10 Steps to Successful Breast- feeding. Hospitals must meet these 10 steps to earn the Baby-Friendly designation, plus neither accept nor offer free infant formula or advertisement products.
• Have a written breast-feeding policy that is routinely communicated to all health care staff.
• Train all health care staff in skills to carry out this policy.
• Inform all pregnant women about the benefits and of breast-feeding and how staff will help.
• Help mothers initiate breast-feeding within one hour of birth.
• Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infants.
• Give breast-fed newborns no food or drink other than breast milk, unless medically indicated.
• Allow mothers and infants to remain together 24 hours a day.
• Encourage breast-feeding on demand.
• Give no pacifiers or artificial nipples to breast-feeding infants.
• Foster breast-feeding support groups and refer mothers
Strengths
Documentation of mothers' feeding decisions • Staff at 98 percent of facilities in Missouri and 99 percent in Illinois consistently ask and record mothers' feeding decisions.
Availability of prenatal breast-feeding instruction • Staff at 98 percent of facilities in Missouri and 96 percent in Illinois include breast-feeding education as a routine element of prenatal classes.
Needed improvements
Appropriate use of breast-feeding supplements • 21 percent of facilities in Missouri and 11 percent in Illinois adhere to standard clinical practice guidelines against routine supplementation with formula, glucose water or water.
Inclusion of model breast-feeding policy elements • 16 percent of facilities in Missouri and 11 percent in Illinois have comprehensive breast-feeding policies including all
HANNIBAL, MO. • At a small hospital here, newborn babies and mothers are cared for differently than at any hospital in Missouri. In fact, the changes Hannibal Regional Hospital made to help moms breast-feed set it apart from most nationwide.
Newborns go straight to mom's arms instead of heading to a warming table to be weighed, pricked, dressed and bundled. The nursery mostly sits empty. Pacifiers are scarce. The hospital doesn't hand out free formula or formula-company diaper bags to parents when they leave the hospital.
Those are a few of the 10 steps the hospital met to be designated a Baby Friendly Hospital, one of just 100 in the United States.
Meeting the 10 steps required changing many routine practices, some of which the staff feared moms wouldn't like. A few nurses even quit. But since earning the designation a year ago, the hospital has seen its breast-feeding rates rise to 77 percent from 62 percent, and moms have noted the change.
Lissa Biggs, 30, said she left the hospital with her second child feeling much more confident than she did with her first. "I really learned a lot by having her in the room," she said. "I was able to pick up on her cues and know a lot more about her. It was very different and very beneficial."
One of the steps requires that over 80 percent of moms keep their babies in their hospital rooms 23 hours a day. To do that, doctors stopped gathering babies in the nursery for their rounds. Everything from hearing tests, to baths to baby pictures are done in the mother's room. To ensure that moms get enough rest, the hospital initiated a family nap time in the afternoon.
The Baby-Friendly Hospital Initiative is a global program sponsored by the World Health Organization and the United Nations Children's Fund — UNICEF — to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The international health organization used the latest research to develop the 10 steps and specifically geared them for the U.S.
The initiative has been under way in the U.S. since 1997, but it's gaining attention as more mothers want to breast-feed yet lack a good start.
Hospital practices and policies that interfere with breast-feeding success are common, according to a Breastfeeding Report Card released last month by the Centers for Disease Control and Prevention.
The report found three of every four new mothers in the U.S. started out breast-feeding in 2007, meeting the national goal for the first time. But while initiation rates have risen steadily, the number of babies who continue to breast-feed remains low. The report emphasizes the critical role that hospitals play in improving duration rates.
"High initiation rates tell us that a lot of moms plan to breast-feed, but these rates do not indicate that a birth facility is doing what it needs to support them in their effort," said Carol MacGowan, public health adviser for CDC's Division of Nutrition, Physical Activity and Obesity. "... The care that mothers receive from hospitals should always be based on practices that are proven to help them continue breast-feeding as they go home."
Less than 4 percent of babies are born at facilities designated as baby-friendly, the report found. Two hospitals in Illinois have earned the designation: St. John's Hospital in Springfield and Pekin Hospital.
Hospitals also fared poorly on a national survey administered by the CDC in 2007 that measured breast-feeding-related maternity care practices. The average score for facilities nationwide was 65 out of 100; just New Hampshire and Rhode Island scored above 80. Missouri scored 64, while Illinois scored 63.
Evaluating hospitals
To be designated as baby-friendly, facilities undergo an extensive evaluation involving surveys, a site visit and dozens of interviews with staff and families.
