Breastfeeding: Strengthening Health Systems

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Breastfeeding: Strengthening Health Systems

The role of hospitals and physicians in breastfeeding

To help get a baby breastfeeding, you don’t need a researcher, an epidemiologist or even an economist. What you need is a mom, a baby and the right person, in the right place at the right time, with the right knowledge and right mindset to help them. You just need a doctor, a nurse or some other member of a health-care team to provide the support it takes to start.”—Todd Wolynn, M.D., 2011

Baby-Friendly Hospitals. In 1991, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) created the Baby-Friendly Hospital Initiative (BFHI). This initiative was an effort to support and recognize hospitals and birthing centers that offer exceptional care for infant feeding and mother/baby bonding. The BFHI recognizes and awards facilities who successfully implement the Ten Steps to Successful Breastfeeding  and the International Code of Marketing of Breast Milk Substitutes. It also provides hospitals with the tools to educate mothers through building skills for them to initiate and continue breastfeeding successfully. Currently 289 hospitals and 47 birthing centers in the United States are designated Baby-Friendly.

In order for a hospital to become Baby-Friendly, it must undergo a thorough assessment that will include challenging and, to some extent, modifying current policies and procedures for the benefit of the mother and baby. For this endeavor to be successful, leadership buy-in is essential, and all staff (inclusive of physicians, nurses and other health-care workers) must be trained accordingly. This detailed process will not only create a more cohesive staff, but it will also motivate and encourage the staff to provide best practice standards of breastfeeding necessary to improve health outcomes of mother and baby. The monetary cost of becoming a Baby-Friendly hospital is about $16,000, including registration and accreditation. Data suggests that the long-term health benefits for both mom and baby far exceed this cost.

In a recent interview, Paula Schreck, M.D., breastfeeding coordinator for St. John Providence Hospital in Detroit, which is also a Baby Friendly hospital, talked with us about the peculiar state of breastfeeding in this country and the role of physicians and hospitals in supporting moms who want to breastfeed.

National Medical Association: Why aren’t more women breastfeeding?

Dr. Paula Schreck: There are several barriers to breastfeeding in our society. The No. 1 barrier is lack of education and awareness about breastfeeding. Marketing and advertising promote formula feeding as equivalent—simply a matter of choice, not health. Because of workplaces that do not support breastfeeding and short maternity leave laws, women often view breastfeeding as something that will not fit into their lifestyle. Although the Affordable Care Act supports breastfeeding, mothers are still unaware of the specifics and are unable to advocate for themselves. Other barriers include demographic and cultural barriers, inclusive of lack of generational support. In some regions of the country, there is also an assumption that African Americans don’t breastfeed, which contributes to wide disparities.

NMA: What do we as a society need to do to encourage breastfeeding among new mothers?

Dr. Schreck: As a society, we need to support women who are breastfeeding in public; there is something beautiful, natural and normal about a woman feeding her infant. We also need to make sure we support our sisters, wives, daughters and friends in their choice.
NMA: How does a clinician talk to patients about breastfeeding?

Dr. Schreck: The prenatal experience should include meaningful breastfeeding discussions. While I understand that doctors don’t want to make mothers feel guilty about their personal choices, they should still be willing to take the discussion to the next level. Because this is a public health crisis, the approach should come from a public health perspective, where the physician should provide mothers with information about how breastfeeding will be beneficial to both mother and child. Breastfeeding decreases the incidence of pneumonia, otitis media, SIDS and gastrointestinal disease in the infant. The benefits follow the infant to childhood, with a decrease in obesity, high blood pressure and diabetes. Breastfeeding decreases the incidence of ovarian and breast cancer in the mother, also.
NMA: What components of prenatal education will enable more women to breastfeed?

Dr. Schreck: The education should outline benefits of breastfeeding and acknowledge challenges of first-time mothers. Be open to questions. Know where to find the answers. While breastfeeding may not feel like the obvious choice for every mother, breastfeeding is the perfect choice for every baby. Physicians should consider infants as patients by putting themselves in the baby’s shoes.

NMA: What barriers do hospitals face when embarking upon a Baby-Friendly Hospital Initiative?

Dr. Schreck: Sometimes hospital administrations feel like a breastfeeding initiative doesn’t fit their maternal demographic, but, remember, breastfeeding fits every baby demographic. Baby-Friendly is an international designation, and has worked to decrease infant mortality and improve breastfeeding outcomes in every corner of the world. Hospitals have been receiving formula for free from the formula companies for over 20 years. Baby-Friendly requires that hospitals purchase the formula they use at a fair market value. This financial commitment, despite being consistent with their corporate compliance policies that prohibit gifts, is a bitter pill to swallow in today’s health economy. Actually, the literature suggests that investing in a Baby-Friendly Initiative is cost neutral, with payback in the form of population health. Finally, hospitals feel that a breastfeeding initiative is too narrow of an initiative. However, Baby-Friendly actually benefits all babies, even those whose mothers have chosen to formula feed, with the promotion of evidence-based hospital practices that decrease infant stress and improve outcomes.

So, the next time you are with a mother who is breastfeeding, whether it be on the bus, or in your living room, give her a thumbs up for her efforts and her choices.

Tamara A. Henry, Ed.D.