Tell me about your baby friendly initiative...

Fyreflie · Dec 2, 2012

That sounds like culture more than accreditation to me. I've worked at a BFI certified hospital and one that was working on it and here is what we did:

First hospital (the certified one) actually didn't have a nursery but we did cuddle babes for moms when we weren't scrambling busy. Second hospital did have a nursery area (only staffed when there was an ill neonate) that we sometimes used as a baby park between feelings at night, but woke and assisted with feeds on demand and a minimum of 3 hours.

Both hospitals we did have to talk about the risks of formula feeding if a mother wanted to switch halfway through her hospital stay. We did do a lot of education around the normalcy of cluster feeding in the first 48-72 hours and how that would change after milk came in. Most moms were encouraged to hear that this q45-90 minute waking and rooting would pass. If a mother came in already decided to formula feed that was documented, a quick discussion to determine reasoning and education about the difference, and that was the end of it. I often would ask my formula feeding moms to hand e press or BF colostrum in the labour room and cited the benefits. Most of them were happy to do it and some of them switched to BF if the baby latched well!

If your rates are so dismal, how did you get accredited to begin with?

BFI doesn't mean that you have to cram it down someone's throat. It means you have to educate, support, and promote healthy Breastfeeding relationships. The culture around doing that can take a long time to change and really depends on the nursing care and hospital policies.

RN*mommy · Dec 3, 2012

I have no idea how we passed our re-accreditation. That's the million dollar question.

I appreciate your answer though, it helps me see where things might be lagging in our set up. What you said about a parent requesting formula and your response is exactly what I've been doing. I never suggest it to a mother. Maybe what's happening is our staff isn't as educated as we should be about the true, easy to understand benefits. We can all cite the rhetoric, breast is best, but do we take it further? I can only speak for myself but we do have a lot of new hires and an almost constant turn over in staff so maybe it isn't much more than lack of staff education.

That gives me something to think about. Thank you.

Fyreflie · Dec 3, 2012

It really has so much to do with our attitudes!! There are respectful ways to give information without being overbearing. I try to do my bf education with support people in the room because they sometimes are under educated as well and they're the ones who will be parroting our words when everyone goes home

PinkNBlue, BSN, RN · Dec 4, 2012

I give them the information and explain why it's important. But I also stress to them that ultimately, it is THEIR decision and they need to decide with what works for them and their family. I am not going to force anyone to do anything, especially when we're dealing with overtired, over emotional patients who are just trying to do their best to feed their baby. I also chart in the computer, if they do decide to bring the baby to the nursery for the night, that I've explained the benefits of rooming in and exclusive breastfeeding, that they've verbalized understanding but opt to have baby brought to the nursery. That way it's documented. I'm forcin' no one.

**LibraSunCNM, BSN, MSN, CNM** · Dec 5, 2012

I work at a Baby Friendly hospital and I think one of the things that has helped the nursing staff is having us all complete the Certified Lactation Counselor course. A lot of nurses think they are giving patients accurate information about breastfeeding when in fact, that information is outdated or just plain wrong. It helped shape our practice in terms of newborn policies and procedures in ways that moved us towards the BFI, and I would recommend the course to anyone working in L&D, PP, or NICU.

Due to Hurricane Sandy, I'm temporarily working at a different hospital where some of our doctors are delivering our patients. The differences between our hospital and this one is scary. They have an old-school nursery nurse/postpartum nurse setup, the baby is whisked away from the mother about an hour or two after birth to be admitted in the nursery and observed there for HOURS, they tell every patient on admission that they can choose to have the baby formula fed in the nursery overnight, and stock at least 8 different kinds of formula on their unit. Newborns on a dex series being admitted in the nursery are often fed formula without even discussing it with the parents first. I could go on and on.

The point is that this hospital is trying to initiate the BFI! The staff honestly has no clue that their practices are detrimental to breastfeeding, simply because "that's the way we've always done it" or "Well, your patients might want to keep their babies at night, but we deal with the Upper East Side crowd, and that wouldn't fly here." But it's simply not the case. We work with a large cultural population that generally chooses to breast and bottlefeed, and we thought that that would keep us from becoming BF accredited. But as long as you have BF policies in place, and OFFER standard education to each patient (NOT cramming anything down anyone's throat, a simple discussion at the beginning of their admission suffices. No need to keep re-educating at each request for a bottle), you can be BF without having each patient exclusively breastfeed, no matter what populations you care for. I feel that having the nursing staff well-educated in the most up-to-date information about lactation policy and practice has helped us maintain our BF standards most optimally.

