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To support education, instigate a hospital policy
Early hands-on skills training essential
Hospital policy needs to be supportive of the education process for breastfeeding for moms to be successful.
"In the hospital setting, clearly policies are key. Policy to support a mother's decision to breastfeed must be in place," says Jane Heinig, PhD, IBCLC, executive director of the Human Lactation Center, Department of Nutrition at the University of California, Davis.
A good starting point is to perform a self-assessment, says Lynn Yonekura, MD, FACOG, director of community benefits for California Hospital Medical Center in Los Angeles. Staff at this health care facility used the model hospital policy toolkit from the California Department of Public Health, which includes a self appraisal.
To start the process, staff at Tahoe Forest Hospital in Truckee, CA, used an assessment tool from Baby-Friendly USA, a nonprofit organization that implements the Baby-Friendly Hospital Initiative in the United States. Also, Cynthia Bansen, RN, IBCLC, RLC, the lactation specialist for the Obstetrics Department who chaired the committee for achieving the Baby-Friendly designation, researched breastfeeding policy at other health care facilities.
Bansen says that when mothers want to breastfeed, babies are placed skin-to-skin with the mother for at least two hours initially after birth, which is placing the baby on the mom's abdomen. "We try to make sure every baby has gone to the breast within the first hour," she adds. Mothers are encouraged to call a nurse when she begins breastfeeding for observation to ensure she is correctly breastfeeding.
If there are problems, the lactation consultant comes to advise the mother. Also, two videos are used to help moms who do not understand how the latch is supposed to look and feel, how the baby is supposed to look, and what swallowing looks like. The DVDs are "Visual Guide to Breastfeeding" by Jack Newman, MD, and Latch 1,2,3, produced by the Healthy Children's Center for Breastfeeding.
Policy at California Hospital Medical Center is thorough and includes steps that initiate breastfeeding. Also it states that perinatal nursing staff will be trained about breastfeeding to educate and support the mother. The baby stays with the mother, and many of the tasks formerly completed in the nursery are done at the bedside, such as the first bath and examination by a physician, says Yonekura. In this way the mothers can learn the feeding cues of the baby and feed the baby on demand. [An interim policy on breastfeeding is enclosed with the online issue of Patient Education Management. To access, sign on to your account at www.achmedia.com under "subscriber access." For assistance, contact customer service at firstname.lastname@example.org or (800) 688-2421.]
An unrealistic view of what babies are supposed to be like can undermine a mother's intentions to breastfeed, says Heinig. For example, a crying baby can cause a mother to loose her confidence by causing her to think something is wrong with her breast milk or the baby. She may quit breastfeeding or supplement with baby formula. Yet consulting with a nurse or her physician could help resolve the issue. Therefore good policy that makes sure staff is supportive of breastfeeding can help women overcome unrealistic expectations that prevent them from exclusively breastfeeding for the first six months.
To order the breastfeeding videos used by Tahoe Forest Hospital in Truckee, CA, visit the following web sites:
Web: www.drjacknewman.com. Click on "DVDs & Books" to find "Dr. Jack Newman's Visual Guide to Breastfeeding." Jack Newman, MD, is a Canadian physician specializing in breastfeeding support and advocacy. The DVD costs $30.00 plus shipping and handling.
Web: www.healthychildren.cc/latchorderform.pdf. This web page has the order form for DVD Latch 1,2,3, produced by Health Education Associates, East Sandwich, MA. The cost is $29.95 plus $9.75 shipping and handling.
To download a copy of the hospital policy toolkit that has an assessment tool available through the California Department of Public Health go to: www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Pages/MainPageofBreastfeedingToolkit.aspx.