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.


Add your comment





sickle cell disease SCD advocacy Baby-Friendly breastfeeding Pediatric journal Best Fed Beginnings infant health safe sleep IM CoIIN QI quality improvement flexibility family partner parent partner vision screening nichq perinatal quality measures sustainabilty preterm birth 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 indiana 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 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 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 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