‘Baby Friendly’ project at hospitals encourages breast-feeding

PHILADELPHIA - In 1989, an international panel of experts called attention to the irony that health workers were preventing many newborns from getting the healthiest possible food - mother’s milk.

Hospital maternity units were contributing, “however unwittingly,” to the long decline in breast-feeding by failing to encourage moms to do it, or by introducing practices that discourage it, such as giving baby formula.

The panel’s statement, sponsored by the World Health Organization and United Nations Children’s Fund, led to a global hospital reform movement called Baby Friendly.

Now, a few decades later, the movement is in place in various parts of the country and has also taken root in Philadelphia, where breast-feeding rates are perennially lower than the state’s, which are lower than the nation’s. All six of the city’s birthing hospitals have committed to investing four years - and considerable capital - to adopt 10 practical steps that promote breast-feeding, including keeping newborns with mothers rather than in a nursery, and not sending them home with free formula.

The region’s Maternity Care Coalition, a nonprofit dedicated to improving maternal and child health, planted the seeds of Baby Friendly in 2011.

“You think, ‘Ten steps, that’s easy. Why do they give us four years to do this?’” said Anneliese Gualtieri, a nurse in the mother-baby unit at Einstein Medical Center, which has 3,000 deliveries a year. “But changing practice and the culture is very difficult.”

The Hospital of the University of Philadelphia and its affiliate Presbyterian Hospital - with more than 8,000 deliveries a year - are closest to earning the coveted Baby Friendly designation from Baby Friendly USA, the nonprofit accrediting firm in Albany, N.Y. Both hospitals jumped through the final hoop of site visits about two months ago.

Rachel Montgomery, 36, can attest to the changes in atmosphere and attitudes at Pennsylvania Hospital, where she gave birth three years ago - and 13 days ago.

“I’ve been a pediatric nurse, so I know a lot about (Baby Friendly) and was elated to see it,” she said. “I knew I was going to have a better experience with my second son, and I did.”

The nutritional, health, and psychological benefits of breast-feeding are undisputed. It’s also more economical than formula. Yet slightly less than 80 percent of U.S. mothers ever do it - meaning 20 percent don’t, according to the most recent survey by the Centers for Disease Control and Prevention. (The survey found about 73 percent of Pennsylvania mothers and 82 percent of New Jersey mothers ever breast-fed.)

Baby Friendly helps medical professionals confront how they may be contributing to this situation by getting in Mother Nature’s way.

Consider what normally happens to a healthy baby delivered in a modern hospital: The infant is whisked away, weighed and measured, treated with a vitamin K shot to prevent bleeding, given antibiotic eyedrops, bathed, wrapped in a blanket, and put under a warming lamp in the nursery while Mom recovers.

“Mom was given back a sweet, clean baby,” said Trish MacEnroe, executive director of Baby Friendly USA. “What we failed to realize was the normal biological instincts we were interfering with.”

In contrast, in the nation’s 267 (and counting) Baby Friendly hospitals, healthy newborns are wiped off and spend their first hour on their mother’s chest so they can begin breast-feeding and bonding. Studies show this helps infant vital signs, including heart rate and body temperature.

Even women who deliver by cesarean section, like Montgomery, can welcome their newborns “skin-to-skin.” After the nurse helped Montgomery with Rowan’s first feeding, his initially low blood sugar normalized.

“I would say it’s a testament to this practice and how effective it is,” Montgomery said.

And if cuddling before cleansing sounds unsanitary, studies show that it lowers the chance of infection.

“The thing is, you want the baby to be colonized with the mom’s bacteria, not bacteria from the nursery,” said obstetrician-gynecologist Gail Herrine, director of Temple University Hospital’s postpartum unit. “We’re not bathing the baby for 12 to 24 hours, and Mom can participate in the bath.”

Some women, of course, say they prefer not to breast-feed. Baby Friendly nurses are trained to find out why. A lack of role models? Concern about discomfort, inconvenience, or embarrassment? Not sure how to maintain lactation after going back to work?

Then they explain why the breast is best.

This is particularly important with low-income women, who generally have lower breast-feeding rates.

“It’s not that you’re forcing the mom to breast-feed,” said Gualtieri at Einstein. “You’re educating her so she can make an informed choice.”