‘Baby Friendly’ Designation Recognizes Hospital’s Breastfeeding Support
Families choosing to have their babies at Einstein Medical Center Philadelphia are finding a much different approach to infant care — and especially breastfeeding —than they might have seen just a few years back.
“In the old days, we would take the baby, wrapped like a burrito, to mom for an hour,” recalls Jane Lodise, RN, MSN, Nurse Manager for the Mother Baby Unit at Einstein Medical Center Philadelphia. “We would separate mom and baby for every task: the first bath, doctor exams, everything.
“The babies would sit in the nursery for hours and the mothers were knocking on the doors saying, ‘Where’s my baby?’ It was like they were our babies, not theirs.”
But things have changed so much that in 2018 Einstein Philadelphia achieved the coveted and hard-won “Baby Friendly” designation.
“This honor recognizes the best practices to promote breastfeeding that our frontline staff had put in place,” says Jennifer Rodriguez, MBA, BSN, RN, Director of Nursing, Women and Children’s Division.
The Baby Friendly distinction was introduced in 1991 by the World Health Organization and the United Nations Children’s Fund.
That doesn’t mean that before last year Einstein was baby unfriendly. But, like many other hospitals, Einstein wasn’t always implementing the evidence-based practices in care and feeding that produce the best outcomes for babies and parents.
No More Formula Ads
It also may not have been the best atmosphere in which to encourage and support breastfeeding. In fact, for decades, the maternity staff were like walking advertisements for baby formula. Literally.
“Nurses wore buttons or lanyards with the name of a formula manufacturer on them,” Lodise says. Babies got bottles in the nursery and mothers got formula coupons in their departure gift bags. Even the newborn crib cards were provided by a formula company.
That was happening even during the years when everyone could parrot that memorable “breast is best” adage. Years when the medical community knew that breastfeeding conferred health benefits to baby and mother: less risk of Sudden Infant Death Syndrome (SIDS), allergies and infections for babies; protection against heart disease, cancer, diabetes and bone loss for the mothers.
“Mothers were coming in wanting to breastfeed and we got in their way,” Lodise says.
Clearly, there was a serious disconnect.
That’s what Lodise thought. So did her colleague Anneliese Gualtieri, RN, BSN, the Patient Safety and Quality nurse for OBGYN.
Changing a Culture
The two proposed that Einstein, as Gualtieri puts it, “take the journey” to the Baby Friendly designation. That journey started in 2011 and took eight years to complete, making it more of an Ulyssean odyssey before Einstein became the fifth hospital in the city to achieve the Baby Friendly designation.
“Would we have liked to have been first? Yes,” Gualtieri says, “but it was more important that when we put this in place, it was going to be part of our culture at Einstein.”
That meant total buy-in from the obstetrics, pediatrics and maternity staff, inpatient and outpatient. Staffers who had been operating one way for decades were going to have to do an about-face.
“We didn’t want to put an edict out that you have to do this now,” Lodise says. “We wanted everyone to do it because they believed in it.”
“We knew we were changing a culture,” Gualtieri says.
That would take time.
10 Steps to Successful Breastfeeding
Meanwhile, Einstein also had to complete the global initiative’s “10 Steps to Successful Breastfeeding,” which meant fundamentally changing how patients were cared for after they gave birth.
Einstein also agreed to follow the International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in 1981 to promote breastfeeding and control the marketing of infant formula, bottles and pacifiers.
To meet those requirements, the medical center stopped accepting free formula from manufacturers, and discharge gift bags stuffed with formula coupons. “We choose not to let our staff or our mothers be unduly influenced by formula companies,” Lodise says. “Protecting the mother’s informed choice is paramount.”
The “Baby Friendly” designation was awarded after a rigorous onsite assessment in which staff were questioned, patients interviewed, and even the gift shop scoured for the stray bottle-shaped balloon or pacifier that might send the wrong message to mothers being educated on how to breastfeed.
Even the artwork on the walls reflects the switch in thinking. It’s hard to look anywhere and not see images of breastfeeding mothers. “The idea is that what you have in your environment says a lot about your beliefs,” Gualtieri says.
Exclusive Breastfeeding Rates Up
Data also helped. Studies have shown that the more of the 10 steps an institution implements, the higher its breastfeeding rate. Before the program began, only about 8% of new mothers at Einstein exclusively breastfed their newborns while in the hospital. Now, 70% begin breastfeeding during their stay, and about 40% breastfeed exclusively, Lodise says. The other 30% may breastfeed some of the time and use formula the rest of the time.
