I started the interview like this: Congratulations on being ranked number one for perinatal care for the fifth year in a row. I know a lot of the work you do contributes to great outcomes for moms and babies in New Hampshire.
She replied so seriously: How do you know that?
Not at all expecting that response, I stuttered; the words stumbled out of my mouth: Well, all the work you do with breastfeeding. That’s what really matters.
Lisa Lamadriz, RNC, IBCLC is one humble woman. Before our interview, I read and heard a lot about her, leading me to believe that she indeed does have a lot to do with NH’s great perinatal care.
Lamadriz works at Dartmouth Hitchcock Medical Center (DHMC), a Baby-Friendly tertiary care center where she heads the Baby-Friendly team. In 2007, she created lactation support programs for families with infants at Children’s Hospital at Dartmouth’s (CHaD) Intensive Care Nursery (ICN). She created a nutrition group that provides staff education. [Retrieved from: http://chad.dartmouth-hitchcock.org/documents/pdf/chad_matters_winter_2007.pdf] She serves as New Hampshire Breastfeeding Taskforce’s co-chair. She contributes to CHaD’s breastfeeding episodes. And the list goes on.
During our chat, Lamadriz continued to prove that she and the collaboratives she’s a part of have a lot to do NH’s breastfeeding success.
As stated, back in April, the 2011 Maternity Practices in Infant Nutrition and Care (mPINC) Survey results from the Center for Disease Control and Prevention (CDC) showed New Hampshire as number one for the fifth straight year in perinatal care practices associated with breastfeeding success. The New Hampshire Department of Health and Human Services (DHHS) says the survey results are due largely to the efforts of the New Hampshire Ten Steps to Successful Breastfeeding Program, headed by Dartmouth-Hitchcock’s Bonny Whalen, MD. [Retrieved from: http://www.dhhs.nh.gov/media/pr/2013/04-apr/04032013survey.htm]
The Ten Steps program began as a hospital-based project but has grown into a state-wide initiative. DHMC’s journey to Baby-Friendly began about 15 years ago, but the facility recently revamped their efforts in 2009. The hospital was awarded designation in 2012. Read more about their efforts here: http://www.dartmouth-hitchcock.org/news/newsdetail/61662/.
Lamadriz tells me families have often told her they chose DHMC for their birthing experience specifically because of its Baby-Friendly designation; a great marketing tool as Baby-Friendly USA project manager Liz Westwater explains in Baby Friendly Hospitals decrease traumatic birth experiences, increase breastfeeding rates.
Getting DHMC staff excited about Baby-Friendly designation started with a large skin to skin campaign. Before the implementation of the Ten Steps began at the facility, Lamadriz admits that while they thought they were doing a great job getting babies skin to skin, they realized they could do a lot better (even with about a 30 percent population of high risk deliveries).
So bulletin boards showing evidence of the effectiveness of BFHI went up throughout the hospital. Staff champions mingled with resistant staff members. Physician champions spread the word about breastfeeding.
Lamadriz names Dr. Whalen one of those physician champions. As a pediatrician, medical director of the Newborn Nursery and a certified lactation consultant, her positive influence on breastfeeding spreads far and wide. Even more, Lamadriz tells me she’s passionate about integrating breastfeeding education and support into young physicians’ curriculum.
Neonatologist Juliette Madan, MD, MS is equally encouraging about breastfeeding and breastmilk feeding. Her efforts allowed for an update of the ICN’s feeding guidelines. Mothers are now encouraged to provide colostrum for baby before any kind of supplementation is offered. Lamadriz says babies are never just automatically started on artificial baby milk.
“The gut is so fragile,” she explains. “It really needs that colostrum before we put anything else on it.”
The ICN’s support and patience with breastmilk feeding low birth weight babies has played a part in allowing the facility to significantly decrease the use of non-medically indicated formula supplementation. In fact, Lamadriz says their breastfeeding initiation rates are close to 98 percent. Any breastmilk feeding at time of discharge varies between 45 and 60 percent.
