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Hospitals Required to Promote Breastfeeding, Support Nursing Mothers

NJ health officials cite benefits to both babies and women in shifting focus away from formula

Lori Feldman-Winter
Dr. Lori Feldman-Winter of Cooper University Hospital says maternity care has shifted away from assuming that babies will be fed with formula – and that hospital staff don't need to know about breastfeeding.

Advocates of breast-feeding are praising an overhaul of state regulations requiring hospitals to be more supportive of mothers who are nursing their babies.

Hospitals with obstetric services are required to identify breastfeeding women and babies when they are admitted or enter the emergency department. In addition, the hospitals must train patient-care staff in breastfeeding practices and launch interdisciplinary breastfeeding teams to develop plans to improve breastfeeding practices and remove obstacles to breastfeeding.

The changes, which the state Department of Health adopted on January 21, make New Jersey the fourth state to have regulations supporting mothers who choose to breastfeed, according to experts involved in drafting the regulation.

Dr. Lori Feldman-Winter, a breastfeeding expert at Cooper University Hospital, said hospitals across the state -- including Cooper -- have been seeking accreditation as “baby-friendly” hospitals, which part of an international effort to encourage breastfeeding by adopting the World Health Organization’s “10 Steps to Successful Breastfeeding” Initiative.

However, they found that some of these steps conflicted with existing state regulations, which helped lead to the regulatory overhaul, said Feldman-Winter, who also serves as a professor of pediatrics at Cooper Medical School of Rowan University and a coordinating partner in ShapingNJ’s healthcare work group, which is a state initiative to improve residents’ health.

Feldman-Winter said that the entire approach to maternity care has shifted away from assuming that babies would be fed with formula – and that hospital staff didn’t need to know about breastfeeding practices.

Instead of sweeping newborn babies away to be kept under warm blankets, hospitals now recognize that the healthiest thing is for them to be with their mothers “skin to skin” immediately after birth, she said.

“Many hospitals have already changed the way they deliver care to babies,” Feldman-Winter said.

Feldman cited as an example of the benefit of the new rules what will happen when a woman has a question about breastfeeding in the middle of the night. Currently, the mother would have to wait until a lactation consultant arrives in the morning. But with the new rules in place, it’s more likely that a nurse will be able to provide necessary information until the expert arrives.

According to a 2013 Centers for Disease Control and Prevention report, New Jersey trails the national average in the percentage of babies who have ever breastfed (71.5 percent in New Jersey vs. 76.5 percent nationally) and who are breastfeeding at 6 months of age (47.8 percent in New Jersey vs. 49 percent nationally).

But Feldman-Winter says the new approach could help change mothers’ perceptions of breastfeeding. She noted that many hospitals traditionally fed babies with formula that had been provided for free from manufacturers – a prime marketing opportunity for the companies but one that led mothers to believe that certain brands carried the hospital’s endorsement.

While the new state regulations don’t ban this practice – although some hospitals like Cooper have – they do require hospitals give mothers and staff information that is based on facts and is free from commercial interests.

State health officials noted CDC research showing that $2.2 billion in annual medical costs could be saved if research-based breastfeeding recommendations were met. They also noted documented health benefits for both babies and mothers from breastfeeding, including decreasing obesity, asthma and sudden infant death syndrome among infants.

Women who breastfeed reduce their risk for breast and ovarian cancer, postpartum depression and type 2 diabetes.

“The choice to breastfeed is personal, but that choice can either be supported or hindered by what happens in the hospital in the first few days after delivery,” state Health Commissioner Mary E. O’Dowd said in a statement.

O’Dowd said the evidence of health benefits from breastfeeding is why state officials are working with providers to improve support for breastfeeding mothers.

State regulators received 32 comments in favor of the rule changes.

There were some critics, though. Mardi Mountford, executive vice president of the Atlanta-based International Formula Council, submitted a comment saying that the rules potentially overstated the benefits of breastfeeding, a contention rejected by state health officials.

Point Pleasant resident Mary Turbek submitted a comment saying that anything less than endorsing and supporting breastfeeding would be an abdication of state officials’ responsibility.

The regulations were published in the New Jersey Register on January 21.

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