How to Select a Hospital that Promotes Breastfeeding

by Lisa Deal

Nearly 65% of American women who deliver their babies in hospitals initiate breastfeeding during their hospital stay, and almost half breastfeed exclusively during this time. Whether or not a mother continues to breastfeed her baby successfully once she returns home largely depends on the support, encouragement, and information that she receives during the delivery hospital stay. But how do expectant parents select a hospital that promotes breastfeeding?

Many expectant parents may not know about the Baby-Friendly Hospital Initiative, an international campaign sponsored by UNICEF and the World Health Organization (WHO) that encourages hospitals to adopt policies and practices that help women get off to the right start breastfeeding. Approximately 15,000 hospitals in 170 countries have earned the Baby-Friendly designation. A list of hospital policies and practices that promote breastfeeding, known as the 'Ten Steps to Successful Breastfeeding', are core to the Baby-Friendly Hospital Initiative.

"These steps, which are based on research studies and much experience, can significantly improve the likelihood that a nursing mother will be able to achieve her personal breastfeeding goals," said Dr. Audrey Naylor, President and CEO of Wellstart, International and Breastfeeding.com medical advisor. Under Dr. Naylor's leadership, Wellstart International was one of a handful of private, nonprofit organizations and government agencies that drafted the Ten Steps in the late 1980s.

Before selecting a hospital to deliver in, expectant parents should interview hospital staff to find out if the hospital has received a Baby-Friendly designation and if the Ten Steps are routinely implemented. The Ten Steps to Successful Breastfeeding are:

Step One: Have a written breastfeeding policy that is routinely communicated to all health care staff.

Step Two: Train all health care staff in skills necessary to implement this policy.

Step Three: Inform all pregnant women about the benefits and management of breastfeeding.

Step Four: Help mothers initiate breastfeeding within one half hour of birth.

Step Five: Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.

Step Six: Give newborn infants no food or drink other than breastmilk, unless medically indicated.

Step Seven: Practice rooming-in: allow mothers and infants to remain together 24 hours a day.

Step Eight: Encourage breastfeeding on demand.

Step Nine: Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

Step Ten: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.1

The Ten Steps have contributed to the rise in breastfeeding rates during the past decade, according to a 1998 publication by WHO. In 'Evidence for the Ten Steps to Successful Breastfeeding,' WHO staff compiled numerous studies supporting the effectiveness of these guidelines. One such study, for example, found that pacifiers affect babies' sucking patterns and reduce breastfeeding rates.2

Current research also indicated the need to modify Step Four: Help mothers initiate breastfeeding within one half hour of birth. Experts now caution against taking this step too literally, since recent evidence suggests that a newborn at her mother's breast will take, on average, 55 minutes to begin suckling. Some organizations, such as Baby-Friendly USA, have increased the recommended time for breastfeeding initiation to one hour. Others believe that "initiating breastfeeding" should be interpreted more broadly to include the skin-to-skin contact, smells and soft conversation that culminates in the infant's taking of milk from her mother's breast.
The Ten Steps are widely accepted by experts around the globe as universal guidelines for promoting breastfeeding in hospitals. "Hospitals that still have not adopted the Ten Steps are falling short when it comes to doing what is best to promote the health of mothers and their new babies," said Dr. Naylor.

Sources:
1 The Baby-Friendly Hospital Initiative Newsletter. March/April 1999. Available at www.unicef.org.
2 Victoria CG, et al. Pacifier use and short breastfeeding duration: Cause, consequence or coincidence? Pediatrics 99(3):445-453, 1997.