Margaret has brought up the recurring problem of those pesky discharge bags.
In Massachusetts we are revising our state perinatal regulations and asking
that these cease being given out in our hospitals. I am copying below some of
my testimony that I will be giving at the public hearing in September. If it
comes through with all those funny marks because I imported the text from a
Word document, please let me know and I would be happy to e-mail it to anyone
who wants it as an attachment
Marsha Walker, RN, IBCLC
Weston, MA
Rationale:
Hospital based maternity care practices influence the initiation, duration,
and exclusivity of breastfeeding during both the hospital stay and post
discharge (Perez-Escamilla et al, 1994). Supportive evidence-based institutional
breastfeeding practices effectively increase breastfeeding initiation and
duration rates (Vallenas & Savage, 1998). Mothers experiencing none of the above
suggested practices are 8 times more likely to stop breastfeeding before 6
weeks compared to those mothers who experience just 5 of these (DiGirolamo,
Grummer-Strawn, & Fein, 2001). Exclusive breastfeeding in the first month is
strongly associated with breastfeeding for at least 6 months. Women who fully
breastfeed (no formula supplements) through the first month are 3.5 times more
likely to breastfeed longer than 6 months than those who do not fully
breastfeed for the first month (Piper & Parks, 1996). One of the main patient
complaints is the inconsistent breastfeeding information experienced during their
hospital stay. The Healthy People 2010 health objectives for the nation
includes increasing the initiation, duration, and exclusivity of breastfeeding (US
Department of Health and Human Services, 2000), something that is not
happening as a partial result of inappropriate hospital practices and the marketing
practices of infant formula manufacturers. Breastfeeding rates are falling,
especially exclusive breastfeeding (Ross Products Division of Abbott
Laboratories, 2003).
Exclusive breastfeeding is recommended for approximately the first six
months of life. The higher the intensity or dose of human milk the lower the risk
and occurrence of acute and chronic diseases and conditions such as diabetes,
overweight and obesity, allergies, asthma, certain childhood cancers.
Cognitive function is also affected by the dose of human milk an infant receives.
The more compromised an infant the higher the number of IQ points gained
through the provision of human milk. For example, small for gestation age infants
who are not breastfed at all show adjusted intelligence scores almost 6.0
points lower than children exclusively breastfed for 5 months or longer
(Slykerman et al, 2005). It has been estimated that the value of one IQ point in
terms of worker productivity is $14,500 (Grosse et al, 2002).
Exclusive breastfeeding rates have been shown to be diminished in the
presence of commercial infant formula discharge bags at all points measured between
0 and 6 months (Donnelly et al, 2004; Dungy et al, 1992; Frank et al, 1987).
HIPAA defines the distribution of infant formula bags as a form of
marketing. The Maternity Center Association surveyed 1583 mothers to create a profile
of childbearing women. The results showed that 80% of mothers who stated to
hospital staff that they wished to exclusively breastfeed were given formula
samples or offers. Almost half (47%) of the infants of these mothers were
supplemented in the hospital with water or formula. By day 7 postpartum, 40% of
these mothers had stopped breastfeeding (Declercq et al, 2002). Most mothers
who supplement with infant formula do so with the same formula brand used in
the hospital. Hospital staff, routines, and interventions exert a stronger
influence on mothers’ infant feeding practices by non-verbal teaching (the
hospital “modeling” of infant formula products) than by verbal teaching
(counseling and supporting breastfeeding) (Reiff & Essock-Vitale, 1985). I have been
unable to find any data regarding the necessity or safety of the hospital
practice of giving new mothers commercial gifts from formula companies. To my
knowledge, marketing of commercial products by hospital employees is not part of
their duty to the patient, violates the ethical principles underlying health
care practice, falls under the purview of corporate compliance, is
unethical, is not therapeutic, and may be hazardous. The powdered infant formula
contained in the discharge bag is not sterile and can pose a risk to the recipient
infant. Economically challenged families do not need these bags and their
impact on a family’s budget is negligible. These families do not receive food,
coupons, and materials that can be detrimental to their health in commercial
discharge gifts from the orthopedic or cardiac units. Prohibiting the
distribution of commercial products does not prevent families from requesting this
product directly from the manufacturer. Hospitals are not obligated to give
gifts to mothers. Other hospital units do not engage in this practice and would
find it unethical to distribute and market commercial products with known
adverse health effects to their patients. There is no scientific evidence to
validate the need for formula containing discharge bags or that they have any
therapeutic value. All of the following organizations have specific hospital
based recommendations to follow the 10 Steps to Successful Breastfeeding
(World Health Organization/UNICEF, 1989). They all recommend the elimination of
the practice of giving commercial discharge bags (with or without formula
inside) to breastfeeding mothers.
