TULARE -- Patti McCowan was fairly new to her job as director of perinatal and pediatric services at Tulare Regional Medical Center when statistics came out showing the hospital had the worst rate in the county for exclusive breastfeeding.
That was four years ago and only 15% of new mothers were breastfeeding, without giving their infants any supplemental formula, while in the hospital. Equally as unsettling, said McCowan, was the fact that 80% of women coming in to give birth said their goal was to breastfeed exclusively.
"We were not doing something right," said McCowan. "We were letting 65% [of babies] have a bottle. We realized something had to be done."
Jump ahead to 2012, and Tulare Regional Medical Center has one of the highest rates for exclusive breastfeeding in the Central Valley and the highest in Tulare County.
According to the California Department of Public Health, in 2011, the hospital's rate for exclusive breastfeeding was 61.9% (up from 58% in 2010); the rate of women who breastfed at all while in the hospital was 88.1%.
The county's other two hospitals had much lower exclusive breastfeeding rates; one was 27.9%, the other was 38.5%.
Changing Policies and Procedures
Much of Tulare Regional Medical Center's increased rate is due to an overhaul in policies and procedures, said McCowan.
The hospital started by sending its obstetrics and gynecology team to a breastfeeding seminar called Birth and Beyond California. Once the medical staff all had the same training, they could offer uniform advice to mothers.
Previously, said McCowan, a nurse or a doctor might speak from personal experience instead of objectively offering information on breastfeeding. "Now we all get the same education and we all educate in the same way," she said.
The hospital also formed an interdisciplinary team so that everyone from management to the nursing staff would be on the same page. Also, a quality assurance team looked at hospital policies to see which ones needed to be changed or updated to better promote breastfeeding.
For instance, nurses no longer give out pacifiers or offer a bottle to a baby just because the mother wants to rest or take a nap. "That's not the right reason to give a bottle," said McCowan. Pacifiers aren't handed out because "you don't want new babies sucking on something artificial. Any baby awake enough to be sucking needs to be nursing."
One thing hospital staff members have learned, said McCowan, is "if you give mothers the right information, they will make the right choice."
Another policy change was the establishment of skin-to-skin bonding during what is called the "golden hour."
"The first hour after a baby is born, we let the family in to say hello, then have them leave and put the baby on the mother skin to skin so they have that attachment and bonding that's so important," said McCowan. She said most infants, if allowed, will breastfeed on their own in an hour or two.
The Affordable Care Act also supports breastfeeding mothers. As of Aug. 1, new or renewing health insurance plans now must cover certain preventive services, including breastfeeding counseling, for women at no out-of-pocket cost.
McCowan said she doesn't think the new law will affect the way the Tulare program operates.
"For us, it hasn't changed anything we're doing at this point," she said. The hospital already has two full-time lactation nurses on staff, a strong ratio for a smaller regional hospital delivering approximately 100 infants a month.
Partnering With First 5 Tulare County
The hospital also partnered with First 5 Tulare County to increase its breastfeeding rates.
"They're able to achieve their outcomes for their moms and babies, and that's what we want, too," said Janet Hogan, executive director of First 5 Tulare County, whose mission is to focus on children's health.
First 5 Tulare County began funding the hospital's breastfeeding program in 2008 and recently awarded the hospital $266,000.
"They have applied themselves, have done the right things and hired some great people," said Hogan.
With funding from First 5, the hospital also offers no-cost prenatal classes for parents, including a four-hour class on breastfeeding.
Tulare County WIC Also Promotes Breastfeeding
Linda Sward, a breastfeeding/nutrition education coordinator with Tulare County Women, Infants and Children, said her program works with Tulare Regional to help women continue to breastfeed after they leave the hospital.
"We are trying to promote WIC as a breastfeeding support program," said Sward. "We have five lactation consultants. Our staff is trained to give support. We'll give phone support or have the mother come here for help."
"Tulare Regional Medical Center has made amazing progress," said Sward, who also is the Tulare County Breastfeeding Coalition chairperson.
Sward said the medical center's program is effective because of the major policy shifts that took place to promote breastfeeding as well as the number of people, including the two lactation consultants, trained to assist in breastfeeding. "They really help the mothers. There are people with real skills there six days a week," she said. "It really, really has come a long way."
In January 2011, the California Women, Infants and Children Association recognized Tulare Regional Medical Center as a leader in promoting and improving breastfeeding rates in the state of California. The hospital also got an award for Most Improved in 2011 from the California Breastfeeding Coalition.