectives in the discussions and planning that must occur to close the infant feeding gap has the potential to set the even further-reaching example of the kind of collaboration needed to make quality healthcare more affordable and accessible across the life cycle.

Beyond the summit

Urban or rural, rich or poor, large or small, degree and type of diversity among populations served  – these are not the characteristics that determine a hospital’s capacity to become Baby Friendly. Commitment to building the necessary connections for closing the current gap is the single-most important distinguishing characteristic for change. Developing and utilizing internal and external lines of communication within and among hospitals as well as with community stakeholders and setting milestone dates are far more important than specific facility characteristics. Facilities making the needed commitments and seeking opportunities to collaborate are in a position to close the infant feeding gap. Those who succeed will align with their mission by honoring their obligation to the mothers and babies of Oregon. It is possible that Oregon could make evidence-based infant feeding care a statewide community standard.

 

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Decisions About Infant Feeding Do Not Happen in a Vacuum – Context Matters

In celebration of its 50th anniversary, Oregon Research Institute recently hosted a public lecture – “Addressing the Nation’s Crisis with Nutrition and Obesity” – by Kelly Brownell, director of Yale’s Rudd Center for Food Policy and Obesity. In the past several years, obesity prevention has gained enough traction to be a well-established national health priority. Public and private funders are actively looking for solutions to cut down on the enormous and growing costs of addressing the innumerable diseases and suffering associated with and exacerbated by obesity.

Curious to see if breastfeeding would figure into the lecture, I attended…

What’s the connection between obesity reduction and breastfeeding? Breastfed children experience lower rates of obesity than do formula-fed babies. Why? “Scientists do not know exactly why… Some people think that a breastfed child can better control how much he or she eats and so may become accustomed to eating less than a bottle-fed child… Also, babies who are breastfed have lower levels of insulin, a hormone that promotes fat storage.”

Because breastfeeding is associated with better outcomes, it, too, is enjoying newfound traction in policymaking circles. Oregon’s one-a-kind insurance collaborative – Oregon Health Insurers Partnering for Prevention (OHIPP) – selected breastfeeding as its first intervention intended to reduce obesity. Nationally, Michelle Obama promotes breastfeeding as part her campaign to reduce childhood obesity.

A well-known recent study reports that 911 deaths, mostly among infants, could be averted and $13 billion per year saved, if 90% of US family could follow medical recommendations to breastfeed exclusively for six months. Nine in 10 Oregonian women initiate breastfeeding. This number declines rapidly so that at six months, 2 in 10 babies are exclusively breastfed.

After establishing obesity as a global epidemic of the first order, Kelly focused his lecture on reduction and prevention in the United States through meaningfully addressing the manufacture and sale of the foods and beverages fueling today’s ghastly health outcomes. Breastfeeding was not discussed. However, the ideas and suggested pathways to obesity reduction that Kelly sketched out are well suited to the development of strategies for reforming the inadequate breastfeeding support models currently accessible to most women and babies here in Lane County and elsewhere.

…reform comes when the environment in which individual choices are made is geared to support rather than thwart decisions that align with healthy, positive outcomes…

Reform: Clean Up for Infant Feeding Models

Brownell argues that real reform comes when the environment in which individual choices are made is geared to support rather than thwart decisions that align with healthy, positive outcomes. Currently, models to promote well-being, whether for nutrition or infant feeding, exist within an environment that encourages behaviors associated with poor outcomes. Today’s decision-making environment for infant feeding is shaped by legislation, regulation and economic prerogatives that promote and protect the interests of manufacturers and non-evidence-based practices at the expense of individual, family and community wellbeing. The current “default settings,” as Kelly refers to them, run counter to science, transparency and good health practices.

In this kind of “toxic” decision-making environment, Brownell describes the disproportionate responsibility individuals bear in becoming educated and motivated to identify evidence-based or effective care and accessing it.  Current default settings put consumers at so great and extreme a disadvantage in making informed decisions that it is unreasonable to expect improved outcomes to result from individual responsibility alone. In other words, individuals are “thrown to the wolves” and then summarily blamed for making the wrong decision – all in the name of personal responsibility.

What is needed to address an asymmetrical and toxic decision-making environment? The default settings must be reset to optimize individual decision making and public well-being. Legislation, regulation and economic practice must be redirected to protect and reward practices that promote rather than undermine individual and national health and economic well-being.

Anyone following funding for Women, Infants and Children can see the power of formula company interest groups on full display. Through costly and effective lobbying campaigns, these companies succeed in shaping national policy for their own benefit and at an extraordinarily high cost to everyone else. These companies create the toxic environment in which WIC is cornered into purchasing and providing formula rather than evidence-based infant feeding support systems. To think the nation’s most vulnerable women and children bear responsibility for allowing this to happen is ludicrous.

