Baby Friendly Hospital

SmilingBluEyes · Aug 6, 2005

Well---you are right to be a bit concerned off the bat; having a well-baby nursery is NOT a sure-fire way to be "baby friendly". :wink2:

From the Baby Friendly Initiative, (sponsored by the World Health Organization---WHO), here are the "10 steps" to successful breastfeeding: (the things that must be done in order to seek designation for "Baby Friendly" Hospital/Birth Center)

The Ten Steps To Successful Breastfeeding

The BFHI promotes, protects, and supports breastfeeding through The Ten Steps to Successful Breastfeeding for Hospitals, as outlined by UNICEF/WHO. The steps for the United States are:

1 - Maintain a written breastfeeding policy that is routinely communicated to all health care staff.

2 - Train all health care staff in skills necessary to implement this policy.

3 - Inform all pregnant women about the benefits and management of breastfeeding.

4 - Help mothers initiate breastfeeding within one hour of birth.

5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

6 - Give infants no food or drink other than breastmilk, unless medically indicated.

7 - Practice "rooming in"-- allow mothers and infants to remain together 24 hours a day.

8 - Encourage unrestricted breastfeeding.

9 - Give no pacifiers or artificial nipples to breastfeeding infants.

10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

Here is a link to the site for more information..... Good luck in your pursuit of a baby-friendly environment where you practice!

http://www.babyfriendlyusa.org/eng/index.html

Hope this does help.

BETSRN · Aug 7, 2005

Hi all,
Our hospital is just beginning to look at becoming baby friendly. I personally don't have much hope in our achieving such status because of our "baby goes to the nursery" policy. We have a hard time getting babies back out of the nursery once they go in, nursery nurses here are generally more interested in following their protocols than in getting babies to the breast.
Anyone here got baby friendly status? How did you do it?

You have to have a proactive manager who is totally committed to this and will work with ALL the staff. You will never change some of those "hard core" nursery or L&D nurses. Nurses don't always think "outside the box" when it comes to stupid, useless protocols.

I would suggest starting with some visits to LDRP units or other similar places that discourage nursery use or have no nursery at all. You also have to get the L&D staff to buy into transitioning the baby along with Mom in those first couple of hours after birth. WE weigh our babies right in the birthing room and so meds and evaluations right there with Mom.

Remember, there is NOTHING that is done to a normal newborn that cannot be done at the mother's bedside. Start with that philosophy and go from there.

Good luck. It is a daunting thought to change so drastically bt it can be done. It does, however, take years to accomplish!

SmilingBluEyes · Aug 7, 2005

One thing Betsys' post brings to mind is, how crosstrained is everyone? I ask because usually LDRP-trained nurses who do couplet care often succeed most at incorporating Baby-Friendly concepts. If you have people who refuse to learn more than their "area", you will have an uphill battle ahead for you.

If you have separate LD/MBU's, like Betsy said, you have to be willing to transport mom and baby together and have nurses there ready to care for both as a "unit" for this to work best. No well-baby nursery should exist in a truly baby-friendly unit. It will be a hard sell, esp for "old school" nurses who think all newborn procedures/admissions should be done in a nursery. But it can be done, if people work together. It's a beautiful thing to do, if you ask me. I love working this way.

Allison T · Aug 22, 2005

Hi. I am just starting as a lactation consultant at a large hospital, after 8 years as a nurse in mother/baby, NICU, and labor and delivery. I will be one of several lactation consultants. There is a war going on, more or less, between the mother/baby nurses and the lactation consultants. And in labor and delivery, couplets are rushed through very quickly and most nurses routinely take the baby from the mom for "baby care" about 10 seconds after birth. I find the nurse in charge of baby policy in labor and delivery to be very anti-baby friendly policies and very pro "let's keep to our routine." At least 3 of us LCs would love to work toward baby-friendly. I will keep you posted on what goes on. Meanwhile, continue to network and see if you can find other supporters. I will be trying to work on the nursery nurses to get them to see how much easier breastfed babies are for them. Enlisting the help of the pediatricians is supposed to be a bonus, too.

Hi all,
Our hospital is just beginning to look at becoming baby friendly. I personally don't have much hope in our achieving such status because of our "baby goes to the nursery" policy. We have a hard time getting babies back out of the nursery once they go in, nursery nurses here are generally more interested in following their protocols than in getting babies to the breast.
Anyone here got baby friendly status? How did you do it?

BETSRN · Aug 22, 2005

Hi. I am just starting as a lactation consultant at a large hospital, after 8 years as a nurse in mother/baby, NICU, and labor and delivery. I will be one of several lactation consultants. There is a war going on, more or less, between the mother/baby nurses and the lactation consultants. And in labor and delivery, couplets are rushed through very quickly and most nurses routinely take the baby from the mom for "baby care" about 10 seconds after birth. I find the nurse in charge of baby policy in labor and delivery to be very anti-baby friendly policies and very pro "let's keep to our routine." At least 3 of us LCs would love to work toward baby-friendly. I will keep you posted on what goes on. Meanwhile, continue to network and see if you can find other supporters. I will be trying to work on the nursery nurses to get them to see how much easier breastfed babies are for them. Enlisting the help of the pediatricians is supposed to be a bonus, too.

Best of luck. It is a never ending battle that is hard to win (depending on the kind of hospital you are working in),

I might start by speaking with the nurse managers of the specific departments. It you do not have their support, you will get nowhere. Are the babies left with Mom in that hour or more during recovery? That's the best time to start and you do NOT have to upset their routine a bit in incouraging breastfeeding during that time. It doesn;t even take 60 seconds to do Vitamin K and eyrthromycin. They have no excuse.

You'll have a far more difficult time with the nursery staff. They are historically the absolute worst!