1. The Department of Health and Human Services, Office on Women’s
Health in its Blueprint for Action on Breastfeeding recommends that hospitals
follow the 10 Steps to Successful Breastfeeding and acknowledges that the
marketing of infant formula negatively affects breastfeeding (US Depart of Health
and Human Services, 2000).
2. The American Academy of Pediatrics specifically states that hospital
practices and policies that discourage successful breastfeeding should be
eliminated including: “promotion of infant formula in hospitals including
infant formula discharge packs, infant formula discount coupons, separation of
mother and infant, inappropriate feeding images, and lack of encouragement and
support by all health care staff.” (American Academy of Pediatrics, 2005)
3. The Centers for Disease Control and Prevention (CDC) recommends that
health care institutions abandon the practice of distributing formula
samples to breastfeeding women (Shealy, Li, Benton-Davis, Grummer-Strawn, 2005)
4. The International Lactation Consultant Association has published
evidence-based breastfeeding guidelines that outline a set of best practices for
delivering lactation care and services in the hospital setting. This
guidelines recommends that maternity care facilities avoid distribution of infant
feeding product samples and advertisements for such products (International
Lactation Consultant Association, 2005)
5. The American Academy of Family Physicians (2001) provides specific
clinical recommendations for the hospital support of breastfeeding and state
that discharge packs containing formula samples and formula company
advertising or literature be avoided
6. The Massachusetts Department of Public Health issued hospital based
clinical guidelines for improving lactation care and services and eliminating
barriers to breastfeeding imposed by hospitals. These guidelines include a
set of best practices and the recommendation that hospitals avoid the
distribution of formula discharge bags and other products produced by formula
companies.
References:
American Academy of Family Physicians. AAFP policy and position statement on
breastfeeding. 2001
American Academy of Pediatrics, Section on Breastfeeding. Breastfeeding and
the use of human milk. Pediatrics 2005; 115:496-506
Declercq ER, Sakala C, Corry MP, et al. Listening to mothers: report of the
first national U.S. survey of women’s childbearing experiences. New York:
Maternity Center Association, October 2002
DiGirolamo AM, Grummer-Strawn LM, Fein S. Maternity care practices:
implications for breastfeeding. Birth 2001; 28:94-100
Donnelly A, Snowden HM, Renfrew MJ, Woolridge MW. Commercial hospital
discharge packs for breastfeeding women (Cochrane review). In: The Cochrane
Library, Issue 2, 2004
Dungy CI, Christensen-Szalanski J, Losch M, et al. Effect of discharge
samples on duration of breastfeeding. Pediatrics 1992; 90:233-237
Frank DA, Wirtz SJ, Sorenson JR, et al. Commercial discharge packs and
breastfeeding counseling: effects on infant feeding practices in a randomized
trial. Pediatrics 1987; 80:845-854
Grosse SD, Matte TD, Schwartz J, Jackson RJ. Economic gains resulting from
the reduction in children’s exposure to lead in the United States. Environ
Health Perspect 2002; 110:563-569
International Lactation Consultant Association. Clinical guidelines for the
establishment of exclusive breastfeeding. Raleigh, NC. 2005
Perez-Escamilla R, Pollitt E, Lonnerdal B, et al. Infant feeding policies in
maternity wards and their effect on breastfeeding success: an analytical
overview. Am J Pub Health 1994; 84:89-97
Piper S, Parks PL. Predicting the duration of lactation: evidence from a
national survey. Birth 1996; 23:7-12
Reiff MI, Essock-Vitale SM. Hospital influences on early infant feeding
practices. Pediatrics 1985; 76:872-879
Ross products Division of Abbott Laboratories. Breastfeeding trends-2003.
Columbus, OH
Shealy KR, Li R, Benton-Davis S, Grummer-Strawn LM. The CDC guide to
breastfeeding interventions. Atlanta: US Department of Health and Human Services,
Centers for Disease Control and Prevention, 2005
Slykerman RF, Thompson JMD, Becroft DMO, et al. Breastfeeding and
intelligence of preschool children. Acta Paediatrica 2005; 94:832-837
US Department of Health and Human Services. Healthy People 2010. 2nd ed.2
vols. Washington, DC: US Government Printing Office, November 2000
US Department of Health and Human Services. HHS blueprint for action on
breastfeeding. Washington, DC: US Government Printing Office, 2000
Vallenas C, Savage F. Evidence for the ten steps to successful
breastfeeding. (revised). Geneva: Division of Child Health and Development, World Health
Organization, 1998. WHO/CHD/98.9
World Health Organization/UNICEF. Protecting, promoting and supporting
breastfeeding: the special role of maternity services. A joint WHO/UNICEF
statement. Geneva: World Health Organization, 1989
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