BREASTFEEDING MEDICINE Volume 9, Number 4, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2014.9988
Editorial
A Perfect Plan or a Perfect Storm Ruth A. Lawrence
F
or the past 5 years, this journal and the Academy of Breastfeeding Medicine, with the generous help of the Kellogg Foundation, have hosted annual Summits aimed at changing the face of breastfeeding for all mothers and babies. The gatherings were not another ‘‘how to session’’ or friendly chats with dedicated promoters of breastfeeding. They brought together major players in the modern healthcare system. The list included healthcare systems themselves, medical health insurance companies, employers, and the government, ranging from small town mayors to representatives of the Senate, the House, the Maternal and Child Health Bureau, and the Centers for Disease Control and Prevention, and in particular the Surgeon General. Also on the list has been the Joint Commission, which evaluates the work of most of the hospitals in the United States and certifies them to provide medical care. Much progress has been made. This was not necessarily due to the Summits, but certainly because of an increased awareness of the value of breastfeeding to the health and well-being of our nation. Every group has formulated an action plan germane to the greater cause and appropriate for its charge. Significant has been the Surgeon General’s Call to Action.1 Insurance companies have added coverage for breastfeeding care and supplies such as pumps. Legislators have crafted mandates for hospital services, reimbursement for medical care, and work-related accommodations. As of January 2014, the Joint Commission has required that all hospitals delivering 1,100 infants or more per year meet some core measures of breast-
feeding. Prior to this mandate, meeting breastfeeding goals was voluntary. We have watched with concern as only a select few hospitals become Baby Friendly. Although ‘‘Baby Friendly’’ is a grand idea and promotes the Ten Steps, created by the World Health Organization and UNICEF decades ago, the Ten Steps are available to all hospitals and should be the goal of maternity hospitals everywhere. The Ten Steps should become the yardstick by which the Joint Commission measures all maternity hospitals. They are the measure of good maternal and infant care. Incorporating the Ten Steps into hospital accreditation will lock in the breastfeeding goals of our nation without need of special funds or applications. In 1945, Dr. Edith Jackson at Yale University received a federal grant to change maternity care. The grant resulted in the establishment of the Rooming-In Unit at Yale New Haven Hospital. The program was founded on ‘‘Childbirth-Without-Fear,’’ developed by Grantley Dick-Reed in the 1940s in England. The Yale program included the first class for mothers to prepare for childbirth, the postpartum stay in the original rooming-in unit, and breastfeeding. Follow-up was also provided, and the pediatric staff made home visits to every family to check on the baby, confirm success of breastfeeding, and even evaluate the mother’s recovery. The program mothered the mothers. The model was described in several publications.2 The details have been slow to be adopted, partially because of the assault of the formula companies that encouraged mothers to let science rear their children.
171
172
The Ten Steps embody many of Dr. Jackson’s tenets, including the value of rooming-in. As the Summits have continued to try to solve the many barriers to breastfeeding, it has become apparent that some degree of regulation and credentialing will be necessary but should be cost-neutral for hospitals. Nationally, over 75% of infants leave the hospital breastfeeding at present, but the numbers plummet in the first few weeks and months to less than 25%. The current system provides no safety net, no support system, and no ‘‘mothering’’ of the mother. Until the mothers who choose to breastfeed are successful and achieve at least 6 months of exclusive breastfeeding, our energies, resources, and focus should be on creating that support system. Dr. Morton proclaims in her article3 in this issue that the intervening of the Joint Commission may be the perfect storm. She describes an excellent plan of management for special infants, including the slightly premature. Every hospital can learn a lot by accessing the resources she has developed. They are available at the Stanford University Newborn Web site as noted in her bibliography, on page 183. A perfect latch and hand expression are essential for managing the establishment of lactation. Dr. Morton’s years of experience and elegant lecture style make these visual aids invaluable resources.
