Hospital regulators let formula vie with breast milk

When it comes to feeding infants, the healthiest option is mother’s milk. But many Chicago-area hospitals don’t act like it. Should authorities crack down?

Chip Mitchell | May. 05, 2011

Vanessa Stokes A new French study shows that breastfeeding may have lasting benefits for a child’s metabolism. Other studies suggest breastfeeding helps prevent infections, chronic diseases and obesity. Evidence like this has moved the American Academy of Pediatrics to recommend giving babies no food or drink other than breast milk for their first six months. At many Chicago-area hospitals, though, breast milk competes with baby formula. At some of them, the real stuff usually loses. From our West Side bureau, we compare how the area’s hospitals approach breastfeeding and see whether watchdog agencies are paying much attention.

MITCHELL: Certified lactation consultant Vanessa Stokes landed a job in December.

STOKES: I was excited just to get to that place to really make a difference.

MITCHELL: That place was the maternity ward of Cook County’s Stroger Hospital. Stokes was there to encourage and train moms to breastfeed. But she noticed the hospital giving them signals it was OK to feed newborns formula.

STOKES: I saw bottles in the cribs.

MITCHELL: Then Stokes met one of the hospital’s newest mothers. Like many patients on the ward, she was young and black. What was less usual was her file. It showed she’d been planning to breastfeed.

STOKES: The baby was born and then, at night, she had some problems with latch-on, which happens. She said, ‘The nurse told me to give the baby a bottle.’ That’s what she told me.

MITCHELL: You believe her?

STOKES: Yes, I do. Most nurses, they just don’t want to take the time to help moms. They have a million other things to do.

MITCHELL: And there was no breastfeeding peer counselor or lactation consultant on duty overnight?

STOKES: No.

MITCHELL: One of Stokes’ supervisors at Stroger confirms that the hospital keeps bottles in cribs and that the nurses sometimes give out formula without any medical reason. Birth-certificate data show that less than 60 percent of infants born at Stroger get to breastfeed there. And there are more places like this. A dozen Chicago-area hospitals have even lower rates. The data show there’s one on the South Side where just 10 percent of newborns start breastfeeding.

SOUND: Elevator door closes.

MITCHELL (on site): I’m inside that hospital now. It’s called Holy Cross. I’m taking an elevator to the 6th floor to see Anita Allen-Karriem. She directs what Holy Cross calls its Family Birth Center.

SOUND: Elevator door opens. Intercom voice. Birth Center door opens.

MITCHELL: Allen-Karriem shows me around the ward.

ALLEN-KARRIEM: And, as you can see, this is our rooming-in. And our moms are here and they can have their baby here 24/7...

MITCHELL: She says Holy Cross initiates breastfeeding within an hour of birth.

ALLEN-KARRIEM: My nurses have the tools that they need to assist with breastfeeding the mom. And we encourage breastfeeding on demand.

MITCHELL (on site): How many lactation consultants do you have on staff?

ALLEN-KARRIEM: We don’t have any. Our volume does not support that at this particular time.

MITCHELL (on site): Any peer counselors that come in as volunteers? Breastfeeding peer counselors?

ALLEN-KARRIEM: No, we don’t have that at the present.

MITCHELL: Allen-Karriem says convincing her patients to breastfeed is not always easy. She says most have not received any prenatal care before showing up in labor. Even more than Stroger Hospital, Holy Cross lets breast milk compete with formula. Allen-Karriem says her hospital sends moms home with a few days worth of formula. The idea’s to tide them over, until they get into a federal nutrition program that provides more.

ALLEN-KARRIEM: Is it the best method of nutrition? No, it is not. Breastfeeding is. However, it’s the mom’s choice. If she wants to exclusively breastfeed, we do not send her home with formula. However, because she has not chosen to breastfeed, would you send her outside your doors with no way to feed her infant and no way to buy any formula?

MITCHELL: Again, Holy Cross is at the bottom when it comes to breastfeeding rates in Chicago-area hospitals. Experts say that’s not a big surprise since it doesn’t have lactation consultants and gives out all that formula. But some hospitals are taking a different tack.

INTERCOM: Stroke alert for the Emergency Room...

