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Advocates, hospitals unite to raise breastfeeding rate

7/15/2014

By DAVE RANNEY

By DAVE RANNEY

KHI News Service

TOPEKA -- Across Kansas, breastfeeding advocates are encouraging hospitals to revamp how they handle moms, babies and visitors after childbirth.

Dozens of studies have shown breastfed babies grow up healthier than those reared on formula or cow's milk. Breastfed babies' immune systems are stronger. They have fewer allergies, fewer ear infections and less diarrhea. Their incidents of asthma, Type 2 diabetes, obesity and sudden infant death syndrome significantly are reduced.

"Human milk is best for human babies," said Libby Rosen, an associate professor at the School of Nursing at Baker University. "It is species-specific. It has tremendous health benefits for both mom and baby and the family."

Rosen has helped lead a Topeka-area coalition of breastfeeding advocates that's spent the past 18 years looking for ways to encourage mothers to "exclusively" breastfeed their newborn babies -- or resist using formula -- for at least six months.

"According to the annual report card that's put out by the CDC (Centers for Disease Control and Prevention), almost 38 percent of mothers, nationally, were exclusively breastfeeding at three months," said Paul Cesare, coordinator with the Mother and Child Health Coalition, a Kansas City-based group that's also active in the breastfeeding coalition. "At six months, 16.4 percent were exclusively breastfeeding."

Kansas' numbers, he said, were below the national average in 2013:

* 30.5 percent were exclusively breastfeeding at three months.

* 15.1 percent were exclusively breastfeeding at six months.

"Between three months and six months, the rate drops by half," Cesare said. "That's significant. ... And 15 percent is a pretty small number."

Efforts to improve these percentages, he said, often are slowed by hospital policies that stress routine and operational efficiency over evidence-based practices that encourage mothers to breastfeed.

In Kansas, 98 percent of the 40,300 babies born in 2012 were delivered in hospital settings.

Three years ago, breastfeeding coalitions throughout the state joined the Kansas Hospital Association and the United Methodist Health Ministry Fund in launching High 5 for Mom and Baby, an ongoing campaign aimed at helping hospitals adopt five principles that have been found to increase breastfeeding rates.

"This is about having a best-practices conversation with hospitals and helping them implement those practices," said Virginia Elliott, a UMHMF vice president in charge of programs. "It's not about being punitive or saying, 'You either do it this way or forget it.' It's about finding solutions to common challenges."

The five principles:

* Assure immediate and sustained skin-to-skin contact between mother and baby after birth.

* Give newborn babies no food or drink other than breast milk unless medically indicated.

* Encourage mothers and infants to "room in" or be together 24 hours a day.

* Give no pacifiers or artificial nipples to breastfeeding infants.

* Make sure mothers are aware of breastfeeding support programs in their communities before they leave the hospital.

So far, Rosen and other High 5 officials have met one-on-one with maternity-unit staffs in 42 of the 71 Kansas hospitals that deliver babies.

The 42 hospitals account for roughly 80 percent of the babies born in Kansas, and five have earned High 5 for Mom and Baby designations:

* Lawrence Memorial Hospital.

* Salina Regional Health Center.

* Newman Regional Health, Emporia.

* Hays Medical Center.

* Holton Community Hospital.

Several others, Rosen said, are "on the cusp" of being designated, including Stormont-Vail HealthCare in Topeka.

Wesley Medical Center in Wichita, the state's largest maternity unit, is seeking an international "Baby-Friendly" designation that is independent of the High 5 initiative.

"The challenge comes with changing routines and patterns when, for years, you've done a full assessment on the baby the minute it is born," Rosen said. "That assessment is important -- nobody is saying it isn't. But as long as the baby is breathing well and has good color, it can wait until after the first breastfeeding, and even then a lot of the assessment can be done skin-to-skin rather than just in the crib."

Research, Rosen said, has shown the benefits of maintaining skin-to-skin contact outweigh those of quick assessments.

"That's not always easy to do when you have a roomful of grandmas, aunts and uncles, and next-door neighbors wanting to know how much the baby weighs so they can put it on Facebook," Rosen said.