Hannibal Regional began working to earn the designation in the summer of 2006. Dr. Sandra Ahlum, an obstetrician at the hospital, had heard Dr. Bobbi Phillip from Boston Medical Center speak about becoming baby-friendly. It was a challenge for Phillip's busy inner-city medical center that serves a large indigent population. But Phillip said, "If I can do this at my hospital with my population, you can do it anywhere."
Ahlum was inspired. Hannibal mainly serves the rural counties of Lewis, Shelby, Marion, Monroe, Ralls and Pike. Patients tend to be less educated and poor. Over 55 percent of patients are on Medicaid. 'Unlearn what we've been doing'. Ahlum and the hospital's lactation consultant, Diane Bibb, formed a task force of nurses, obstetricians, pediatricians and administrators. They began educating staff about the 10 steps and the research behind them. "We had to unlearn what we had been doing and what we thought was the best thing," Bibb said. "That was the biggest challenge." Many were apprehensive at first.
The designation requires at least 80 percent of moms, even those who want to bottle feed or had a cesarean section, to have skin-to-skin contact with their babies immediately after birth. Breast-feeding moms must maintain contact for an hour, or until their baby nurses.
Previously, babies were first dressed in a T-shirt, hat and wrapped in two blankets, said Annette Hendricks, who has worked as a labor and delivery nurse for 25 years. "We just knew that baby would get cold." Nurses also feared moms would object.
But what they are finding is that babies' temperatures are more stable, which in turn keeps their blood sugar levels in check, Hendricks said. Babies are calmer. They are better able to nurse. For moms, it's more gratifying.
"Having the baby placed on your chest was surreal. It was amazing," said Stacey Bibb, 32, who gave birth at the hospital five months ago. "That was a great moment, like crossing the finish line kind of."
Unless medically necessary, moms must "exclusively" breast-feed — no supplementing with formula, glucose water or water, which occurs in nearly 80 percent of Missouri hospitals and makes infants more likely to receive formula at home and stop breast-feeding. Supplementing is often seen as a quick fix for a crying baby or a way to stabilize dropping blood sugar levels, Bibb explained.
"A few drops of colostrum is all the baby needs," Bibb said of the nutrient-dense early breast milk. "If the baby has trouble latching on, we can just use a dropper" of pumped milk.
Not using pacifiers except when medically necessary was also a challenge. The use of pacifiers in the first two weeks of life is associated with fewer and shorter feedings, yet most hospitals in Missouri and Illinois offer them to breast-feeding infants, according to the CDC survey.
To prevent the temptation to use a pacifier to quiet a crying baby, the nursing unit manager at Hannibal kept them in her car, Ahlum said.
All doctors and nurses at Hannibal completed a three-day training on breast-feeding, to ensure that moms receive consistent messages. When moms leave the hospital, they are given a number they can call any time with questions. The hospital hosts support groups twice a week.
"I think we are seeing significant increases in breast-feeding duration," said Dr. Bryson McHardy, a pediatrician who cares for babies delivered at Hannibal. "We have no hard and fast statistics, but I'm seeing a lot more moms at 4 months and 6 months sticking with breast-feeding."
Area hospitals adapt
St. Louis area hospitals say educating moms and staff about the benefits of the changes is the biggest challenge to becoming baby-friendly. To earn the designation, hospitals must pay for their own infant formula and not accept any advertising products such as diaper bags or pens. Distributing samples of formula has been shown to decrease breast-feeding, especially among first-time, less-educated moms.
St. John's Mercy Medical Center delivers 8,000 babies a year compared to Hannibal's 700 — by far the most babies in the St. Louis area. Maureen Swingle, nurse manager for the postpartum unit, said the hospital formed a task force to address the Baby-Friendly Initiative and is in the process of reviewing and adopting new policies.
Nurses are already promoting skin-to-skin contact and rooming in, she said. More certified lactation consultants have been added, and all postpartum and nursery staff will be scheduled to complete 18 hours of breast-feeding training.
Missouri Baptist Hospital in Creve Coeur, which delivers the second highest number of babies at 4,000 a year, reports having largely met the 10 steps and boasts an 88 percent initiation rate for breast-feeding.
To encourage hospitals across the state to improve, the Missouri Department of Health and Senior Services is working on a Show Me 5 Steps campaign. Bibb said several county health departments, including Cole County's, have asked her to speak about how to help local hospitals make changes.
