Sharon Willmarth gave birth to her second child, Clara, at 8:08 a.m. last Wednesday. Within minutes, nurses placed the newborn — skin-to-skin — on Mom’s chest. And minutes later, Clara was breast-feeding.
For Willmarth, a firm believer in the benefits of breast-feeding, the experience contrasted differently with her first born, son Jonah, who was born in a hospital in Lexington, Ky. He was taken away for a bath and other preparations for at least an hour before being brought to her. Subsequently, he took longer to latch on.
The difference between the two experiences — namely, using methods to improve breast-feeding — is part of a new national effort, Best Fed Beginnings, that has been under way at the Medical University of South Carolina since July.
“Here (at MUSC), everyone seemed to be on the same page in trying to accommodate breast-feeding,” says Willmarth, contrasting it with her experience in Kentucky.
MUSC is one of 90 hospitals chosen out of 235 that applied for the two-year program that is attempting to raise breast-feeding rates in states where the rates are the lowest. Four other hospitals in South Carolina also are part of the initiative: Greenville Hospital System University Medical Center, Palmetto Health Richland Hospital (Columbia), Piedmont Medical Center (Rock Hill) and Tuomey Healthcare Systems (Sumter).
According to the Centers for Disease Control and Prevention’s Breastfeeding Report Card 2012, the rates for breast-feeding in South Carolina were well below national averages.
In South Carolina, rates for breast-feeding exclusively were 27 percent at three months and 13 percent at six months. In the U.S., those rates were 36 percent and 16.3 percent, respectively. The rates of some level of breast-feeding a year after birth were 16.4 percent in South Carolina and 25.5 percent nationally.
At MUSC, the rates are 28 percent for breast-feeding only, 31 percent for bottle feeding only and 41 percent for some combination of the two.
Global, local effort
The National Initiative for Children’s Healthcare Quality is leading the Best Fed Beginnings effort to improve rates through a cooperative funding agreement with the CDC. The initiative also works closely with Baby-Friendly USA Inc., a nonprofit created by the World Health Organization and the United Nations Children’s Fund that seeks to improve hospital care for babies.
Despite numerous studies underscoring the benefits of breast-feeding for brain development, building the immune system, decreasing the risk of obesity, better mental health and even saving money, it’s not a given that today’s mothers choose to breast-feed or feed beyond six months.
Obstacles beyond the challenges of breast-feeding itself remain, namely at workplaces and in the public.
In 2006, the state legislature passed a bill that guaranteed women the right to nurse their children in public without interference from business owners or law enforcement. The law came on the heels of a West Ashley mom’s experience of being told by a Victoria’s Secret employee to go to a public rest room rather than use a store dressing room to feed her newborn baby. Still, some women don’t feel comfortable nursing in public and not all workplaces offer private areas outside of restrooms.
Beyond logistics, it’s not a given that obstetricians and hospital staff give adequate information differentiating breast-feeding from the combination of breast- and formula-feeding or just formula-feeding.
“We see some of the biggest challenges for us internally will be re-educating our staff and addressing the culture that we have internally about how we navigate the mother and the baby through the delivery and postpartum process,” says Vicki Marsi, MUSC Women’s Care administrator.
Karen Driggers, nurse manager for the postpartum/newborn nursery, says all staff, including doctors who deliver care to mothers and babies, will go through training to improve breast-feeding rates in a common goal for MUSC to receive the Baby Friendly Hospital designation by 2014.
Both Marsi and Driggers insist the effort will not be about pushing a program on mothers, but rather providing adequate information on the benefits and obstacles to breast-feeding. That education was not previously being provided by staff.
“Before, people just came in and we’d ask, ‘Breast or bottle?’ ” Driggers says, “and the mothers usually based their decision on what their mama or friends did. Many didn’t know all of the benefits.”
“This will affect the care of infants with the outcome being healthier babies,” adds Marsi.
“The bigger component will be the culture change in the community for promoting breast-feeding,” says Marsi.
Health care workers often find trends for breast-feeding that vary on cultural levels.
Marsi and Driggers say, for example, many in Hispanic cultures have difficulty realizing that colostrum — a thicker, yellowish milk that comes out in small quantities on the first days of feeding — is quality breast milk.
“Colostrum is liquid gold,” says Driggers. “You only get it at the very beginning. It contains a lot of nutrients. That’s the first day or so. It’s a golden, yellowish color. Culturally, a lot of Hispanics don’t like that. They think it’s not milk, so they want to do breast and bottle.”
They also note that a newborn’s stomach is about the size of a nickel on the first day and it doesn’t take much to satiate a baby.