Los Angeles County is working hard to support new mothers to breastfeed because it helps keep both mothers and babies healthy, and reduces illness and medical costs. Research shows that breastfed babies are healthier babies—they’re less likely to develop a range of infections and chronic diseases, such as diabetes, later in life. That makes support for breastfeeding a critical component of the Department of Public Health’s (Public Health) efforts to improve the health of all Angelenos. From 2012 to 2014, an additional 10,000 babies were born in Los Angeles hospitals recently designated as Baby-Friendly and their prospects for future health will be brighter as a result. The hospitals earned the Baby-Friendly designation—with help from Public Health and its partners —by providing a range of services that support new mothers to breastfeed their newborns.
The county breastfeeding initiative, supported by a federal Community Transformation Grant from the Centers for Disease Control and Prevention (CDC), aims to ensure that babies born in Los Angeles County get nothing but breast milk for the critical first six months of life. The key to that effort is the support and assistance mothers receive from the hospitals where they deliver their babies.
What’s the Problem?
The CDC, the American Academy of Pediatrics, and the World Health Organization, among many other professional groups, recommend that mothers exclusively breastfeed their babies for the first six months of life and continue breastfeeding, in combination with other foods, for at least the first year, and as long as mother and child desire. Breastfeeding rates in Los Angeles County, as in many other places, vary greatly depending on the demographic, but Public Health has been working to increase rates for all populations.
While 87 percent of Los Angeles mothers report breastfeeding their babies on at least some occasions and 73 percent say they fed their babies only breast milk on the first day of life, those numbers decline rapidly. The percentage of babies being exclusively breastfed fell to 45 percent by day 3, 31 percent at 3 months and 10 percent at 6 months, according to a 2011 survey of new mothers conducted by county researchers.1 Significant racial disparities also emerged in the survey with Latina and African- American mothers reporting lower rates of exclusive breastfeeding at every phase.
Why it Matters
Babies who receive all of their nutrition for the first six months of life, and most of it for the next six months, from breast milk are less likely to develop Type 2 diabetes, asthma, childhood leukemia, ear infections, lower respiratory infections and eczema, and are less likely to have problems with diarrhea and vomiting, and to die of sudden infant death syndrome, or SIDS.2 Mothers also benefit: breast- feeding is associated with lower rates of diabetes and reduced risk of breast and ovarian cancer.
Reducing infections and other conditions leads to reduced spending on healthcare. If 90 percent of new mothers exclusively breastfed their babies for six months, it would save the Los Angeles economy $400 million per year, according to a recent analysis by Public Health based on data from the journal Pediatrics.3
What We’re Doing
Hospitals can help establish a healthy foundation for newborns by providing their mothers with the information, environment and encouragement they need to breastfeed in the hospital and beyond.
The Baby-Friendly Hospital Initiative is a global initiative of the World Health Organization and UNICEF which awards hospitals that have implemented the evidence-based Ten Steps to Successful Breastfeeding with the Baby-Friendly designation. Glendale Memorial Hospital became the first hospital in Los Angeles County to achieve the designation in 2005, followed by Providence Holy Cross Medical Center and the Southern California Kaiser Permanente Medical Centers. Attitudes around breastfeeding practices started to shift. In 2010, with support from a CDC grant, Public Health partnered with BreastfeedLA to establish the Regional Hospital Breastfeeding Consortium (RHBC). The consortium hosted monthly meetings to provide maternity care and breastfeeding technical assistance and to foster collaboration among the 57 maternity hospitals across the county.
While organizers were initially concerned hospitals would compete with one another and be unwilling to share ideas, nurses, physicians, and hospital administrators were excited to be part of this learning collaborative. The meetings provided a space where participants could discuss ways they could more effectively support breastfeeding, and how to successfully carry out the steps laid out in Ten Steps to Successful Breastfeeding – the basic criteria that Baby-Friendly hospitals are expected to follow. For example, nurses at the meetings identified a common challenge: teaching new parents how to identify when their baby is hungry, also called “feeding cues,” which is Step 8. A Feeding Cues poster was developed and is now available in English, Spanish, Chinese, Korean, and Vietnamese. It can be found on post-partum room walls in hospitals across the county.
