he American Association of Pediatrics, as well as the American Association of Family Physicians, has long identified that breastfeeding is the cornerstone to infant health, nutrition and development.
The nutrient-rich breast milk mothers make during pregnancy and just after birth - called colostrum, but nicknamed "liquid gold" - helps to protect their baby from illnesses. As an infant matures, so does colostrum, offering the perfect amount of fat, sugar, water and protein.1
The Surgeon General recognized the importance of this natural aspect of motherhood, and issued a Call to Action in 2011 to support breastfeeding. In it, Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, notes, "every mother in our nation deserves information, guidance and support with this decision from her family and friends, the community where she lives, the health professionals on whom she relies, and her employer."2
The Texas Department of State Health Services also acknowledged the significance of breastfeeding, and in collaboration with the Texas Hospital Association, developed the Texas Ten Step (TTS) Program in 1999. Designed to encourage mothers in breastfeeding before, during and after delivery, the TTS designation is presented to hospitals and birthing centers that provide an optimal level of care for infant feeding.
"Assisting with the initiation of breastfeeding in the hospital gives new moms and babies a foundation for healthy and successful breastfeeding outcomes," said Kristen Hood, RN, IBCLC, CBE, registered nurse and lactation consultant at CHRISTUS Santa Rosa Hospital-Westover Hills, a TTS facility in San Antonio. "Successful and quality-focused breastfeeding initiatives, such as Texas Ten Step, helps hospitals improve patient safety, cost effectiveness, timeliness, equity and patient-centered care."
Earning the Distinction
To earn the distinction as a Texas Ten Step Facility, CHRISTUS Santa Rosa Hospital-Westover Hills needed to put in place several policies and programs.
In spring of 2012, CHRISTUS Santa Rosa Hospital-Westover Hills hired Hood as a lactation consultant to serve the inpatient population in need of lactation and/or breastfeeding assistance, as well as consult with post-partum breastfeeding couplets in the hospital's community by referral from physicians. Until this time, there was not a designated lactation consultant for the hospital to serve in this capacity.
That summer, Hood reviewed, edited and facilitated the passing of the breastfeeding policy for the full-term, normal newborn throughout the CHRISTUS Santa Rosa Health System Hospital Women's Services Units. In August, she coordinated a two-day education program with the Texas Department of State Health Services to educate and train the entire nursing staff of CHRISTUS Santa Rosa Hospital-Westover Hills Women's Services Unit on "Principles of Lactation Management and Breastfeeding Management," as well as "Breastfeeding the Complicated Infant."
"Every new hire to our team shadows one day with me to learn hands-on lactation assistance techniques. Every patient that arrives to deliver her baby is educated on the benefits of breastfeeding, regardless of stated feeding preference," she noted.
Within the first hour of birth, patients with normal, uncomplicated deliveries are assisted with the first breastfeeding session, and are encouraged and educated on cue-based feedings, rather than scheduled feedings.
Patients with infants requiring a higher level of care via transport to the level IV neonatal ICU are educated on the benefits of breastfeeding and are assisted with beginning to pump breast milk within the first six hours after delivery/birth.
Hood noted the program entails a great deal of education and team work.
"I truly believe all of the nurses that work in CHRISTUS Santa Rosa Hospital-Westover Hills Women's Services Unit want to help our moms achieve their infant breastfeeding goals - specifically by assisting and educating new moms and dads on the benefits and principles of successful breastfeeding," she said.
Since the creation of an official lactation program with policies and staff, the nursing team has accepted and embraced a more breastfeeding-friendly environment. Just how does the program encourage breastfeeding as the preferred method of feeding for newborns and infants? More nurses are using "skin-to-skin" as a preferred method for facilitating infant comfort, temperature regulation, and bonding between the mom and baby.
"There are more infants being placed skin-to-skin directly after uncomplicated deliveries and being transitioned on mom's abdomen when desired. Our team has even encouraged dads to do skin-to-skin for bonding when the mom is unavailable," Hood said.
Skin-to-skin contact is also used to encourage breastfeeding in Medical Center Arlington, South Arlington, TX, another TTS-designated facility.
"In labor and delivery, all newborns are placed skin-to-skin within the first hour unless medically contraindicated," said Dawn DeVoe, BSN, RN, IBCLC.
In addition, all Women's Center staff at Medical Center Arlington is trained to assist mothers with providing breast milk for their infants. A breastfeeding task force meets monthly, and the lactation department has doubled in size to allow lactation services on all shifts.
After the baby is born, Medical Center Arlington offers ongoing breastfeeding support.
"On Mondays, new moms and babies are invited to attend our postpartum breastfeeding support class and we are available 6 days a week by phone. We collect and report breastfeeding statistics to all staff, including physicians. We are committed to supporting new mothers with their breastfeeding goals," DeVoe stated.
'All About the Baby'
A cost analysis prepared in 2009 for the Texas Department of State Health Services found that implementing the Ten Steps to Successful Breastfeeding is a cost-neutral way to raise the quality of a facility's maternity services.
For hospitals and birthing centers interested in improving their breastfeeding outcomes through this designation, the TTS program suggests forming a task force that consists of lactation specialists, nurse managers, nursing staff, physicians, hospital administration and others. Offered on their website, the Texas Ten Step Scorecard Evaluation Tool can be used to assess a facility's readiness. Facilities that score an 85 or higher are awarded the designation.
Hospitals have an opportunity to improve outcomes for babies and mothers by supporting breast milk as the preferred method in infant nutrition, DeVoe said.
"After delivery, it is all about the baby," she said.
New mothers look to their healthcare providers as their role models of good health, and specifically look to nurses and physicians for guidance and education.
"It is our job as healthcare professionals to inform all mothers of the benefits of breast milk for their newborns," DeVoe concluded. "The first few days after delivery can be very challenging for a new mother-as nurses we must support and empower her early on so that she will have the confidence she needs to reach her breastfeeding goals."
References for this article can be accessed at www.advanceweb.com/Nurses. Click on Resources, then References.
Beth Puliti is a frequent contributor to ADVANCE.
Texas 10 Step Program Facilities