2. Commentary
136 Nursing for Women’s Health Volume 20 Issue 2
Milestones and Achievements
In the ensuing 20 years since I wrote that edi-
torial, all of us have seen—and many nurses
have contributed to—evidence to support better
breastfeeding practices with literally thousands
of additional studies. We have seen the develop-
ment of scientific rationales for a host of practic-
es we have long suspected were evidence-based,
such as active birthing positions, skin-to-skin
contact, delayed cord clamping, and breastfeed-
ing. We have celebrated the Surgeon General’s
Call to Action to Support Breastfeeding (U.S. De-
partment of Health and Human Services, Office
of the Surgeon General, 2011). We have rejoiced
to see an increase in membership in the Human
Milk Banking Association of North America to
23 milk banks in the United States and Canada
(up from 17 just one year ago—and with 6 more
currently in development). We have been glad
to see the importance of breastfeeding recog-
nized by passage of the “Break Time for Nurs-
ing Mothers” requirement as part of the Patient
Protection and Affordable Care Act in 2010
(U.S. Department of Labor, n.d.). As a found-
ing member of the U.S. Breastfeeding Com-
mittee (and AWHONN’s representative to that
committee), I personally advocated for and wit-
nessed the launch of the first national awareness
campaign. With the slogan “Babies Were Born
to Breastfeed,” this campaign carried radio
and TV public service announcements. It is
heartening to see the progress we have made.
The Work That Remains
There is still much work to be done. On a regu-
lar basis, I am contacted by hospitals that are
pursuing designation as Baby-Friendly facilities.
The Baby-Friendly Hospital Initiative, launched
in 1991 by the World Health Organization as the
quintessential body of evidence-based practices
for a global increase in breastfeeding rates, is
about to celebrate its 25th anniversary, but hos-
pitals in the United States have been surprisingly
slow to jump on board. It was not until 1997
that a U.S. hospital was designated as Baby-
Friendly for the first time. Even a decade later,
in 2007, only 2.7% of U.S. births occurred in
Baby-Friendly facilities. As I write this com-
mentary, I see that 325 U.S. facilities have
earned the Baby-Friendly designation, and they
provide care for 16.23% of U.S. births (Baby-
Friendly USA, n.d.). And yet, the hospitals that
reach out to me often describe themselves as
“stuck” in the process.
Sometimes, the problem is related to insti-
tutional factors, such as a lack of breastfeeding
policies, procedures, or protocols. In some cases,
it is a lack of staff buy-in to the importance of
breastfeeding support. Other times, hospitals
are stuck because of problems with implemen-
tation. Although the structure is present, the
process is considered to be too cumbersome.
Still other times, it is what I call “familial” fac-
tors that are the culprit: hospital staff express
commitment to evidence-based practice, but
families do not want it. Families often complain
when they don’t get their formula “freebies.”
Mothers refuse to room-in because they believe
the only way to get a good night’s sleep is if the
baby is in the nursery. Could they be right?
Fortunately, the past 20 years have given us a
wealth of resources to draw on that show, mostly,
that the existing common hospital practices are
not right. Numerous publications, public health
initiatives, compliance mandates (e.g., the Peri-
natal Care Core Measures [Joint Commission,
2015], which now apply to nearly all hospitals in
the United States), and much more have made a
difference in our understanding of best practices
for mothers and babies in our care.
Conclusion
I plan to be here in another 20 years to write
another commentary, and I hope we will have
achieved a wonderful state of evidence-based
practices in maternal–infant care nationwide. I
hope that evidence-based practice will be better
aligned with client satisfaction. I allow myself to
fantasize that the Baby-Friendly Hospital Initia-
tive will be everywhere, available to and enjoyed
by every mother and every baby, and supported
by every nurse.
The evidence for better
breastfeeding practice exists, but
the integration of evidence into
practice has been woefully slow.
