Slow and Steady Breastfeeding Education Wins Over Moms

May 17, 2013
By Cindy Hutter

A three-pronged approach to patient education about the benefits of breastfeeding is resulting in one big win for hospitals and families—breastfeeding rates are going up.


Post-Delivery Education 101

The education topics hospital staff cover with mothers post-delivery include:

• Benefits of breastfeeding to the mother and baby
• How milk is made and how to maintain supply
• Hunger cues and emphasizing that “you don’t feed a clock, you feed a baby”
• Signs to know a baby is receiving plenty of milk
• Baby stomach size
• How many wet and dirty diapers to expect
• Ways to manually express breast milk
• Fluid and caloric needs of the baby
• Normal baby behaviors
• Ways to soothe a baby without giving a bottle

The approach—stemming from the Ten Steps to Successful BreastfeedingExternal Link as outlined by the World Health Organization—suggests that healthcare providers start education at prenatal visits, continue in the hospital and follow up with discharge support.

“Our hospital has always offered prenatal breastfeeding classes, but once we started working with our local WIC breastfeeding coordinator and introduced new breastfeeding curriculum we’ve seen our prenatal education have more impact. We now have moms coming into the hospital requesting the type of care we are trying to provide that promotes breastfeeding,” says Cindy Nash, RN, a registered lactation consultant at Erlanger Hospital in Chattanooga, Tenn. (WIC, which stands for Women, Infants and Children, is a federal program to support the healthcare and nutrition of low-income pregnant and breastfeeding women and children under the age of 5.)

At the University of Kentucky Chandler Medical Center, staff also found partnering was essential to supporting prenatal education. In their case, it was with doctors.

“In the past, our physicians would ask moms if they planned to breast or bottle feed but they didn’t actually discuss the pros or cons of the mom’s response,” says Childbirth Educator Diana Frankenburger. “We have been educating physicians on how beneficial breastfeeding is and reminding them that they have a huge influence on their patients’ feeding choices. That has helped change the physicians’ approach and encourages them to have conversations with patients.” 

Re-educating doctors has also helped the hospital raise its documented prenatal breastfeeding instruction rate from 8 percent in July 2012 to a high of 40 percent in early 2013.

Erlanger Hospital and the Chandler Medical Center are two of 89 hospitals participating in Best Fed Beginnings, a first-of-its-kind nationwide project to help hospitals improve maternity care and increase the number of Baby-Friendly designated hospitals in the United States. Led by NICHQ (the National Initiative for Children’s Healthcare Quality), Best Fed Beginnings teaches participants how to use quality improvement techniques to make evidence-based, system-level changes to maternity care practices.

One of Erlanger Hospital's patient education brochures for breastfeeding moms

Erlanger hospitals provides moms-to-be with three prenatal brochures, one per trimester, about the benefits of breastfeeding.
Click the image above to view the brochures.

Continuous In-Hospital Education
From the moment women arrive to deliver until they are discharged, the goal for these hospitals is to provide education that is continuous but not overwhelming. Upon admittance, nurses now talk to the patients about what they can expect, including the hospital’s practice of rooming-in (keeping the baby in the mother’s room rather than a nursery 24 hours a day) and exclusive breastfeeding support and resources. Education continues immediately post delivery. After birth, the baby is placed on the mother’s chest in a practice called skin-to-skin contact, which has been shown to encourage breastfeeding. Nurses are quick to teach moms how to look for hunger cues and know when the baby is starting to look for the breast and latch on.

“Previously, we took the baby to the warmer to dry off and administer a Vitamin K shot and erythromycin ointment to the eyes. This resulted in a three-to-four-minute delay in skin-to-skin contact,” explains Rebecca Collins, the newborn nursery director at the Chandler Medical Center. “When we changed the protocol to allow the baby immediately after delivery to be placed and dried off directly on mom until after the first feeding was complete, we saw our exclusive breastfeeding rate jump 15 percent in a one month period.”

Once a mom is settled in her room, Nash says lactation consultants try to find teachable moments when the mom is alert, with the baby and not seeing a lot of company.

“Hearing this information when the mom is handling the baby appeals to multiple senses,” says Nash. “She has the touch of the baby’s skin to hers, she can see the baby’s feeding cues and she hears the baby’s sounds. That’s when we try to get the education done. If dad is in the room we like to include him in the teaching and encourage him to see what we are doing and show him how he can be involved.”

Breastfeeding education isn’t without challenges. One of the most common is mothers worrying that their babies aren’t getting enough milk and asking for formula supplementation. Frankenburger says mothers are often surprised to learn how small babies’ stomachs are and that the little bit of breast milk they are producing is enough. It is in instances like this that staff education about breastfeeding is essential.

Erlanger Hospital's newsletter for new moms

Erlanger Hospital gives out New Mommy News to new moms before they leave the hospital. The flyer helps the hospital promote the discharge support that is available for breastfeeding moms.
Click the image above to view the newsletter.

“I recently overheard one mom asking her nurse to go and get her some bottles and the nurse responded with teaching the mother about how giving a bottle could potentially have a negative effect on breastfeeding,” says Nash. “The nurse was giving the response not only with evidence-based knowledge, but with compassion. Nurses are not just putting their fists down and saying we aren’t going to do what you requested. They are taking the time to talk through the situation and make sure moms understand how breastfeeding works and how using a bottle could impact her ability to breastfeed.”

The multi-disciplinary support from lactation consultants, nurses, physicians and residents makes sure each mom feels supported and prepared to breastfeed and take care of her baby once she leaves the hospital says Frankenburger.

Discharge support
Chandler Medical Center has seen its discharge support rates (e.g., instances of giving out pamphlets, making calls to families, referring to support groups, etc.) climb from 68 percent in July 2012 to 96 percent in March 2013. They want to make sure moms who choose to breastfeed feel supported even after they leave the hospital. For first-time mom Christina Colquitt that support was essential.

Colquitt gave birth to a baby boy, George, April 26. At first George struggled with breastfeeding, but support from lactation consultants in the hospital helped Colquitt to get through the initial few days. Hospital staff spent time teaching her husband how to help George latch, and staff continued to provide support after the Colquitts went home.

“It was not easy at first,” says Colquitt. “We had to work with George a lot to learn to suck. The nurses would try to get him to suck on a finger, and then suck on my nipple and go back and forth. He finally got it, but it took a lot of time. They taught my husband the technique so he could do it at home.”

The family was sent home with literature to read but also got calls from lactation nurses checking in. “The support from the hospital made a big difference,” says Colquitt.

Prenatal breastfeeding instruction completed and documented
  July 2012 March 2013
Erlanger Hospital 6% 13%
University of Kentucky Chandler Medical Center 8% 27%

Assistance and support with breastfeeding, no medical need for separation
  July 2012 February/March 2013
Erlanger Hospital 58% 91%
University of Kentucky Chandler Medical Center 100% 100%

Discharge support (e.g., giving out pamphlets, making calls to families, support groups, etc.)
  July 2012 February/March 2013
Erlanger Hospital 60% 100%
University of Kentucky Chandler Medical Center 68% 96%

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