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Read this report of inspiring stories from Phase One of the Be Our Voice project.

Best Fed Beginnings: Helping Hospitals Support Breastfeeding

August 14, 2012
By Kristina Grifantini

With more than 8,500 births a year, Women & Infants Hospital is the largest birthing facility in Rhode Island—and one of the largest in the country. The hospital already encourages breastfeeding but now it’s aiming for the next step: to become “Baby Friendly,” an international designation granted to facilities that adhere to the WHO/UNICEF evidence-based Ten Steps to Successful Breastfeeding.

“It’s always been a dream of mine that our hospital would be able to have the level of excellence reflected in Baby Friendly status for the care of our breastfeeding moms and babies.” says Cynthia Zembo, RN, IBCLC, who has been a lactation consultant for 20 years and with the hospital for 23 years. “Rhode Island has a lower breastfeeding rate than the rest of New England. 75% of women intend to breastfeed and the ten steps will help them be successful.”


On June 29, 2012, the team at Howard County General Hospital celebrated their acceptance into Best Fed Beginnings with a cake kickoff celebration. (Pictured: Doris Cybert Wilcher, left, and Sheila Donahue, Director, Women and Children.) Staff and patients and their visitors joined in the celebration as the team delivered cake to each room. Credit: HCGH

The US has a lower rate of breastfeeding than other countries, despite research showing that babies who exclusively breastfeed for 6 months receive better protection against infections, obesity and mortality. While recent data from the Centers for Disease Control and Prevention confirm that more women than ever are breastfeeding in the US, only 16% of mothers exclusively breastfeeding for 6 months. Part of the reason, experts contend, is that hospitals and staff aren’t trained or set up to educate and support mothers who want to breastfeed.

Around 6% of the approximately 2,000 birthing faculties in the US are Baby Friendly certified and currently no state is fully Baby Friendly. NICHQ’s new national, two-year initiative called Best Fed Beginnings will help 90 hospitals—including Women & Infants Hospital—take the steps necessary to become Baby-Friendly certified. The 90 hospitals serve a diverse population and range from locations in dense urban settings to sprawling rural landscapes. Some participating hospitals are small, serving only a few hundred births a year while others, like Women & Infants, are home to thousands of births per year. By the end of the project, all of the participants will have taken steps toward Baby Friendly status by, for example, educating all of the staff in breastfeeding, eliminating the use of pacifiers, and encouraging skin-to-skin contact for new infants and their mothers.

Zembo says that Best Fed Beginnings will offer deadlines and a structure for achieving the steps, some of which—like educating their 400-plus providers and changing their daily practices in regards to breastfeeding—will be a challenge.

“We’re embarking on a project that’s going to require increased staff training to learn updated practices and changes to our electronic medical records to document and monitor care practices,” says Zembo. “This initiative is attractive to us because it’s a way to effectively make change and be as efficient as we can. Getting everyone on the same page is an important opportunity and also a huge undertaking.”

She adds, “My determination to see us achieve Baby Friendly designation comes from the relaxed and blissful face I see when a new mom first hears the baby swallow and sees her newborn so peaceful at her breast.”


HCGH employee and new mother, Kursten Jackson, with her infant Korey Jackson Travers. Credit: HCGH

Representatives from Howard County General Hospital, a member of Johns Hopkins Medicine located in Columbia, Maryland, also express excitement about the initiative. Howard has an initial breastfeeding rate of 90% for its 3,000-plus births a year, but that drops to well below half for exclusive breastfeeding at 6 months. The Best Fed Beginnings team plans to focus on creating a breastfeeding curriculum for the physicians and nursing staff.

“The opportunity provided by this program is especially appealing to us because it adds the valuable element of not only the quality improvement expertise but of all the other hospitals nationwide working on this initiative,” says Doris Cybert Wilcher, RN, BSN, and lactation consultant at Howard. “We can problem-solve and share information with other hospitals.”

Like a number of other hospitals, Howard will stop handing out free formula samples to new mothers in the near future as another way to support breastfeeding, drawing criticism as well as praise from the community.

“There’s a misconception that we will not provide formula for mothers who want it when, in fact, it’s only the free samples we will not provide,” says Cybert Wilcher. “When hospitals offer a product, the implications follow that the product is endorsed by the medical community to sustain nutrition. Research shows that the use of formula is one of the strongest predictors of breastfeeding failure.”

She adds, “We honor the preference of all mothers: they are all our patients and they deserve the best regardless of their choices of feeding.”


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