Wednesday, August 4, 2010

A Provider’s Perspective on Baby Friendly Breastfeeding Care in Lane County

Welcome to Lane County Friends of the Birth Center’s third blog post celebrating World Breastfeeding Week 2010. Our first post was by Sen. Jeff Merkley. Our second post invites mothers, fathers, extended family and friends to complete a short survey about the Birth Center’s evidence-based breastfeeding care. 

Today Janie Akerlund guest blogs about her more than two decades’ experience with breastfeeding as a mother, a WIC peer counselor, a nurse and a lactation consultant in Lane County. Formerly employed at the PeaceHealth Nurse Midwifery Birth Center, Janie is currently pursuing a PhD in Immunology at UC Denver/National Jewish Health Hospital. 

A Provider’s Perspective on 
Baby Friendly Breastfeeding Care in Lane County

It’s time for me to recertify as an International Board Certified Lactation Consultant. Sitting here amongst piles of breastfeeding literature, I am thinking back over the 20+ years since my lactation obsession began. When Friends of the Birth Center asked me to reflect on my experiences as a provider in a Baby Friendly facility – the PeaceHealth Nurse-Midwifery Birth Center, it seemed the perfect way to start preparing for the exam.

Baby Friendly facilities are officially designated hospitals and birth centers where women and families receive evidence-based care known to positively influence breastfeeding initiation, exclusivity and duration. The Baby-Friendly Hospital Initiative (BFHI) works with these facilities to implement comprehensive evidence-based practices referred to as “Ten Steps.” Over ten thousand birthing facilities around the world have achieved this designation, including 96 facilities in the US; the Nurse-Midwifery Birth Center was designated in 1997 as one of the first ten US facilities.

In the nearly 14 years since becoming a Baby Friendly facility, it is gratifying to note the maintenance of breastfeeding initiation rates and the increases in duration and especially in duration of exclusive breastfeeding that have occurred at the Nurse-Midwifery Birth Center. We can attribute these positive outcomes to our adherence to Baby Friendly basic care standards.

It is frustrating to still see the largely preventable difficulties experienced by women who deliver and initiate feeding inside most hospitals. Along with a newborn, these families bring home contradictory, confusing information about feeding. Before discharge, women and families come into contact with pediatricians, lactation consultants, obstetric nurses, postpartum nurses, neonatal nurses, nurse’s aids and the housekeeping staff. All have different opinions, levels of knowledge and degrees of experience regarding breastfeeding initiation.

Women and families routinely experience this informational chaos even at hospitals like Sacred Heart Medial Center and McKenzie-Willamette. These facilities practice some of the Ten Steps including written breastfeeding policies and 24-hr rooming-in. They also have excellent lactation consultants. In the absence of the additional evidence-based practices including consistent training across the healthcare team, these practices fall short. The Baby-Friendly Hospital Initiative works with facilities to identify and address gaps and inconsistent practices.

Personal experience – not a substitute for evidence-based breastfeeding management

Having nursed three children, I thought I knew all there was to know when in 1990 Lane County Women, Infants, and Children (WIC) asked me to participate in their pilot peer counseling program. This volunteer program provided training for WIC participants who were successfully breastfeeding so that they could provide phone support to WIC peers who were new to breastfeeding. I thought,  “You need breastfeeding training? Don’t you just decide to do it?”

After the first WIC training session, I realized I knew NOTHING and set about immediately to rectify the situation. I went through the LCC nursing program thinking I would surely learn all I needed to know to assist with birthing and breastfeeding. NOT! Here is the only reference to breastfeeding in my maternity nursing module:

I.               Breast feeding (sic)
a.     Advantages
b.     Disadvantages

II.             Bottle feeding
a.     Advantages
b.     Disadvantages

It was clear that I was on my own if I wanted further education in lactation. The more I learned, the more enthusiastic (aka annoying) I became. This was exciting! Breastfeeding reduces infant mortality! It prevents allergies, autoimmune disease and asthma as well as decreasing the incidence of a host of childhood diseases! It decreases the mother’s risk of breast cancer, decreases her postpartum bleeding and helps her more quickly return to her pre-pregnancy weight! Why is this all-natural-miracle “drug” not more widely appreciated? People must not know! I sure didn’t. I shall tell them! I naively thought that if women knew of the risks associated with artificial feeding they wouldn’t do it; surely they would see the value in breastfeeding. Right?

Working at the Nurse-Midwifery Birth Center I heard the stories of many, many women; those who didn’t want to try breastfeeding and those who truly wanted to nurse their babies, and all the women in between. Everyday, I was humbled to see how complicated decisions around breastfeeding are and how much more than an individual woman’s preferences are involved. It wasn’t and still isn’t a simple matter of individual choice.

Every woman I have worked with wanted the absolute best for her baby. Suggesting otherwise is an insensitive simplification. The majority of these women believed that breastfeeding was best but many of them made rational decisions to formula feed in line with the realities of their lives. Not because they wanted less for their babies but because in the absence of a supportive environment at home, at work and in the healthcare system it would have been virtually impossible for them to succeed. So, they expended their resources on more achievable goals. 