MITCHELL: Like Stroger and Holy Cross, Mount Sinai on Chicago’s West Side serves mostly low-income patients. Last year about half the babies born at the hospital were getting breastfed there. To lift that rate, Mount Sinai says it’s planning to apply for a pro-breastfeeding designation from the United Nations called Baby Friendly.

SAIDEL: This is the room where the hearing screen is done...

MITCHELL: Lou-Ellen Saidel is one of two half-time lactation consultants on Mount Sinai’s maternity ward. She says you can see the effect of the Baby Friendly program right in this room. Saidel says the nurses used to quiet down babies for hearing tests by giving them formula. Now, she points to a big sign at eye level.

SAIDEL: It says, ‘Bottles should only be given for a documented medical reason.’ So now they don’t use formula on breastfeeding babies anymore in here.

MITCHELL: Saidel says Mount Sinai puts almost every staffer who comes into contact with new mothers or infants through breastfeeding training...

SAIDEL: ...from registered nurse to secretary. This is a process of people acquiring skills that were not taught in nursing school and medical school.

MITCHELL: For the Baby Friendly designation, some Sinai staffers will need more training. The sessions won’t cost the hospital much money but will eat up staff time. That could explain why no Chicago hospital has applied for the designation. But a lot of breastfeeding experts say the hospitals should give it a try.

ABRAMSON: Breastfeeding is one those priority areas that are life-and-death for their patients.

MITCHELL: Rachel Abramson is a former post-partum nurse who heads a Chicago nonprofit group called HealthConnect One.

ABRAMSON: Those of us who grew up thinking that formula feeding is the norm and perfectly adequate have a hard time shifting our vision to see the risks of illness in the first year of life, juvenile diabetes, of breast cancer for mother, of obesity and diabetes — lifelong — for mothers and babies.

MITCHELL: Abramson says the costs for treating these diseases often ends up on the shoulders of taxpayers. If that’s the case, you might think the government and hospital oversight groups would push hard for better breastfeeding rates. But they don’t push. They mostly nudge.

MITCHELL: One group with some accountability is the Oakbrook Terrace-based Joint Commission. It accredits hospitals. Ann Watt helps direct the commission’s quality-evaluation division. Watt says about a year ago the commission published some standards for hospitals to measure whether newborns were breastfeeding.

WATT: Our medical experts have indicated to us that this is a best practice.

MITCHELL: But these commission standards are voluntary. In fact, just three Illinois hospitals have adopted them.

MITCHELL (on phone): Could a hospital be performing poorly by these measures and still get accreditation?

WATT: Yes.

MITCHELL: Another group with some say is the Illinois Hospital Association. I asked the group whether it would support more public oversight of hospital breastfeeding practices. A spokesman declined to answer on tape but sent a statement saying the rules should not be rigid. The statement says breastfeeding management should begin with prenatal care, not the mother’s hospital stay. The hospital association also points out that the decision to breastfeed is personal.

MITCHELL: The folks with the most to say about hospitals breastfeeding rates are at the Illinois Department of Public Health. The department is in charge of enforcing the state’s hospital-licensing code. The code requires hospitals to follow basic breastfeeding guidelines that two physician groups published in 2007. In a statement to WBEZ, the Illinois Department of Public Health says it investigates breastfeeding infection-control issues. Otherwise, though, the department says it does not enforce the guidelines. That leaves public policy on breastfeeding largely up to individual hospitals — places like Stroger, Mount Sinai and Holy Cross.

Correction: An earlier version of this story misstated the status of Mount Sinai Hospital’s Baby Friendly effort. Chicago officials announced in August 2010 that Mount Sinai was seeking the international designation. The hospital registered to begin that four-phase process in September 2011.

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Comments

Rachel Abramson wrote:

Thank you for this strong push to improve hospital practices to support breastfeeding - and for highlighting Mt. Sinai's efforts towards Baby-Friendly designation.

My name is Rachel Abramson -- I was lucky enough to be part of this story. As the Executive Director of HealthConnect One (www.healthconnectone.org), I believe that every new family deserves accurate breastfeeding information and support. And while it is not ideal for a new mom to begin the decision-making process about breastfeeding when she's already in the hospital, we know from nearly twenty-five years of experience that these one-on-one connections in the hospital make a difference - both for moms who have not yet made a decision, and for those who decided to breastfeed but face barriers as they begin. We applaud all efforts to increase support and information, and reduce the distribution of formula, in the hospitals.

