I had lunch last week with a group of Pediatric (Peds) nurses. I knew our Baby-Friendly efforts would affect Peds, but until last week, I had little idea how. Let’s look at the Ten Steps to Successful Breastfeeding with Peds-colored goggles.
Step 1: Have a written breastfeeding policy that is routinely communicated to all health care staff.
Many of the Baby-Friendly breastfeeding policies written for the Childbirth Unit and Mother Baby Unit will not be relevant on Peds. Policies guide practices and help assure consistency in care. A Baby-Friendly breastfeeding policy on a Peds unit may include: resources (i.e. you can still call a lactation consultant–we want to help!), setting up a pump, establishing a supplemental nursing system (SNS), syringe and cup feeding, maintaining milk supply when the mother cannot breastfeed, managing common breastfeeding obstacles and skin-to-skin parent/infant contact.
Step 2: Train all health care staff in skills necessary to implement this policy.
Because Peds staff regularly care for breastfeeding babies, nurses need to receive regular, ongoing education on breastfeeding practices.
Step 3: Inform all women of the benefits and management of breastfeeding.
I hear regularly from women that they are frustrated by inconsistent information. ALL health care workers, from the hospital volunteer in the gift shop to the pediatric surgeon, need to have a basic understanding of breastfeeding. I have heard stories of volunteers giving out pacifiers and suggesting bottles, and I have heard stories of surgeons and other specialists giving advice which clearly have no basis in fundamental lactation knowledge. I have also heard stories of physician specialists, volunteers, Unit Assistants and others who said the right words of encouragement at just the right time to make a BIG difference for a mother.
In order to inform mothers, we first need to inform ourselves. Baby-Friendly trainers will be doing this beginning next year. Thirsty for knowledge right now? Keep reading the blog and click on over to the Surgeon General’s Call to Action to Support Breastfeeding.
Step 4: Help mothers initiate breastfeeding within one hour after birth.
This step is specific to the Childbirth Unit. Peds nurses will have to come visit in order be part of step 4!
Step 5: Show mothers how to breastfeed and maintain lactation, even when they are separated from their infants.
Peds nurses who do not already know can and should learn:
1. the basics of how to latch a baby to the breast,
2. how to assess latch,
3. how and when to use a pump or hand expression to maintain lactation.
Step 6: Give newborn infants no food or drink other than breastmilk, unless medically indicated.
We’ll work together to decide how and when this is relevant in Peds.
Step 7: “Rooming-in”— allow mothers and infants to remain together 24 hours a day.
This is the default on a Peds unit. There isn’t a nursery to take the baby so the mother can rest, and typically breastfeeding mothers stay with their infants on Peds.
Step 8: Encourage breastfeeding on demand.
Parenting styles and trends range from strict, scheduled feedings to continuous baby-wearing with frequent, on-demand feeding. Once breastfeeding is established, parents can choose what fits their lifestyle. However, one thing we know for sure is that in the early weeks of breastfeeding, the frequent, on-demand style is necessary to establish an adequate supply of milk.
When a baby who is still very young is readmitted to the hospital, nurses need to promote skin-to-skin holding and breastfeeding on demand. Breastfeeding requires more energy from a sick baby. Thus, maintaining lactation and meeting the nutritional and energy needs of these babies have to be considered. If a baby is admitted due in part to poor feeding, we need to be sure appropriate supplementing tools (cup, syringe, SNS) are used. Assessment of milk transfer from the breast to the baby and milk supply should be done by a lactation consultant as soon after admission as possible.
Step 9: Give no pacifiers or artificial nipples to breastfeeding infants.
Imagine a family delivering at a Baby-Friendly hospital where they are encouraged to delay pacifier use. The baby may have had a pacifier for a painful procedure, but the pacifier was thrown away afterwards. The family understands why pacifiers should be delayed for a breastfeeding infant, and they have chosen to follow this recommendation.
Now imagine the same family in another unit of the hospital just a few days after going home. It could be the ER, Peds or even one of our medical offices. What if we never communicated the Ten Steps to Successful Breastfeeding? What if the family who was 100% on board with delaying pacifier use was later given advice to use one without regard to what was taught in the Mother/Baby Unit? A few words come to mind: frustration, confusion, patient (dis)satisfaction, employee (dis)satisfaction, just to name a few. It may be a term from the 90’s, but the idea that we cannot function in isolated silos is still true today. “Baby-Friendly” is a prestigious designation given to hospitals, not hospital units.
Step 10: Foster the establishment of breastfeeding support groups and refer mothers to them upon discharge from the hospital or clinic.
We have this! Every Monday and Thursday from noon to 1:30 p.m. at Memorial’s BrainWorks 534 N. Michigan Street! Mothers can bring their babies, have them weighed, talk to a lactation consultant and, most importantly, get support from other mothers.
Thanks for lunching with me Peds nurses! Friday was the start of our Baby-Friendly conversation. Looking forward to much more!