But I, and nurses who share my
passion, have been determined
to bring about change
![Commentary
136 Nursing for Women’s Health Volume 20 Issue 2
Milestones and Achievements
In the ensuing 20 years since I wrote that edi-
torial, all of us have seen—and many nurses
have contributed to—evidence to support better
breastfeeding practices with literally thousands
of additional studies. We have seen the develop-
ment of scientific rationales for a host of practic-
es we have long suspected were evidence-based,
such as active birthing positions, skin-to-skin
contact, delayed cord clamping, and breastfeed-
ing. We have celebrated the Surgeon General’s
Call to Action to Support Breastfeeding (U.S. De-
partment of Health and Human Services, Office
of the Surgeon General, 2011). We have rejoiced
to see an increase in membership in the Human
Milk Banking Association of North America to
23 milk banks in the United States and Canada
(up from 17 just one year ago—and with 6 more
currently in development). We have been glad
to see the importance of breastfeeding recog-
nized by passage of the “Break Time for Nurs-
ing Mothers” requirement as part of the Patient
Protection and Affordable Care Act in 2010
(U.S. Department of Labor, n.d.). As a found-
ing member of the U.S. Breastfeeding Com-
mittee (and AWHONN’s representative to that
committee), I personally advocated for and wit-
nessed the launch of the first national awareness
campaign. With the slogan “Babies Were Born
to Breastfeed,” this campaign carried radio
and TV public service announcements. It is
heartening to see the progress we have made.
The Work That Remains
There is still much work to be done. On a regu-
lar basis, I am contacted by hospitals that are
pursuing designation as Baby-Friendly facilities.
The Baby-Friendly Hospital Initiative, launched
in 1991 by the World Health Organization as the
quintessential body of evidence-based practices
for a global increase in breastfeeding rates, is
about to celebrate its 25th anniversary, but hos-
pitals in the United States have been surprisingly
slow to jump on board. It was not until 1997
that a U.S. hospital was designated as Baby-
Friendly for the first time. Even a decade later,
in 2007, only 2.7% of U.S. births occurred in
Baby-Friendly facilities. As I write this com-
mentary, I see that 325 U.S. facilities have
earned the Baby-Friendly designation, and they
provide care for 16.23% of U.S. births (Baby-
Friendly USA, n.d.). And yet, the hospitals that
reach out to me often describe themselves as
“stuck” in the process.
Sometimes, the problem is related to insti-
tutional factors, such as a lack of breastfeeding
policies, procedures, or protocols. In some cases,
it is a lack of staff buy-in to the importance of
breastfeeding support. Other times, hospitals
are stuck because of problems with implemen-
tation. Although the structure is present, the
process is considered to be too cumbersome.
Still other times, it is what I call “familial” fac-
tors that are the culprit: hospital staff express
commitment to evidence-based practice, but
families do not want it. Families often complain
when they don’t get their formula “freebies.”
Mothers refuse to room-in because they believe
the only way to get a good night’s sleep is if the
baby is in the nursery. Could they be right?
Fortunately, the past 20 years have given us a
wealth of resources to draw on that show, mostly,
that the existing common hospital practices are
not right. Numerous publications, public health
initiatives, compliance mandates (e.g., the Peri-
natal Care Core Measures [Joint Commission,
2015], which now apply to nearly all hospitals in
the United States), and much more have made a
difference in our understanding of best practices
for mothers and babies in our care.
Conclusion
I plan to be here in another 20 years to write
another commentary, and I hope we will have
achieved a wonderful state of evidence-based
practices in maternal–infant care nationwide. I
hope that evidence-based practice will be better
aligned with client satisfaction. I allow myself to
fantasize that the Baby-Friendly Hospital Initia-
tive will be everywhere, available to and enjoyed
by every mother and every baby, and supported
by every nurse.
The evidence for better
breastfeeding practice exists, but
the integration of evidence into
practice has been woefully slow.
But I, and nurses who share my
passion, have been determined
to bring about change](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)