Melinda Ridenhour, Cole County's nutrition services director, said that county's breast-feeding coalition recognizes that 75 percent of women are choosing to breast-feed, yet six months later, many are no longer nursing.
"It's clear that most are aware that breast-feeding is healthiest for baby. However, 40 percent of these women are not reaching their goals," Ridenhour said. "We recognize that maternity care practices need to change ... to support breast-feeding success."
Documentation of mothers' feeding decisions • Staff at 98 percent of facilities in Missouri and 99 percent in Illinois consistently ask and record mothers' feeding decisions.
Availability of prenatal breast-feeding instruction • Staff at 98 percent of facilities in Missouri and 96 percent in Illinois include breast-feeding education as a routine element of prenatal classes.
Needed improvements
Appropriate use of breast-feeding supplements • 21 percent of facilities in Missouri and 11 percent in Illinois adhere to standard clinical practice guidelines against routine supplementation with formula, glucose water or water.
Inclusion of model breast-feeding policy elements • 16 percent of facilities in Missouri and 11 percent in Illinois have comprehensive breast-feeding policies including all
HANNIBAL, MO. • At a small hospital here, newborn babies and mothers are cared for differently than at any hospital in Missouri. In fact, the changes Hannibal Regional Hospital made to help moms breast-feed set it apart from most nationwide.
Newborns go straight to mom's arms instead of heading to a warming table to be weighed, pricked, dressed and bundled. The nursery mostly sits empty. Pacifiers are scarce. The hospital doesn't hand out free formula or formula-company diaper bags to parents when they leave the hospital.
Those are a few of the 10 steps the hospital met to be designated a Baby Friendly Hospital, one of just 100 in the United States.
Meeting the 10 steps required changing many routine practices, some of which the staff feared moms wouldn't like. A few nurses even quit. But since earning the designation a year ago, the hospital has seen its breast-feeding rates rise to 77 percent from 62 percent, and moms have noted the change.
Lissa Biggs, 30, said she left the hospital with her second child feeling much more confident than she did with her first. "I really learned a lot by having her in the room," she said. "I was able to pick up on her cues and know a lot more about her. It was very different and very beneficial."
One of the steps requires that over 80 percent of moms keep their babies in their hospital rooms 23 hours a day. To do that, doctors stopped gathering babies in the nursery for their rounds. Everything from hearing tests, to baths to baby pictures are done in the mother's room. To ensure that moms get enough rest, the hospital initiated a family nap time in the afternoon.
The Baby-Friendly Hospital Initiative is a global program sponsored by the World Health Organization and the United Nations Children's Fund — UNICEF — to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The international health organization used the latest research to develop the 10 steps and specifically geared them for the U.S.
The initiative has been under way in the U.S. since 1997, but it's gaining attention as more mothers want to breast-feed yet lack a good start.
Hospital practices and policies that interfere with breast-feeding success are common, according to a Breastfeeding Report Card released last month by the Centers for Disease Control and Prevention.
The report found three of every four new mothers in the U.S. started out breast-feeding in 2007, meeting the national goal for the first time. But while initiation rates have risen steadily, the number of babies who continue to breast-feed remains low. The report emphasizes the critical role that hospitals play in improving duration rates.
"High initiation rates tell us that a lot of moms plan to breast-feed, but these rates do not indicate that a birth facility is doing what it needs to support them in their effort," said Carol MacGowan, public health adviser for CDC's Division of Nutrition, Physical Activity and Obesity. "... The care that mothers receive from hospitals should always be based on practices that are proven to help them continue breast-feeding as they go home."
Less than 4 percent of babies are born at facilities designated as baby-friendly, the report found. Two hospitals in Illinois have earned the designation: St. John's Hospital in Springfield and Pekin Hospital.
Hospitals also fared poorly on a national survey administered by the CDC in 2007 that measured breast-feeding-related maternity care practices. The average score for facilities nationwide was 65 out of 100; just New Hampshire and Rhode Island scored above 80. Missouri scored 64, while Illinois scored 63.
Evaluating hospitals
To be designated as baby-friendly, facilities undergo an extensive evaluation involving surveys, a site visit and dozens of interviews with staff and families.
Hannibal Regional began working to earn the designation in the summer of 2006. Dr. Sandra Ahlum, an obstetrician at the hospital, had heard Dr. Bobbi Phillip from Boston Medical Center speak about becoming baby-friendly. It was a challenge for Phillip's busy inner-city medical center that serves a large indigent population. But Phillip said, "If I can do this at my hospital with my population, you can do it anywhere."