Marymoomoo · Dec 7, 2012

If a parent demands formula, we have to try to talk them out of it. Even when they come to L&D and have the mindset to formula feed their baby, the nurses have to try and talk them out of it. I understand the educating parents to the benefits of breastfeeding, and I understand explaining to parents why introducing formula can hinder successful breastfeeding, but I know of nurses in our facility that have literally told parents that formula is poison.

The point of the BFHI is not to talk women out of using formula, but rather to promote and protect breastfeeding. Part of that is to provide mothers with the information they need in order to make an informed choice about infant feeding, which includes an explanation of the risks of not breastfeeding. Formula doesn't just hinder successful breastfeeding, there's a much bigger picture.

That said, no one should ever tell a parent that they are feeding their child poison. Formula isn't ideal, but it is far from being poison. It's a substitute for the normal food for human infants. THAT is what parents need to understand. They are replacing the food their baby should be eating with something that can never be the same. Formula provides adequate nutrition for growth and development, and nothing more.

We deal with primarily the hispanic culture, which often chooses to offer breast milk and formula, but while they are in our hospital we offer them no cultural support even when they tell us exactly how they nourished their previous children.

There are educational materials available for this subject.

Here's a presentation on the "Los Dos" campaign by the MA Breastfeeding Coalition:

http://massbreastfeeding.org/conference/2010/Lieberman-Ouptatient_Support_Panel-Latina_Exclusive_Breastfeeding.pdf

Breastfeeding and Early Combination Feeding 'los dos' in Latinas

http://www.cchap.org/storage/newsletter-six-files/article%201.pdf

Here's a great trifold for parents. Maybe your hospital might like to work on some educational/promotional items of their own? A good time to offer this info would be during a prenatal class.

http://www.nal.usda.gov/wicworks/Sharing_Center/CO/Breastfeeding_Handout.pdf

Many of our patients are young, and economically poor as well. I just feel there has to be a better way because this isn't working. Our numbers of mom's who leave our hospital exclusively breastfeeding are dismal.

Why do you think that is? Does WIC in your community actively promote breastfeeding? Do they have an operational Peer Counselor program? Do your local OB/GYNs and midwives promote breastfeeding as the norm? What kind of breastfeeding support is available in your community?

I've recently had the opportunity to work in the community and I'm shocked by how many mom's of different cultures and economic backgrounds are still exclusively breastfeeding or offering breast milk to their infants who were born extremely premature (24-26 weekers) and are now approaching the one year mark. In our level 2 nursery many of our babies leave after a few weeks or less and are on solely formula, even though pumping and breastfeeding were initiated in the beginning. We don't keep micro-preemies obviously, but we have babies generally 32 weeks and above. Somehow we are missing the mark here and I'm not entirely sure how.

Usually, moms of micro preemies are told that breastmilk is medicine and their babies need their milk. The importance of the milk is a focus, and mothers are told that expressing milk is the most important thing they can do for their baby(ies) and they are given the support and tools necessary to be successful.

If babies in your nursery are not getting breastmilk, perhaps look at the culture of the nursery. Are mothers encouraged to breastfeed? Is the importance of their milk stressed? Are they given the support and tools to succeed? Do the physicians promote and support breastfeeding? Are mothers expressing milk soon after birth? Are they using "hands on pumping"? Are they able to stay with their babies, and hold them skin to skin?

My last pregnancy I had my baby at a hospital without the baby friendly accreditation and I received excellent lactation support. My baby lost over 10% of his weight so I had to initiate supplementation. I was devastated but the lactation nurse was so kind and caring and made me realize this was only a bump in the road. I supplemented until my milk fully came in and was able to stop offering formula shortly thereafter. When I compare my experience with what we do at my hospital I realized a few things. First of all the nurses offered to take my baby to the nursery at night. I didn't have to beg for that. They also asked if I wanted them to give my baby formula and keep him all night. I said no, please bring him back in 3 hours and I will feed him. I wasn't offended that they ASKED me if I wanted formula offered. At my hospital we can be "written up" if we offer the baby to stay in our nursery and if we offer formula be given. We don't even have a healthy newborn nursery. In fact, if our nursery is closed due to no "sick" babies we usually have to tell parents who ask if their baby can go there, "no, our nursery is closed".

I can see why you appreciated the "support" of your nurses. Offering to keep the baby overnight and feeding formula instead in reality isn't helpful to parents. Except in rare circumstances (such as when a mother is ill or exhausted and doesn't have any kind of support), babies should be with their mothers at all times, even if they are formula feeding.

It sounds like you want to see some changes in your hospital culture. It's possible, you know. Sometimes all it takes is one person to stand up and say there's a better way. Best of luck to you!