Hospital regulators let baby formula vie with breast milk
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?
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?
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.