I also agree that breastfeeding rates will not be improved by focusing solely on the hospitals. HealthConnect One, with the Illinois Department of Human Services and the UIC School of Public Health, released a 5 year plan last Monday that provides specific recommendations -- not only for hospitals and health professionals -- but for workplaces, community organizations, insurers and state and local government. The Illinois Breastfeeding Blueprint: A Plan for Change (www.ilbreastfeedingblueprint.org) is holding the first post-kickoff meetings of the Implementation Working Group on May 25 & 26 -- and all are welcome to join! For more information, please contact Beth Pellettieri at bpellettieri@healthconnectone.org.

Fri May 6 2011, 3:14 PM

Sarah Simmons, CNM wrote:

Thanks for airing this report. Cultural, social and educational barriers to breastfeeding are enormous, so it is particularly frustrating when women who have decided to breastfeed are undermined by hospital practices. Much of the problem stems from the corporatization of healthcare, from staffing issues which prevent busy floor nurses from providing sufficient support for breastfeeding, to formula companies which foist their "free" samples on new parents, both in the mail and during their hospital stay. The argument that formula feeding is a "personal decision" makes as much sense as saying that parents giving their children a steady diet of chips, candy and soda is a "personal decision." It may be their legal right but it is not good public health policy!
Congratulations to Mt. Sinai for leading the way in this!

Fri May 6 2011, 1:54 PM

Ann Twiggs wrote:

Ohio WIC did a study in 2005 and we found that 50% of moms who went into the hospital PLANNING to breastfeed exclusively ended up NOT exclusively breastfeeding. USDA funds(with tax payer $) a lot of prenatal breastfeeding education for moms and WIC staff breastfeeding education. We work very hard to educate mothers on what they need to be successful. Many of those things are not supported in the hospital setting. Blaming our mother's lactation failure on "personal choice" is not fair when the hospital does not support her with best practice for breastfeeding success. It is also very disappinting for moms who are excited about BF and leave the hospital feeling that they have failed.

It is very frustrating! (Hi Rachel!)

Fri May 6 2011, 12:51 PM

Laura Monahan wrote:

Kudos to Mount Sinai Hospital for seeking Baby Friendly status! Crystal White, the Unit Director of Labor and Delivery and the Mother/Baby Units, is effectively not only not pushing baby formula onto new mothers, but is also restricting formula coupons, brochures, and any other type of formula advertising. This is a fabulous initiative, and shows great clarity of vision and single minded commitment to the importance of promoting breastfeeding. To start mothers and babies with what is best for both, which is breastfeeding, that is really moving in the right direction!

Fri May 6 2011, 12:39 PM

Jamie Thompson wrote:

Hello!

I was OVERJOYED when I heard you talking about breastfeeding issues on air!! It is a very serious problem that needs much more attention. I am a dietitian at WIC and hospital supplementation is by far the number one, if not the ONLY reason why our mother's who go into delivery wishing to breastfeed, end up needing some or only formula. It is unbelievably frustrating to me, and I am baffled at how hospitals are getting away with this. As you noted on the program, it is clearly the best (only) food for baby, best for mom, and for society as a whole. So why are hospitals not following best practices? Why are they not encouraging the healthiest way of feeding? A big reason is the way in which hospitals operate in general, not enough time or training for nurses, etc. However, a big part of the problem is formula companies giving money and incentives to hospitals. They know that if baby gets even just ONE bottle of formula within the first week to 1 month of life, breastfeeding is severely compromised. And they are hooked. They want to get in there and get nurses to push it. It is really so sad to me. Not only is breastmilk the optimal food, but the bonding and security of breastfeeding is priceless. And so many mothers are unnecessarily 'jipped' of this most wonderful experience.
Thank you sooooo very much for bringing this to the attention of the public. I hope someday soon hospitals will be held accountable.

Thanks!
Jamie

Fri May 6 2011, 9:48 AM

SKEdman wrote:

"The hospital association also points out that the decision to breastfeed is personal."