Shifting a decision-making environment to empower choices in line with good health and economic outcomes is not a new idea. Before obesity reduction and breastfeeding promotion managed to make it onto the national agenda, other examples abound in which default settings have been positively reset. Smoking cessation and tobacco regulation is just one, good and well-known example. Another example? Air bags. All new cars now come equipped with them but this wasn’t always so. Having one or not is not a private but a public decision. This idea is so firmly supported by legislation and regulation that buying a new car without one is impossible.

Improvement looks like…

What if default settings for infant feeding were optimized to serve the nutritional and economic interests of women, babies, families and communities? Here are few ideas for what a non-toxic environment would look like….

  • Evidence-based breastfeeding models of care in hospitals and birth centers
  • Higher reimbursement rates for evidence-based facilities and providers
  • Universal access to early and comprehensive prenatal care
  • Access to evidence-based childbirth and breastfeeding education as part of prenatal care
  • Effective employer-based supports systems to support breastfeeding mothers

In Lane County, there are positive signs of increased access to evidence-based breastfeeding models. Sacred Heart Medical Center is pursuing the Baby Friendly Hospital Initiative designation for evidence-based care. McKenzie Willamette Medical Center reports being in the midst of internal discussions about a similar commitment to mothers and babies in our community. The PeaceHealth Nurse Midwifery Birth Center is already one of Oregon’s five designated facilities. See what women who access breastfeeding care have to say about Baby Friendly care – read A Consumer Survey on Baby Friendly Breastfeeding Services.

Lane Co’s extends prenatal to women ineligible for OHP due to immigration status

Following six other counties, Lane County is implementing Oregon’s Prenatal Expansion Program to provide Oregon Health Plan (OHP) Plus Prenatal services to pregnant women who have “Citizen / Alien Waived Emergency Medical” (CAWEM) coverage.

Expansion of CAWEM coverage to include prenatal care is made possible through the federal Children’s Health Insurance Program (CHIP) that allows States to serve the unborn children of women who would be Medicaid-eligible except for immigration status. Oregonians access Medicaid through OHP.

The CAWEM Plus prenatal benefits are the same as OHP Plus with four exceptions: sterilizations, therapeutic abortions, hospice care services and death with dignity services. Maternity coverage ends at delivery, unless postpartum services are provided through a bundled (packaged) rate. The newborn will be enrolled in OHP Plus for one year of automatic eligibility.

Providers accepting OHP can now serve CAWEM Plus clients. For more information, see the Provider Alert Sheet (includes Spanish-language description) and Quick Facts. Clients can enroll at any Department of Human Services site.

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Project Aims to Improve OR Hospital-Based Breastfeeding Services

With funding support from Oregon WIC and Multnomah County Health Department, the Breastfeeding Coalition of Oregon (BCO) recently launched a new statewide project – Oregon Hospitals Partnering for Evidence-Based Infant Nutrition. This project supports hospitals in developing the evidence-based systems associated with increased rates of breastfeeding.  The project aims to promote evidence-based hospital maternity practices related to breastfeeding by offering technical assistance, convening a spring 2011 hospital summit, and supporting the formation of a hospital collaborative learning community.

Lane County’s Desiree Nelson joins the project’s four-member team:  BCO Director Amelia Psmythe, Helen Bellanca, MD, MPH, Rachel Burdon, RN, MPH, and Mary Lou Hennrich, RN and Executive Director of Oregon Public Health Institute (OPHI).  Oregon WIC allocated federal funds for increasing breastfeeding rates through outreach to hospitals. Locally, Nelson is well known for co-founding Baby Connection, a phenomenally successful live demonstration of Baby Friendly step 10:

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Arriving early and leaving well after closing time, families and babies consistently demonstrate the very real but unmet demand for weekly, drop-in evidence-based lactation support in the weeks and months following birth.

Key Backers

The BCO’s parent organization, the Oregon Public Health Institute recently formed an innovative working group for health insurers – the Oregon Health Insurers Partnering for Prevention (OHIPP). The first of its kind in the nation, OHIPP is a collaborative obesity prevention effort between health plans and public health policy advocates.

Currently, six health insurers participate in OHIPP – representing 65% of private insurance and 45% of Medicaid. Insurers contribute money to fund selected interventions. Because breastfeeding is increasingly associated with reduced risk of childhood obesity, OHIPP has selected increasing breastfeeding rates as its first collaborative public health intervention.