Eventually, I started talking to physicians and other health care colleagues about their training around breastfeeding. Aware of the inadequacy of my training, I was curious to know about their experiences. I wasn’t surprised to find that the majority, even pediatricians, had little or no formal education around breastfeeding. Fortunately, this is improving somewhat.

Well then, I thought, what we really need is a supportive environment; we need all health care providers, including the housekeeping staff, to be knowledgeable about how to help women succeed; we need employers and the community to understand what moms and babies need to make breastfeeding work. Piece of cake or chasing windmills? It’s a mixed bag.

A glimmer of hope: Baby Friendly Hospital Initiative

Around the time I was learning that I knew nothing, a small group of neonatal health care providers in San Diego went to a course on lactation physiology. They came away realizing that much of the care they were providing in the mother-baby wards was not evidence-based and was counterproductive to successful breastfeeding. They had a series of meetings where they laid out a policy with ten simple guidelines to bring their mother-baby care in line with lactation physiology and the developmental capabilities of the newborn infant.

These ten simple steps have been adopted by the World Health Organization (WHO) as the standard of care for all mothers and babies; they were intentionally conceived so that any hospital, whether in an industrialized nation or a developing nation, urban or rural, rich or poor, could achieve them. Ten Steps is backed by a fully referenced 109-page document containing the best evidence available from peer-reviewed journals.

I brag a lot about the Nurse-Midwifery Birth Center’s BFHI designation and the high rates of breastfeeding we see there – “best of the best of the best, SIR!” Perhaps our exuberance plays into the frequent dismissal that these excellent outcomes can be attributed to the special, self-selected group of birth center moms. Of course, I agree they are special, but no more so than any other mom and family in Lane County.

Besides, these dismissals overlook the fact that Birth Center moms are a representative cross section of Lane County. They come from all walks of life; ages 14 to 46 from the ivory tower professor to the fast food restaurant worker to the inpatient at Willamette Family Treatment Center. Every one of these women receives consistent standard Ten Step care. I believe our outcomes are best understood as indicative of the model, one that can be replicated.

Fortunately, awareness of the efficacy of providing evidence-based breastfeeding care is rising. The special supplemental nutrition program for Oregon WIC has recognized the importance of evidence-based care in hiring Desiree Nelson, a Lane County lactation consultant with BFHI expertise, to be an available resource to support Oregon hospitals to improve breastfeeding practices; the Joint Commission for the Accreditation of Hospitals Organization (JCAHO) is now monitoring breastfeeding exclusivity outcomes at discharge as a part of their periodic hospital assessment; the CDC recently surveyed all birthing facilities on their level of breastfeeding support through the 2007 CDC National Survey of Maternity Practices in Infant Nutrition and Care (mPINC). (Oregon nPINC results)

In light of these shifts in understanding and, hopefully, priorities, hospitals will need a comprehensive plan to meet the standards of their accrediting bodies, governmental organizations and consumers. BFHI provides these tools and the clearest pathway forward to implementing comprehensive evidence-based care in the form of the “Ten Steps.”

I challenge Sacred Heart Medical Center, Peace Harbor Hospital and McKenzie Willamette Hospital to partner in providing 100% of Lane County’s hospital-born babies with comprehensive evidence-based breastfeeding care through implementation of the Ten Steps to Successful Breastfeeding.

Contact Janie at

Comments welcome - feel free to post below!

And, please share your experience with Baby Friendly care at the Nurse Midwifery Birth Center by completing a short online survey. Click here


  1. Thanks for the great post. I remember when Janie was teaching the lactation course and helping me with nursing and considering grad school (I was a grad student at the time). I am glad to see that she has advanced to candidacy and is achieving her goal of a PhD!

    I rave to anyone that will listen about the amazing support we received from the lactation consultants at the birth center. I ran into so many problems while nursing and the LC's were with me every step of the way- day or night! I truly do hope that more medical facilities can adopt baby friendly practices because everyone deserves this amazing level of care.

  2. What a great post. I also remember working with Janie, and I think she is my favorite person in the world!

    She was always so caring and positive. I'd see so many of my new mom friends struggle with breastfeeding, and give up or get advice to give up...but the ones who went to Janie always succeeded! I loved how she looked at each of us as an individual, with our own unique issues to overcome, and gave us advice and support based on our personal needs. Her enthusiasm for breastfeeding was contagious, and she made it so clear why it was so very important, and then made the support to make it an achievable goal.

    I haven't worked with any other LCs there since Janie, but have heard equally good things about them. I, also, rave to anyone in the Lane County area about the Birth Center and it's support of evidence based care, and breastfeeding! Now that we've moved away, I almost fear the idea of going through another pregnancy without a place like that to turn to...I'm convinced there is nowhere that can measure up to my experiences with you guys!