Because of the size of the facility, Lamadriz says it’s often difficult to engage everyone in the Baby-Friendly process, a common challenge facilities face when working toward designation.
However like many other successful Baby-Friendly facilities, DHMC formed a multidisciplinary quality improvement team comprised of clinicians including those from CHaD, the Prenatal Clinic, Birthing Pavilion, Newborn Nursery, INC, Pediatrics, Food and Nutrition Services, Finances and Purchasing to ensure every care provider a mother comes in contact with supports her breastfeeding goals. [Retrieved from: http://www.dartmouth-hitchcock.org/news/newsdetail/61662/]
“Our biggest improvement was in the area of prenatal breastfeeding education in the clinic,” Lamadriz says in a DHMC news release. “We updated our patient education materials, and created a process with the staff in the prenatal clinic to provide small amounts of breastfeeding education at each prenatal visit.”
While DHMC excels in its prenatal breastfeeding education, it still struggles with sustaining Baby-Friendly’s rooming-in model.
“Nurses feel like they are doing mom a favor if they take baby out for sleeping,” Lamadriz tells me, yet another common but not unconquerable challenge.
By improving prenatal education, Lamadriz says parents are better able to advocate for their families.
“They actually drive the practice,” she says. “They really take the initiative of keeping their baby with them.”
Postnatally, DHMC offers lactation support services including a Lactation Clinic and referrals to support groups like the Women’s Health Resource Center. We know that continuity of care is essential when supporting moms’ breastfeeding goals, so DHMC lactation professionals make sure to communicate with mom and babys’ other health care providers.
Lamadriz says she and her co-workers connect with other maternal child health programs in NH through the state’s breastfeeding taskforce. Representatives from different organizations including WIC, universities, La Leche League and the Department of Health and Human Services (which heads the obesity prevention program) work toward a common goal to support breastfeeding throughout the community.
Members of the 10 Steps Collaborative including Lamadriz, Whalen, Joyce Kelly, RN, MPH and Dr. Alison Holmes of Concord Hospital and Dartmouth-Hitchcock have educated staff at six of the 20 birthing hospitals in NH about the 10 Steps program.
Through a survey, Lamadriz says they learned that one of hospitals’ biggest barriers to become Baby-Friendly is the cost of educating their staff. Lamadriz provides education and skills days to facilities in need.
“Hospitals are really working on the ten steps and trying to improve,” Lamadriz says. “I’m hoping that will increase our [breastfeeding] duration rates.”
According to the CDC’s 2012 breastfeeding report card, NH’s exclusive breastfeeding rates at six months came in just under 25 percent, about ten percentage points higher than the national average. While NH’s duration rate is one of the highest in the nation, 25 percent of babies breastfeeding at six months is still arguably a very dismal number.
The 10 Steps Collaborative provides education across the border to Maine’s Let’s Go! program, an initiative to reduce obesity that includes a breastfeeding component. Maine’s exclusive breastfeeding rates at six months come in just above 15 percent.
Despite the somewhat gloomy numbers, Lamadriz says she is very optimistic about future birth and breastfeeding outcomes in our country.
“I think we have a lot of work to do and I sometimes worry about the hightechness of everything,” she says. “But I am optimistic because I do see the younger mothers reading about breastfeeding and knowing a lot when they show up for their appointments.”
Lamadriz says it’s sometimes difficult to get people to slow down and recognize the importance of the biological and anthropological connection between mom and baby.
“It’s my generation’s responsibility to make sure young women are aware of how important this special time is.”
Lamadriz will take her responsibility to the next level this fall when she attends Boston University’s Master of Public Health: Maternal Child Health program. As a graduate of Union Institute and University’s Bachelor program in Maternal Child Health: Lactation Consulting, she says she gained a more global perspective on maternal child health issues. (The Healthy Children Project collaborates with UI&U to provide the lactation content of this degree program.)
“I became keenly aware of the horrible things happening to women and girls,” she says. “It flipped me upside down. Something inside of me said, ‘OK, now you know this so what are you going to do?’”