Of course it is. The practice of breastfeeding is not. Eating is a communal act, no less so with babies. For this to happen successfully, these women need support-- that means active encouragement, good information, and a network of healthcare professionals whose practice matches up to what we are preaching regarding the risks of formula use.

The decision to breastfeed may be personal, but it doesn't happen in a vacuum. A thousand times a day women get the message that formula is just as good. It is not-- it is a distant third behind mother's milk and donor breastmilk, and that's the message organizations like WHO and the US Department of Health and women like Michelle Obama are trying to get across-- but when that message is implicitly contradicted by nurses who recommend bottles, by hospitals who send home formula, and by pediatricians who tell struggling moms to supplement instead of referring them to lactation support, who are these vulnerable moms going to believe?

It's such a tragedy, and a public health disaster, and it's going to take a huge wave of public education and awareness to turn the tide. Thanks for an excellent piece of reporting.

Fri May 6 2011, 7:50 AM

Megan Renner, United States Breastfeeding Committee wrote:

Although Chicago is home to The Joint Commission, our state's hospital performance ranks # 35 (effectively scoring a D) on CDC's survey of Maternity Practices in Infant Nutrition and Care:
http://www.cdc.gov/breastfeeding/pdf/mPINC/states/Illinois.pdf

"The Surgeon General's Call to Action to Support Breastfeeding" and Mrs. Obama's Let's Move! campaign are putting a major emphasis on accelerating the Baby-Friendly hospital program, but we need more coverage like this around the country to put the pressure on hospitals and inform consumers!

The IL Breastfeeding Task Force has created comment letters that moms can send to their hospitals to express whether they were pleased or dissatisfied with the breastfeeding support, education and care received: http://www.illinoisbreastfeeding.org/21401/21422.html

View the list of Baby-Friendly hospitals: http://www.babyfriendlyusa.org/eng/03.html

Learn more about the Call to Action: http://www.surgeongeneral.gov/topics/breastfeeding

Megan Renner
Executive Director
United States Breastfeeding Committee (USBC)
www.usbreastfeeding.org

Fri May 6 2011, 7:10 AM

Megan Renner, United States Breastfeeding Committee wrote:

View the list of Baby-Friendly hospitals: http://www.babyfriendlyusa.org/eng/03.html

Learn more about the Call to Action: http://www.surgeongeneral.gov/topics/breastfeeding

Megan Renner
Executive Director
United States Breastfeeding Committee (USBC)
www.usbreastfeeding.org

Fri May 6 2011, 6:52 AM

Rachel Crowl wrote:

I am an avid public radio listener and supporter - and have been for a decades. I was shocked to hear this breastfeeding report today as it did not meet the standards normally maintained by WBEZ and NPR. I am an educated woman with 2 children of my own that I breast fed by choice and with great commitment as well as great difficulty. This report concentrated solely on lactation services within hospitals as the impetus for making the choice to breast feed without the major factors being discussed: money and education. The decision to breast feed one's child is probably made prior to going to the hospital. And the lack of lactation consultants on staff for an overnight shift, or not at all, may have some impact on women's decision to breast feed, but I would doubt it would impact a large percentage of women. Providing prenatal care and education would most likely have the best and most lasting impact by empowering women making these choices with information regarding the benefits to both themselves and their baby. Additionally, it was not discussed how women who need to return to work factor breastfeeding into their lives. Breast pumps are expensive and i am certain that there is a large population of women who are unable to afford this wonderful convenience. I am also certain that there are countless jobs that are not flexible or structured to allow for women who need to take a break to use their breast pump. How does a working woman feed their child a strict diet of breast milk for the first 6 months? There are so many factors and impacts on breast production as just as many complications that can occur with inadequate milk supply, mastitis or a colic-y reaction to foods the mother consumes.

I say all this as working woman who was fortunate enough to breast feed both of my children for more than 6 months each, but it was a challenge. I believe this report short changed the root of the issue and cast an unfair light (dare I say accusatory) on some of the hospitals without lacation consultants.

Mr. Mitchell, i would gamble, does not have children and has not experienced the challenge of breast feeding children. Where was the discussion regarding health education in high school, affordable prenatal care, or affordable classes/support for new parents? Where was the editing on this report? Did this really pass the threshold of a well supported argument? I dont think so.

Thu May 5 2011, 9:26 PM

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