So Normal Now

blog-graphicIt all seems so normal now, this Baby-Friendly journey. It’s been made part of our work lives, and sometimes I forget we’re special, part of a single-digit percentage of hospitals in the country making these recommended changes. But then I have moments when my head snaps and I remember how incredibly WOW everything we’re doing really is.

This week a nursing student told a group how excited she was to get the coveted spot with our Lactation Coordinator for her school’s community health rotation. She wanted to be a part of Baby-Friendly and learn more about it.

Our Childbirth Unit and Mother/Baby Unit track skin-to-skin in the operating room, rooming-in and exclusive breast milk feeding as Key Performance Indicators. These data are determined daily and posted on a large bulletin board on each unit. We’re not quite halfway through to designation, and I see green, green, green on these boards. Green is good!

What is traditionally called the “nursery” is now my favorite room in the hospital. We still need to think of a new name for this behemoth of an empty room. About a year ago a group of us visited Community Hospital in Anderson, Ind. Their nursery looked like a storage room. I thought it would be a long, hard road for our nursery to achieve storage room status. Not so, thanks to a crazy good group of nurses!

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Nourishing a Baby

amy-baby-pic-250My parents made the next major life step – the winter home in Florida! The move happened last week and with it, plenty of cleaning and purging. As a result, I received a package of childhood memorabilia, including pictures of me and my brothers, yearbooks, health records and a document called “Instructions for Newborn Care: Instructions for Baby Simmons.” I came with instructions! I had to read this right away!

The instructions were written as if personally authored by the pediatrician I remember well, Dr. John T. Burns. His practice was in a converted family home across the street from the hospital where I was born.  There was a fish tank in the lobby, nurses with white caps and a picture of the cow jumping over the moon in one of the exam rooms.  This is where my mom taught me to sing when I was scared or in pain, and maybe where I first fell in love with the antiseptic smell of hospitals.

True to the time in history, the instructions included only a blurb on breastfeeding, and much of that information was, well, it was 1973 and women were commonly told to strictly limit feeding time and to give “prescribed formula” if needed.

The part of Dr. Burns’ instructions I so appreciate is this: “Feeding is one of the baby’s first pleasant experiences. The baby’s first love for its mother arises primarily from the feeding situation. At feeding time the baby receives nourishment from his food and nourishment from his mother’s love. The food, correctly taken, helps him to grow healthy and strong. The mother’s love, generously given, helps him to feel secure. Help your baby get both kinds of nourishment.”

Thanks Dr. Burns for timeless advice, and thanks Mom and Dad for providing both kinds of nourishment. Enjoy your retirement in Florida!

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Not Just About Football

I’ve lived in South Bend, Indiana for 12 years. Becoming a Notre Dame football fan is not required to live here, but you’re the odd duck if you don’t at least know a little bit about the game when you arrive at church on Sunday morning. That’s how I slowly became a fan. Over the years I’ve gone from Googling the score on Sunday morning, to trying to catch few plays on TV on Saturday afternoon, to full-out watching and cheering.

What sealed my fan-ship was during this season’s first game when I heard a commentator talking about Brian Kelly’s coaching strategy. It is more than just how the game is played on the field but about developing the players into leaders. He meets with key players on and off the field, privately and in small groups. He sends cards and text messages encouraging them along their personal journeys to excellence. Kelly’s leadership style mirrors that of legendary Notre Dame Football Coach Lou Holtz. Coach Holtz said every player wanted to know the answer to these three questions: Can I trust you? Are you committed to excellence? Do you care for me?

I believe patients want answers to those same three questions. Nursing is a lot like coaching. Our job is to be there by our patients—teaching, pushing, training, working, encouraging and advocating on their behalf. There is a huge body of research out there that tells us what excellence in health care means. Are we committed to it? Can our patients trust us to truly put evidence-based practice into practice? A culture of consistently committed-to-the-goal nurses is what sets a hospital apart—what differentiates the very good hospitals from the championship hospitals.

Notre Dame Head Football Coach Brian Kelly led Notre Dame to a 12-0 season this year, earning the team a No. 1 ranking and a spot in the national championship for the first time since 1988. Go Irish!

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Why Not a Big Pink Bus?

Originally, I thought I would write about each task force meeting. I quickly realized writing about meetings is boring. But our last task force meeting? Well, you all need to read about that one!

Ryan Comfort, a 29-year-old graduate of Wharton School of Business, came to visit us. I met Ryan in September at a conference in Indianapolis and thought, “We’ve got to get aligned with this guy! His ideas are going to be BIG!” He talked about technology as a means of disseminating timely, relevant information in a way that would be familiar and attainable to the childbearing demographic. His ideas were beyond one-size-fits-most text messages or websites; they represented the innovative spirit we are known for at Memorial. Phone calls, emails and even a webinar followed our first meeting, leading up to an unforgettable November task force meeting.

The first order of business was to explain why a 29-year-old guy would leave his successful job in finance for breastfeeding. While at Wharton, Ryan says he looked around and saw wealthy people learning how to help make other wealthy people wealthier while becoming very wealthy themselves. He wanted no part of that, but played the game for a few years after graduation, living on 20% of his income in hopes of someday self-funding a tech start-up that would make a lasting impact.

Still, the question loomed. Why breastfeeding? Ryan observed the difficulty his sister had with breastfeeding, but she was fortunate to have their mother, a labor and delivery nurse, help her. Additionally, his sister turned to Google where she received often conflicting and confusing messages. Drawing from his training and expertise in business and technology, Ryan saw opportunities to coordinate breastfeeding messages in order to offer consistent information.

