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.


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