Tag Archives | BFHI

Clinicians in the Trenches: Francisca Orchard from Santiago, Chile

Screenshot 2014-10-20 10.41.26

By Francisca Orchard, CNM, IBCLC

I became a certified midwife 20 years ago, assisting women in labor since my early adult days. I came into this field with an eye toward low intervention birth and respect for mothers, with special emphasis on the humanization of birth. This was probably because, during my internships in hospitals, I saw very little respect for women and a lot of poor treatment of them.

In the 1990s, I worked in a neonatal intensive care unit where the promotion of breastfeeding in preterm infants was a priority. Later, I also received doula training in the U.S. and earned a diploma in infant massage in London.

In 2011, I achieved my goal of becoming an International Board Certified Lactation Consultant® (IBCLC®). The road was not easy for me. The year I took the exam was the first time in Chile the exam was given at the same time as in the rest of the world.

Since then, I have been working in breastfeeding promotion, and consulting in support of perinatal health professionals. I began a prenatal education program for pregnant women and their families that promotes breastfeeding and respectful delivery to reduce the number of caesarean section deliveries in Chile, and to increase our prevalence of exclusive breastfeeding to 6 months of life.

In Chile, we have 43% of mothers still breastfeeding at 6 months, but there is a huge disparity in breastfeeding rates related to women’s income.  We have an urgent need to follow mothers during the first days after maternity hospital discharge, where most abandon exclusive breastfeeding. We also struggle with  health professionals who, due to their lack of knowledge about breastfeeding, are perhaps our biggest barrier to breastfeeding duration. Most pediatricians encourage the use of artificial supplements instead of working with mothers and babies early to help them continue breastfeeding.

Currently, I am a member of the Chilean Committee on Breastfeeding and the Lactation Committee of the Chilean Society of Pediatrics. Some months ago, I collaborated with a multidisciplinary team of psychologists and photographers on a project called “Breastfeeding Mothers.” We created a space where women of different ethnicities and Chilean places were professionally photographed in different breastfeeding situations.  It is a beautiful work with more than 50 photographs. We are awaiting funding to publish it for breastfeeding promotion in Chile.

In my daily work, I consult with women and babies with breastfeeding difficulties and write articles of interest to our community.As of this writing, I am one of only 2 IBCLCs in Chile. During World Breastfeeding Week, I traveled to different cities in Chile to participate in breastfeeding promotion activities. Additionally, I work on an advisory team of the ministry of health. We are working toward implementing the Baby Friendly Hospital Initiative in Chile during 2015. The Chilean government is also discussing the approval of human milk banks.

It is an exciting time in Chile with so much going on to support and promote breastfeeding. I am thankful for the International Lactation Consultant Association’s® resources that help me inform my community about the competencies and value of IBCLCs, and to increase our numbers throughout Latin America.

chiliPhoto via the author

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ILCA Launches New NEO-BFHI Webpage

ILCAThe ILCA website now hosts a special webpage to disseminate information about the expansion of the Baby-Friendly Hospital Initiative to neonatal care, or Neo-BFHI. The Neo-BFHI program was developed by a Nordic and Quebec working group consisting of health professionals from Sweden, Norway, Denmark, Finland and Quebec, Canada.

The working group developed a unified expansion of the BFHI to neonatal wards, based on review of the evidence, expert opinion, and experiences in the Nordic countries and other countries around the world. To remain consistent with the WHO/UNICEF Global Criteria, the expansion closely follows the revised Ten Steps to Successful Breastfeeding. The preparation of this adapted version of the BFHI is being done in consultation with representatives of the WHO and UNICEF. The UNICEF has agreed to disseminate the program assessment materials in the same way as for the original BFHI assessment.

Please visit the Neo-BFHI webpage to learn more about the piloting phase of the program. Also on the page is information about an international conference planned to launch the program in late 2014, with invited experts who will complete the program’s documents and form an international steering committee. The core document will be posted soon. Watch the webpage for that and for further updates as planning continues!

