Transcript for CDC Telebriefing: Breastfeeding Support Improves in Many U.S. Hospitals

OPERATOR: To ask a question please press star 1. Today's conference is being recorded. I would like to turn the meeting over to Kathy Harben. You may begin.

KATHY HARBEN: Thank you, Brandon and thank you all for joining us for the release of the new CDC vital signs. This one on hospital practices to support breastfeeding. We are joined by the director for the Centers for Disease Control and Prevention, Dr. Tom Frieden and Dr. Cria Perrine. That's Cria Perrine, P-e-r-r-i-n-e, of CDC's Division of Nutrition, Physical Activity and Obesity, and lead author of this MMWR. At the end of their remarks, you will be able to ask questions. Dr. Frieden.

TOM FRIEDEN: Good afternoon, and thanks to all of you for joining us today. CDC works 24/7 to keep Americans safe, healthy and secure, and in every Vital Signs we focus on a health issue on the front lines of CDC science to tell you what can be done to protect and save more lives. Here's the bottom line from this month's report on breastfeeding. Hospitals can give mothers and their newborns the best chance for the best nutrition, and we have seen significant progress in recent years. But there's still much more to be done. Of the 4 million babies born in the U.S. each year, only 14 percent are born in hospitals designated as baby friendly. However, if we look at the number of hospitals that are adopting some aspects of baby friendly hospitals, and there are ten steps to that, this is the global and national standard for hospital care, the proportion implementing most of those steps doubled, from 29 percent in 2007 to almost 54 percent in 2013. That's a nearly two-fold increase in six years. Breastfeeding is important. It's good for the infant's health, and it's good for the mother's health. The facts are these. That breastfed infants have lower risk of infections, ear and respiratory infections, intestinal infections, and others. They also have a lower risk of asthma and sudden infant death syndrome and appear to have a somewhat lower risk of obesity. Mothers also benefit. Mothers who breastfeed are less likely to get breast cancer, ovarian cancer, diabetes and heart disease. And breastfeeding saves money. It is estimated that more than $2 billion a year in annual medical costs for children could be saved if breastfeeding recommendations were met. This Vital Signs examined data from CDC's National Survey of Maternity Practices and Infant Nutrition Care or MPINC. The survey is done every other year to see how hospitals are doing and we're grateful that hospitals participate in this survey. We found that more than 9 out of 10 hospitals used at least 2 of the 10 steps, offering mothers-to-be education and teaching mothers breastfeeding techniques. Another of the ten steps, specifically starting with breastfeeding within one hour of birth, which is very important, grew substantially from 44 percent in 2007 to 65 percent in 2013. We also found that some steps aren't improving as much as others. In that same six-year time period, the percent of hospitals that made sure that only breast milk was given to healthy infants whose mothers want to breastfeed went from only 20 percent to only 26 percent. And hospitals that gave adequate support for breastfeeding mothers after they left the hospital, understanding that the hospital has to really support women before, during and after that hospitalization, also increased only slightly from 27 percent to 32 percent. Every one of the ten steps is important to use in a hospital to give babies the best start to help mothers start and continue to breastfeed as recommended. So today I'd really like to ask hospitals to keep making progress. For hospitals that want to start using the ten steps or use more of them, make a plan for what you can do right now what's in line with the ten steps and phase that in over time. Ideally, we would like every birth hospital in this country to adopt all of the ten steps and become baby friendly. I'll now turn this over to Cria Perrine to talk about the progress being made.

