August 15, 2013
By Cindy Hutter
Mixing Pacifiers and Breastfeeding
Just because a mother is breastfeeding doesn’t mean her baby can never use a pacifier. The American Academy of Pediatrics recommends that breastfeeding babies only be given pacifiers after breastfeeding is established, typically after one month.
In hospitals around the country the break-ups are happening. Pacifiers and babies are no longer being seen together. These once ubiquitous partners are now going their separate ways as hospitals are tossing pacifiers and other artificial teats following evidence that they can interfere with breastfeeding.
Since beginning work to create an environment that supports breastfeeding—including removing artificial teats—Providence Hospital in Washington, DC, has seen its exclusive breastfeeding rates climb from 4 percent in July 2012 to 55 percent in April 2013. Texas Health Huguley Hospital in Forth Worth similarly has seen its exclusive breastfeeding rate rise from 33 percent in January 2013 to 49 percent in June.
Break-ups are never easy. Hospitals purging the pacifiers say that educating staff and mothers as well as slowly ramping up removal efforts were vital to the successful systems change.
“Once our team was educated about the drawbacks of pacifier use we shared it with physicians and got their buy-in. Then we started talking to the nurses and they saw that the pacifiers weren’t needed. This buy-in is what has made the removal so successful for us,” says Sharon McMillian, RN, director of the Maternal and Infant Health Unit at Providence Hospital.
McMillian is part of a team at Providence that is participating in Best Fed Beginnings, a national quality improvement project that aims to help hospitals improve maternity care and increase the number of “Baby-Friendly” hospitals in the United States. The Baby-Friendly designation is granted to facilities that adhere to the evidence-based Ten Steps to Successful Breastfeeding.
One of the steps calls for giving no pacifiers or artificial nipples to breastfeeding infants because they interfere with the development of optimal breastfeeding habits. Lori Feldman-Winter, MD, MPH, faculty chair of the Best Fed Beginnings project, explains that sucking on a pacifier often leads to unrecognized hunger cues that would otherwise result in more breastfeeding. Also, the way a baby positions its mouth and tongue when sucking an artificial nipple is different than when at the breast. Going back and forth between the breast and artificial nipples is associated with breastfeeding problems such as poor suckling technique and damage to the mother’s nipple.
A poster used at Texas Health Huguley Hospital to support their change efforts.
Sharing this education with mothers has made all the difference. Providence Hospital’s Bilingual Parent Educator, Soledad Sheppley, RN, describes the education that mothers receive on pacifier use both prenatally and as inpatients as pretty extensive. And so far, it’s helped to reduce the number of mothers asking for pacifiers. Ragan Steelman, RN, IBCLC, a member of a team at Texas Health Huguley Hospital participating in the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative, says when mothers at Huguley ask for pacifiers, staff first provide evidence-based education about the risks of pacifier use, including how it masks infants’ signs of hunger, reduces the number of feedings at the breast, interferes with effective feeding, delays milk production, reduces the volume of milk, and may contribute to painful latches.
When it came time to make the shift at Texas Health Huguley, the team started with a few small tests to gain confidence and momentum for the change. “Staff support helps a lot in making a large-scale change like this,” says Steelman. “We start small by getting a few team members to be advocates and by finding supportive leaders to help push along those who weren’t quite as receptive.”
Providence did the same. The team started with a test group and a small sample. It monitored the results for a few days, made adjustments and then expanded the test group. Providence Hospital’s Nurse Educator Lisa Cleveland, RN, says it didn’t take long for word of mouth about the change to start happening, so when the unit was ready to officially adopt the practice of no pacifiers, the job was easier.
“Peers were communicating to each other about what they are doing and the excitement around the effort,” reflects Cleveland. “Using the small tests of change process has made our job more effective.”
When the change was ready to be scaled up across the unit at Huguley, Steelman and her team made a pacifier discard bucket right near the circumcision table, one of two places a pacifier is allowed because it is used for pain management. The second place is in a unit for infants requiring higher levels of care. The team also put up “no pacifier zone” signs that reminded staff if they have one to throw it away.
“Know that what you’re doing is improving the well-being of moms and babies. Be persistent and consistent,” recommends Steelman.
To test the success of removing artificial teats at Providence, McMillian occasionally goes to the postpartum unit or the nursery and asks for pacifiers, even insisting there is a secret stash. Her efforts are quickly rebuffed, as staff reminds her there are no pacifiers anymore.
“I was pleasantly surprised by how easy it was to remove the pacifiers once staff were educated and we took the time to scale up the change,” says McMillian.
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