Elizabeth Kiamar gave birth to her first child 20 years ago, her second 11 years ago, and her third, Jonah, just two days ago.
“I like the fact that the baby never leaves us now,” Kiamar said. The lights in her room at University of Texas Medical Branch’s Mother-Baby Unit were turned down low and her husband, John Rutherford, reclined on a fold-out bed just next to Kiamar’s. Jonah lay on her lap, wrapped snugly in a blanket.
When Kiamar’s first child was born, standard practice in maternity wards was to take the baby immediately after birth, bathe it, perform medical exams on it and move it to a nursery from where it was taken to its mother on a schedule, often interrupted because of nurses’ multiple responsibilities.
At the medical branch now, that practice has changed completely.
When Jonah was born, he was laid immediately on Kiamar’s chest, skin-to-skin, to give mother and baby — and father, standing by — a chance to touch and bond, then attempt the first breastfeeding.
From there, Jonah roomed in with his mom and dad, with nurses and doctors checking in regularly.
“A lactation consultant came in last night to talk with me,” Kiamar said. “It’s been 11 years since I’ve done this.”
The lactation consultant helped with the latching-on process, checked the baby’s suction strength and talked to both parents about how to read the signs that Jonah might be hungry and ready to feed, encouraging feeding on demand rather than on schedule.
Both mother and father were instructed in the benefits of breastfeeding, exclusively if possible, for the first six months of Jonah’s life, and both were encouraged to integrate the process into their daily lives.
A doctor came in to check on baby and family and said if all continued to go well, they could leave at the end of the day.
“Get some rest,” he said and both mother and father smiled tiredly.
Jonah Marcos Rutherford, age one day, was born the day after University of Texas Medical Branch announced its official designation as a Baby-Friendly hospital by Baby-Friendly USA, the accrediting body of the Baby-Friendly Hospital Initiative begun in 1991 by the World Health Organization and the United Nations Children’s Fund.
In 2007, less than 3 percent of United States births occurred in about 60 Baby-Friendly designated facilities, and in 2018, those numbers have risen to more than 25 percent of births in a little more than 500 Baby-Friendly designated facilities, including University of Texas Medical Branch.
Baby-Friendly designated hospitals are required to adopt practices in support of successful breastfeeding that, across the world, have transformed maternity wards from places heavily influenced by the commercial presence of baby formula manufacturers, where medical practices often separated babies from families in their first formative hours after birth and supplemental feedings were routine rather than a choice made by the family.
The designation promotes breastfeeding and lactation support from prenatal stages through post-birth, and especially during the time in the hospital when a mother gives birth.
The movement toward Baby-Friendly facilities is based on one over-arching guideline, that breastfeeding has been internationally recognized by scientific authorities as the optimal method of infant feeding and should be promoted as the norm within all maternal and child health care facilities, according to the World Health Organization.
Nonetheless, factors influencing the decision to breastfeed often have been more about cultural influences than health promotion, according to widespread analysis in medical journals, despite longstanding medical knowledge that breast milk encourages bonding, strengthens digestion and promotes a healthy immune system in infants.
The Baby-Friendly Health Initiative was launched, in part, to stem those influences and to promote understanding of the benefits of best feeding practices for babies and parents alike.
A CHANGING MODEL OF CARE
The process for the medical branch to achieve Baby-Friendly distinction has been years in the making and was made possible by a gift of $125,000 made to the medical branch by Barbara and Dominick Sasser of Galveston.
“We’re extraordinarily pleased with the effort that UTMB made,” Dominick Sasser said. “There are so many babies born at UTMB, and this will be a lasting legacy for the hospital, to give them the best start possible.”
An estimated 5,000 babies will be born at the medical branch in the upcoming year.
Barbara Sasser was involved in the activities of La Leche League International, an organization that supports breastfeeding, during her time mothering three children. Both Barbara and Dominick Sasser were inspired to see change in the hospital birth experience based on their own personal experience of support for breastfeeding that included both mother and father.
“We wanted to move the needle,” Barbara Sasser said.
Instrumental in moving that needle were chairpersons from the departments of pediatrics and obstetrics-gynecology, Drs. Joan Richardson and Gary Hankins, as well as Deborah Mordecai, assistant chief nursing officer and director of patient care services, the Sassers said.
Since the medical branch began its participation in the initiative in 2014, the number of babies born there that are breastfed for the first six months has risen from 5 percent to 45 percent, said Tracey Santiago, nurse manager for the Mother-Baby Unit.
“It’s really about giving parents an informed choice,” Santiago said. If breastfeeding isn’t working, for any reason, mothers receive support in supplementing as well, including how to safely mix and store formulas.
To be designated Baby-Friendly, Santiago and her team of nurses had to change the unit’s model of patient care, starting in the delivery room.
“There used to be a nurse for the mom and a nurse for the baby,” she said. “We had to cross-train all the nurses to do both, and all nurses received breastfeeding education.”
Under the new model, barring any medical distress, the baby stays with its mother and father, skin to skin, from its first moments rather than being swept away for bathing and examination. The first bath is delayed for up to 12 hours, giving the baby’s body temperature time to regulate and giving parents the option to give the first bath. Newborn evaluations take place next to the mother’s bed, in her room, and lactation support is available from the first hours up to several months later when mothers can continue to participate in lactation support groups.
“I used to think that this was about promoting exclusive breastfeeding for the first six months of life,” Santiago said. “Now I think it’s about making that mom feel more successful.”