SmilingBluEyes · Aug 22, 2005

I agree w/Betsy. If management and administration are not "on board" employing the "Baby Friendly" initiative will be impossible. There are specific steps and training required of all personnel for this ever to happen. You would be banging your head if the mangement is not on board and if people are not willing to give up the formula company's nice little gifts and luncheons for staff to sell their product to us.

MarieClaude · Apr 21, 2010

Our county hospital is seeking to go "Baby Friendly." After reading the other posts, I can see we have some real issues to deal with. First, we do not have mother/baby unit, we have the well baby nursery. Second, we have a large number of indigent and illegal immigrant moms at our hospital. Third, L&D, OB and newborn are NOT all on the same page. Fourth, the mom's that say they want to breastfeed have no prior knowledge of what this entails until they have already had their baby, and after possibly hours of labor, or pain of C-section, they are told, " you need to bfd your baby every 2 hrs. aound the clock for milk synthesis, etc. Because of this and many other issues, All the newborn nurses are at odds with our lactation nurses. First, we have mom's that want to both breast and bottle feed. I ,for one, believe in the rights of the mother to feed her infant however she chooses even though I agree that breast is better (I breastfed my children.)At our hospital, the lactation nurses feel it is their business, through fear and guilt, to control/limit that mothers choice to supplement after bfg. My dilema is being caught in the middle. On the one hand, we literally have to give an account to our lactation nurses as to why we didn't do more to dissuade a mom from supplementing thereby incuring the downright anger of the lactation nurses, versus doing what the mom has said she wants to do. The bottom line is, these lactation nurses may be able to get these moms to "fall in line" as it were, while in the hospital, but as soon as they go home, they will do exactly what they want to do. In the meantime, the newborn nurses go through heck with lactation. We do not force rooming in. I have had nights where I might have 4 mom's that are bfg. only, but want their babies brought to them when time to feed. That means I am up and down hallways my whole shift, at least 32 times.

I know this is long, but one last thought. What gives any person/organization the right to tell anyone how to live their life by imposing their own opinions, based on fact or not, because they believe one choice is far better than another? Where does this stop? Do we want someone telling us we can't buy junk food because healthy food is better? Or tell us what kind of gas to put in our cars, etc. - I think you get the idea. I believe the job of the lactation nurse is to teach and inform in such a way as to leave the decisions to mom as to what she will do with that information without using fear/guilt in such a way as to influence that decision.

Allison T · Apr 23, 2010

A couple of issues here. Health teaching should be evidence based. What we "think" or "believe" does not need to enter into it; there is plenty of research to back us up. No nurse who works dialysis needs to give her opinion of appropriate fluid intake or renal diets. We perinatal nurses do not need to give our opinion either.

Mothers who say they want to "do both" are probably speaking to wanting someone else to help them with infant care responsibilities. These moms can gently be told, "OK, and the best time to start the bottles is at 4 weeks. Moms who start bottles before 4 weeks usually don't make enough milk. They end up quitting breastfeeding, and then you're not doing both, you're just bottlefeeding. I'm here to help you do what you want, and I hear you saying you want to do both."

The research behind this statement is very clear. I'm including two references below, but there are many many others.

Dunn, S., Davies, B., McCleary, L., Edwards, N., & Gaboury, I. (2006). The relationship between vulnerability factors and breastfeeding outcome. Journal of Obstetric, Gynecologic and Neonatal Nursing, 38(1), 88-97.

Schwartz, K., D'Arcy, H., Gillespie, B., Bobo, J., Longeway, M., & Foxman, B. (2002). Factors associated with weaning in the first 3 months postpartum. Journal of Family Practice, 51, 439-444.

It's too great a burden for all of breastfeeding education to be dumped onto inpatient nurses and lactation consultants. (By the way, not all with "IBCLC" are nurses, so they should be called lactation consultants, not lactation nurses.) I'm sorry the lactation consultants have set up a warfare state with the nurses; this benefits no one. Maybe you could ask them to model a conversation with you? Have them come in for a night shift and do an inservice? Or just observe on nights and see what you're up against.

Prenatal care providers (physicians and midwives) need to be talking about breastfeeding and giving patients appropriate educational materials. Many indigent families participate with WIC, and WIC has been steadily improving at breastfeeding education. Some counties in some states have free breastfeeding peer counselors who meet with WIC-eligible moms prenatally and postpartum.

In my area, several hospitals breastfeeding committees' have collaborated with the prenatal care providers to ensure a consistent message to mothers. This is a lot of work, but so worth it. Every successfully breastfeeding mother and every breastfed baby has a chance at optimal health (and this saves our country $).

When I worked nights on mother/baby, and had 4 couplets, and all the moms sent the babies to the nursery but wanted them back for breastfeeding, I wore a pedometer. I logged over 5 miles one night. I feel your pain!

Good luck; please post more and let us know how it's going.

MarieClaude · Apr 24, 2010

Thank you Alison, for your reply.

As I stated in my post, I do not dispute the benefits of breastfeeding and do agree that it is the healthier way to nourish the newborn. But even with all the evidence to the benefits of breastfeeding, my main issue is this: Just because there is evidence out there as to why breastfeeding is best for babies, this does not justify taking away the mother's right to choose one method over the other, or both. The personal right to choose, no matter what the issue ( lawfully, of course) is a fundamental principal most of us treasure.

klone, MSN, RN · Apr 25, 2010

Being "baby friendly" does not mean that you force a woman to breastfeed against her wishes.

MarieClaude · Apr 26, 2010

Point number 6 of the ten steps to a baby friendly hospital states: Give newborns no food or drink other than breastmilk unless medically indicated.

If taking away a breastfeeding mother's right to supplement while in the hospital for reasons other than medical ones, isn't forcing a mother to breastfeed only, then what do you call it?