Children’s hospital changes breastfeeding culture

Progress materializes in time. Without devotion and determination, change is not possible.

For Children’s Hospital of Philadelphia (CHOP), an institutional culture shift to promote and support human milk and breastfeeding took nearly two decades and undeniable effort.

Froh presents a poster on infants with congenital diaphragmatic hernia and human milk in Vienna.
Froh presents a poster on infants with congenital diaphragmatic hernia and human milk in Vienna.

In the mid 90s, CHOP established a lactation program under the direction of the hospital’s board certified lactation consultants.

Several years later,  leading breastfeeding educator, researcher and supporter Diane Spatz, PhD, RN-BC, FAAN joined the team. Through a collaborative approach including the work of  nurses, physicians, researchers, administrators and other health care professionals, the program expanded to include comprehensive lactation support for both families and patients as well as the hospital’s employees.

Arguably the best children’s hospital in the nation, CHOP has made important changes to the way they look at breastmilk which has resulted in national and international recognition of their lactation services, especially those in the Newborn/Infant Intensive Care Unit (N/IICU).

Froh tells me it took someone passionate and well-educated like Dr. Spatz to implement a successful system that supports breastfeeding in the hospital. Froh adds that teamwork was an essential part of the process.

“You have to start from the ground up,” she says.

The pathway

CHOP’s lactation programs are inspired by a nurse-driven model.

Transition to Breast Pathway, created by Spatz and co-author Taryn M. Edwards, BSN, RN-BC, is one example led by N/IICU nurses. Infants in the N/IICU face very unique feeding challenges. For instance,  very rarely are they able to enjoy immediate skin to skin contact with their mothers.

The pathway is a systematic guide to help mothers breastfeed their sick infants even in the most extreme and challenging situations.

Step one of the pathway serves to initiate and maintain mother’s milk supply while she is separated from her baby.

Step two is called Human Milk Oral Care. Family members are encouraged to take fresh human milk on a sterile Q-tip and rub it into baby’s oral mucosa. Froh says this allows baby to absorb all of the milk’s critical components. It also aids in gut preparation.

As soon as the medical and surgical teams grant clearance, babies progress to step three where he or she is held skin to skin with mother.

Step four involves non-nutritive sucking at the breast after mother has pumped. Froh calls it Dry Run Breastfeeding. Babies are fed through a supplemental device while practicing at the breast so that a full feeding experience is replicated.

Eventually, baby and mother engage in breastfeeding as possible.

Prenatal consultations

While CHOP provides extensive lactation services after birth, the hospital also includes Prenatal Lactation Consultations for all of their patients.

“We value a model of informed decision when it comes to infant feeding,” Froh says.

Each consultation lasts one hour and allows a lactation professional and family members to discuss infant feeding options. Consults are tailored to family’s specific needs. For instance, if a mother has breastfed several babies before but has never used a pump for a sick baby, the lactation professional focuses on pump use and safety.

Froh tells me about a study that shows that girls form their opinions about breastfeeding between 13 and 14 years of age. While this study shows that high school age girls may be receptive to breastfeeding promotion, when needed, CHOP’s prenatal consultations serve as gentle intervention for the mothers who may have never questioned their predetermined infant feeding choice. To read more about young peoples’ attitudes about breastfeeding, click here.

Froh says many families express positive feelings about breastfeeding.

However, “This is a high stress situation and goals and intentions can change,” she says of families dealing with congenital anomalies.

While exclusive breastfeeding between biological mother and baby is the ideal, it is not always possible.

“We love breastfeeding and we would love to see all of our moms directly breastfeed,” Froh explains. But exclusive human milk provision is an equally important goal at CHOP.

The hospital now has a donor milk program which allows for more families to provide human milk for their babies. Expenses are consumed by the hospital so human milk provision is a very real option.

Integrated care

Among the many reasons CHOP is successful with its breastfeeding support, Froh ranks its integrated care very important. A consistent team of providers offer multidisciplinary care and services all within one building, so help is physically convenient.

While replicating CHOP’s facility layout probably isn’t feasible for most hospitals, Froh offers different, more attainable advice.

“Start considering training your nursing staff,” Froh says. While we know for a fact that we don’t have enough lactation professionals to serve all of the mothers in need, we do have a population of three million plus nurses, she explains.

CHOP N/IICU nurses are required to take additional breastfeeding education throughout their careers. Courses are offered through the hospital, count for continuing education credits and don’t require extra hours at work.

“This really separates our staff from others,” Froh says. “We value our nursing staff as the front line for protecting breastfeeding.”

In fact, CHOP values all of its staff.

Its employee lactation support program offers free prenatal classes, free lactation support, discounted breast pumps and private pumping rooms. The hospital was named by Maternity Care Coalition one of three winners of the 2010 Breastfeeding-Friendly Business Award.

Froh says the hospital is currently collecting employee  breastfeeding initiation and duration rates to quantitatively measure the program’s success.

CHOP recently finished filming The Power of Pumping, an informational video for parents and medical professionals alike. Moms of patients in the N/IICU relate why they made the decision to pump milk for their medically fragile children. Reserve your copy of the full version here.

For information about CHOP’s lactation services in the N/IICU visit: Additional information can be found here:

Froh’s dissertation, a qualitative descriptive study titled, “Breastfeeding the Infant Born with Congenital Diaphragmatic Hernia,”  is currently going through the final process of board review at University of Pennsylvania School of Nursing Science.

She recently spoke at Healthy Children’s International Breastfeeding Conference about her findings and her work alongside Dr. Spatz.

2 Replies to “Children’s hospital changes breastfeeding culture”

  1. I applaud the progress chronicled in this article that CHOP has made in nursing education in support of breastfeeding. However this interview fails to mention that the programs for prenatal consults, use of donor milk and employee education, for example, were started by an IBCLC. Day to day assistance with pumping, NNS, breastfeeding etc. are handled by nurses and IBCLCs working together. As an IBCLC at CHOP I value the strides Spatz and Froh are making in the education of nurses and I hope that the value of teamwork with IBCLCs is not ignored. The history of lactation at CHOP starts with Rachelle Lessen and Liz Lopez. The first policies, pumps, pump rooms and standards for consultations were created by them years before Dr. Spatz came to CHOP. This isn’t meant to take anything away from what Diane has accomplished but to recognize that the creation of a culture of breastfeeding was the result of the efforts of many other people and the foundation for that shift was largely laid by Rachelle. Continuing that culture requires the work of nursing, administration, IBCLCs, and all those who interface with families. To engender that support we need to be vigilant against revisionist histories of this progress that fail to take into account the contributions of all who have made this possible.

  2. Georgette,
    Thank you so much for taking the time to express your concern and for sharing the achievements of other professionals involved in CHOP’s breastfeeding efforts. A huge part of Our Milky Way’s mission is to highlight the work of ALL lactation professionals and to stress the importance of collaboration when it comes to shifting our breastfeeding culture. Please see my most recent post apologizing for not adequately describing the importance of team work in the implementation of CHOP’s lactation programs.

Leave a Reply