CRIA PERRINE: Thank you, Dr. Frieden. I would just like to give an example of some of the progress that's being made around the country to give an example that this is possible. This is something hospitals can achieve. So as an example, here in Georgia, one year ago there were no baby friendly hospitals. And as of today, there are four baby friendly hospitals in the state of Georgia which accounts for 10 percent of all births. As far as improvements on implementing the ten steps, the percent of hospital using the majority of the steps rose from 9 percent in 2007 to 39 percent in 2013. So as a mom who gave birth to a baby a year and a half ago in the state of Georgia, this is very exciting to me. Additionally, CDC funded the Best-fed Beginnings Program in partnership with the national institute for children's health quality so with this effort, we worked with 89 hospitals in 29 different states to work towards baby friendly designation.  As of August, 50 of these hospitals had achieved baby friendly designation and the other 39 were in the final phase. And this effort specifically targeted hospitals with a large number of births that were serving populations that were predominantly African-American and low income. As a result of this effort, an additional 155,000 babies per year are now born in hospitals offering ideal breastfeeding support. Another wonderful example of this effort is the Indian Health Service. So they began their baby friendly journey in 2011, and as of now all 13 Indian Health Service hospitals are designated baby friendly. So, what is contributing to this success? We think it is likely several things. One being just increased attention on this effort, recognizing the importance of hospitals in helping support moms to be able to breastfeed. Another thing is CDC's MPINC survey, this is both a survey that we use as a surveillance tool but it is also an intervention. So every single hospital that participates receives a report back of their own practices and how they compare to other hospitals nationally in the same state and among hospitals of a similar size. And it's really been a tool that hospitals have been able to take to their leadership and to use as an example of where they may need to make some improvements. There have also been funded efforts by CDC: Best-fed Beginnings, which I've mentioned and we are funding 33 state health departments to work on improvements in maternity care practices. So we have come a long way but there's a lot more room to go but I think it's certainly something that's achievable. And in an area we would like to continue to work. Thank you. Dr. Frieden?

TOM FRIEDEN: Thanks very much. Just to continue on what hospitals and others can do, every hospital that supports the delivery of babies can participate in CDC's MPINC survey and get an individualized report of how they compare to other hospitals. Hospitals can work with doctors, lactation consultants and organizations to create networks that support breastfeeding mothers and their infants. At CDC we are also helping state health departments to do their work to improve maternity care. State and local governments can adopt standards for hospitals to support breastfeeding. They can help hospitals use the ten steps and help hospitals connect mothers to community support once they leave the hospitals. Doctors and other health care providers can help write hospital policies that encourage mothers to breastfeed,  they can counsel mothers on breastfeeding during prenatal visits and include lactation care providers on patient care teams. They can support breastfeeding at hospitals and well-baby visits. And finally, moms and families can speak with doctors and nurses about the breastfeeding plans and how to get help and ask about baby friendly designation when choosing a hospital and encourage their own local hospital if they're not already to become baby friendly. We're also very encouraged that starting next year the joint commission will be looking at exclusive breastfeeding during and at discharge unless medically contra-indicated as a key indicator for hospitals and all of this I think, is leading to a real acceleration of the adoption of baby friendly practices in hospitals throughout the U.S. and that's a good thing. That means that babies are healthier, our children are healthier, mothers are healthier. I remember some of the best clinicians that I have worked with over the years being incredibly effective advocates for breastfeeding. For example, one pediatrician I know would say to a mother who brought in a child who was healthy, as they did the examination, they would point out each of the findings on physical examination and say, it's because you're breastfeeding he's so healthy. Or if the child was sick they'd say just think how much sicker the child would be if you hadn't been breastfeeding. I think doctors can make a really big difference in encouraging and supporting women who choose to breastfeed to breastfeed, and that hospitals can play a critical role in those first few days of life which really do form the basis of the pattern of breastfeeding, and encourage and help women who want to breastfeed to be able to do so throughout the entire, at least six months, that's recommended. Thank you very much.

KATHY: Thank you, Dr. Frieden and Dr. Perrine. We are now ready to take questions.

OPERATOR: At this time, if you would like to ask a question, please press star 1. You will be prompted to record your name. To withdraw your question, press star 2. Once again, at this time if you would like to ask a question, please press star 1. One moment please for our first question. First question is from mike with the associated press. Your line is open.

MIKE STOBBE: Hi. Thank you for taking the question. I just wanted to make sure I caught the number. I think Dr. Perrine said the number of babies born each year to hospitals that are baby friendly, I guess are doing all ten steps, could you repeat that number?  

TOM FRIEDEN: So currently it is at 14 percent of the hospitals babies born in the U.S. are born to hospitals which are baby friendly. That's a big increase from the past and the number of babies who are born in those hospitals currently is --

CRIA PERRINE: For the numbers gave were specific to Georgia. Is that what you were asking about?

MIKE STOBBE: Oh. I'm sorry. I thought you had a national number. I misunderstood. Do you have a national number?

CRIA PERRINE:  The percent of babies born in baby friendly hospitals is 14 percent.

MIKE STOBBE: 14 percent of 4 million?