EDITORIAL
The Sixth Summit will take place in June 2014. We will continue to work toward a system that will facilitate breastfeeding after hospital discharge by providing a personal safety net, coverage for professional services, and support in the workplace and in the neighborhood for all mother/baby dyads. We do plead that the introduction of the Joint Commission onto the playing field in the drive to make breastfeeding possible for most women is not the prodrome for the perfect storm, but the perfect start for change! References
1. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Office of the Surgeon General, U.S. Department of Health and Human Services, Washington, DC, 2011. 2. Barnes GR, Lethin AN, Jackson EB. Management of breastfeeding. JAMA 1953; 151:192–196. 3. Morton JM. Perfect storm or perfect time for a bold change? Breastfeed Med 2014; 9:180–183. —Ruth A. Lawrence, MD, FABM Editor-in-Chief
Editorial
A Perfect Plan or a Perfect Storm Ruth A. Lawrence
F
or the past 5 years, this journal and the Academy of Breastfeeding Medicine, with the generous help of the Kellogg Foundation, have hosted annual Summits aimed at changing the face of breastfeeding for all mothers and babies. The gatherings were not another ‘‘how to session’’ or friendly chats with dedicated promoters of breastfeeding. They brought together major players in the modern healthcare system. The list included healthcare systems themselves, medical health insurance companies, employers, and the government, ranging from small town mayors to representatives of the Senate, the House, the Maternal and Child Health Bureau, and the Centers for Disease Control and Prevention, and in particular the Surgeon General. Also on the list has been the Joint Commission, which evaluates the work of most of the hospitals in the United States and certifies them to provide medical care. Much progress has been made. This was not necessarily due to the Summits, but certainly because of an increased awareness of the value of breastfeeding to the health and well-being of our nation. Every group has formulated an action plan germane to the greater cause and appropriate for its charge. Significant has been the Surgeon General’s Call to Action.1 Insurance companies have added coverage for breastfeeding care and supplies such as pumps. Legislators have crafted mandates for hospital services, reimbursement for medical care, and work-related accommodations. As of January 2014, the Joint Commission has required that all hospitals delivering 1,100 infants or more per year meet some core measures of breast-
feeding. Prior to this mandate, meeting breastfeeding goals was voluntary. We have watched with concern as only a select few hospitals become Baby Friendly. Although ‘‘Baby Friendly’’ is a grand idea and promotes the Ten Steps, created by the World Health Organization and UNICEF decades ago, the Ten Steps are available to all hospitals and should be the goal of maternity hospitals everywhere. The Ten Steps should become the yardstick by which the Joint Commission measures all maternity hospitals. They are the measure of good maternal and infant care. Incorporating the Ten Steps into hospital accreditation will lock in the breastfeeding goals of our nation without need of special funds or applications. In 1945, Dr. Edith Jackson at Yale University received a federal grant to change maternity care. The grant resulted in the establishment of the Rooming-In Unit at Yale New Haven Hospital. The program was founded on ‘‘Childbirth-Without-Fear,’’ developed by Grantley Dick-Reed in the 1940s in England. The Yale program included the first class for mothers to prepare for childbirth, the postpartum stay in the original rooming-in unit, and breastfeeding. Follow-up was also provided, and the pediatric staff made home visits to every family to check on the baby, confirm success of breastfeeding, and even evaluate the mother’s recovery. The program mothered the mothers. The model was described in several publications.2 The details have been slow to be adopted, partially because of the assault of the formula companies that encouraged mothers to let science rear their children.
171
172
The Ten Steps embody many of Dr. Jackson’s tenets, including the value of rooming-in. As the Summits have continued to try to solve the many barriers to breastfeeding, it has become apparent that some degree of regulation and credentialing will be necessary but should be cost-neutral for hospitals. Nationally, over 75% of infants leave the hospital breastfeeding at present, but the numbers plummet in the first few weeks and months to less than 25%. The current system provides no safety net, no support system, and no ‘‘mothering’’ of the mother. Until the mothers who choose to breastfeed are successful and achieve at least 6 months of exclusive breastfeeding, our energies, resources, and focus should be on creating that support system. Dr. Morton proclaims in her article3 in this issue that the intervening of the Joint Commission may be the perfect storm. She describes an excellent plan of management for special infants, including the slightly premature. Every hospital can learn a lot by accessing the resources she has developed. They are available at the Stanford University Newborn Web site as noted in her bibliography, on page 183. A perfect latch and hand expression are essential for managing the establishment of lactation. Dr. Morton’s years of experience and elegant lecture style make these visual aids invaluable resources.
EDITORIAL
The Sixth Summit will take place in June 2014. We will continue to work toward a system that will facilitate breastfeeding after hospital discharge by providing a personal safety net, coverage for professional services, and support in the workplace and in the neighborhood for all mother/baby dyads. We do plead that the introduction of the Joint Commission onto the playing field in the drive to make breastfeeding possible for most women is not the prodrome for the perfect storm, but the perfect start for change! References
1. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Office of the Surgeon General, U.S. Department of Health and Human Services, Washington, DC, 2011. 2. Barnes GR, Lethin AN, Jackson EB. Management of breastfeeding. JAMA 1953; 151:192–196. 3. Morton JM. Perfect storm or perfect time for a bold change? Breastfeed Med 2014; 9:180–183. —Ruth A. Lawrence, MD, FABM Editor-in-Chief
