Aids Health Foundation

Nursing Tales

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When 20-year-old Alicia Lewis-Howard delivered her first child at Harlem Hospital two years ago, she planned to breastfeed—but only for one month. “It’s going to be painful,” her aunt and others told her. But the nurses at Harlem Hospital provided just the right amount of support to teach Lewis-Howard the proper way to painlessly breastfeed her newborn daughter, whom she named Aniyah.

Lewis-Howard says the nurses offered to help her nurse Aniyah, but she told them she wanted to do it herself; otherwise, she says, “I’d never learn. They directed me. They taught me to put the full areola in the baby’s mouth and not just the nipple, and I did it.” Not only did Lewis-Howard learn to breastfeed at Harlem Hospital, she also learned the many ways nursing benefits both mother and child.

The American Academy of Pediatrics recommends that women exclusively nurse their babies for at least a full six months. Ideally, all women would breastfeed for the first year of their babies’ lives. According to Atlanta-based pediatrician Joyce Lovett, M.D., research indicates that nursing an infant may lead to a stronger immune system, less diarrhea, less constipation, fewer colds and ear infections, and lower rates of SIDS (Sudden Infant Death Syndrome). For the nursing mother, Dr. Lovett says breastfeeding promotes faster loss of pregnancy weight, stimulates the uterus to contract to pre-pregnancy size, produces naturally soothing hormones and may lower the risk of developing some types of cancer and osteoporosis in later life. Dr. Lovett adds that “breast milk is best for babies because it contains nutritional components that are natural tranquilizers for babies and is always clean and at the right temperature.”

Despite all this evidence to support breastfeeding, the Centers for Disease Control and Prevention report that only about 32 percent of American children born in 2005 were exclusively breastfed for three months and only 12 percent of American children born that same year were nursed without formula supplementation for the recommended first six months of the infant’s life. Among specific groups of women, particularly African Americans, Latinas, low-income women and women younger than 20, the numbers are even lower.
To help improve breastfeeding rates worldwide, in 1991 the World Health Organization (WHO) and UNICEF launched a global campaign to encourage breastfeeding and thus improve infant and maternal health. Called the Baby Friendly Hospital Initiative (BFHI), the program encourages health care facilities to follow 10 steps to provide the optimal environment for successful breastfeeding. Nationwide, BFHI has had some success. According to one study, the mean rate of exclusive breastfeeding initiation in baby-friendly hospitals was 78 percent, compared with a national mean of breastfeeding initiation of just 46 percent.

In New York City, all public hospitals, which operate under the Health and Hospital Corp., or HHC, have improved the way they care for newborns and their mothers as a result of this initiative. Yet, while all HHC public hospitals in New York City are mandated to create a baby-friendly atmosphere, only one, Harlem Hospital, has been designated “baby-friendly” by UNICEF/WHO.

For Lewis-Howard, delivering at a designated BFHI hospital helped change her attitudes and expectations regarding breastfeeding. Not only was she successfully able to nurse just minutes after her daughter was born, but when she learned how she could help achieve optimal health benefits for herself and her child, she chose to breastfeed Aniyah for a full six months. Now, she plans to do the same with her second baby, also delivered at Harlem Hospital.

Encouraged by Harlem Hospital’s 2008 designation, BFHI USA National Coordinator Cindy Turner-Maffei says, “great strides are being made toward creating a breastfeeding-supportive environment in New York City public hospitals.” Benjamin Mojica, M.D., former acting New York City Health commissioner, agrees. Dr. Mojica has made it his overall goal to “increase breastfeeding as the choice for nutrition for infants in the city” and emphasizes the benefits of exclusive breastfeeding.

He insists that all HHC hospitals promote breastfeeding and that all follow the 10 steps outlined by UNICEF/WHO. Dr. Mojica says Harlem Hospital is the lone New York facility to achieve the coveted Baby Friendly status because “the process for designation is complex.” According to Turner-Maffei, “designation is indeed rigorous. It involves many interviews with mothers, staff, administrators, as well as observations of staff at work and review of documents and records.”

One requirement for Baby Friendly designation Dr. Mojica says his office struggles with is that they no longer receive free formula from companies and, instead, must purchase formula for those mothers who request it during their stay at HHC hospitals. Instead of infant bags from companies like Enfamil, HHC hospitals provide gift bags that contain breastfeeding instructions, educational materials and “I Eat at Mom’s” onesies. HHC hospitals also loan breast pumps or help facilitate the process of acquiring them through insurance or for free through Medicaid to help women avoid the use of formula.

Many black wo­men feel they save money when they use the free samples and cou­pons they often receive before their babies are even born. Ironically, however, of the many benefits of breastfeeding, a most important one in this economy is financial. Nursing saves the average American mother formula costs that, according to Turner-Maffei, can run as high as $2,000 per year.

Dr. Mojica points to Harlem Hospital as a success story that, he says, “shows how aggressive we are in promoting breastfeeding.” According to Michael Lettera, senior director of administrative services in health promotion and public health services at HHC, his office makes periodic site visits to make sure no magazines published by formula companies are distributed in HHC hospitals.

Lettera claims his staff is vigilant, and representatives from formula companies are not allowed to visit HHC hospitals to promote the formula they sell. All staff  undergo training in the promotion of breastfeeding. While nurses train in this area for 18 hours, even auxiliary staff, including housekeeping, train in a four-hour course that promotes breastfeeding. And a board-certified lactation consultant is also on staff at each facility.

Turner-Maffei applauds New York City for implementing changes in line with BFHI and improving breastfeeding care in related community programs and in the city’s 11 maternity hospitals. She also contends that all around the country the BFHI “is growing. Eighty-two hospitals and birth centers in the United States have been designated. Eighty-nine birth facilities have committed to implementing the BFHI through their participation in the Certificate of Intent program.”

About the Baby Friendly Initiative in New York, Dr. Mojica says, “we would like to think the program has been successful.” For mothers like Alicia Lewis-Howard, it has. Other health care facilities like Harlem Hospital that serve largely black communities need greater support to improve breastfeeding rates through the BFHI, so more African-American women can give their daughters and sons the healthiest start in life.

– Eisa Nefertari Ulen

Aids Health Foundation

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