Guided by data, and in an effort to promote equity, Public Health and BreastfeedLA have focused on changing the practices of hospitals serving communities with the lowest rates of breastfeeding. “People in high poverty areas, especially Latino and African American families, are most at risk of not receiving adequate breastfeeding assistance,” said Helen O’Connor, breastfeeding policy analyst with the Division of Maternal, Child and Adolescent Health. “Breastfeeding rates vary, depending on where you’re born, so it’s important that we
target those hospitals where mothers really need the support.” Through their contract with Public Health, BreastfeedLA created the BEST Project (Bringing Education, Systems-change and Technical assistance to you) to offer individualized technical assistance to address the unique barriers within each hospital. Twenty-two hospitals participate in the BEST Project.
By 2012, 13 hospitals, accounting for 18 percent of all births in LA County, had received the Baby-Friendly designation. All are located in low-income areas and serve a high proportion of Medi-Cal patients. In the first six months of 2014, three of the BEST Project participants – Pomona Valley Medical Center, Hollywood Presbyterian Medical Center, and San Gabriel Valley Medical Center – achieved Baby-Friendly designation. St. Francis Medical Center became the latest designee in October 2014. A number of other hospitals are on track to earn the designation by the end of 2014.
Achieving Baby-Friendly designation is clearly paying off. From 2010 to 2013, exclusive breastfeeding rates in the county have increased by about 20 percentage points, outpacing the statewide gain of 13 percentage points. Additionally, hospitals that received technical assistance from Public Health and BreastfeedLA had impressive increases, highlighting the impact of technical assistance. “We can engage healthcare providers and offer them talking points to use with new moms,” said O’Connor. “When healthcare providers look mothers in the eye and talk about breastfeeding, rates of breastfeeding in the hospital go up.”
San Fernando Valley resident Natasha Oiye had the pleasure of delivering her second child at Los Angeles County USC Medical Center, which earned its Baby-Friendly designation in 2012 with assistance from BreastfeedLA and Public Health. Her first son was born in a hospital that wasn’t Baby-Friendly and he was taken from her for a while shortly after he was born. This time, her newborn son never left her side, and they were together for his physical exam and vaccinations during her recovery. “My child was never out of my sight from the moment he was born and we were able to bond this way,” says Oiye. “I was worried that my milk wasn’t coming in but the lactation specialist knew just what to do. She was very reassuring and if she hadn’t been there, I probably would have given up.”
While many hospitals have strongly supported Baby-Friendly, it will take ongoing efforts to get all hospital administrators, doctors and staff members fully on board in promoting Baby-Friendly initiatives and prioritizing newer maternity care practices, such as immediate skin-to-skin contact after birth and having mothers and babies room-in together. Many of these practices continue to be addressed in the collaborative learning sessions the consortium convenes. “Part of coordinating the consortium means that we
are continually touching base with hospitals, attending to their individual needs, and giving them space if they need it,” says O’Connor. “We need to be patient, understand the hospital culture and show them the path to stay focused.”
Helping hospitals earn the Baby-Friendly designation is one way Public Health is shifting norms around breastfeeding practices. Other efforts are also in the works. The BEST Project also provides training, resources, and one-on-one support to staff members in prenatal clinics throughout the county to ensure that families are learning about breastfeeding and what to expect in the hospital long before they arrive. New mothers also need support to continue breastfeeding once they return to work, assistance from BreastfeedLA is available to any employer that would like to provide lactation accommodation in compliance with state and federal law.
In the future, Public Health and BreastfeedLA would like to promote breastfeeding-friendly community pediatric clinics as a way to sustain breastfeeding among new mothers and increase breastfeeding duration in low-income communities. “Every child deserves to be breastfeed. It’s the best way to provide a healthy start,” said Karen Peters, executive director of BreastfeedLA. “Even though we have significantly increased the number of babies who breastfeed, there is still much to do to improve breastfeeding practices across the county and ensure this best start for all infants.
Helen O’Connor, MSPH, MA
Breastfeeding Policy Analyst
Los Angeles County Department of Public Health Division of Maternal, Child and Adolescent Health
- The 2011 Los Angeles County Health Survey, “Hospital Practices: Can They Impact Breastfeeding?”
- Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153. AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality. April 2007.
- Figures extrapolated from Bartick M, Reinhold A. The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis. Pediatrics. 2010;125(5). Extrapolating formula based on population data of 130,000 births in Los Angeles County annually (LA County Department of Public Health) and 4,140,000 births in U.S. annually (US Census)