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Hospitals upend old rules for breastfeeding

DETROIT ― Voletta Bonner knew the benefits of breast-feeding long before baby Riley came along.

But after a rocky start for mom ― an emergency C-section and a fever ― nurses at St. John Hospital and Medical Center in Detroit persuaded her not to give up on the sometimes-difficult process of breast-feeding a newborn.

“I was nervous. I wanted to make sure everything was OK,” said Bonner, a 29-year-old high school teacher from Highland Park, Michigan.

Too few hospitals are doing enough, according to a report by the U.S. Centers for Disease Control and Prevention. Just one in 20, in fact, fully supports breast-feeding parents, it says.
Voletta Bonner of the U.S. with her 2-month-old Riley Johnson on Aug. 4. Voletta had decided before his birth to breast-feed. (MCT)
Voletta Bonner of the U.S. with her 2-month-old Riley Johnson on Aug. 4. Voletta had decided before his birth to breast-feed. (MCT)

And the research is clear: Mom’s milk best fortifies babies in a world filled with disease.

With every month of breast milk, a baby’s odds of becoming overweight drop 4 percent, according to one study. Plummeting, too, are chances of infections, respiratory problems, diabetes and sudden infant death syndrome (SIDS), as well as a mother’s odds of getting breast and ovarian cancer.

“It’s the first, best preventive medicine,” said Dr. Paula Schreck, a pediatrician at St. John.

That growing body of research also is challenging long-held routines at U.S. hospitals, said Liz Westwater, a program manager at the Baby-Friendly Hospital Initiative, a program created by the World Health Organization and UNICEF. The program assesses hospitals’ commitments to mothers who want to breast-feed through a rigorous checklist.

The hospitals can’t give formula to breast-feeding babies unless medically necessary. They don’t offer pacifiers to breast-feeding babies. Nor can they accept free baby formula from companies, a popular practice now considered an impediment to creating a strong breast-feeding bond between mother and child.

Those items are available, but mothers have to ask, said Missy Knudsen, nurse coordinator and lactation consultant leading the effort at Beaumont Health Systems, which delivered 9,082 babies last year.

“We explored: ‘Is this ethically appropriate to accept free formula and distribute to breast-feeding moms?’ We decided ... it’s not.”

Beaumont, in fact, is among the most progressive of Michigan hospitals when it comes to promoting breast-feeding.

Officials with Baby Friendly USA are scheduled to tour the Beaumont facilities in September and October. If its three hospitals ― in Royal Oak, Troy and Grosse Pointe ― pass inspection, Beaumont will join fewer than 5 percent of hospitals nationally to have the designation, Westwater said.

St. John also has begun the process toward the designation. The system is using a $1.2-million grant from the W.K. Kellogg Foundation to hire more staff to establish outpatient services and coordinate support groups focused on supporting nursing mothers.

The grant will help cover expenses as St. John begins buying formula, and it will help pay for training for nurses, lactation consultants and administrative staff.

The designation means upending long-held routines such as separating baby and mom just after birth to take measurements and apply medicines, said Schreck, the St. John pediatrician leading the effort.

Those first moments of life are when a baby is most awake and eager to explore and nurse, Schreck said. “We’re trying to delay practices that could be stressful ... to after (the first) feeding.”

Those who have been fighting for years for better support for mothers say research has helped them turn a corner in the past few years.

The U.S. Surgeon General made breast-feeding a priority earlier this year. IRS rules and federal laws changed to support breast-feeding mothers. And the CDC now closely tracks breast-feeding rates and health care practices that encourage breast-feeding.

In Michigan last year, billboards began proclaiming the benefits to mom: Sharing calories with baby will help her return to her pre-baby body.

“I feel like we’ve been pushing this rock up the hill forever ... but now we’re finally getting to the top,” said Julie Lothamer, who leads the Michigan Department of Community Health’s efforts to get more mothers to nurse.

But a “change in culture” hasn’t been easy, said Diana Derige, a program officer at Kellogg.

“You hear it often: ‘Let the mother get some rest,’” she said. “But what about the time to learn about her newborn when they have the support around them versus handing the baby to Mom as she leaves the hospital and saying ‘Good luck’?”

It isn’t cheap, either. Hospitals must commit to hiring lactation consultants and retraining staff.

“Hospitals look at it, but the struggle is finding the money for staff education to bring staff up to a skill level,” said Alice Christensen, a longtime nurse and lactation consultant at St. Mary’s Health Care in Grand Rapids, Mich.

Plus, hospitals are reluctant to tackle visiting hours, a hallmark of customer service, even though a line of excited guests in the room of exhausted parents interferes with the time needed to breast-feed.

“It’s an exciting time, and (loved ones) would like to share that,” Christensen said. But “keeping visitors at bay until mom and baby can have that skin-to-skin contact ... can be a challenge.”

In addition to the cost and challenges to existing routines, hospitals also must be careful that in their zeal to promote breast-feeding, they’re not bullying those who choose formula, said Knudsen, the nurse coordinator and lactation consultant leading Beaumont’s effort.

About 15 percent of new mothers at Beaumont opt for a bottle for a number of reasons ― job and time constraints, a feeling of awkwardness, or even a medical condition, she said. “There’s a big difference between support and coercion.”

By Robin Erb

(Detroit Free Press)

(MCT Information Services)