OHIPP’s direction could have a huge impact on breastfeeding practices in Oregon. Imagine, for example, the impact of a reimbursement system in which rates for births were higher for hospitals certified as evidence based by the Baby Friendly Hospital Initiative. This type of innovative intervention conveys the importance of becoming evidence based and signals growing understanding that evidence-based care is preventive and effective in the long run.  In this scenario, hospitals would be incentivized to seek support and resources like those the BCO is offering through this project.

Additional critical support for evidence-based breastfeeding services comes from the Oregon Association of Hospitals and Health Systems (OAHHS). A recent OAHHS membership survey indicates 85% of nurse managers are aware of the gold standard for evidence-based breastfeeding support systems – the Baby Friendly Hospital Initiative. 39% want technical assistance and support on Baby-Friendly 10 Steps. Plans are underway for OAHHS to partner with the BCO to co-brand educational opportunities and communicate the importance of evidence-based breastfeeding support to its membership.

Hospital Outreach

The Oregon Hospitals Partnering for Evidence-Based Infant Nutrition project is in the initial outreach phase to hospitals and health system leaders. Interested hospitals are encouraged to begin forming multi-disciplinary teams for the purpose of assessing current internal practice. Representatives from these teams will be invited to participate in a Spring 2011 summit for a day of education, group facilitation and collaboration. Participants will be encouraged to form an ongoing network of communication between their facilities, to support the path toward institutional change.  Interested hospitals should contact Amelia@breastfeedingOR.org or Desiree@breastfeedingOR.org for more information.

Lane County’s PeaceHealth Nurse Midwifery Birth Center is one of four Baby Friendly Hosptial Initiative-designated facilities in Oregon. Community and consumer support for moving the birth center from downtown Eugene to the new Sacred Heart Medical Center campus in Springfield were centrally linked to the unwavering demand for ongoing access to evidence-based breastfeeding services. Judging by the outcomes and immense demand for these services, making them available at the county’s two leading hospitals, Sacred Heart Medical Center (SHMC) and McKenzie-Willamette Medical Center would be a tremendous boon for families and communities.

Next week, Lane County Friends of the Birth Center will release results from a recent survey taken by more than 100 local women and families describing their experiences evidence-based breastfeeding services at the PeaceHealth Nurse Midwifery Birth Center. Demonstrating the connection between evidence-based services and consumer satisfaction, LaneCoFBC intends the survey to encourage all Lane County hospitals to achieve the Baby Friendly designation. For a copy of the survey, email lanecofbc@gmail.com. (Click here to access the survey.)

Progress already

Locally, there is positive discussion of SHMC RiverBend Labor and Delivery staff’s recent innovative and successful introduction of uninterrupted skin-to-skin contact immediately following birth. Providing skin-to-skin as standard care is a very positive development because it is bedrock practice for developing evidence-based breastfeeding services. Babies placed skin-to-skin with their mother are more likely to be breastfed and to breastfeed for longer.

Having SHMC Labor and Delivery staff describe how front-line practices and internal systems have been altered to bring more evidence-based care to the floor is an example of useful information that could be shared at the upcoming Spring 2011 summit hosted by the Oregon Hospitals Partnering for Evidence-Based Infant Nutrition project. Attending health professionals would return to their respective hospitals with a concrete, doable action for improving mother-baby breastfeeding outcomes.

Writing on the wall

Discussion of evidence-based breastfeeding care is a roundabout way of saying hospitals should identify ways to understand and implement Baby-Friendly practices. Savvy hospitals understand consumers, legislators, government agencies, the business community and accreditation bodies have connected hospital-based breastfeeding practices with the success mothers and babies have in the months following discharge.

Perusal of the following links demonstrates a trend toward adoption of Baby Friendly language for discussions of evidence-based care. They also demonstrate large-scale convergence around breastfeeding as a top-ranking major objective in health care.

  • The Joint Commission’s new perinatal care core measure set includes exclusive breast milk feeding

The question hospitals must answer about breastfeeding services is no long whether or not to become evidence based but (1) how to do it and (2) how to demonstrate that it is being done. Because Baby-Friendly is the established and universal standard for effective breastfeeding care, pursuing and maintaining this designation answers both questions in the most expedient manner. The project’s greatest potential value to hospitals lies in the efficiencies it can generate through developing models of collaboration for identifying and removing barriers to reform. The potential for idea sharing and cost sharing for staff training and education increases significantly with each hospital’s commitment to participate.

To learn more, contact Amelia@breastfeedingOR.org or Desiree@breastfeedingOR.org for more information.

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