For more information about the program, contact Kerstin Hedberg Nyqvist at kerstin.hedberg_nyqvist@kbh.uu.se.

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IBCLCs Play a Critical Role in the US Best Fed Beginnings Program

By Debi Ferrarello, MSN, MS, IBCLC

The National Initiative for Children’s Healthcare Quality (NICHQ) launched it’s CDC-supported Best Fed Beginnings program with the ambitious goal of preparing 90 US hospitals for Baby-Friendly designation by September, 2014. The 90 hospitals were selected from 235 applicants and represent 29 states with dubious distinction of having the lowest breastfeeding rates and the highest rates of supplementation during the hospital stay. The 90 hospitals were further divided into three geographical cohorts of 30
hospitals each.

IBCLCs gathering at the recent NICHQ Region B conference in Baltimore.

Each hospital has a “core team” that includes a senior administrator, at least one physician, a nurse leader, a bedside nurse, a data manager, a team leader, a senior lactation consultant, and a mother who does not work for the hospital and has given recently given birth at the hospital. This model addresses administrative “buy-in” issues by requiring senior administrator participation. In fact, the senior administrators have their own track tailored especially for their needs. Since creating a community that supports breastfeeding is a goal of Baby-Friendly, involving a mother from the community makes so much sense!

Recently, hospital core teams from “Region B” gathered in Baltimore, MD for a two day learning session (and Baltimore’s famous crabcakes on our own!). National public health leaders such as CDC’s Laurence Grummer-Strawn and Charles Homer, MD, MPH, president of NICHQ and on faculty at Harvard University, kicked off the event and energized the crowd. Over the course of two days, participants learned more about why breastfeeding is so important, how hospital practices make a difference, and what teams can do to transform the culture. We heard specifics about Baby-Friendly designation directly from Trish Mac Enroe and Liz Westwater of Baby Friendly USA. ILCA members Lori Feldman-Winter, MD, MPH, IBCLC and Anne Merewood, PhD, IBCLC provided specific strategies for success. Pediatrician Sahira Long, MD, gave insights into providing culturally appropriate care. We learned Continuous Quality Improvement (CQI) techniques that are essential to measure our baseline, develop strategies for change and chart our progress as we strive to support breastfeeding from the prenatal period, throughout childbirth and the hospital stay, and into the postpartum period. Finally, we heard from hospitals in our region who have already become Baby-Friendly as they shared trials and triumphs that we could all relate to.

Each participating hospital made a “story board” or video about their hospital, their goals, their successes, and challenges. Pennsylvania Hospital Core Team members enjoyed seeing what others have done and were proud to share our history of “rooming-in” dating back to 1765! Debi Ferrarello, Susan Meyers, Brittany Stofko, Kelly Wade, Pam Powers, and Karen Anastasia in front of their hospital story board.

So what do IBCLCs need to know about this initiative? IBCLCs need to know that after years of pushing that boulder up the mountain alone, there is suddenly an army of folks pushing right along with us…And we need to welcome the newcomers to the task. We need to be prepared to graciously play support roles as leaders who may never before have considered breastfeeding suddenly “discover” it. Many of the hospital team leaders are IBCLCs, meaning that we need to quickly become experts in CQI tools that were never part of The Exam and develop the essential skills to effectively lead an interdisciplinary team through a complex and multi-layered transformation. This is challenging work, but then again, IBCLCs have always be up for a challenge!

Best Fed Beginnings brings opportunities for IBCLCs. In order to become Baby-Friendly, hospitals need to make sure that all of their nurses have at least 20 hours of breastfeeding education, including five hours of competency-based demonstration. IBCLCs can teach classes and conduct skills labs for the competency education. While hospitals are not required to employ IBCLCs for Baby-Friendly designation, many do hire IBCLCs to care for their patients, as well as to provide education for other staff members. And finally, as hospitals invest resources into breastfeeding support, the visibility of those with expertise in lactation care rises. IBCLCs become far more valuable in the eyes of the hospital and the community. This is all good for IBCLCs, and ultimately for mothers and babies!

