Alabama Makes mPINC Improvements!

by Glenni Lorick, IBCLC

According to recently released data, Alabama improved its mPINC score by 5 points to an all-time high of 72 in 2015. You might wonder what in the world that means, and why it is cause for celebration, so I will gladly explain it! The mPINC survey is conducted by the Center for Disease Control (CDC) each year to assess maternity and infant feeding practices at hospitals and birthing centers across the country. The acronym stands for Maternal Practices in Infant Nutrition and Care.

The mPINC survey questions measure infant feeding care practices, policies, and staffing expectations in place at hospitals that provide maternity services. The survey measures a range of factors affecting breastfeeding. Our 72 puts us well ahead of Mississippi (60), Arkansas (67) and Puerto Rico (69). Nevertheless, we lag behind Utah (75), Louisiana (76), Alaska (82), Washington (83) and Colorado (85) - and most of the country, to be honest. We ranked 47th out of 53 respondants.

Labor and Delivery Care

Some of the really encouraging results include that 76% of our facilities are making sure that mothers and babies have 30 minutes of skin-to-skin contact within 1 hour after a vaginal birth, and 51% are making sure that this happens within 2 hours after a cesarean birth. However, less than half are making sure that mothers have the initial breastfeed within the first hour of life. More disturbing is that only 24% perform routine procedures with baby on mom's abdomen/chest.

Feeding of Breastfed Infants

The really good news here is that 90% of Alabama facilities do not give water or glucose water to breastfed infants. However only 76% make sure that the first feed for infants whose mothers have declared their choice to breastfeed is actually breastmilk. Most disappointing is that only 18% of Alabama facilities would say that formula supplementation of breastfeeding infants is rare. 

Breastfeeding Assistance

Here is our only 100% - we as a state are perfect in documenting feeding choice in patient charts. We are also very good about having facility staff provide breastfeeding instruction to parents and teach breastfeeding cues. In 78% of our facilities staff actually directly observe a feed. However, only 32% do not routinely offer pacifiers to breastfed infants. It is worth noting that 97% offer prenatal breastfeeding classes, and 83% have a designated staff member coordinating lactation services.

Contact Between Mother and Infant

A startling 41% of mothers and infants are separated during the transition period immediately following birth. Only 24% of facilities report not separating mothers and infants during the stay (in a normal, healthy situation). And only 8% perform routine infant procedures, assessment and care in the mother's room.

Conclusions

Since the first mPINC survey in 2007, Alabama has improved in many areas. Our overall score has increased by 17 points. While that is exciting, it is not enough. We still have a very long way to go to truly normalize breastfeeding in our state. Sadly, 41% of our institutions still routinely provide discharge packs containing formula samples and coupons.  85% of Alabama hospitals receive free formula. Only a dismal 20% of Alabama hospitals have written breastfeeding policy that incorporates all 10 steps of the Baby Friendly Hospital Initiative. The only Hospital in North Alabama to actively seek this designation is Madison Hospital. Nevertheless, as mothers demand more support for breastfeeding and gravitate toward facilities that support them, we can expect to see our numbers continue to improve! I look forward to seeing the 2016 numbers next year!

Formula Gift Bag Rates Plummet at Local Hospitals!

by Glenni Lorick, IBCLC

Recently we did an informal poll on the Facebook page for A Nurturing Moment. The post  reached over 4000 people and nearly 200 responded. A cross section of North Alabama hospitals was represented as well as a smattering of out-of-state facilities, but the majority of the respondents had given birth in Huntsville.

From the Similac site - free gifts....

The question asked was this: "Were you offered a formula gift bag or given free formula when your baby was born? If so was it at the hospital, a doctor's office (pediatrician? or OB?) or another location. Please answer for your MOST RECENT birth. Please give month and year. If you were not offered a gift bag, please respond with 'NO' and tell us where you had your baby."

We got some terrific data about the changing patterns of formula bag distribution. One of the steps for a hospital to become Baby Friendly involves the hospital no longer accepting free formula samples from the formula companies and not giving formula to breastfed babies unless there is a clear medical indication and it is ordered by a physician.

Hospitals in Madison County

There was a very obvious shift in lthe formula distribution at Huntsville Hospital over the course of the last year or so. Prior to 2014, 19 mothers indicated that they had been given formula. Since 2014 only 8 mothers were given formula, and 30 mothers said they were not given formula at all. As early as August 2013 one mother at HH was told that they no longer were giving formula bags. Several mothers who delivered there in the last year reported receiving a Huntsville Hospital bag with an insulated bottle bag, but no formula. 

Fourteen mothers reported giving birth at Crestwood in 2014. Nine of them did not receive formula, and 5 of them did. Fifteen mothers had given birth at Madison Hospital. Fourteen of those mothers received no formula, and one did, but she reported that there was a medical indication for the formula, and it was given by physician recommendation.

Other Local Hospitals

Three respondents had given birth at Athens-Limestone Hospital; all three received formula. Of the three who had given birth at Decatur in the last year, two did receive formula, and one did not. A mother who gave birth last February said the nurse told her they weren't trying to push formula feeding, but were required to offer it so they could give away the free bags. However, by November, a mother who gave birth there did not receive any formula at all. 

The Nurses at RMC in Anniston,
Alabama's only Baby Friendly Facility!

