Baby Friendly Initiative
Innovative postnatal care is changing how newborns spend their first days at Mary Greeley Medical Center.
Breastfeeding rocks. That pretty much sums up the feeling at Mary Greeley Medical Center’s Birthways unit, where new, research-based best practices are dramatically changing an infant’s post-delivery introduction to the world. This effort is driven, in part, by Birthway’s pursuit of “the gold standard” of postnatal care — the national Baby-Friendly™ designation.
Birthways has long been respected for its quality medical care and compassionate treatment of mothers and babies. But in 2010, when the department welcomed back the lactation program it had begun 20 years earlier, McFarland Clinic pediatrician John Paschen encouraged unit leaders to pursue the national accolade, a recognition not yet achieved by an Iowa hospital.
“When I worked as a visiting physician in St. Lucia, every woman breastfed,” Paschen says. “One day, one woman said she’d rather give her baby formula. In the U.S. we’d say, ‘Here, that’s fine.’ There, nurses berated this woman. Soon they were all yelling back and forth. For these women, breastfeeding is a necessity. To us, it’s nice, but we need to help all women realize it’s a wonder drug that’s absolutely free.”
Massachusetts-based Baby Friendly USA launched the Baby-Friendly™ designation in 1997, based on the “Ten Steps to Successful Breastfeeding” established in 1991 by UNICEF and the World Health Organization to protect, promote and support breastfeeding globally. The Baby-Friendly™ program requires hospitals to complete 10 steps, most of which involve educating and assisting mothers of newborns on the initiation and duration of breastfeeding.
"It's such a beautiful experience to
watch. Instead of our interrupting the
baby/mom bond, the baby stays there,
nestled in skin to skin with Mom and
often Dad, too."
-Nyla Carswell, Maternal Child Services Dir.
The Birthways program already boasts success. In Iowa in 2011, the percentage of babies fed only breast milk for their first three months was a mere 37.2 percent, compared to 81 percent of babies born that year at Birthways. At 6 months, only 17 percent of babies in the state of Iowa were still being breastfed, according to the hospital, compared to nearly half of all Birthways-born babies.
Since last September 2012, the Birthways staff has obtained letters of administrative support, completed self-appraisals, created a hospital breastfeeding policy and designed staff training curriculums, prenatal/ postpartum teaching plans and a data collection strategy.
“Through this process we have raised the competencies of what nurses
need to do to support moms with breastfeeding,” says Nyla Carswell, director of maternal child services. “Before, everyone had a basic view, but with all this new education, they are really strengthening their abilities.”
That education has included continued training sessions conducted by the likes of Marie Biancuzzo, a nationally known medical professional, educator and author specializing in childbearing issues, including breastfeeding. Grant money secured for the project pays for such training, and Mary Greeley reimburses staff members for the extra hours they attend the sessions. Nurses are required to complete training on 15 different breastfeeding topics plus five hours of breastfeeding clinical work.
“It would be nice to get Baby Friendly recognition for our staff and department, but that’s not why we’re putting our hearts and souls into this,” says Carswell. “Improving care for our patients is just the right thing to do. If there were steps in this process that we didn’t think were backed up well enough by research, we wouldn’t do them. It has been a journey for us, and we’ve been able to pass our love for doing the right thing on to each of our staff members and now our patients.”
The Baby Friendly initiative is supported, in part, by the Mary Greeley Medical Center Foundation.
Mom, Meet Your New Roomie
At Mary Greeley, a precious newborn is no longer whisked away right after birth for weighing and assessing. Instead, babies “cocoon” with their moms and dads for about 30 minutes while Birthways nurses perform assessments right there. “It’s such a beautiful experience to watch,” Carswell says. “Instead of our interrupting the baby/mom bond, the baby stays there, nestled in skin to skin with Mom and often Dad, too.” In most cases, nurses help mothers breastfeed their infants within an hour of birth.
“This is another great example of how research evidence is driving our practice,” adds Val Myers, RN, international board certified lactation specialist. “We didn’t understand before how separating babies from their moms interfered with their ability to learn and become confident with identifying babies’ feeding cues. And we’ve learned that placing baby skin to skin after birth decreases their stress and gets breastfeeding off to the best possible start.”
First-time parents Laura and Mark Mogler
receive advice from Val Myers as Laura prepares
to breastfeed her baby, Alden.