I’m sure you’ll agree the next logical step would be to drive a big pink bus all across the country to assess the needs of breastfeeding women. I have to admit, that may not have entered my mind, but with his dad as the driver, that’s exactly what Ryan did the summer of 2011. He met members of breastfeeding coalitions and La Leche League, milk bank leaders, regular moms and their families, even the Surgeon General. You can read the blog about the cross-country trip by clicking here. Significantly, he met Tina Cardarelli, Indiana’s State Breastfeeding Coordinator. Tina showed him the infrastructure Indiana has to support breastfeeding, including 44 coalitions, representation of more than 95% of delivering hospitals at annual summits, four Baby-Friendly hospitals with several more on their way, Indiana Mother’s Milk Bank and a WIC program that is a leader in breastfeeding support and education.

So what does Ryan do? He moved to Indiana.

At our task force meeting in November, Ryan shared all this and more. He led us through an exercise to identify where the potential is to have betting continuity of care. We identified our strengths and our weaknesses, leaving the whiteboard looking like my head felt—swimming!

The peace, however, is that we are not in this alone. There is an opportunity to pool our resources, knowledge and talents with others in Indiana, as well as national leaders, and come up with something completely unprecedented. Announcements to follow … Stay tuned!

This Thanksgiving I’m thankful for the 22-member task force who helped complete the Development Phase of Baby-Friendly at Memorial Hospital of South Bend. Our task force will meet for the last time on Dec. 5 as we usher in a different organizational structure for the Dissemination Phase. I’m grateful to the nurses, leaders, doctors and community members who lent an ear and voice to the task force over the last year. Each person, their presence each month and their unique contributions are what kept us on schedule and helped us create new systems, policies and educational materials. Thank you! God bless you this Thanksgiving with an abundance of love for family and friends, as well as the community we serve together.


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Unattended Baggage

You think it will never happen. The perils of unattended baggage are broadcast every 30 seconds over  the airport PA system. So who would do that! Um … me.

I hadn’t seen my high school friend in probably 20 years, and there she was at LaGuardia Airport. I know it’s sappy, but it was just like in the movies–the running, the hugging, the quick catching up while TSA officials came with the bomb-sniffing dogs. Well, that last part only happened in my head.

You don’t have to fly often to memorize the constant admonishment about unattended baggage and packing your own bags. You would think by now we’ve got it. They can stop the messages, and we’ll be fine. Maybe not.

Some messages are worth repeating. Without repetition, we begin to wonder, “Does it matter anymore? Is it still true? Did they stop doing that?”

Baby-Friendly designation happens in four phases: Discovery, Development, Dissemination, Designation. As we move into the Dissemination Phase, our units are going to sound like an airport. Messages will be repeated. Nurses will complete breastfeeding education. Posters, new patient education, checklists, interviews and data collection will be the words of the day.

The end result will be earning a designation in early 2014 that is so much more than a plaque on a wall or something we can post on our website. The result will be improved evidence-based care of our patients, families bonded together like glue and more confident parents. And just like you know to wear easy-to-slip-off shoes when you fly, families will know what to expect when they come to have a baby at Memorial Hospital.

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Policy Shmolicy

Breastfeeding is an art. Helping a woman with breastfeeding requires taking in all kinds of information–social, emotional, physical, medical–and formulating a unique plan of care for her. There are few pat answers or solutions to obstacles.

Given this, some nurses are hesitant to institute hospital policy for breastfeeding. But isn’t what I described above true of all areas of nursing? Each person and disease process is unique and requires nursing judgement in order to provide the most effective care.

I’ve also heard, “It’s just breastfeeding. Is a policy really necessary?” In February 2012, the American Academy of Pediatrics (AAP) updated their policy statement on breastfeeding.  According to the AAP, “Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.”

It’s time to lose the “policy shmolicy” attitude toward breastfeeding and use policy to point us all in the same direction, thus giving mothers consistent support and information.

Our Baby-Friendly related policy drafts have been given the green-light by Baby-Friendly USA! Take a sneak peak right here!

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Choosing Formula at a Baby-Friendly Hospital (Part 2)

Last week I posted email exchanges between me and a woman who will be delivering at my hospital and who is concerned because she has made an informed decision to formula feed her baby. Comments and controversy abounded in response to this post. Most of the comments were along the line of—“How can someone really make an `informed’ decision to formula feed? If you really have the information, the logical decision is to breastfeed?” Here are my thoughts:

  1. Most of us make decisions that are contrary to logic and statistics. Ask yourself if you always eat and exercise in the way you know will lead to optimal health. Do you ever speed? Talk on the phone while driving? Or worse, text? These are all personal decisions we make, but they do affect others. Health care providers should encourage us to make the healthiest choices, assessing our knowledge base and offering additional information as needed. However…
  2. If it becomes clear a person’s decision is made, we have to think of what is most important. Beating a person up with statistics will not change her mind and will often alienate her. The resulting chasm will strip away any future, potential opportunities for influence. Thus, our focus rests on building a positive nurse/patient relationship, growing her confidence as a parent and helping her bond with her baby.
  3. I want to keep the bigger picture in mind. I know the mother who wrote me will probably tell at least 100 people about her experience at my hospital. If her experience is bad, she’ll probably tell even more. Let’s say that as a result of her positive experience, 100 people choose to have their babies here. Statistically, I know chances are 80 of them will choose to breastfeed, and I know the practices we are putting in place to become Baby-Friendly will help those 80 women realize success. I want them at my hospital!
  4. Numbers aside, everyone deserves to be respected, valued and cared for.  It’s what we do as nurses and as human beings.
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