By Michele Munz – St Louis Post-Dispatch
When Sarah Sidwell gave birth to her son five years ago by Cesarean section at Barnes-Jewish Hospital, she briefly peeked at him before he was taken away “for what felt like hours” to get bathed, tested and warmed in blankets.
But this month, after Sidwell gave birth to her daughter by C-section at the same hospital, her baby was placed immediately on her chest, and baby Lena stayed there for next hour and a half.
“The cool thing was she was screaming bloody murder, but the second she was on me, she was instantly quiet,” said Sidwell, 35, of St. Louis. As Sidwell’s incision was being stitched and with the help of her husband and a nurse, Lena began nursing right away.
Placing babies on mom’s chest immediately after birth – even on the operating table – is one of many changes that in just one year have led to dramatic increases in breast-feeding rates at Barnes-Jewish Hospital and other hospitals across the country.
Barnes-Jewish is one of 89 hospitals taking part in a national initiative called Best Fed Beginnings, which calls for significant changes in how mothers and babies are cared for.
ONE YEAR LATER
The $6 million federally funded initiative got under way more than a year ago, and the rate of mothers exclusively breast-feeding when discharged from Barnes-Jewish has gone from 18 to 44 percent. Among all the participating hospitals, that rate has gone from 39 to 56 percent, with all three regions across the country seeing big boosts.
“I don’t think we knew what was possible when we started this,” said Jennifer Ustianov, director of Best Fed Beginnings for the National Initiative for Children’s Healthcare Quality. “We haven’t had this large enough of an initiative that is this geographically dispersed with hospitals serving such diverse populations.”
The hospitals must complete 10 steps that international health organizations have determined will provide optimal support for mothers wanting to breast-feed. The 89 hospitals, together responsible for more than 275,000 births each year, were selected in states with the lowest breast-feeding rates and highest rates of supplementation during the hospital stay.
Other hospitals in Missouri include Truman Medical Center-Hospital Hill in Kansas City and the University of Missouri Women’s and Children’s Hospital in Columbia. They also boasted big jumps in their exclusive breast-feeding rates: Truman went from 42 to 73 percent; and Women and Children’s, even after having already worked the past four years on improving rates, went from about 70 to 82 percent.
Pediatricians recommend exclusive breast-feeding for the first six months to get all the health benefits. Yet in the U.S., only a fraction of moms meet that goal, according to this year’s federal Breast-feeding Report Card. Missouri is slightly below the national average, with only 15.7 percent of 6-month-olds exclusively breast-feeding.
Rates are lowest among impoverished and African-American mothers, which make up a majority of births at Barnes-Jewish.
‘TURNING THE TITANIC’
The hospital stay is critical to success. One thing that can sabotage a woman’s effort to breast-feed is supplementing with formula, said Dr. Courtney Barnes, an obstetrician at Women’s and Children’s, which changes the makeup of the baby’s gut and inhibits mom’s production of milk.
“The thing we’ve seen the greatest success in is formula supplementation,” Barnes said. “We’ve gone from a 40 percent supplementation rate to 18 percent, and that is tremendous.”
The changes the hospital must make include no longer accepting free formula, keeping babies out of the nursery and in mothers’ rooms, not giving pacifiers to breast-feeding babies and training all health-care staff – which can be 100 to 200 people – how to support breast-feeding.
“It’s like turning the Titanic around,” said Beth Sevart, lactation consultant and leader of the initiative team at the Kansas City hospital. “It’s a big change to the whole system, to the way we’ve been doing things.”
For example, keeping babies and moms together requires encouraging pediatricians – who are used to bringing their patients into the nursery to do exams one after another – to visit each baby in their rooms. It requires researchers to bring moms along with their babies for tests. And nurses used to assessing babies in an open-bed warmer have to learn to do so on a mother’s chest. With each change, a stalwart requires convincing.
“From the outside looking in, it’s like, ‘What’s the big deal?’ But it’s actually a huge change in practice,” Ustianov said. “It changes the culture.”
CONTACT IS BEST
The participating hospitals hold regional meetings to learn from one another. The possibility of putting babies skin-to-skin in the operating room was born in these meetings.
Skin-to-skin contact immediately after birth has been shown to better stabilize the baby’s temperature, heart rate, breathing and blood sugar. The baby is alert and instinctively searches for the breast and is more like to latch on well and nurse longer, meaning less soreness and better milk supply for moms.
While skin-to-skin contact is becoming more routine with vaginal births, doing so immediately after C-sections – which account for 1 in 3 births – is a new concept for the surgeons, anesthesiologists and nurses involved.
Barnes-Jewish began placing babies skin-to-skin in the operating room in February, said Dr. Camaryn Chrisman Robbins, an obstetrician at Barnes-Jewish helping lead the Best Fed Beginnings initiative. Already, 38 percent of babies born via C-section are immediately placed on their mothers’ chests if both are healthy and stable.
“We’re offering Cesarean delivery moms a very different birth experience than we ever have,” Robbins said.
Sidwell said she was excited when nurses explained before her C-section how they would immediately tuck her baby girl under her surgical gown. “My husband thought it sounded like something a bunch of hippies made up, but when he saw it in action, it was really amazing,” she said. “He couldn’t believe how calm she was right away.”
Sidwell was able to nurse Lena easily, whereas last time with her son, he was very hungry by the time she finally got to hold him. They both ended up frustrated, she said.
Women’s and Children’s began doing skin-to-skin in the operating room about a year ago with planned C-sections, Barnes said. Starting Friday, the hospital will place babies skin-to-skin for all C-sections.
“The response has been so positive regardless of feeding choice,” Barnes said. “Even mothers who are not breast-feeding enjoy being together and bonding with their infant. It is one that is universally liked.”
The operating room staff began the practice last month at Truman Medical Center, Sevart said. “The staff loves it because they see how happy moms are.”
ALL MOMS BENEFIT
Many of the changes are beneficial for moms and babies who are not breast-feeding.
Sidwell said she enjoyed watching her son help give Lena her first bath in their room. She quickly learned her cues for hunger by keeping Lena by her side. She got more practice at swaddling.
“This birth with her was truly different. You felt more involved as a mother, that it revolved around you and your baby whereas with him, it was more about making things easier for the doctors and nurses.”
At the end of the two-year initiative, the hospitals will be assessed to see if they’ve met the 10 requirements. If they do, they earn the designation as a Baby-Friendly Hospital. Only 168 hospitals and birthing centers in the country are Baby-Friendly, including Hannibal Regional Hospital, the only one in Missouri.
With just 7 percent of U.S. babies born in Baby-Friendly hospitals, the Best Fed Beginnings initiative will more than double the number of babies born in hospitals that fully support breast-feeding.
“It’s snowballing now,” Chrisman Robbins said. “I think we are going to see things change fast from here on out.”