CRIA PERRINE:  Yes.

CRIA PERRINE:  Okay. And the second question was, so what -- what's the primary obstacle that you've encountered in getting more hospitals to do all the steps? Is it doctors? Hospital administrators? What's the stumbling block?

CRIA PERRINE:  I think every hospital has a slightly different, sort of depending where they're starting from. Sometimes it is convincing leadership. Sometimes, other hospital leadership are really on board and it's just actually going through the process of implementation. Step two is about training all health care staff, and that can sometimes, not necessarily be a huge obstacle, but just a time consuming endeavor and takes a listening time to get everybody trained and up to speed. Sometimes there are existing staff there, you know, head, labor and delivery nurse there for 30 years and this is how I've always done things and why should I change? It could be convincing specific people why the practices are important and the benefits of moms of implementing them. I think as Dr. Frieden pointed out, the two where we've seen the least amount of progress is limiting the use of non-breast milk feeds to breastfed infants and a providing that optimal discharge support of connecting moms to resources after the hospital stay.

MIKE STOBBE: Okay. Thank you.

OPERATOR: Our next question is from Dan Childs with ABC News.

DAN CHILDS Yes. Thank you so much for taking my question. The first question that I had was, in addition to the joint commission recommendations, what else is going to be done to enforce, I guess better breastfeeding practices at hospitals?

TOM FRIEDEN: Really, this is an effort that involves the hospital leadership, the local government, the state government, the joint commission, of course, but also, community groups and mothers and having perspective mothers ask hospitals if they're baby friendly, identify those that are, express a preference for that will be really important. As Dr. Perrine indicated it is not simple to go through the ten steps. I have helped hospitals to do it in my former roles. It can take several years and very intense effort. These are all evidence-based steps but they all take real changes in practice, training of staff, and policy change in terms of formula feeds. And that can take time. Dr. Perrine, anything you would like to add to that?

CRIA PERRINE:   I think that was good. Thank you.

DAN CHILDS: Thank you so much. I had just one follow-up question from a colleague of mine who's also listening in on this.

LILY: Hi. I'm Lily. I had a quick question regarding the non-breast milk, the formula provided by the hospitals, that is big challenge and I think I have also seen that, and do you have any recommendations or any implementation specifically for that targeted goal for hospitals or what challenges have you seen be overcome for that particular goal?

CRIA PERRINE So you're referring particularly to sort of a steps six and how to operationalize that?

LILY: Yeah.

CRIA PERRINE: It's a good question. I think different hospitals are doing it differently and it needs to figure out what works with the hospital. I think just some of these steps hang together.  So, for example, rooming in, if a baby is with a mom 24 hours a day and the mom wants to breastfeed it removes the opportunity for the baby's in the nursery at night. Let's just give them a bottle so we don't wake mom and really helping with the feeding on demand. They all go together for making sure that the baby gets everything that they want. But it's  this is all based on when there's no medical necessity. So we're talking about healthy, breastfed babies. Mom wants to breastfeed. Baby doesn't need formula for any reason and making sure that's all the baby gets.

TOM FRIEDEN: It may not be widely understood by all of the care team in hospitals that even a little bit of formula may undermine the strong start to breastfeeding of the mother/child bond. And so, that's one thing that needs to be more widely understood so that this can be done. Also, there may be in situations where there isn't a medical necessity, there may be excessive and sometimes unrealistic concern on the part of some hospital staff, oh, what if the child becomes dehydrated? And just sometimes we medicalize things when we should just allow a more holistic approach to care of the mother and infant. Of course, if there is a health risk or a medical condition, that needs to be dealt with. But outside of that context, we sometimes see an overzealousness in providing feeds when maybe the baby just needs a couple hours more sleep or some other intervention to allow time to take its course.

LILY: Thank you.

TOM FRIEDEN Next question please.

OPERATOR Our next question is from Michael with NPR. Your line is open.

MICHAEL: I'm wondering if you could speak a little bit about why the practices especially early on are so important. You mentioned it sets up a pattern. Maybe you can talk a little bit about that critical window of time period for breastfeeding success.

CRIA PERRINE:  Breastfeeding is a very physiological -- a mother needs to start right away to establish her milk supply, and it's initially very much a supply and demand issue, so these practices that interfere with that demand aspect then as a result, end up interfering with the supply. So, a mother needs every opportunity to express her milk in the beginning to begin to establish a milk supply.