Debi Ferrarello, MSN, MS, IBCLC is honored to lead the NICHQ Core Team for the nation’s first hospital—Pennsylvania Hospital in Philadelphia.  Over the years she has worked in private practice, co-founded the nonprofit communty-based Breastfeeding Resource Center with Colette Acker, IBCLC, and led hospital-based lactation programs.  She conducts breastfeeding-related research, writes and speaks about breastfeeding, and is passionate about breastfeeding as public health.  She currently serves on the board of the United States Lactation Consultant Association. 

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Interview with Trish MacEnroe of Baby Friendly USA

Lactation Matters recently caught up with Trish MacEnroe, Executive Director of Breastfeeding USA.  While the Baby Friendly Hospital Initiative is well established in many areas of the world, the number of facilities pursuing the designation has soared recently in the US.  Trish gives us a glimpse into the current trends.

1.      Can you give us a brief history of the Baby Friendly Hospital Initiative in the US?

The Baby-Friendly Hospital Initiative (BFHI) is an international recognition and quality improvement program that evaluates hospital practices to ensure the successful implementation of the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) Ten Steps to Successful Breastfeeding and International Code of Marketing of Breast Milk Substitutes. In addition, the Baby-Friendly assessment serves as an external verification of the CDC’s mPINC survey and is a key strategy to sell my settlement for meeting Healthy People 2020 Goals for breastfeeding. At its core, this designation process involves significant quality improvement and organizational change that replaces long-standing practices with new evidence-based practices that have been proven to lead to better outcomes.

The Baby Friendly Hospital Initiative was launched globally in 1991.  In 1992, the US Department of Health and Human Services funded an Expert Work Group to consider how to implement the BFHI in the United States. In 1994, with support from the U.S. Committee for UNICEF, Wellstart International Screen Sharing developed the evaluation tools to implement the BFHI assessment process. At the request of the U.S. Committee for UNICEF, in January 1997, the Healthy Children Project, Inc. accepted responsibility for creating the organization to serve as the designating body for the BFHI in the United States. Since August 1997, Baby Friendly USA, Inc, a non-profit 501(c)(3) organization, is the US national authority for this global breastfeeding initiative.

Currently, 145 hospitals and birthing centers in 34 states are designated as Baby-Friendly Facilities in the United States. 23 hospitals were added in 2011 and 22 more have already received the designation in 2012. Another 675 are working towards designation. The Baby Friendly Hospital Initiative is growing rapidly in this country as more and more birthing facilities commit to becoming Baby Friendly.

 2.      How has the Surgeon General’s Call to Action impacted the practice?

The US Surgeon General acknowledged the benefits of the Baby-Friendly Hospital Designation in her Call to Action to Support Breast Feeding. Baby-Friendly USA, Inc. (BFUSA) is committed to advancing effective strategies that assist hospitals, breastfeeding coalitions, public health entities and funders to work collaboratively in implementing Action 7 of the Call to Action and improve outcomes.

Since the Surgeon General’s Call to Action, the number of local departments of health, breastfeeding coalitions and other community organizations (auto glass replacement houston shops) assisting hospitals in working to become Baby-Friendly designated has risen dramatically. While there is no direct evidence that it is specifically attributable, since the Call to Action was released 512 hospitals have officially begun work on the BFHI in the US.  My opinion is that the surge in hospital interest is the result of a combination of factors: a call to action from the highest levels of the US government, as well as some new funding opportunities to help hospitals change practices.

3. There has been news lately of the Latch On NYC  initiative to “lock up” formula in the hospital?  What is Baby Friendly USA’s stance on such practices?

Mayor Bloomberg and the NYC Department of Health and Mental Hygiene are to be commended for being proactive on a very important consumer protection issue.

