Breastfeeding and Hospitals - No cause for celebration
Hospitals and birthing centers in the U.S. have a long history of providing sub-standard medical care to mothers and their newborn infants. Unfortunately, that situation continues today. Please allow me to explain.
The U.S. Centers for Disease Control and Prevention (CDC) is an operating division of the U.S. Department of Health and Human Services. One of the services the CDC provides is to collect information effecting human health, analyze that information, and distribute their findings with the goal of improving the health and knowledge of people worldwide. The following information can be seen on the CDC’s website:
“In the U.S., nearly all infants are born in a hospital or free-standing birth center. Their stay is typically very short, but events during this time have lasting effects. Many of the experiences of mothers and newborns in the hospital affect breastfeeding. In most cases, these experiences reflect routine practices at the facility level, and patients rarely request care different from that offered them by health professionals. Experiences with breastfeeding in the first hours and days of life significantly influence an infant’s later feeding. Due to its inextricable relationship with the birth experience, breastfeeding must be established during the maternity hospital stay, not postponed until the infant goes home.”
“Hospital routines can help or hinder new mothers and babies while they’re learning to breastfeed. Hospitals influence how the nearly 4 million U.S. babies born each year are fed. Further improvement in hospital practices could increase breastfeeding rates and contribute to better child health.”
The Surgeon General of the United States is the leading spokesperson on matters of public health in the U.S. federal government. The U.S. Surgeon General is nominated by the President of the United States and confirmed by the Senate. The Surgeon General has many informal duties, such as educating the American public about health issues and advocating healthy lifestyle choices.
Dr. C. Everett Koop was appointed as the U.S. Surgeon General by President Ronald Reagan and served in that position from January, 1982, until 1989. On June 11, 1984, U.S. Surgeon General Dr. C. Everett Koop released a report titled “Report of the Surgeon General’s Workshop on Breastfeeding & Human Lactation.” You can find that 1984 report at: http://profiles.nlm.nih.gov/ps/access/NNBCGF.pdf
The following are several concerns and recommendations taken directly from Dr. Koops’ 1984 report:
“At the present time, some of the federal programs serving women and children include disincentives to breastfeeding. The federal government should address these barriers and become committed to the elimination or modification of such policies.” (on page 69 of the report)
“Explore the potential for third-party coverage for lactation counseling and breastfeeding support through the Health Care Financing Administration, the National Association of Insurance Carriers, and other appropriate groups/agencies.” (on page 70 of the report)
“A policy to limit the distribution of packages of free formula at discharge only to those mothers who are not lactating.” (on page 91 of the report)
“A capacity for telephone assistance to mothers experiencing problems with breastfeeding.” (on page 91 of the report)
“The availability of lactation counseling as a means of preventing or solving lactation problems.” (on page 91 of the report)
Dr. Koop’s 1984 report could have been written yesterday because we are currently discussing many of the same issues today… thirty-two years (32 years!!) later.
Dr. David Satcher was nominated to become the U.S. Surgeon General by President Bill Clinton and began his term as Surgeon General on February 13, 1998. Dr. Satcher released a report in 2000 titled “HHS Blueprint for Action on Breastfeeding.” You can see that report at:http://health.utah.gov/wic/pdf/BF%20pdf/HHS%20Blueprint%20for%20Action%20BF.pdf
The following appears on page 14 of the report by Dr. Satcher, “Early experience with breastfeeding is critical, and nonsupportive hospital experiences and lack of support from health care providers have been identified as barriers to breastfeeding, especially among African American women. Therefore, maternity care and newborn facilities should follow practices conducive to proper lactation even when in-hospital maternity care is of short duration. For example, hospitals and other maternity centers are encouraged to adopt the “Ten Steps to Successful Breastfeeding” as outlined by the United Nations Children’s Fund, the World Health Organization, the Breastfeeding Hospital Initiative Feasibility Study Expert Work Group, and Baby Friendly USA. Furthermore, the 1984 Surgeon General’s Workshop on Breastfeeding and Human Lactation recommended several hospital practices which influence breastfeeding initiation and are important during hospital stays.”
Dr. Regina M. Benjamin was nominated to become the 18th U.S. Surgeon General by President Barack Obama in July, 2009, and was unanimously confirmed by the United States Senate on October 29, 2009.
In 2011, Dr. Benjamin released a report titled “The Surgeon General’s Call to Action to Support Breastfeeding.” You can see that report at: http://www.surgeongeneral.gov/library/calls/breastfeeding/calltoactiontosupportbreastfeeding.pdf
The following appears on page 15 of Dr. Benjamin’s 2011 report, “Studies have identified major deficits relevant to breastfeeding in hospital policies and clinical practices, including a low priority given to support for breastfeeding and education about it, inappropriate routines and provision of care, fragmented care, and inadequate hospital facilities for women who are breastfeeding.”
