One of the most personal and certainly one of the most widely discussed decisions every mother must make is whether or not to breastfeed her baby. The benefits of breastfeeding are legion, and there is more support and education available to expectant mothers about the process than ever before. At Staten Island University Hospital, Staten Island, N.Y., the nurses in the Labor and Delivery Unit have developed an evidence-based approach to promotion of breastfeeding and helping the new mother and baby to share this important experience successfully.
Last year, Unit Manager Marianne DiStefano, RN-C, MSN, inquired whether there was staff interest in conducting a research project. A group of nurses attended the organizational meeting and selected breastfeeding as a topic for investigation. The rate of new mothers who elect to breastfeed was low in their hospital, and as a group, they wanted to see whether they could make a difference. They developed a thesis question about whether or not breastfeeding within the first hour of life would have an impact. They began looking for funding. Initially, the March of Dimes provided a small grant, and the New York City Breastfeeding Initiative was launched.
“City hospitals have been given $1 million each for breastfeeding initiatives,” says DiStefano. “There is no city hospital on Staten Island, so we wrote letters to our congressman and representatives requesting that Staten Island receive a share of the funding. We received a grant for $50,000 from New York City.”
Using the grant, they developed an education program for nurses, physicians, and residents. “Unicef and the World Health Organization have the Baby Friendly Hospital Initiative to promote breastfeeding worldwide,” says Lisa Paladino, RN-C, MS, Labor and Delivery staff nurse. “Our project is based on their ‘Ten Steps to Successful Breastfeeding’ as outlined on their website [http://www.babyfriendlyusa.org]. We are focusing our attention on Step Four: ‘Help Mothers Initiate Breastfeeding Within One Hour of Birth.'”
The presentation was developed by Paladino and Joan Greenberg, RN, BS, CLC, also a staff nurse on the unit. “All the hospital routines have to be supportive of the mother and baby, keeping them together and really caring for them as a dyad, rather than as two separate patients,” says Greenberg. “We had to work on changing the culture of the department.”
Nothing but skinMembers of the SIUH Labor and Delivery unit (clockwise from left): Marianne Di Stefano, Menay Drake, Diane Werneken, Mary Jane Baillie, Marie Tancona, Lisa Paladino, and Joan Greenberg.
After surveying the current literature, the group decided to implement an evidence-based care model to promote successful breastfeeding within the first hour of life. Skin-to-skin contact between mother and baby initiates a hormonal cascade that causes the mother to begin lactation. This contact is achieved in the most simple and ancient way the baby is placed on the mother’s abdomen immediately after birth. What about all the activity that usually occupies the first moments of the infant’s life?
“We find that almost everything can be done with the baby from that position,” says Greenberg. “The infant is dried off, a hat is put on to prevent body heat loss, the initial assessment is performed, and the baby is covered with a warm blanket. The physicians are even able to do perineal repairs for the mother without problem. The baby is calmer, and the mother has a sense of control and is happier.”
DiStefano notes that the new practice required a change in policy for the medical and nursing staff, as well as a reprogramming of some of the charting fields in the electronic medical record. The group presented the results of its literature survey to the medical staff, enlisting their support in changing policy and practice. The success of the process has been the best advocate. Babies treated in this way maintain their temperature and glucose and often latch onto the breast within the first hour or so of life, making the transition to life outside the uterus easier for the mother and baby.
The group agrees that patients, nurses, and physicians have all become enthusiastic about the new policies. Mary Jane Baillie, RNC, MS, Labor and Delivery educator, helps to facilitate the committee meetings and the educational process that keeps the program evolving. The group has obtained New York Nursing Association recognition, so that CE units can be offered to the nurses participating in the program. Baillie says that one of her goals is to offer the education program on the hospital web-based learning site.
There is a story about a little girl who chooses to make a difference in the lives of starfish, one at a time, by throwing each one that washes up on the shore back into the sea. In the story, the girl points out that a simple action can make all the difference in another life. DiStefano and her staff have found a way to make a small change in procedure pay off in a very big way, one patient at a time.