A Breastfeeding Friendly Medical System is a healthcare institution dedicated to promoting, supporting and sustaining breastfeeding within the population that it cares for.
Many hospitals are redesigning their policies and procedures to align with Baby Friendly Hospital Initiative principles, otherwise known as The Ten Steps. Mothers who give birth in Baby Friendly Hospitals have a greater likelihood of breastfeeding initiation and longer breastfeeding duration rates.
The Baby Friendly Hospital Initiative requires training for all nursing staff and for the hospital providers.
Once mothers and their families leave the hospital, they require evidence-based breastfeeding guidance and management that is accessible and affordable. Unfortunately, unlike the staff at Baby Friendly hospitals, outpatient medical care providers and staff are often inadequately trained in breastfeeding during their professional education. This ongoing lack of education exists despite the fact that more than 75% of mother-baby dyads in the USA are breastfeeding at the time of hospital discharge. In addition, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetrics and Gynecology have formal statements advising breastfeeding education during specialty training. Can you identify any other health behavior that the majority of mothers and babies are engaged in, for which medical professionals are not educated?
Families often sense that their pediatricians, family physicians, and/or obstetricians do not have sufficient knowledge for primary care management of their breastfeeding problems. Families therefore seek other sources of support, such as lactation consultants at the hospital, WIC (Supplemental Nutrition for Women, Infants and Children), and community groups such as La Leche League, or other mother-baby groups.
This places the United States population at risk for racial and ethnic disparity in breastfeeding support since families with more resources will have a greater chance of accessing lactation care in their communities. In addition, breastfeeding mothers and babies are at risk for maternal/infant complications of breastfeeding because of inadequate breastfeeding medical care. Such complications include chronic breast infections, breast abscesses, insufficient milk supply, infant hypoglycemia, insufficient weight gain, premature weaning, and side effects from medications given to mothers by physicians who are well intentioned but lack knowledge on evidence-based breastfeeding management.
Research has shown that providing breastfeeding training to office providers and staff can increase breastfeeding initiation and duration rates. In order for a medical system to optimally support breastfeeding dyads, more structure is required beyond educating office staff and providers.
The Breastfeeding Friendly Outpatient Medical System (BFOMS) is a model of support with basic principles including:
A committee dedicated to overseeing breastfeeding support throughout the BFOMS charged with:
- Establishing a policy of breastfeeding support within the medical system.
- Determining means and budget for ongoing provider and staff education.
- Creating avenues of communication between health care consumers and office staff in order to manage breastfeeding questions.
- Communicating between administration and staff regarding financial and other needs to provide breastfeeding support throughout the system.
Basic breastfeeding care within its primary care medical homes (PCMHs)
- An adequate number of office staff and providers are trained in primary care breastfeeding management.
- Patients/clients have access to the providers for telephone counseling and in-person breastfeeding evaluations.
Create a breastfeeding friendly physical environment
- Display images of breastfeeding, avoid bottle feeding images, no gift packs of formula, provide an environment that allows breastfeeding women to feel safe and comfortable, with an option to be private or not. Provide comfortable chairs and other supports such as pillows and foot stools. Allow breastfeeding women to nurse during infant procedures.
Coordination of care between the PCMHs and the hospital
- Hospital staff have the means to communicate feeding plans and other breastfeeding concerns to office staff who will be assuming care of the breastfeeding dyad.
- Hospital staff are available to help protect and support breastfeeding dyads who require admission to the hospital beyond the birth episode.
Breastfeeding support beyond the PCMH into specialty departments
- Specialty departments are aware that mothers and babies are nursing, and adapt care to optimize the breastfeeding relationship.
Provision of a higher level of breastfeeding management with breastfeeding specialists
- The office staff and providers within the PCMHs have access to breastfeeding specialists who can provide a higher level of breastfeeding management.
Collaboration with community supporters
- Provides resources in the community for ongoing breastfeeding support, such as public health nurses, home visitors, WIC, mother-infant support groups such as LLLI, and private practice lactation consultants.
- Establishes coordination of care between community breastfeeding supporters and the medical system.
Ongoing breastfeeding education for the PCMH staff
- Breastfeeding education within the PCM is sustainable. Office staff and providers receive basic breastfeeding training and periodic updates to maintain evidence-based knowledge.