Ahlum was inspired. Hannibal mainly serves the rural counties of Lewis, Shelby, Marion, Monroe, Ralls and Pike. Patients tend to be less educated and poor. Over 55 percent of patients are on Medicaid. 'Unlearn what we've been doing'. Ahlum and the hospital's lactation consultant, Diane Bibb, formed a task force of nurses, obstetricians, pediatricians and administrators. They began educating staff about the 10 steps and the research behind them. "We had to unlearn what we had been doing and what we thought was the best thing," Bibb said. "That was the biggest challenge." Many were apprehensive at first.
The designation requires at least 80 percent of moms, even those who want to bottle feed or had a cesarean section, to have skin-to-skin contact with their babies immediately after birth. Breast-feeding moms must maintain contact for an hour, or until their baby nurses.
Previously, babies were first dressed in a T-shirt, hat and wrapped in two blankets, said Annette Hendricks, who has worked as a labor and delivery nurse for 25 years. "We just knew that baby would get cold." Nurses also feared moms would object.
But what they are finding is that babies' temperatures are more stable, which in turn keeps their blood sugar levels in check, Hendricks said. Babies are calmer. They are better able to nurse. For moms, it's more gratifying.
"Having the baby placed on your chest was surreal. It was amazing," said Stacey Bibb, 32, who gave birth at the hospital five months ago. "That was a great moment, like crossing the finish line kind of."
Unless medically necessary, moms must "exclusively" breast-feed — no supplementing with formula, glucose water or water, which occurs in nearly 80 percent of Missouri hospitals and makes infants more likely to receive formula at home and stop breast-feeding. Supplementing is often seen as a quick fix for a crying baby or a way to stabilize dropping blood sugar levels, Bibb explained.
"A few drops of colostrum is all the baby needs," Bibb said of the nutrient-dense early breast milk. "If the baby has trouble latching on, we can just use a dropper" of pumped milk.
Not using pacifiers except when medically necessary was also a challenge. The use of pacifiers in the first two weeks of life is associated with fewer and shorter feedings, yet most hospitals in Missouri and Illinois offer them to breast-feeding infants, according to the CDC survey.
To prevent the temptation to use a pacifier to quiet a crying baby, the nursing unit manager at Hannibal kept them in her car, Ahlum said.
All doctors and nurses at Hannibal completed a three-day training on breast-feeding, to ensure that moms receive consistent messages. When moms leave the hospital, they are given a number they can call any time with questions. The hospital hosts support groups twice a week.
"I think we are seeing significant increases in breast-feeding duration," said Dr. Bryson McHardy, a pediatrician who cares for babies delivered at Hannibal. "We have no hard and fast statistics, but I'm seeing a lot more moms at 4 months and 6 months sticking with breast-feeding."
Area hospitals adapt
St. Louis area hospitals say educating moms and staff about the benefits of the changes is the biggest challenge to becoming baby-friendly. To earn the designation, hospitals must pay for their own infant formula and not accept any advertising products such as diaper bags or pens. Distributing samples of formula has been shown to decrease breast-feeding, especially among first-time, less-educated moms.
St. John's Mercy Medical Center delivers 8,000 babies a year compared to Hannibal's 700 — by far the most babies in the St. Louis area. Maureen Swingle, nurse manager for the postpartum unit, said the hospital formed a task force to address the Baby-Friendly Initiative and is in the process of reviewing and adopting new policies.
Nurses are already promoting skin-to-skin contact and rooming in, she said. More certified lactation consultants have been added, and all postpartum and nursery staff will be scheduled to complete 18 hours of breast-feeding training.
Missouri Baptist Hospital in Creve Coeur, which delivers the second highest number of babies at 4,000 a year, reports having largely met the 10 steps and boasts an 88 percent initiation rate for breast-feeding.
To encourage hospitals across the state to improve, the Missouri Department of Health and Senior Services is working on a Show Me 5 Steps campaign. Bibb said several county health departments, including Cole County's, have asked her to speak about how to help local hospitals make changes.
Melinda Ridenhour, Cole County's nutrition services director, said that county's breast-feeding coalition recognizes that 75 percent of women are choosing to breast-feed, yet six months later, many are no longer nursing.
"It's clear that most are aware that breast-feeding is healthiest for baby. However, 40 percent of these women are not reaching their goals," Ridenhour said. "We recognize that maternity care practices need to change ... to support breast-feeding success."
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