Currently, the CDC’s website provides the information below which may be seen at: http://www.cdc.gov/vitalsigns/breastfeeding2015/index.html
“Hospital practices in the first hours and days after birth make the difference in whether and how long babies are breastfed. The World Health Organization and UNICEF’s Baby-Friendly Hospital Initiative is the global standard for hospital care to support breastfeeding, with the Ten Steps to Successful Breastfeeding at its core.”
“Practices in many U.S. hospitals do not fully support breastfeeding.
Some of the Ten Steps on which hospitals fell shortest in 2013 include:
The Baby-Friendly Hospital Initiative (BFHI) is an effort launched by the World Health Organization and UNICEF in 1991 to implement practices that protect, promote and support breastfeeding. UNICEF, the World Health Organization, and many national government health agencies recommend that babies should be breastfed exclusively for their first six months of life.The Baby-Friendly Hospital Initiative is a very practical ten step process which has the goal of improving the role of maternity services and enable mothers to breastfeed babies for the best start in life. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services by protecting, promoting and supporting breastfeeding. The Baby-Friendly certification process was designed to help hospitals to make breastfeeding the normal, standard method of infant nutrition within their facility.
According to the Baby-Friendly USA website, as of March, 2016, “17.00% of births (approximately 678,000 births/year) occur in Baby-Friendly designated facilities.” Those facilities have completed the Baby-Friendly 10 step certification process. In other words, there is an 83% chance that an infant born in the U.S. will be born in a facility that has NOT fully committed to providing the mother and baby with a standard of care that would assure the best possible health outcome. This is not a criticism of the Baby-Friendly Hospital initiative, it is a criticism of the hospitals and birth centers throughout the U.S. that continue to provide women and infants with the same type of services they provided over 30 years ago. Considering all of the information that has been available for decades regarding the numerous positive effects of breastfeeding for both mothers and their babies, it is inexcusable that medical professionals at hospitals continue to interfere with, or discourage women from, breastfeeding. In my opinion, doctors who knowingly allow their patients to be exposed to anti-breastfeeding medical services while in the care of hospitals or birth centers are not simply using poor judgement, they are guilty of malpractice.
During the beginning of the Baby-Friendly certification process, the CEO of the hospital or birthing center must submit a “support letter” to Baby-Friendly USA which signifies their desire to begin the Baby-Friendly certification process. The Baby-Friendly USA website has a template of a letter that may be used by CEO’s to help draft their “support letter.” The template of the “CEO Letter of Support” does not include a simple declaration that the CEO recognizes the fact that breastfeeding is the most beneficial method of feeding healthy infants.
In my opinion, the CEO at any hospital or birthing center should be able to articulate why it is that she/he is making the commitment to become a Baby-Friendly facility. If the medical personnel at the hospital or birthing center have the impression that the CEO is not fully committed to promoting and supporting breastfeeding, then it will be difficult to convince all of the other personnel working at that medical facility that the effort needed to become a Baby-Friendly facility is a serious, permanent change in protocol. I believe the very logical first step in the Baby-Friendly certification process should be to require that the CEO at any hospital or birthing center that is seeking the Baby-Friendly designation must publicly acknowledge that breastfeeding is the best source of nutrition for infants.
Promoting and supporting breastfeeding is all about doing what is best for the mother and child. That is THE reason why hospital administrators should adopt the “Baby-Friendly” philosophy and it is the justification for creating a more supportive breastfeeding environment within the hospital. The goal of maternity services at all hospitals and birthing centers should be to provide care which results in the best possible health outcome. While most hospitals tout the fact that they are pro-breastfeeding, their actions indicate otherwise. Let’s stop pretending that hospitals throughout the U.S. have made great progress in improving their support of breastfeeding. At best the progress has been painfully and shamefully slow, with resistance to change at every step of the way. That is no cause for celebration!
- Just 26% of hospitals had a model breastfeeding policy.
- Only 26% of hospitals did not routinely feed formula to healthy, breastfed infants when there was no medical reason to do so.
- Less than half (45%) of hospitals kept mothers and babies together throughout the entire hospital stay, which provides opportunities to breastfeed and helps mothers learn feeding cues. [Editor’s note: dealing with this issue was included under the “needed services” section of a 1980 report by U.S. Surgeon General Julius B. Richmond titled, “The Surgeon General’s Workshop on Maternal and Infant Health.” The specific recommendation was this… “Bonding and attachment support activities including provision for extended contact between parents and their infant immediately after delivery and, where desired by the parents, rooming-in arrangements or the equivalent.” Dr. Richmond’s recommendation was made in 1980. [That was 36 years ago!!!]
- Just 32% of hospitals provided enough support for breastfeeding mothers when they left the hospital.” [Editor’s note: this problem was also mentioned in the 1980 report by U.S. Surgeon General Dr. Julius B. Richmond.]
Last edited by devoted2kids; 06-28-2016 at 06:29 AM.