Human milk fed through the mother’s own breast is the normal way for a human infant to be nourished.  Breastfeeding is the biological conclusion to pregnancy and an important mechanism for the continued normal development of the infant.  Naturally, things that occur outside the norm have side effects, including health consequences.  The “Latch-On NYC” campaign, which is voluntary for the facilities, asks that mothers be educated about the benefits of breastfeeding, which naturally includes the possible consequences of formula.  Some mothers will weigh the benefits and risks and compare them to other factors in their lives and decide that formula feeding is the best option for their circumstances.  When that occurs, their wishes should be respected.  This is very much in keeping with the tenants of the Baby-Friendly Hospital Initiative.

Another very important point that has been lost in the media frenzy around the Latch-On NYC campaign is that hospitals have standard policies that either limit access to (which is what Latch-On NYC calls for) or “lock up”  most of the products they use.  This is done for patient safety reasons as well as inventory control.  What we really should be asking is why is this not standard operating procedure for infant formula in all facilities throughout the US, and why has the suggestion of it stirred up such a controversy? It just makes good sense.

4.  What is your hope for BFUSA as we move forward in the US?

I can’t wait for the day that the last hospital in the US receives the Baby-Friendly designation.  My hope is that we effectively fulfill our vision of creating an American culture than values the enduring benefits of breastfeeding and human milk for mothers, babies, and society.

Trish MacEnroe is Executive Director of Baby-Friendly USA, treasurer of the NYS Breastfeeding Coalition, and former chair of the WIC Association of NYS. At Baby-Friendly USA, Trish has reorganized the Baby-Friendly designation process and created
tools to assist facilities pursuing designation. Previously, Trish worked for the WIC program, most recently as Director of the NYS WIC Training Center, and oversaw development of training programs for all aspects of WIC including the development of their Breastfeeding Peer Counselor website and curriculum. Trish received her Bachelor of Science degree in Food Science and Nutrition from the University of Rhode Island.

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JHL’s Newest Podcast: Challenges and Successes: The Baby Friendly Initiative in Norway

The Journal of Human Lactation’s (JHL) newest podcast is now available on their website.  Based upon “Challenges and Successes: The Baby Friendly Initiative in Norway” from the latest issue of JHL, this podcast is an interview by Editor-in-Chief, Anne Merewood, of one of the paper’s authors, Mette Ness Hansen. Hansen is a registered nurse and IBCLC at The Norwegian Resource Centre for Breastfeeding at the Oslo University Hospital and has been involved with the Baby Friendly Hospital Initiative since the early eighties.

Click HERE for the latest podcast.

We asked Hansen to share a bit about how the tide turned in regards to being Baby Friendly in Norway and here is what she had to say:

 When we first began to implement the BFHI back in 1993, we were lucky to be supported by the Norwegian health authorities.

At that time, our maternity ward routines were not particulary Baby-Friendly: 24 hour rooming-in was rare, supplementing with formula and / or sugar water from day one was quite common and breastfeeding knowledge among staff was generally poor.

The general idea was that the best care for the mother after birth, was if she could sleep the whole night after beeing provided with pain killers and sleping pills, while the staff were looking after the baby, giving supplement and pacifiers.

For the staff who were used to taking care of the baby, it was hard to accept that the mother was capable of both feeding and nursing the baby herself. Losing ”control” of the newborn was like loosing their professional identity. Soon we realized that it was necessary to introduce a guiding principle: Caring for the mother, enabling her to care for the baby.

Changing routines is always a challenge and when implementing the BFHI. The most important task was to train the clinical staff members in breastfeeding skills to make them understand the usefulness of the Ten Steps. Today more than 90 % of all babies in Norway are born in a designated Baby-Friendly unit.

The Initiative has been expanded to the NICU’s and since 2005 the Initiative has been adapted to the Community Health Services. Today almost 50% of all mothers with newborn babies are linked to a Maternal and Child Health Center which are designated as, or are in the process of becomming Baby-Friendly.