What led to this outcome was education, starting with staff. From doctors and nurses to security and dietary staff, even file clerks in outpatient offices — everyone who came into contact with mothers and babies was given training in the new practices. “We didn’t want someone coming in with a breakfast tray to make an offhand comment like, ‘Oh, you don’t really need to breastfeed your baby — I didn’t.’ That might send the wrong message,” Lodise says.
The new practices include “rooming in,” in which a baby remains in a crib next to the mother’s bed for their entire stay in the hospital.
Learning Infant Care
Rooming in turns the mother’s room into a classroom. The subject: her own baby. With her infant nearby 24/7, a new mother can learn to pick up her baby’s feeding cues and start a breastfeeding schedule before leaving the hospital.
There are three lactation consultants on staff to assist breastfeeding mothers. They troubleshoot any breastfeeding problems that occur and help to inspire confidence in new mothers.
Instead of bringing a little stranger home — where there’s no one to answer questions or provide care techniques and alleviate any concerns — mothers and fathers learn by caring for their infant on their own, but with expert help nearby.
No more whisking the baby to the nursery for the pediatrician exams. The doctor comes to the room, where parents are able to get all their questions answered.
Today, nurses no longer provide the bulk of infant care in the nursery. It is the same care, just in a different location — at the mother’s bedside. Now Mom and Dad can see the first bath, learn how to change a diaper, and practice the burrito wrap.
“Nurses are there to help parents learn to take care of their babies,” Gualtieri says, “so when they leave parents feel confident. They feel, ‘This is something I can do for my baby.’”
That’s not to say that exhausted moms can’t get a reprieve, says Lodise. Nurses will remove babies from the room to allow new mothers to get some sleep, bringing them back for feedings.
Though the thrust of the program is to support and promote breastfeeding as an infant feeding choice, parents who make a different choice are also fully supported, Lodise says.
“We believe that mothers deserve to make the choice of what’s best for their baby, and if they choose to formula feed, our nurses are able to give them guidance on how to make and feed formula. We make sure they know that we support their choice.”
Rooming in is also a way to encourage bonding. That part of postpartum education starts right after birth, when the newborn is placed on the mother’s bare chest.
This “skin-to-skin contact” does even more: it keeps the baby warm and stabilizes vital signs and blood sugar, says Lodise. It also keeps the baby calmer; cuddled babies cry less.
Partners are included in all the bonding opportunities except, of course, for breastfeeding. In fact, partners doing skin-to-skin contact is one reason that training in the new practices was extended to the security staff. “In one case, a security officer came in and found a dad with his shirt off holding a baby,” says Gualtieri. “He called the nurse, who assured the officer, ‘No, we want him to do that!’”
Babies placed against the mother’s bare skin are also more successful at breastfeeding, studies have found. Holding her newborn to her chest can help a mother quickly learn her baby’s feeding cues.
New mothers are also encouraged to breastfeed within one hour of birth, says Lodise. Suckling helps the mother produce colostrum, the first iteration of breastmilk that is rich in nutrients and antibodies. It’s the baby’s first food and first vaccine. Even mothers whose infants require a stay in the Neonatal Intensive Care Unit, because of illness or prematurity, are encouraged to pump breast milk for their babies.
“Studies show that breastfeeding can help prevent necrotizing enterocolitis (NEC),” Lodise says. NEC is an inflammatory disease, targeting mainly premature babies, in which bacteria enter the wall of the intestines, causing a local infection that can spill out into the abdominal cavity. It can be fatal.
Support Outside the Hospital
Einstein also set up support groups for new mothers, a requirement for the Baby Friendly designation. There’s a free breastfeeding support group every Tuesday morning on the third floor of Einstein Philadelphia’s Paley Building. At Einstein Montgomery, the group meets Tuesdays at the Einstein Women’s Resource Center, 633 W. Germantown Pike, Plymouth Meeting. Lactation consultants are also available by appointment.
Parents have been responding positively to all the new changes, says Gualtieri — a confirmation for the two women since the project occupied eight years of their professional lives. In fact, just recently, while they were explaining the new designation to a group of new Einstein Philadelphia employees, one woman raised her hand to offer her personal assessment.
“She said she had had a baby at Einstein Philadelphia 12 years ago and another one just three months ago and she said it was totally a better experience,” Gualtieri says. “Jane and I were so excited to hear that!”
Find out more about Einstein obstetrics services.