OPERATOR: Our next question is from Dennis Thompson with Health Day. Your line is open.

TOM FRIEDEN: Yes. Before the question, there's also an importance in the first few days in that initial breastfeeding because it's very rich in antibodies, colostrum that's very protective of the infant. So it both sets up a good pattern, and provides good protection for the infant.

DENNIS THOMPSON Thanks for taking my question. This gets at the same issue a little bit from a different angle. In your background information, you note that 60 percent of mothers who stopped breastfeeding in the first year reported they stopped earlier than desired. Could go into a little bit about why they abandoned breastfeeding earlier than they would have liked, what some of the problems that the mothers face that, you know, this extra support might help them overcome?

CRIA PERRINE: Sure. That statistic is from an analysis of our infant feeding practices study, too. So it interviewed moms throughout the year after their baby was born and when they stopped breastfeeding asked them whether they breast fed as long as they wants and 60 percent said no. So -it asked why they stopped. The majority of reasons given is really related to early problems with breastfeeding, things like pain, problem with the baby latching on appropriately, problems with enough milk so either the baby losing weight or perceiving they didn't have a sufficient milk supply and can be overcome with early professional support and management which is why that early period in the hospital and then immediately after the hospital is so critical.

DENNIS THOMPSON: Thank you.

TOM FRIEDEN: Next question.

OPERATOR: Our next question is from Kyle Maza with UNF News. Your line is open.

KYLE MAZA: Thank you very much for taking my question. Dr. Frieden, I want to ask you three questions. Why is important about breastfeeding to mothers who may be giving birth to a child important? Then, what are the ten steps vital for hospitals to adopt in the procedures? And also, my colleague Henry Pratt would want to ask you how would health insurance and the government play a role in this, as well?

TOM FRIEDEN: It's clear that breastfeeding is the best nutrition for mothers and infants who can have breastfeeding as a source of nutrition. We know that exclusive breastfeeding for six months is important to child health. And that a good start to that is crucially important. The hospitals can be critical to determining, in fact, whether a woman who wants to breastfeed is successful at initiating and continuing breastfeeding. That's why these ten steps cover every aspect of breastfeeding in the hospital, from the clear plan, to the education of the woman, to support after discharge. All of those are important for support of the woman and the infant. In terms of insurance coverage, I know Dr. Perrine can speak about this more but there have been important changes in improvements in the way that some federal programs have addressed breastfeeding, including in the WIC program which is now very supportive of breastfeeding and a big part of the solution and something that I think is having a big impact on improving childhood nutrition overall. Dr. Perrine?

CRIA PERRINE: We recently learned that Blue Cross Blue Shield of Mississippi is really supporting this effort and is actually hosting training sessions for Mississippi hospitals about the ten steps, and implementing them so they have really recognized it as an important quality improvement effort. The Kaiser Hospital has helped a lot of their hospitals work towards baby-friendly or sort of improving their maternity care practices.

KYLE MAZA:  As a follow-up, how would you say the coordination's going between all these different insurance providers and the community at large?

TOM FRIEDEN: I think what we're seeing is a significant improvement in hospital practices promoting breastfeeding, and that's encouraging. Frankly, I think we are seeing more progress than many of us had thought there would be. To see the number of hospitals adopting most of the steps nearly double in a six-year period is very encouraging. Health care practices often don't change that rapidly. So that's encouraging. But we do have much more progress to make. And I would just like to conclude this by first thanking all of you for joining us and repeating the bottom line here which is that breastfeeding offers the best chance for the best nutrition. Hospitals are going to be a big part of the solution here in increasing the breastfeeding rate in the U.S. We have seen really great progress in recent years, but still lots of hard work that needs to happen. And that will happen by cooperation and collaboration among patients, families, communities, hospitals, health care providers and insurers, state, local and federal governments and we're encouraged by the direction that this is going in and thank you all for your coverage.

KATHY HARBEN: Thank you. That concludes this tele-briefing. We will post a transcript later this afternoon at the CDC newsroom site: cdc.gov/media. If you have follow-up questions you can call us at 404-639-3286. Thank you.

OPERATOR: Thank you for participating in today's conference. All lines may disconnect at this time. 

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES