The announcement came late last week. After over two years of planning, policy changes, repeated audits, and a two day site visit by Baby-Friendly surveyors in January, we are finally a certified Baby-Friendly USA site!
We are one of two in Kentucky (St. Elizabeth’s Medical Center in Edgewood, Ky., is the only other site in the state). We are the 268th facility to be designated in the United States, covering 46 states.
This journey began in 2012, with a core team of physicians, our director, the Birthing Center manager, lactation specialists both from our facility and from the Lexington-Fayette County Health Department, hospital nurses, the childbirth educator, and a volunteer mother who had given birth at our facility. Over time our group grew to include more lactation specialists and nurses representing our clinics. Each of us had important roles in making the changes necessary for this designation.
Baby-Friendly requires that institutions follow the 10 Steps to Successful Breastfeeding:
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breast-milk, unless medically indicated.
7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
As you can see from this list, there are many areas to consider when implementing such a change in practice. We had already begun kangaroo care, also called skin-to-skin, immediately after vaginal deliveries. We were also practicing Rooming In, or keeping the baby with their mother as much as possible. But we still took babies to the nursery for physicals and procedures such as weights and blood tests. Our pediatricians had to complete training and change how they evaluated infants; this process took several trials and continual reworking of our routine.
We also began trialing skin-to-skin in the operating room when feasible. This required careful planning, especially in order to keep a sterile field for surgery, and extra staff so that mom and baby each had a nurse.
Our hospital nursing staff had to complete 20 hours of extra training, which included time with a lactation specialist and training on hand expression. Nurses had to learn how to finger and syringe feed infants, and be especially vigilant in assisting moms not to give up and change to formula feeding when they encountered difficulties. It took our problem solving to a whole new level. This resulted in sending more of our night shift nurses for training to become lactation specialists so we had more assistance available for moms at night.
We had to create fliers to explain why we did not encourage the use of pacifiers in those first few weeks as breastfeeding is established, due to it confusing effect for infants.
Teaching our staff to help moms look for cues, not to the clock for when to feed baby was another hurdle. Learning to tell moms to feed eight to 12 times in 24 hours, not every three hours, was part of this step, and included infants who were formula fed.
Women must also be provided with information on support for breastfeeding after discharge, which we accomplished through our Mommy and Me Clinic, and support group information from the Lexington-Fayette County Health Department.
Another hurdle in our journey was providing all pregnant women with information on the benefits and management of breastfeeding. As childbirth education coordinator, I was responsible for creating the educational materials used, and providing training for the clinic staff. Eventually our clinic nurses completed the same training as our hospital staff, and this made an obvious improvement in their ability to answer questions and encourage breastfeeding.
Our OB physicians also had to complete training, as well as our residents. More importantly, they had to recognize the essential part they play in encouraging a woman to choose breastfeeding as the optimal feeding method. This encouragement can’t take place just once during pregnancy, but is an ongoing conversation, that includes information on the benefits of breastfeeding, the importance of breastfeeding exclusivity and the risk of supplements, and the importance of immediate skin to skin contact and rooming in. By addressing these areas at specific times during pregnancy, physicians and nurses are able to consistently provide the information to every patient.
The mom on our committee had breastfed successfully, but did not feel she had received much education prenatally to encourage her. Our first audits revealed that only 8 percent of our patients received education on the benefits and management of breastfeeding. We had nowhere to go but up. But up we went, and by our site visit in January, more than 80 percent of our prenatal patients could verbalize the education they had received!
Not all of our changes have been met with enthusiasm. Some repeat moms, when our rooming in policy is explained, complain that they have several small children at home and had planned to send the baby to the nursery so they could rest after delivery.
Having had three children under the age of 4 myself, I fully understand this position. But this time is for bonding with this baby, and will be important in establishing mom’s milk supply. Napping when baby naps also helps mom rest, an advantage during hospitalization that won’t be possible at home.
I have had some questions about our changes, and would like to dispel some concerns: We do still have formula at our hospital; you don’t have to bring your own. We will encourage you not to give your baby supplemental formula unless medically indicated, and will assist you in feeding your baby without an artificial nipple if possible. We will not throw away a pacifier you bring from home, or buy in our gift shop.
Recently I saw the mom from our committee, and she shared with me the great news that she is expecting again. She had been for her screening visit, and reported that the nurse who screened her asked if she planned to breastfeed, and explained the benefits to her, while giving her written materials. She then went for her new obstetrical visit, and the resident she saw also asked if she planned to breast feed, and provided education. She noticed the posters, flip charts, and available apps on breastfeeding she saw displayed throughout the clinic. She also remarked on a message I had written on the dry-erase board:“Your nurse is specially trained to answer your questions on breastfeeding”. “It’s so different from my first pregnancy,” she said.
It is different. It is a culture change we are proud of, and worked hard for. We are committed to helping babies get the best possible start, while providing moms and families with all the support they need.
Soon another sign will go up at the hospital and clinics: We are Baby-Friendly USA! It has meant many changes, but in the end, team work by many made this possible, and I’m proud to have been a part of it.