In Medscape yesterday. Enjoy!
Pamela Morrison IBCLC
--------------------------------
Medscape Medical News
Actions Alone May Improve Breast-feeding Rates
Nancy A. Melville Nov 12, 2012 Authors & Disclosures
SAN FRANCISCO — The right interventions can
improve breast-feeding rates at hospitals, even
when motivation and knowledge are lagging, a new
study shows. The results were presented here at
the American Public Health Association 140th Annual Meeting.
The Baby-Friendly Hospital Initiative, a joint
effort of the World Health Organization and
UNICEF, was designed to improve breast-feeding at
hospitals worldwide. In the United States, it has
had very limited impact; only about 5% of
hospitals have achieved the status, compared with
about 28% of hospitals in 152 countries worldwide
and 31% in less-developed settings, according to
research conducted by Miriam Labbok, MD, MPH, and
colleagues ( Breastfeeding Med. 2012;7:210-222).
According to data from the Centers for Disease
Control and Prevention, in the first 2 days of
life, hospitals provide formula to more than 25%
of breast-fed infants born in the United States,
which is known to undermine breast-feeding efforts.
"This tells us that something is going on in
hospitals that is undercutting women's intention
to breast-feed," said Dr. Labbok, who is director
of the Carolina Global Breastfeeding Institute at
the Gillings School of Global Public Health,
University of North Carolina at Chapel Hill, in
North Carolina, and lead author of the new
research. "We're introducing a heck of a lot of
formula in those first few days," she said.
The baby-friendly initiative encourages hospitals
to adopt the 10 steps for successful
breast-feeding measures.1. Have a written
breast-feeding policy that is communicated to all
healthcare staff on a routine basis
2. Train all healthcare staff in the skills necessary to implement this policy
3. Inform all pregnant women about the benefits
and management of breast-feeding
4. Help mothers initiate breast-feeding within 30
minutes of birth (by supporting immediate
skin-to-skin attachment and baby-led first latch)
5. Show mothers how to breast-feed and maintain
lactation, even if they should be separated from their infants
6. Give newborn infants no food or drink other
than human milk unless medically indicated (first
choice, breast-feeding by mother; second choice,
expressed mother's milk; third choice, donor milk)
7. Practice "rooming in," which allows mothers
and infants to remain together 24 hours a day
8. Encourage breast-feeding on demand
9. Give no artificial teats or pacifiers to breast-feeding infants
10. Foster the establishment of breast-feeding
support groups and refer mothers to them on
discharge from the hospital or clinic
Can Interventions Improve Breast-feeding Practices?
To better understand how the measures encourage
breast-feeding at American hospitals, Dr. Labbok
and her team evaluated 6 hospitals serving
low-wealth populations that were not necessarily seeking baby-friendly status.
"There's a lot in the press about hospitals that
tried to go after the baby-friendly designation,
but there's not much in the literature about
hospitals that are wishy-washy about it or low
wealth, so we sought out those hospitals."
The hospitals were systematically assigned to 2
groups that received an intervention on the 10
steps: the first group received the intervention
in 2009, and the second group received it in 2010
(so it could serve as the control for the first year).
The results on breast-feeding rates, health
worker knowledge, attitudes, and other factors at
the first interim analysis in 2010 showed that 8
of 10 steps had intervention-associated increases
in breast-feeding and exclusive breast-feeding in
the first group, compared with baseline.
The steps most closely associated with
improvements in any breast-feeding were hospital
policy, training, no supplementation of formula,
and restricting artificial nipple use.
The steps of most importance to exclusive
breast-feeding were policy, training, and
immediate skin-to-skin attachment within 30 minutes of birth.
"It's interesting that immediate skin-to-skin
attachment was so strongly associated with
exclusive breast-feeding," Dr. Labbok said.
Knowledge, Attitudes, and Actual Practice
The 2-year results showed that, although
knowledge improved little, if at all, and
attitudes improved only slightly in the 2 groups,
the actual practice of breast-feeding did improve in both groups.
"What we saw, in terms of improvements in any
breast-feeding, was that the [first] group...had
a significant change in the year during the
active intervention, and continued to increase thereafter," said Dr. Labbok.
The breast-feeding rate in the second group
actually decreased in the first year, but in the
second year, it increased at the same rate as the
first group, "so the intervention clearly had a very good impact," she said.
The findings are striking in demonstrating that
change is possible, even when enthusiasm is lackluster, she explained.
"What this tells us is that knowledge and
attitudes may not be necessary to make practice
changes that make the difference, even in
settings where people are not really all on
board," Dr. Labbok said. "This was unexpected, so
it was a very interesting finding for us," she added.
"It is reflective of many other countries I've
worked in where breast-feeding was dictated from
above and people simply had to do it...whether
they cared about it or had knowledge or not," she explained.
According to Melissa C. Bartick, MD, MS, from the
Cambridge Health Alliance in Massachusetts, the
suggestion that attitudes and knowledge will fall
into place after actions are implemented, and
might not be required beforehand, makes some sense.
"The findings are interesting, but in some ways
not too surprising to me," said Dr. Bartick, who moderated the session.
"For many things, I think actions themselves are
important drivers, and knowledge and attitudes do
not always drive behaviors," she added.
"It's encouraging to know" that changes in
attitudes "may not always be necessary, even if desirable," Dr. Bartick said.
Dr. Labbok and Dr. Bartick have disclosed no relevant financial relationships.
American Public Health Association (APHA) 140th
Annual Meeting. Abstract 259973. Presented October 29, 2012.
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