The High 5 for Mom and Baby initiative also encourages hospitals to restructure their visitation policies in ways that encourage mothers to nap when their babies are sleeping.

"A lot of times, Mom tries to do so much and has so many interruptions that by night No. 2, she's exhausted and asking for supplements," said Brenda Bandy, who's active in the Kansas Breastfeeding Coalition. "Or everybody is concerned that Mom isn't getting enough rest, so they say, 'Let's get the baby a bottle so (Mom) can get some sleep.' All of these things are well-intentioned and understandable, but they're not supportive of breastfeeding."

Breastfeeding advocates also object to the hospitals sending mothers home with free cans of baby formula provided by manufacturers.

"We see the formula industry as a barrier," said Bandy, who's also a member of the U.S. Breastfeeding Committee. "We know it markets itself aggressively and can put a lot of money into those practices. But we also know it hasn't been able to chip away at mothers' desires to breastfeed. Most (soon-to-be) mothers still go to the hospital wanting to breastfeed. That's not changed."

According to the CDC report card, almost 77 percent of the nation's infants begin breastfeeding while they're in a hospital's maternity unit. After six months, the level of non-exclusive breastfeeding -- mixing breast milk with formula, cow's milk or cereal -- drops to 49 percent nationally; after 12 months, 27 percent. In Kansas, those rates are 41.8 percent and 27.3 percent.

Coalition members, generally, have decided to focus most of their efforts on helping mothers breastfeed during and after their hospital stays rather than battling formula makers.

"There are so many other barriers out there, cultural and societal, that trump what formula marketers are able to do," Bandy said. "And we don't get into this argument where formula companies say their product is great and we say, 'No, it's not,' and then we come off looking like we're extremists. So all we're saying, really, is 'Formula is not evidence-based best practice. Breast milk is better for baby.' "

The biggest of the barriers comes when mothers re-enter the workforce.

"There are many, many moms who have to go back to work after just a few days or a few weeks after delivery," said Melinda Toumi, a leader with the La Leche League International breastfeeding support group in Lawrence. "And they end up in jobs that don't offer the support that they need when it comes to mixing work and breastfeeding. Things like having a place to express milk -- not just the restroom -- or having a supervisor who understands that it can be a slow, clumsy and difficult process when you first start collecting milk. Not having that support makes it really, really tough."

Toumi, 34, successfully breastfed three children, now ages 15, 10 and 4. She works full-time outside the home but continues to breastfeed her youngest child, 11-month-old William Henry.

Toumi said 95 percent of the babies born at Lawrence Memorial Hospital are breastfeeding when they leave the hospital.

"But after three months, there's a big drop-off because that's when maternity leave ends," she said. "And that's if you're lucky enough to have a job that qualifies for family medical leave. If you're working at Burger King, you don't get your job back, guaranteed, after 12 weeks. You just don't."

In keeping with the federal Family and Medical Leave Act, mothers and fathers are each entitled to up to 12 weeks of "unpaid, job-protected leave" after a child's birth if they've worked for the employer for at least 1,250 hours in the previous year and if the employer has at least 50 workers within a 75-mile radius.

"Those are huge loopholes," Bandy said. "The vast majority of young mothers simply are not eligible for FMLA. And even if they are, they can't afford to go 12 weeks without a paycheck."

Bandy leads an in-state initiative called Business Case for Breastfeeding that's designed to help employers understand the needs of breastfeeding moms.

"Employers, for the most part, want to support their breastfeeding employees, but they don't know how," Bandy said. "That's where we come in. I tell them it's really pretty simple, the needs are few, and we have lots of resources to cover the challenges that are there."

Coalition members last year convinced Kansas legislators to enact a law that protects a mother's right to breastfeed in public.

"We had a lot of legislators tell us they support breastfeeding," Bandy said. "But then, at the same time, they'd say, 'I just don't want to see it,' which, of course, feeds into the whole thing with moms being uncomfortable or embarrassed to breastfeed in public. We're trying to change that as well."