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Hospitals Nurture A More 'Baby-Friendly' Environment

OPB | Oct. 17, 2013 6 a.m. | Updated: Jan. 3, 2014 2:18 p.m. | Portland

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Oregon hospitals are trying to encourage more mothers to breast-feed. The idea is that breast-feeding will reduce the risk that babies will develop obesity, diabetes and asthma later in life.

But accreditation as a Baby-Friendly hospital comes with some big changes like: breast-feeding lessons immediately after birth, no more hospital nursery and no pacifiers.

Shavantee Scott is struggling to breast-feed her 10-month-old twins because they're getting teeth.

Shavantee Scott is struggling to breast-feed her 10-month-old twins because they're getting teeth.

Kristian Foden-Vencil / OPB

Helen Phillips is the director of women’s service at Legacy Health Systems.

Standing outside the nursery window at Good Samaritan Hospital, she explains how a few years ago, visitors would have been able to see lots of newborns.  Now, there are no babies in the room.

“Today, I’m told we have five new babies here on the unit. But all five of those babies are out, with their moms, in mom’s room, which is typically where they’ll spend their time,” Phillips says.

Encouraging mother-baby “together time” is just one of 10 ten steps hospitals have to take to become accredited as Baby-Friendly.

The World Health Organization started the Baby-Friendly hospital campaign in 1991 to encourage more breast-feeding.

The USA Baby-Friendly accreditation program started shortly afterwards, and several Oregon hospitals are now pursuing it - including six in the Legacy Health System.

Phillips says the other steps to becoming Baby-Friendly include:  not giving newborns anything other than breast milk - so no formula unless it’s medically necessary; and helping mother initiate breastfeeding within one hour of birth.

“There’s a lot of very solid research around how that experience contributes to initiating breastfeeding within that hour. It’s kind of fascinating, there are studies and actually some videos on how the infant just seems to find the breast by instinct,” Phillips says.

To make sure a baby is fine and its airways aren’t plugged by mucus, Phillips says staff do an immediate assessment. But they don’t use a bulb syringe to clean the baby up, unless there are excessive amounts of mucus. Instead, the focus is on getting the baby into mother’s arms as soon as possible.

Some of the other steps to become Baby-Friendly include training staff and having a written breast-feeding policy. But Phillips says one of the biggest steps — and the one her hospitals have yet to take — is to cut the use of the pacifier.

“There’s data to show that until breastfeeding is established, so not forever, but in those early few weeks, you have for most kids better initiation of breastfeeding and breast milk supply for mom, if, rather than giving the baby a pacifier when they’re fussy and maybe hungry, to just breastfeed that baby,” according to Phillips.

She says Legacy plans to use pacifiers only to calm babies during painful procedures, like shots.

While the federal government is encouraging breast-feeding, the Affordable Care Act does not link payments to it. But Phillips thinks that may be coming.

“Breast-feeding at discharge is a metric that’s being more and more measured. And I think in the future this is going to be a factor around reimbursement,” Phillips says.

Breast-feeding is already relatively popular in Oregon, about 24 percent of babies are exclusively breast-fed by six month — as opposed to the national average of 16 percent.

Denise Johnson, the health education coordinator with Care Oregon, says the Affordable Care Act also promotes breast-feeding.  It requires insurance companies to cover breast-feeding counseling and the rental of breast pumps, she says.

“Also the wage laws have been changes so that there’s protection for the rights of nursing women in the workplace,” Johnson says.

Community health nurse, Violet Larry, gets her baby scale out of her car. She says they're putting a greater emphasis on mothers to breast-feed now.

Community health nurse, Violet Larry, gets her baby scale out of her car. She says they're putting a greater emphasis on mothers to breast-feed now.

Kristian Foden-Vencil / OPB

The push for breast-feeding doesn’t end when mom and baby leave the hospital, either. Violet Larry is a community health nurse with the Healthy Birth Initiatives Program in Multnomah County. She says things have changed over her 23 years of service.

“I go into the client’s homes and do an assessment and provide information and education. We would talk about do you plan to breast-feed and if they said ‘No,’ it wasn’t a big deal. You go on and do your formula and move forward. But in the last five years the push has been really strong. And we’d start on that first visit its: ‘You are planning to breast-feed aren’t you?’ And they say: ‘No.’ I say, ‘Yes you are planning to breast-feed aren’t you?’ “

One of the mothers who Violet Larry visits is Portlander Shavantee Scott. She has 10-month-old twins who she’s happy to show-off.

She says in the nine years between the births of her twins and her eldest, she’s noticed substantial changes in the way hospitals deal with breast-feeding.

“It’s a big difference for me because they advocate for it more,” Scott says.

She says she’s being told to breast-feed the twins until they’re a year old.

But she’s not so sure.

“I personally can’t do it because of the teeth thing. And that’s what I’m having right now is teeth coming in. So this is not fun,” Scott explains.

The U.S. Breast-feeding Committee’s Healthy People 2020 goal is to increase the percentage of infants who are exclusively breast-fed for six months nationwide from 16 percent, to 25 percent.


This story is one of a series we’ve been running all week, on how health care providers are testing ideas to prevent disease and save the health care system money. If you missed stories about people in recovery from mental illness who are helping others in treatment; or about a Eugene health insurance company paying for teachers to play a game with students that has been shown to reduce tobacco and drug use; you can find them on the Vital Signs page at  www.opb.org.

The series is a part of a reporting partnership between OPB, NPR and the Kaiser Family Foundation.

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