We have no Baby-Friendly assessment and designation for educational establishments. Most education programs for midwifery and health visitors schools offer education on breastfeeding. The Norwegian Resource Centre for Breastfeeding in co-operation with the College of Health care studies have a program where we educate specialised breastfeeding counsellors on a national level.

Since Febryary 2012, we have been pilot testing an electronic reassessment tool based on WHO’s monitoring tool for BFHI. In October this year, we plan to carry out this reassessment in all Baby-Friendly hospitals and birthing units, and at the same time we are asking for Infant Feeding Records to register the use of supplements.

BFHI is an effective tool in increasing breastfeeding rates and interaction between mother and child. The training of staff is crucial; the more you know about breastfeeding, the more you understand the importance of implementing the Ten Steps.

For subscribers to the journal, you can read the full paper HERE.

Mette Ness Hansen, RN, RM, IBCLC, has been working several years in delivery- and maternity wards. She is now employed in The Norwegian Resource Centre for Breastfeeding, Oslo University Hospital. She has been involved in breastfeeding promotion support since the eighties including initiation and assessment of the WHO/UNICEF “Baby-Friendly Hospital Initiative” (BFHI) and the expansion of BFHI to the neonatal units in Norway. She is a BFHI coordinator, and is also working as a community midwife.

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World Breastfeeding Week: Massachusetts, USA Hospitals Go Bag Free

By Marsha Walker, RN, IBCLC

Massachusetts is now the second state in the US, behind Rhode Island, to have had all of its maternity hospitals eliminate the practice of distributing formula company discharge bags. Ban the Bags is a campaign that began in 2006 to rid hospitals of the practice of distributing formula company discharge bags or other discharge gifts to mothers when leaving the hospital. It was started after efforts in Massachusetts failed to insert regulations regarding such a ban into our hospital perinatal regulations. Ban the Bags, the Massachusetts Breastfeeding Coalition, and the MotherBaby Summit have all encouraged hospitals to eliminate this practice through letter writing, education of hospital management at summits designed just for them, and downright shamed them into doing it in order to get off the list of hospitals we kept who continued engaging in this practice. The list of hospitals who continued to give out these bags was displayed on the MotherBaby Summit website and was placed on a large poster board and displayed annually at the Massachusetts Breastfeeding Coalition’s yearly conference. Ban the Bags answered many e-mails with suggestions, references, and approaches to help individuals get the bags removed from their hospital.

Ban the Bags found that many hospitals did not really care about the effect of formula bags on breastfeeding but responded when told that it was a breech of medical ethics, was in opposition to the hospital’s own mission and vision, and was no different than unethical arrangements with pharmaceutical companies. We encouraged people to contact their hospital Ethics Committee for an opinion on a practice that promoted the use of a potentially hazardous product and how this related to the ethical principles of “first do no harm” and the obligation of health care providers to act in the best interest of their patient. We counseled people to contact the hospital’s Corporate Compliance Department to report how these bags were a conflict of interest, especially since HIPAA defines them as a form of marketing. We recommended that people contact the hospital’s Risk Management Department to inform them that because the hospital had no stock control there was no method to contact patients who had received the bags if there was a recall of the formula. Such a recall occurred in 2006 when one company’s bags were recalled due to the defective packaging of formula inside which resulted in a vitamin C deficiency. Also, the powdered version of formula is not sterile and the hospital could be handing out and liable for a product contaminated with Chronobacter sakazakii. Mothers were never instructed by the hospital in how to safely prepare the powdered formula that they were essentially marketing for formula manufacturers. Eliminating the bags was a fairly easy way to increase the hospital’s score on the mPINC survey.

Ban the Bags advocates toss bag into the original location of the Boston Tea Party!

