Despite breastfeeding’s documented health benefits for infants and new moms, the Centers for Disease Control and Prevention estimates less than a quarter of U.S. infants are exclusively breastfed through the first six months of life.
In 2016, about 30% of mothers at Winnie Palmer Hospital for Women and Babies in Orlando were going home with their new babies breastfeeding exclusively, meaning their babies’ only source of nutrition was breast milk.
Nurses at the Orlando Health hospital thought they could do better, and by 2019 nearly doubled the exclusive breastfeeding rate to 56.9%.
They shared their success and how nursing played a big role during a presentation at the American Nurses Credentialing Center National Magnet Conference in October 2019.
“We considered the fact that we deliver between 14,000 and 15,000 babies a year,” said Cynthia Tinder, MSN, RN, NE-BC, CBC, program manager for nursing and special projects, Winnie Palmer Hospital.
“We take that very seriously, knowing we need to provide the best care for our consumer — the patients,” she said.
Tiana Hayes, BSN, RNC-OB, nursing operations manager at Winnie Palmer Hospital for the Mother Baby Unit and Transition Care Nursery, said she and Tinder researched the evidence-based practices today and all supported that exclusive breastfeeding was not only essential to babies but had great health benefits for moms.
“As a hospital, we decided to go on a baby-friendly journey to increase our exclusive breastfeeding rates so we’d give our moms a better chance of being successful at being exclusive breastfeeders,” Hayes said.
Practice vs. evidence on exclusive breastfeeding
The nurses started by reviewing the hospital’s existing practices to encourage exclusive breastfeeding and compared them with the evidence. They later brought the proposed changes and reasoning behind them to nurses at the hospital.
“We are a Magnet hospital and we practice change with transformational leadership,” Tinder said. “We let the nurses decide how the changes will happen. We gave them the opportunity to help make the workflow work best for them, at the same time teaching them that this was what was best for their patients.”
Among the changes were:
Putting babies skin-to-skin with moms immediately at birth.
Rooming in and providing care at the bedside, rather than taking newborns to the nursery for assessments.
Implementing a glucose gel nurses can use instead of formula along with breast milk when treating hypoglycemic babies.
The initiative had a rocky start, but increases in exclusive breastfeeding came gradually once nurses had their say about how to implement the changes, Hayes said.
“We weren’t confident in how to make that roll out, so that’s when we really understood that we needed the feedback from our nursing teams,” she said. “Using those tools that we have from Magnet, we were able to build committees with our nurses, we were able to bring it to our nurse practice councils and run those processes through our nurses to make their workflow better.”
Hayes said she believed this helped the nurses own the project. “If we start initiating something they suggested, that builds excitement,” she said. “That builds encouragement that we’re listening and we’re making the changes they wanted to make.”
Giving nurses input not only drove the steady increase of the hospital’s exclusive breastfeeding rates but also helped to establish the hospital’s breastfeeding protocol as permanent, according to Tinder.
In fact, every nurse in the facility has received education on how to help moms facilitate breastfeeding so the hospital can keep up and increase the exclusive breastfeeding rates.
“As a nurse, you can’t always get that process down to where it is perfect, but we can get it as close as possible for nurses in their workflow, so it’s a better workday for them,” Hayes said.
Tinder and Hayes continue to learn about best practices and the evidence to keep driving up the hospital’s exclusive breastfeeding rates.
“We see a lot of patients, and the more patients that we can help exclusively breastfeed, we are really making an impact on the health of many women and babies in our community,” Tinder said.
Hayes said the best advice she can give is to involve nurses in hospital projects that will impact their workflows. Initiatives that do will stand a better chance of success.
More best practices, resources
The World Health Organization and the United Nations Children’s Fund launched the Baby-Friendly Hospital Initiative in 1991. This global program encourages implementation of the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes.
More than 20,000 maternity facilities in 150 countries have earned the designation. Winnie Palmer is one of more than 500 Baby-Friendly designated facilities in the U.S.
Along with the exclusive breastfeeding recommendation in the first six months of life, the American Association of Pediatrics says moms should continue breastfeeding along with the introduction of complementary foods for at least one year, according to the CDC’s Breastfeeding Report Card.
Mothers in the U.S. often start out with the best intentions, with more than 83% trying to breastfeed initially, the CDC says.
Despite the CDC’s six-month recommendation, less than 50% of infants were exclusively breastfed through three months and about 25% were exclusively breastfed through six months. These rates suggest that mothers may not be getting the support they need from healthcare providers, family members and employers to meet their breastfeeding goals, according to CDC.
About one of every six breastfed infants born in 2015 received formula supplementation within the first two days of life, according to the CDC, which notes the early postpartum period is critical for establishing and supporting breastfeeding.
Resolve to be an legislation advocate in 2020, not only on the federal level but the state level as well.
Take these courses to learn more about mom and baby care:
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The nurse who cares for the laboring patient should understand what information is being taught to support a patient and her family’s wishes appropriately. This course explains the history of childbirth education, current childbirth options, the birth plan and managing pain during labor.
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