One mother gave birth at the state's only Baby Friendly Hospital, Regional Medical Center in Anniston. She was not offered formula. Two mothers had given birth in Cullman, and both were offered formula. Both Helen Keller and Eliza Coffee Memorial had one mother reporting; both hospitals gave formula. Marshall Medical Center was represented by one mother in each of their facilities (North and South). Both mothers reported receiving formula. 

Four hospitals from Birmingham were represented in the poll. One mother delivered at UAB  and one at Brookwood. Neither one received formula. One mother delivered at Princeton and did receive formula. Three delivered at St. Vincents, and all three received formula.

About 17 mothers had delivered in hospitals in other states. Eleven of them had not received any formula at all. Several other mothers had delivered at Birthing Centers or the Farm. As expected, they didn't receive any formula samples.

Physicians

Surprisingly, many mothers who didn't receive formula gift bags at the hospital did receive them from their OB/Gyn. Eight different OB/Gyn practices were mentioned as having given formula. One mother, however, made a point of saying that her OB, Dr. Conrad, never mentioned anything at all about formula! A couple of mothers mentioned receiving formula from their pediatrician, but one mother emphasized how thankful she was for it because she was having problems with milk production. 

In a final surprising note, one mother mentioned receiving a formula gift bag from 4D Mommies!

Madison Hospital gets our ANM "Formula Free" Award!

Why It Matters

Some mothers really liked the idea of getting the cute bag. Some actually donated the formula to a local food bank or a mother in need. That is wonderful; however, studies have demonstrated that when a mother receives formula from a health care provider, it subtly undermines her confidence in her ability to breastfeed. Health Care providers have an obligation to help mothers offer the healthiest possible start to their babies. When they give a mother a formula sample, they are in essence saying that breastfeeding might work, but it might not, so just in case, Mom needs a backup. The truth is that with proper support, the vast majority of mothers can provide sufficient milk for their infants. 

In conclusion, we want to applaud Huntsville Hospital for their elimination of formula gift bags and drastic reduction in infant formula being distributed. Actually, most of the formula that was distributed in 2014 was to NICU moms. But the hands-down winner of the ANM "Formula-Free" award is Madison Hospital! Congratulations are in order for the nursing staff and lactation consultants who have created an incredibly supportive environment for breastfeeding moms!

World Breastfeeding Week: Celebrating 20 Years of Breastfeeding Promotion

It has been 20 years since the World Alliance for Breastfeeding Action (WABA) launched the first World Breastfeeding Week campaign. The theme that first year was "Baby Friendly Hospital Initiative." So much has happened in these last 20 years! Let's look at how far we've come.

• The Innocenti Declaration from 1990 has continued to be a guiding force in breastfeeding promotion.
• In 1992 the Healthy Mothers, Healthy Babies Coalition received a grant to move forward with the Baby Friendly Hospital Initiative (BFHI) in the US. Wellstart International in San Diego, CA, developed the assessment tools.
• In 1997 the Healthy Children Project, Inc. accepted responsibility for the initiative and formed Baby-Friendly USA to implement the BFHI in the US.
• In 2002, The World Health Organization (WHO) and UNICEF reaffirmed the Innocenti targets and added additional targets in the Global Strategy for Infant and Young Child Feeding.
• In December of 2011, Regional Medical Center in Anniston became the first Alabama facility to receive the Baby Friendly designation.
• As of May, 2012, 143 hospitals and birth centers in the United States have received this designation.

However, we still have a very long way to go! One of the goals of this year's World Breastfeeding Week is to call attention to the state of policy and programs related to the feeding of infants and young children.

The New York Initiative

Just yesterday there was a lengthy discussion on the WHNT facebook page about the Latch-On NY initiative which encouraging participating hospitals not to give free formula to women and to only distribute formula when medically necessary. A mother who chooses to formula feed will first learn about the benefits of breastfeeding her baby, at least while she's in the hospital. No mother will be denied formula, nor will any baby ever go hungry. The program is voluntary and simply helps hospitals take steps toward becoming Baby Friendly.  What the critics don't understand is that many hospitals are already doing this - there's been no fanfare or political upheaval about it; rather, they have simply implemented evidence-based medicine in their facilities.

Help for Working Moms

An argument that I have seen repeatedly in this discussion is the hardship that returning to work while breastfeeding imposes on women. The US Department of Health and Human Services office on Women's Health put together a promotion called The Business Case for Breastfeeding. It is very true that many women do indeed struggle. That is why it is so important for employers to recognize the important role they play in supporting their breastfeeding employees. Programs like ANM Workplace Solutions help employers provide the level of support necessary, and actually have a positive Return on Investment!

Truth in Advertising for Formula Companies

This week let's celebrate how far we've come, but let's recognize how far we still have to go! Let's help women and doctors alike understand that breastfeeding isn't just a matter of maternal choice. It is a decision that can affect their baby's health. It's time for our government to sign onto the International Code for the Marketing of Breastmilk Substitutes and stop allowing formula companies to mislead the public. 

No Guilt! Lots of Support!

Should mothers who don't breastfeed be made to feel guilty? No, I don't think this is about guilt. But every mother should have the opportunity to know just why breastmilk is so important for her baby. Furthermore, every mother should have the support necessary to breastfeed successfully.