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More NJ Hospitals Encourage Breastfeeding Through ‘Baby Friendly’ Initiative

State regulations also contribute to gains in percentage of mothers who choose to nurse their children

celeste milton
Celeste G. Milton, the Joint Commission’s associate project director, speaks during a conference on initiatives aimed at getting hospitals to encourage new mothers to breastfeed their babies.

More New Jersey hospitals are adopting measures aimed at improving the health of both babies and new mothers – by encouraging breastfeeding.

And four hospitals in the state have been officially designated as “Baby Friendly” since 2012: Inspira Medical Center in Elmer, Capital Health in Hopewell, CentraState Medical Center in Freehold and Jersey Shore University Medical Center in Neptune.

In addition, 22 other New Jersey hospitals are seeking that designation, while the state has enacted regulations requiring every hospital in the state to take steps to make breastfeeding easier.

The New Jersey Baby Friendly Hospital Initiative stems from a worldwide effort launched by the World Health Organization and UNICEF to encourage breastfeeding.

The policy changes required to be designated as “Baby Friendly” include having a written policy on breastfeeding that’s regularly communicated to all hospital staff, training the staff in how to implement that policy, and informing pregnant women about the benefits of breastfeeding.

New Jersey hospitals have made progress in recent years, according to U.S. Centers for Disease Control rankings of how much hospitals support breastfeeding, rising in rank from 33rd out of 52 in 2009 (the 50 states, plus the District of Columbia and Puerto Rico) in 2009 to 21st place in 2011.

But there is still room for improvement. Only 10.9 percent of New Jersey mothers are exclusively breastfeeding when their babies are 6 months old, compared with a national rate of 16.4 percent. In addition, the percentage of mothers who exclusively breastfeed for 24 hours before discharge from the hospital varies widely within the state.

While some of these differences are due to the preferences of each hospital’s patients, roughly 40 percent of the fluctuation stems from hospital policies, according to Ellen Maughan, a lactation consultant and president of the New Jersey Breastfeeding Coalition, which worked with state officials on the new regulations.

The progress and challenges of the “Baby Friendly” initiative were the focus of a “Mother-Baby Summit,” a gathering of hospital staff members and lactation consultants, held yesterday. The New Jersey Hospital Association hosted the event.

Dr. Lori Feldman-Winter, a pediatrics professor at Rowan University’s Cooper Medical School, said it’s important for hospitals to set concrete goals -- such as increasing the percentage of mothers and babies who have “skin to skin” contact during the baby’s first hour after birth or allowing mothers and newborns to sleep in the same room -- and then measure whether the hospital is making progress toward those goals.

Hospitals learn from experience how to meet these goals. For example, Cooper University Health Care in Camden found that the hospital gowns it was using were making it difficult for mothers to have skin-to-skin contact with their babies. Switching to gowns with snaps it made it easier for mothers to remove part of the gowns, said Feldman-Winter, who is division head of adolescent medicine at the Camden hospital.

“You won’t know (what’s needed) until you try things out,” she said.

Feldman-Winter encouraged hospitals officials responsible for maternity and neonatal care to make it clear to hospital executives that changes are needed right away.

“You have to go back and say, ‘We can’t wait anymore, every other hospital is doing this,’ ” Feldman-Winter said.

Of the NJHA’s 52 maternity hospitals, 47 sent representatives to the summit, which drew 180 people.

Maughan said the new state regulations will make it easier for nursing mothers in a variety of ways, ranging from requiring that babies be allowed to stay with their mothers in hospital emergency departments to changing the word in the regulations for a baby that breastfeeds from “infant,” defined as younger than 12 months old, to “child,” which she said would raise awareness that there are babies older than 12 months who breastfeed.

New Jersey hospitals are beginning to feel pressure to make breastfeeding easier from outside the state as well.

The Joint Commission, a hospital accreditation organization, is encouraging hospitals to track five measures of prenatal care, including the percentage of mothers who exclusively breastfeed.

The commission would like to see hospital staff members discuss the potential benefits of exclusive breastfeeding, said Celeste G. Milton, the Joint Commission’s associate project director.

“We’re trying to make sure that there’s been a discussion -- you can’t be supporting and promoting it if you’re not talking about it,” Milton said.

State Health Commissioner Mary E. O’Dowd pointed out that the CDC has found links between breastfeeding and improved health for both babies and mothers.

The risk of obesity is cut by 30 percent for infants who breastfeed for nine months,and they also have also have a lower risk of asthma, ear infections, pneumonia, sudden infant death syndrome and type 1 diabetes. Mothers have a lower risk of post-partum depression and breast and ovarian cancer, and are more likely to bond with their baby and lose the weight they gained through their pregnancy, she said.

O’Dowd said it’s important that hospitals provide training to both nurses and doctors about steps that make breastfeeding easier.

“The last thing you want is the nurse coming in and giving advice to the mom and then the physician coming in and giving different advice, having a conflict and really having confusion and frustration on the part of the mom,” O’Dowd said. “And so really making sure that everyone is one the same page is critical to delivering care in this particular area.”

The state also is working with its federally funded Women, Infant and Children (WIC) nutrition program to encourage breastfeeding. The program provides additional food, as well as breast pumps, to low-income mothers who breastfeed.

The percentage of mothers who are WIC recipients and choose to breastfeed has increased from 9.2 percent last year to 11.5 percent in the current fiscal year, O’Dowd said.

O’Dowd said the state isn’t ready to ban formula manufacturers from giving gift bags with formula to mothers, a practice that is prohibited at “Baby Friendly”-designated hospitals but was not eliminated in the state regulations. She said she wanted to respect the choices of mothers who prefer to use formula, and well as those who can’t breastfeed for physical reasons.

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