Only five birthing facilities have achieved “Baby-Friendly” breastfeeding status in Arizona, with only one in the Phoenix metro area: the Phoenix Indian Medical Center (PIMC), a full-service hospital that has provided free health care since 1970 for Native Americans registered through tribal census.
Baby-Friendly USA (BFUSA) is the non-profit organization that designates the status on birthing facilities where women labor and deliver their newborns. To receive and retain full Baby-Friendly status, hospitals or birthing centers must adhere to a list of 10 “steps”—or evidence-based practices—that increase breastfeeding initiation and duration.
PIMC’s designation, conferred by BFUSA in June 2013, was spearheaded by Captain Kimberly A. Couch, PIMC Women & Infants Service line director. It took just over two years.
It isn’t easy to satisfy the ten steps required to become Baby Friendly. Facilities must train not only employees but also private practice physicians and other health care practitioners who may work on a contract basis for the hospital.
One advantage for PIMC is that all staff—physicians, nurses, administrative and even janitorial personnel—work for a single employer: the U.S. government. Still, it was a huge task to make sure everyone was on board, says Couch. “We had a closed system—and it was still difficult.”
During the transition, Sue Murphy, IBCLC, a lactation consultant at PIMC, was on the front lines. She helped implement and explain to PIMC staff the reasons behind the changes. Though pleased with the outcome—Murphy says that the number of moms who report that they are exclusively breastfeeding has doubled since the PIMC attained Baby-Friendly status—it wasn’t easy. “Change is hard,” says Murphy. “It takes a while to move away from old habits.”
What were some of the hurdles to achieving Baby-Friendly status? Murphy explains.
No more casual supplementation
Before, if a mom asked for a bottle or pacifier or had trouble with breastfeeding, she was given a bottle of formula to feed her baby. Often, the result was that the baby was overfed. Then the baby would sleep for hours, missing the chance to practice the sucking that helps stimulate milk production in women. “That tended to destroy the mom’s confidence,” says Murphy. “But it was perceived as easier.”
Now, according to Baby-Friendly policy, babies cannot be supplemented with formula without a medical reason or an informed request from the family. If the baby’s weight is healthy, and blood sugar count and bilirubin (produced by the liver) tests are within the normal range, Murphy says there is no medical need to supplement.
If the mom says that she wants to give her baby formula or a pacifier, the staff is trained to ask why, to address her concerns and to help reassure her. Staff also explains how both formula and pacifiers can interfere with breastfeeding.
Murphy says that nursing staff members were pleasantly surprised at how successful they were in guiding and reassuring new moms about the breastfeeding process. Sometimes, just a few minutes of encouragement was all it took to make a big difference. But ultimately, says Murphy, mom makes the call. “If the mom decides that she still wants formula, we provide it.”
Ditching the magazines
Studies show that when written materials with advertisements for formula products are distributed by hospitals and birthing centers, breastfeeding rates are hindered. PIMC stopped passing out free magazines with advertising for formula and pacifiers to new families. “‘But there are such good articles in the magazines!’ was what we heard a lot,” says Murphy. She adds that once staff realized that passing out the magazines was tacitly showing approval for supplementing, it was easier to stop.
Murphy says that determining ways to monitor the changes so staff doesn’t slip back to the “just-give-the-baby-a-bottle” practice is an ongoing challenge, especially with personnel changes. New staff members must be trained to meet Baby-Friendly guidelines, too.
Raising Arizona Kids – By Vicki Louk Balint | August 4, 2014