Hospitals were concerned that they would have to pay for formula, as the formula companies fought hard to prevent the disappearance of this lucrative and inexpensive marketing tactic. We have found that this was not actually true, as manufacturers did not remove their product from the hospital which represented essentially a captive audience. Companies know that well over 95% of mothers continue to use the brand of formula given to their infant in the hospital. Why would a formula company give up this potent marketing advantage? We heard how terrible it would be for poor mothers who could not receive this “gift.” Of course there is only enough formula in the bag for about a week or so worth of feedings, just enough to reduce a mother’s milk supply and accustom the infant to the bottle. Detractors complained that we were “forcing” mothers to breastfeed or removing their choice of infant feeding methods. Mothers decide how they wish to feed their infants well before entering the hospital. Bags have no effect on feeding decisions, they have only one purpose, which is to cause a breastfeeding mother to use formula and create a customer/market where none existed before. We have found that when hospitals remove the bags, they show up in community pediatric and obstetric offices, clinics, and even in ultrasound departments. Make sure to ask that all of these entities cease distributing formula company materials, as this works directly to counteract your efforts in the hospital.

Ban the Bags at www.Banthebags.org has many helpful recommendations on approaching the elimination of this practice. I am happy to help and you can email me at Marshalact@gmail.com.

Marsha Walker is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently a member of the board of directors of the Massachusetts Breastfeeding Coalition, Baby Friendly USA, Best for Babes Foundation, and the US Lactation Consultant Association (USLCA). She is a past president of the International Lactation Consultant Association (ILCA).

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A BFHI Update – ‘Call to Action for Breastfeeding Support from the Surgeon General ‘

How do you see the Call to Action impacting Baby Friendly in the United States? (Maybe even internationally?)

The United States now has a strong, evidence based national policy on infant and young child feeding that specifically calls for expanding implementation of the Baby-Friendly Hospital Initiative (BFHI). This is an extremely important turn of events and status change.  BFHI is also specifically mentioned in the White House Obesity Report, and possibly even more importantly, in The Joint Commission’s recent Speak Out campaign. Internationally, Baby Friendly USA (BFUSA) has always been a strong collaborator with other nations’ BFHI Authorities and I would expect this collaboration to increase.

What changes are you hoping to see?

The Director of Health of my state met with our state Lactation Consultant chapter in early August, and within two weeks convened a high-level meeting of organizations to begin discussions on moving BFHI ahead. That’s amazing progress! Several states have conducted in-depth surveys of maternity facilities (in addition to encouraging hospitals to respond to the Center for Disease Control’s mPINC surveys), developed interim goals and local incentive programs, held Hospital Summits, and more.  Maternity Practices in Infant Nutrition and Care (mPINC) is a national survey of maternity care practices and policies that is conducted by the CDC every 2 years beginning in 2007. The survey is mailed to all facilities with registered maternity beds in the United States and Territories.  I expect the Call to Action will resonate with and inspire the entire public health professional community, at every level.

Why is this Call to Action coming at a critical time?

I’m tempted to say “It’s about TIME!” The momentum for breastfeeding has escalated in the past ten years in the US, partly due to the collaborative work of the US Breastfeeding Committee. The economic conditions are encouraging everyone (individuals and companies) to re-think spending patterns; health decision-making is becoming more transparent; and virtually everyone is calling for better health outcomes. Over 40,000 IBCLCs around the world are working with other health care providers to provide the up-close one-to-one clinical support for mothers and babies. Without this rich network of support, mothers would face far more avoidable problems.

How will the Call to Action impact not only hospital-based lactation consultants, but lactation consultants in private practice, as well?

There’s something in the Call to Action for everyone. As an lactation consultant in private practice myself, I was thrilled to see a call for appropriate reimbursement for my services as an LC, regardless of other credentials or licenses. I’m currently in graduate school and was very excited to see a call for more research on breastfeeding. The Call to Action’s recognition of lactation consultants as important players on the health care team was extremely gratifying.

Linda J. Smith, BSE, FACCE, IBCLC, FILCA
Bright Future Lactation Resource Centre Ltd.
6540 Cedarview Ct., Dayton OH 45459-1214
Phone (937) 438-9458   Fax (937)-438-3229
www.BFLRC.com

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