Yellow road sign that says "Change Ahead"

Improvements in Maternity Care Practice Are Not Easy

Posted September 22, 2014 by Lori Feldman-Winter, MD, MPH

Lori Feldman-WinterLori Feldman-Winter, MD, MPH, is the lead faculty for NICHQ’s Best Fed Beginnings project.

As NICHQ’s faculty chair for Best Fed Beginnings, a national initiative that supports hospitals seeking Baby-Friendly designation, I am frequently exposed to pushback regarding the improvements required for a hospital to achieve this designation.

Recently, an article published in the Washington Post portrayed Baby-Friendly practices as a problematic set of policies that “force” a new mother to breastfeed against her wishes. Nothing could be farther from the truth. Being a Baby-Friendly hospital does not mean that mothers are unable to make individualized and informed choices. Baby-Friendly hospitals work to ensure new mothers understand the benefits of breastfeeding and better support those who make this choice.

But more to the point, these concerns divert attention from the fact that science conclusively supports breastfeeding as the best choice for mom and baby. The changes required for a hospital to become designated as Baby-Friendly are based on the best available evidence to support healthy and safe maternity care practices. These practices enhance the patient experience (mother and baby) and lead to improved health outcomes – and they are endorsed by multiple national organizations, including the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC).

The former ways of providing maternity care were neither evidence-based nor healthy and safe. Having newborns cared for by hospital nurses in large ward-type nurseries resulted in fewer mothers meeting their breastfeeding goals, diminished self-efficacy of new mothers, no improvement of sleep/rest during the post-partum period, overfeeding, unnecessary formula supplementation, and increased risk of acute and long term health consequences.

These “traditional" practices were supported, at least in part, by an industry seeking to promote infant formula use and led to a dramatic increase in infant formula usage over the past half of a century. Not surprisingly, shifting this environment to support breastfeeding, while at the same time permitting personal choice and individualized care, has led to a dramatic rebound in breastfeeding rates, translating into better health outcomes.

Still, the U.S. has much room for improvement. Data from the CDC have shown that while the majority of mothers intend to breastfeed (about 80 percent), only 60 percent achieve their personal breastfeeding goals. And the U.S. continues to lag well behind most other industrialized nations in exclusive breastfeeding and infant mortality.

Change is not easy. Most of these practices have been engrained in the culture of delivery hospitals, and the practitioners who work there, for many years. Change requires teamwork, buy-in from leadership, and practice. But most of all, adoption of evidence-based practice involves education—so new mothers can make well-informed decisions for themselves and their child.

Share:

Add your comment

 
 

 

Archive

Tagcloud

QI quality improvement sustainabilty im coiin nichq preterm birth Baby-Friendly breastfeeding Pediatric journal Best Fed Beginnings infant health safe sleep tips PDSA cycle baby box infant mortality family engagement eccs coiin immunizations health equity health disparities accreditation astho onboarding collaboration engagement partnerships larc nashp new york wic new york state hospitals mom mother partners epilepsy data AAP early childhood pdsas texas community support learning session children's health new technology engineering transgender collaborative learning planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke toolkit e-module dental care oral health underserved populations health inequity public health Maternal and Child Health Journal leadership engagement Sickle cell disease indiana SCD medicaid perinatal regionalization sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision vision screening eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series access BQIH exclusive breastfeeding long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in parent partner patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media advocacy leadership Berns Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Cross-Sector Collaboration Knowledge Sharing Child Health