In a move criticized for reaching outside the realm of politics, New York City Mayor Michael Bloomberg initiated and endorsed an initiative that asks city hospitals to put baby formula out of the reach of moms and push breast-feeding instead.
The mayors request comes as part of his push in recent months to help New Yorkers become healthier, and it has had an impact on nurses caring for new mothers. The New York City Department of Healths Latch On NYC initiative, launched Sept. 3 by New York City Public Health Commissioner Thomas Farley, MD, asks city hospitals to voluntarily agree to:
Enforce the New York State hospital regulation to not supplement breast-feeding infants with formula feeding unless medically indicated and documented on the infants medical chart;
Restrict access to infant formula by hospital staff, tracking infant formula distribution and sharing data on formula distribution with the citys health department;
Discontinue the distribution of promotional or free infant formula;
Prohibit the display and distribution of infant formula promotional materials in any hospital location
The New York City DOH is promoting the campaign to the public with posters displayed in subways and hospitals. Early news reports of the initiatives requirements drew criticism from feminist groups and even some mothers on various online blog sites.
An article published on NYPost.com painted the campaign as a thorn in the side of those involved. “Making formula more difficult to get in the hospital will only lead to frustrated staff and distraught mothers of hungry babies,” wrote opinion columnist Karol Markowicz in the July 31 article. “Its one thing to provide the breast-feeding education and then let the mother make her own choice. Quite another to keep formula under lock and key.” The NYC DOH responded by clarifying the initiatives goal on its website, and the furor has died down.
All 11 New York City Health and Hospitals Corporation hospitals are participating in the initiative. The DOH conducted a news conference in May announcing the initiative at NYCHHCs Harlem Hospital Center, the citys first Baby-Friendly designated hospital. Baby-Friendly designation is awarded by Baby-Friendly USA as part of a World Health Organization and United Nations Children’s Fund initiative. The initiative wont require a learning curve for HHC nurses. NYCHHC, the largest public health system in the country, already had banned the inclusion of formula samples in its gift bags and promotions in 2007, and its nurses are equipped to counsel mothers on breast-feeding.
“We are a Baby-Friendly designated hospital, so we already promote breast-feeding,” said Judith Daniels, RNC, MSN, MSA, associate director of nursing, OB/GYN, at the Harlem facility. “Designation requires breast-feeding promotion as part of its 10 steps. The other hospitals are on the pathway to becoming Baby-Friendly as well.”
The initiative does not deny a mother formula if she chooses not to breast-feed. But it will require her to be counseled by a nurse before formula is distributed.
A big part of the initiative is explaining the benefits of breast-feeding over formula. In addition to preventing ear infections and diarrhea, the DOH explains, studies show breast milk helps stave off pneumonia.
“If a mom says she prefers formula, we first find out what is preventing her from wanting to breast-feed,” Daniels said. “Sometimes its misconceptions that are holding them back. Sometimes its because they think they dont have enough milk to sufficiently feed the child. They dont know that the milk doesnt come until the third day.”
Daniels said that when formula is distributed, compliance with the initiative mandates a notation is made. “We count the formula and report the numbers to the department of health on a monthly basis,” she said.
Bronx-Lebanon Hospital Center was practicing the four tenets of Latch On NYC before the program was announced, said Marguerite Tirelli, RN,C, IBCLC, a lactation consultant. Tirelli said the most noticeable difference has been the patient interest in the Latch On announcement that took place during World Breast-feeding Week.
“Its given staff an even greater opportunity to discuss, promote and support breast-feeding with patients,” she said.
All of the maternal child nurses at Bronx-Lebanon have completed a 20-hour interdisciplinary breast-feeding management course, which outlines the curriculum in support of the 10 steps to successful breast-feeding, Tirelli said.
“One of the 10 steps is to train all healthcare staff in the skills necessary to implement this (breast-feeding) policy,” she said.
The curriculum provides strategies to improve breast-feeding, so nurses have been trained to discuss breast-feeding from prenatal care through the postpartum period, Tirelli said.
Formula always has been accounted for through a supply distribution center on the postpartum unit at Bronx-Lebanon.
And like other HHC hospitals, Bronx-Lebanon no longer offers promotional formula. “We stopped distributing formula discharge bags well before the Latch On NYC initiative, and there hasnt been any formula promotional items on the units for many months,” Tirelli said.
Like Harlem Hospital and Bronx-Lebanon, Brooklyns Maimonides Medical Center was proactive in breast-feeding education and had encouraged the practice long before Latch On NYC.
“We are highly committed to supporting a mothers choice to breast-feed,” said Lori White, RN, MS, assistant vice president of maternity services. “Our electronic health record is set up so that breast-feeding is the default method of feeding. Nurses are already on board not to supplement breast-feeding infants with formula feedings unless medically indicated and documented in the infants health record.”
White said Maimonides was one of 27 hospitals to send a representative to the news conference announcing the initiative.
“A majority of the staff are in support of this initiative,” she said. “Our two full-time lactation consultants have led the charge in our journey to become Baby-Friendly and to keep the staff informed and on board.”
Maimonides is on track to comply with reporting any formula that is distributed. “We are in the process of developing a system that will assist us in ways to track infant formula distribution and be able to share aggregate data on formula distribution with the department of health,” White said.
Other states are joining the push for breast-feeding as well. Rhode Island and Massachusetts — in 2011 and 2012, respectively — have joined NYCHHC in banning formula samples, a move Maimonides recently made by eliminating discharge gift bags.
“In an effort to meet the expectation of a free gift upon discharge, the department is considering giving a bag with the … hospital logo,” White said.
Tracey Boyd is a regional reporter.