Ames couple Laura and Mark Mogler welcomed their first child, son Alden, in July. Nurses immediately offered the skin-to-skin option, and didn’t cut the umbilical cord until it had stopped pulsing. They rubbed Alden and made subtle observations while he was on Laura’s chest, waiting to weigh him until he was at least an hour old. Like most newborns now, Alden bunked in his mom’s room rather than spending his nights in the nursery.
“I think that helped us form a bond right away,” Laura Mogler says. “That first night, I was really aware of the noises he was making. So if I heard his little mouth clicking or his tongue licking his lips, I knew maybe we need to check on him and see if it’s time to nurse him. I think that really helped because it just kind of kicks breastfeeding into high gear.”
Under the new protocol, babies sleep in mom’s room because, mother’s milk production hormone, prolactin, is at its highest at night. “Babies are meant to nurse a lot at night,” Myers says, and by doing so, mother’s milk often comes in sooner. To better prepare moms, Birthways enforces “quiet time” from 1:30 to 3:30 each afternoon, visiting hours end at 8 p.m. and then mothers are scheduled to nap until around midnight when the more frequent feedings begin.
“We were told, ‘Now you’re on Night #2 … the baby is not going to sleep … you’re going to be up all night,’” Laura Mogler recalls. “Our nurse came in that night and said, ‘If he’s fussy and you just don’t know what to do, don’t feel bad, just buzz me and I’ll come in and help you.’ That was really helpful.” Nurses also reminded the Moglers that Mark could hold Alden skin to skin after feedings, which reassured them both. (And one nurse even conducted an impromptu “swaddle” tutorial at midnight for Mark during the Moglers’ stay.)
“We’ve been receiving very good feedback about our new rooming-in protocol,” Myers says. “Moms have that very busy, hard second night here in the hospital, but then milk comes in sooner and the first nights at home go much smoother. When we kept babies in the nursery, we were holding off that cluster feeding, so when moms experienced this at home, they’d call and say, ‘What’s wrong with the baby? He didn’t do this in the hospital.’ Now they understand baby’s nighttime behavior and they relax more.”
“We used to work under the assumption that we were rescuing the mom by letting her sleep while we kept the baby in the nursery,” Carswell says. “In reality, moms were thinking, ‘I sent my baby to the nursery, now I hear them all crying. Is that my baby?’ Really, what other mammal takes the baby from its mother?”
“We’ve gone from that rescue mentality now to one of empowerment,” Myers adds. “The cocooning together gets the family off to their best start.”
Buh Bye, Binky
Pacifiers are passé, as far as Birthways is concerned.
The comfort aid may satisfy an infant’s need to suck, making the baby less interested in latching on to his mother’s breast. This lack of breast stimulation then can lead to a delay in the milk coming in or its subsequent production. Since babies latch differently onto a pacifier, that same learned latch on a breast can be painful for the mom. Bacteria on pacifiers can cause ear infections, thrush infections and future dental problems. And sometimes, the devices are used to stretch out time between feedings. Myers says that just leaves a baby overwrought and unable to organize
himself at the breast.
If mothers bring pacifiers to the hospital, nurses will provide “gentle education” on not using them, but ultimately it’s the mother’s decision. Birthways does provide pacifiers to babies during circumcisions, but disposes of them after the procedures. And both the department and the American Academy of Pediatrics say binkys are okay once a baby is about
a month old and has established good breastfeeding habits. Even then, pacifier use should be limited to naptime and bedtime, and only until the child is 6 months old.
Mom’s Best Friend
Expectant moms learn about Birthways’ Baby Friendly initiatives before the Big Day, as content is woven into prenatal classes and doctor visits. Breastfeeding classes are held the first Monday evening and the second Thursday evening of each month at the hospital.
Three to five days after a breastfeeding mom leaves the hospital, she is encouraged to return to Birthways for a visit with a lactation specialist. The baby is weighed and checked for jaundice, nurses answer questions
and observe moms breastfeeding to ensure effective techniques. And Birthways runs a telephone hotline for moms of infants during the day, Mondays through Fridays (515-233-7525). “Some moms call in on a regular basis because they just need a little encouragement,” Myers says.
“They’ll tell us, ‘We just like to hear your voice.’”
A breastfeeding support group meets the third Thursday afternoon of each month at the hospital, from 1:30 to 3 p.m. The meetings, led by a breastfeeding specialist, educate moms and allow babies to be weighed. Likewise, moms can reach out to one another through the Birthways Breastfeeding Support Group Facebook page. There are links and more information at www.mgmc.org/breastfeeding.