A Breastfeeding Culture Starts in the Community, Not the Hospital

Posted August 27, 2015 by Heidi Agostinho

This is one of a series of posts for National Breastfeeding Month about NICHQ's work to improve breastfeeding-related maternity care practices in hospitals.

Heidi Agostinho
I have worked in Florida helping women to breastfeed for over 25 years and I have heard multiple stories of mothers being misdirected and unsupported by healthcare professionals. I also experienced it myself. So in 2009, when I was asked to begin a project to help Florida hospitals become Baby-Friendly designated and make policy and environmental changes that most believed to be impossible, I couldn’t say no.

My Story
When my water broke with my first child and I noticed meconium stained fluid, I was immediately alarmed. At the hospital, accompanied by my mother, my contractions were one after the other. I was scared. The nurse motioned me into the bed to perform a vaginal examination and gasped. I asked, “What is the matter?” But she did not answer. Instead she ran out to the hall and returned with another nurse, who examined me. That nurse ran out and yelled, “Call the doctor!”

I was going to have an emergency C-section because my baby was footling breech. I asked, “Is my baby OK?” but no one answered. The nurses came in and strapped me to the table with my arms out Christ style and legs together. I kept asking, “Is my baby OK?” Still no one answered.

The anesthesiologist noticed I was distressed, crying and having constant contractions. He put his hand on my shoulder and said, “It is going to be OK.” He told me he was going to put a mask over my face and that I would smell something bad. He urged me not to worry, just breath. He put the mask over my face. The doctor walked in, clapped his hands and said, “Let’s get started!” That was the last thing I remember.

In recovery, I was unable to open my eyes or move my body, but I could think. I was trying to say, “Where is my baby?” Finally the words began to come out and I heard a nurse say, “Is she talking?” I tried again. Unable to move or open my eyes I got out, “Where is my baby? I need my baby!” I was sobbing. They urged me to calm down. I got my eyes open and continued, “Where is my baby?” “Is my baby OK?” Finally a nurse said, “Yes, he is OK.” I exclaimed, “I want to see him.” I sobbed persistently.

Finally a nurse brought him to me. I demanded that my baby stay with me rooming in and was met with anger and treated as a non-compliant patient. I would not let them take my baby again. Breastfeeding was another thing all together. I asked for help and got a bottle of formula. Thankfully I was able to get my baby to latch. It hurt the first six weeks. When I asked for help from a community support group, I was told to bite down on a towel each time he latched. I thought I would stop breastfeeding at six weeks because it hurt too much. I continued to complain about breastfeeding and found a mother-to-mother support group. From other mothers, I learned that a position change could fix my latch. It was a simple fix that, had the nurses or other healthcare workers known, would have made my experience much more pleasant.

Forming Community Collaborations to Take on the Challenge
That was the beginning of the rest of my life. I survived and continued to breastfeed despite the lack of initial support. I not only enjoyed breastfeeding all of my children but have committed my life’s work to help mothers through the creation of continuity of care—forming links for mothers to have easy access to support and accurate information. No mother should have to look for a needle in a haystack when finding support for feeding her baby.

Many years later, I learned that many of the hospitals felt ashamed with the type of care they provided. They wanted to do better but didn’t know how.

At the beginning of my work on the Communities Putting Prevention to Work project, there were only two hospitals designated as Baby-Friendly in Florida, none in the counties where I worked. No one was willing to work with the hospitals because they thought the project was too lofty and would fail. However, we initially got nine hospitals to agree to participate. As we started to work with state agencies and held conferences about Baby-Friendly practices, hospitals began to hear about the quality work being done by their competitors and the ripple effect brought 21 hospitals into the project. As the project progressed and national momentum began to trickle into Florida, NICHQ recruited an additional five hospitals to improve practices and become Baby-Friendly as part of the Best Fed Beginnings initiative. I was tasked with helping those five hospitals connect with their community.

We implemented two key concepts:
  1. “You don’t know what you don’t know.” This was exactly what was happening with our patients and our hospital staff. 
  2. “Through the act of story telling you transform the hearts of those making change.” Forming my own story helped to transform the project and gave a clear understanding of how the community connection was an intricate part of the whole picture.
One of the greatest outcomes of this project was the relationship formed between hospitals and the Women, Infants and Children (WIC) program. The relationship helped to solidifying messages across disciplines throughout the community and helped mothers know what to expect at the hospital.

A number of solutions were implemented including:
  • The development of uniform prenatal education modules for hospital and other support organizations to use.
  • Updated referral lists for new mothers that included all breastfeeding support in the community.
  • Task forces formed that pulled in community agencies, organizations and concerned citizens to work on projects improving prenatal and postpartum care in and out of the hospital.
  • WIC Breastfeeding Peer Counselors began to work in hospital settings, complementing support of nursing staff and building a community connection.
By forming collaborations within the community, unifying messages and working on a shared goal with organizations such as NICHQ, Florida was able to increase the percentage of women exclusively breastfeeding at 6 months (as recommended by the American Academy of Pediatrics) by 9 percentage points to 18.9 percent. The state also improved its CDC mPinc score by 9 percent, turning it into a “C” state in hospital maternity care practices, up from a “D.” Today Florida has 10 designated Baby-Friendly hospitals. We have much more work to be done, and as we do, I know I’ll hear fewer stories that resonate with my own.


Heidi Agostinho, PhD, IBCLC, is the director of the Foundation For A Breastfeeding Culture. She participated in the Best Fed Beginnings, a NICHQ-led, groundbreaking national initiative to help hospitals improve breastfeeding-related maternity care and increase the number of Baby-Friendly hospitals in the U.S.



Learn more about NICHQ's breastfeeding initiatives.


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