Maryland releases breast-feeding recommendations for hospitals

Maryland health officials want the state's hospitals to play a larger role in encouraging mothers to breast-feed in the crucial hours after they give birth, as growing evidence points to the health benefits of feeding babies human milk.

The Maryland Department of Health and Mental Hygiene is looking to increase the number of women in the state who breast-feed with new recommendations they hope every hospital in the state will eventually adopt. No hospitals in the state currently practice all of the recommendations, which include not offering pacifiers and allowing mother and child to stay together 24 hours a day.

The health department will also encourage hospitals to stop giving out free formula from manufacturers, a controversial practice that some say tempts moms to give up on breast-feeding when they are at home by themselves and get frustrated.

The new recommendations, issued Tuesday, are the first the state has ever issued for breast-feeding. They come as medical groups and government health agencies, including the U.S. surgeon general, have placed more focus on breast-feeding.

While studies have found that breast-fed babies have lower incidents of ear infections, allergies and other health problems, many mothers find the practice more difficult than they anticipated. Nurses and lactation specialists can help ease the process while mothers are still in the hospital and provide support groups after they return home, state health officials hope.

"There is nothing like having a supportive environment with a coach and a cheerleader that can help get you through the process," said Frances B. Phillips, deputy secretary at the health department.

The state is asking hospitals to beef up breast-feeding practices by attaining "baby-friendly" status through the World Health Organization and United Nations Children's Fund, or by adopting 10 state recommendations that the health department unveiled Tuesday.

The state recommendations are voluntary and hospitals won't be penalized if they don't adopt the policies. The health department will post hospitals' breast-feeding practices on the agency's website in a form of peer and public review.

The state recommendations call for hospitals to create a written breast-feeding policy. They also encourage hospitals not to give babies food or drink other than breast milk. Newborns may have trouble switching back and fourth.

The guidelines also recommend initiating breast-feeding within one hour of birth and showing moms how to breast-feed and maintain lactation even if they are separated from their babies for medical reasons.

Maryland hospitals embraced the recommendations and many said they already carry out many of the practices.

"Maryland hospitals will continue their efforts to support breast-feeding," said Amber Bradford, a spokeswoman for the Maryland Hospital Association.

Phillips said the state wants to promote breast-feeding without demonizing mothers who choose to bottle-feed instead.

"These recommendations will give moms an environment to make a choice," Phillips said. "Some moms will choose not to breast-feed, and that will be supported."

About 72.6 percent of mothers in Maryland initiate breast-feeding, but that number dwindles as babies get older. About 48.5 percent of babies are still breast-feeding at six months and 22 percent at a year, according to the Centers for Disease Control and Prevention.

Mothers give up on breast-feeding for a number of reasons. Babies don't always latch correctly and some mothers don't always produce enough milk. Many mothers get overwhelmed with breast-feeding, especially after they return to work and have to pump milk that is fed through bottles when they are away from their baby. Many moms may decide to supplement with formula, which health organizations say is not ideal.

Philips said her own daughter-in-law had trouble breast-feeding initially, but with the help of telephone consultations with lactation specialists was eventually able to adapt.

"Everything has worked out for the better," Phillips said.

Among new mothers like Andrea Proffitt, the question of whether to breast-feed can be a touchy one. Proffitt, who gave birth to son William on Monday at Mercy Medical Center, said she avoids asking anyone but her closest friends whether they breast-feed to avoid seeming judgmental.

But Proffitt, 35, said she made the decision to breast-feed even before she was pregnant because of the health benefits it would give her baby. That was despite challenges she recognized — having to pump breast milk once she goes back to work as a paralegal in three months, for example, and even learning how her son should properly latch to her breast in the first place.

"There is definitely a learning curve. That's what I'm experiencing now for sure," Proffitt said. "I think it's worth it."

At some hospitals, many of the recommendations the state released are already in place, said Dr. Robert Atlas, chief of obstetrics at Mercy Medical Center. Mercy stopped giving new mothers free samples of formula and coupons for more several years ago, for example. Nevertheless, he welcomed the new policies.

"By the state health department putting this forward, it helps solidify to patients the importance of breast-feeding," Atlas said.

The University of Maryland Medical Center said in a statement that it actively promotes breast-feeding and also has many of the state recommendations already in place. The hospital has a breast-feeding council that looks for ways to promote breast-feeding to new mothers. It offers a pump in the NICU, cooling bags for mothers to transport milk and a phone line for real-time support once moms are discharged.

State health officials made the announcement about the new recommendations at Shady Grove Adventist Hospital in Rockville, which has agreed to adopted the 10 state standards. Phillips said at least five others have also agreed to adopt every recommendation.

They were joined by the Maryland Chapter of the American Academy of Pediatrics and the Maryland Breast-feeding Coalition, both which applauded the plan.

"I know this will have an impact — a real and lasting change — on Maryland's youngest residents," said Dr. Dana Silver, co-chair of the breast-feeding committee of Maryland AAP.



State breast-feeding recommendations

•Maintain a written breast-feeding policy that is routinely communicated to all health care staff.

•Train all health care staff in skills necessary to implement this policy.

•Inform all pregnant women about the benefits and management of breast-feeding.

•Help mothers initiate breast-feeding within one hour of birth.

•Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infants.

•Give newborns no food or drink other than breast milk, unless medically indicated.

•Practice "rooming-in" — allow mothers and infants to remain together 24 hours a day.

•Encourage unrestricted breast-feeding.

•Give no pacifiers or artificial nipples to breast-feeding infants.

•Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

Source: Maryland Department of Health and Mental Hygiene

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