Hospitals pressured to back more breastfeeding

California advocates for women and children are making a major push for breastfeeding and laying the groundwork for proposals in the Legislature that could require hospitals that deliver babies to reduce the number of newborns fed with bottled formula.

The campaign is coming from an association that represents the Women, Infants and Children program (WIC), which provides nutrition for low-income families and is the largest purchaser of baby formula in the state.

Registered Nurse Barb Hanson meets with new mother Phana Yon, 28, in the drop-in Lactation Center at Kaiser Permanente South Sacramento Medical Center. Yon, who gave birth to her son three days ago, walked into the clinic to ask questions about breastfeeding. Photo from Kaiser Pemanente.

Studies have shown that breastfeeding helps prevent a number of diseases and conditions, including childhood obesity. The Centers for Disease Control estimates that 15
percent to 20 percent of obesity could be prevented through breastfeeding.

“It can’t cure everything, but it can help prevent a lot of acute and chronic disease,” said Karen Farley, a program manager for the association.

Bottle feeding is thought to contribute to obesity for several reasons.

Breastfeeding and formula are believed to have different effects on metabolism and hormones, including insulin, which helps regulate how much fat the body stores.

Breastfed babies also may be better at regulating their food intake. Mothers who cannot see how much milk their babies are getting are more likely to rely on the infant to signal when he or she is full, rather than feeding them a bottle until all the formula is gone.

“It’s kind of like cleaning your plate when you are already full,” Farley said. “Breastfed babies stop when they are no longer hungry.”

Citing data that show a wide disparity among hospitals in the number of women who feed their infants exclusively breast milk before taking their children home, the association asserts that much of that difference is due to practices that could be and should be changed.

The WIC program is trying to lead the way by giving new mothers incentives to breast feed, including extra food in a breastfeeding mom’s food package and breast pumps so that mothers who return to work can still feed their babies.

Baby Friendly Policies
Hospitals must follow these ten policies in order to be certified as “Baby Friendly.”
1. Maintain a written breastfeeding policy that is routinely
communicated to all health care staff.
2. Train all health care staff in skills necessary to implement
this policy.
3. Inform all pregnant women about the benefits and
management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain
lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breast milk, unless
medically indicated.
7. Practice “rooming in” – allow mothers and infants to
remain together 24 hours a day.
8. Encourage unrestricted breastfeeding.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and
refer mothers to them on discharge from the hospital or clinic.

The group is also pushing hospitals to adopt a collection of “Baby Friendly” guidelines developed by the World Health Organization. The policies require more training of hospital staff, education of pregnant women about the benefits of breastfeeding, helping mothers initiate feeding within an hour of birth, and giving infants no food or drink other than breast milk unless medically indicated.

Hospitals must also agree not to accept free or discounted formula from the manufacturers – a perk that advocates of breastfeeding believe makes hospitals more likely to use formula.

Sheree Kruckenberg, vice president of the California Hospital Association, said her members support breastfeeding but do not necessarily want to follow the “Baby Friendly” guidelines. Instead, she said, the association backs a separate set of model policies already recommended by the state.

“In order to qualify for the Baby Friendly status, there’s a lot of things that a hospital would have to do,” she said. “For some hospitals, they don’t do enough births to justify the expenditure.”

The bigger issue, Kruckenberg said, is that new mothers are usually in the hospital for less than 24 hours.

“The ability for a hospital to influence a mother’s decision is very short-lived,” she said. “Most mothers that come to us have predetermined whether they ae going to breast feed or not.”

That decision can be affected by cultural norms, socio-economic levels, a family’s support and whether or not a woman is going to return quickly to work.

“There are so many factors a mom takes into consideration,” she said. “We’re not able to influence their decisions.”

But many hospitals are trying. One is Kaiser Hospital in South Sacramento. Barb Hansen, a registered nurse there and assistant manager of health education, said the hospital started by adopting the model guidelines the state recommends and then found it easy to move on to the more involved Baby Friendly system.

That step required nurses to get 18 hours of training in how to help new mothers breast feed, and all staff, including doctors, had to have at least some training.

The hospital, which delivers about 200 babies a month, has large birthing rooms where mothers can keep their babies with them, and even mothers who have Caesarian sections typically have their babies with them within an hour. The hospital also discourages mothers from supplementing their milk with formula, which can distract a baby from nursing.

“The concept is that babies are born healthy and are wired to breast feed,” Hansen said. “They don’t need to be supplemented unless there is a medical indication.”

Hansen said some hospitals balk at giving up free formula from the manufacturers, but she believes it is wise to do so.

“You don’t have the formula reps coming into your hospital and offering education, free trips, free formula if the nurses have babies,” she said. “You remove that conflict of interest and that’s a huge hurdle if hospitals have to pay for that.”

Although Kruckenberg of the hospital association said cultural traditions often lead Hispanic women to prefer bottle-feeding, Hansen said those habits can be overcome with supportive hospital staff.

“Most Hispanic moms do breastfeed,” she said. “Understanding their beliefs and being supportive of their cultural beliefs helps.”

Statewide, records on the behavior of new mothers while still in the hospital show that 87 percent do some breastfeeding but only 43 percent breast feed exclusively. Among major counties, the rates for exclusive breast feeding range from a high of 76 percent in San Francisco to a low of 24 percent in Los Angeles County. At Kaiser in South Sacramento, the most recent numbers from the state, from 2007, show that 90 percent of new mothers breastfeed and 71 percent do so exclusively. Those numbers are likely higher today.

Laurie True, executive director of the WIC Association, said the group will probably push soon for legislation requiring any hospital that is reimbursed by Medi-Cal for delivering babies to follow the Baby Friendly guidelines.

“Breast feeding is a learned skill,” she said. “It’s not easy. It needs a lot of support. It needs to be built into the health care system.”

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