Technology from a nurse’s perspective

I am currently adapting to life with a smart phone. I traded in my bulky, old-fashioned cell for a more fancy, streamlined iPhone. Yes, I am slowly but surely entering into the 21st century.

As I personalized my new gadget, I searched “breastfeeding” in the app store to see what it had to offer. I nearly dropped dead when this came up: Baby Nursing. The app’s description reads: Baby Nursing is a simple and intuitive app to help you keep track of your baby’s nursing progress and more! Our easy-to-use timer lets you track your nursing records real-time. Simply press “Start” and “Stop”!

Before I bash the program, I have a confession to make. During Willow’s first several weeks of life, I set my alarm every one to two hours during the night to offer her the breast. I was so concerned that I’d miss her feeding cues throughout my slumber and starve her. Talk about obsession!

All new moms worry about their infants in one way or another. An app like Baby Nursing serves to “subdue” those concerns by offering high-tech solutions. Here’s the problem: when we put gadgets before observation and instinct, we lose the very essence of motherhood. And while most technology is designed around practicality, when it comes to birth and breastfeeding, technology sometimes ends up doing more bad than good.

Even so, apps like Baby Nursing have rave reviews. “Definitely recommending this app to all new moms”…  “amazing”… “easy to use.”

Just how easy it is to juggle a device every time you go to nurse your baby, especially considering how often newborns feed. How long do moms remain attached to the program? For several weeks? Until baby weans? When mom relies on a tool like this, does she really get to know her baby’s language or is she consumed by tracking and counting and recording?

Technological reliance

CarinRHealthy Children faculty Carin Richter, RN, MSN, APN-BC, IBCLC, CCBE has been a women’s health nurse for 26 years. She currently works and teaches at St. Anthony’s Medical Center in Rockford, Ill.

“When we talk about breastfeeding and everything that needs to be done, we feel like we are churning the ocean,” she says. So why complicate things with potentially harmful technology?

Richter suggests creating a shift in U.S. culture in order to curb the use of unnecessary breastfeeding gadgets and intrusive technology in the hospital.

“Our culture is very much into let me do the fastest thing to get the job done,” she says.

Productivity can be a wonderful thing but not when mothers are staged with a false sense of assistance and efficiency.

In the United States, the majority of births occur in a hospital setting which means that most mothers receive (or don’t receive) infant feeding support from their nurses. Breastfeeding support is a core skill for nurses because infant feeding is of new mothers’ greatest concern, Richter explains.

“When it comes to breastfeeding,  we have to remember that the relationship you have with a mother is extremely important especially in the first two weeks,” Richter says.

She tells me that  nurses tend to rely on technology (i.e. breast pumps, shields, supplemental devices) before they use alternative problem solving (i.e. latch assessment, skin to skin implementation, simple encouragement.)

“They are always looking for a quick fix so technology is frequently something they employ,” she says.

During my hospital stay with Willow, I received such inadequate breastfeeding support I still get angry about it 20 months later. I rarely had anyone by my side cheering me on and when I did, it was a hurried. At one point, a nurse forcefully attempted to shove my entire areola into my newborn’s tiny mouth. Unless she was equipped with a shrinking machine, this was never going to happen.

Until I spoke with Ms. Richter, I hadn’t considered why my lactation support was so awful; I simply thought I was dealt a bad hand of nurses.

Pressed for time

Postpartum hospital stays are generally very short, making it difficult for nurses to establish relationships with mother and baby, Richter explains.

Not only that, nurses have other time-consuming demands to satisfy like clinical documentation including mandatory assessments, documentation of daily care plans, documentation of patient learning, documentation of resources, and the list goes on. Electronic documentation makes things even more complicated.

Also consider the nurse who is responsible for four to five mother baby couplets. That’s eight to ten patients relying on one provider.

In a Medical News Today article, one nurse describes her experience: “I didn’t become a nurse to be chained to documentation.”

Electronic programs can take a long time to learn and to integrate into practice.

“Documentation takes up so much of [nurses’] time, it cuts into their ability to set up a relationship with their patient,” Richter explains.

Even so, Richter tells me that nurses really do want to help moms with breastfeeding, they just sometimes feel trapped.

She adds that some nurses take on physician’s work when the physicians themselves are not familiar with new systems.

Still, nurses have a tendency to cling to technology simply because health care in the hospital has become so technology based.

“When we ask them to just do the natural, which is what giving birth and breastfeeding are all about, they don’t feel empowered,” Richter explains.

She says that if nurses don’t have tools at their beck and call, it’s difficult for them to remain hands off. A hands off approach is often the best method when it comes to moms and babies, especially when you consider skin to skin contact.

Effectively implementing skin to skin contact between mother and baby involves no intervention. Richter says this is the number one thing that will lessen nurses’ workloads.

That’s because when baby’s nine stages are allowed to progress organically, breastfeeding problems are often averted.

Because the Baby-Friendly Hospital Initiative nurtures early skin to skin contact and baby-led breastfeeding, nurses’ workloads are potentially lessened when mothers need less technical assistance with infant feeding.

Implementing breastfeeding education

In order to better prepare nursing students for their OB rotations, Richter is working diligently to integrate skin to skin and breastfeeding training into their curriculum.

“It is imperative that nursing students get a good foundation in the fundamentals of breastfeeding,” Richter says.

Ideally, Richter says a lactation professional should teach the breastfeeding portion of the curriculum.

Along with curriculum changes, Richter suggests implementing breastfeeding training with a lactation professional during nursing orientation.

“We have to start before the problems are even developed,” she says.

When nurses aren’t properly trained to support mothers in their feeding choices, lactation consultants become hot commodities. Most hospitals have a severe lack of lactation professionals and that insufficiency presents yet another barrier to breastfeeding.

Richter says she would love for all nurses to be trained as Certified Lactation Counselors (CLC).

When nurses are trained to properly support and assist mothers with breastfeeding, we become that much closer to securing normal feeding goals.

Even more, the CLC training is a valuable way to build nurses’ confidence in their own ability to provide breastfeeding education and support.

“When organizations require a certification such as the CLC, that really bolsters a nurses’ ability to assess and teach [breastfeeding] effectively and efficiently,” Richter explains.

But do nurses express interest in receiving breastfeeding education, or do supplemental certifications overwhelm?

“I believe that any nurse in whatever specialty she is in has a professional obligation to have a thirst for the newest knowledge that improves the care she gives to her patient,” Richter explains. “What I do find with obstetric nurses is that some of them do not see breastfeeding education and support to be within the scope of their practice.”

In actuality, obstetric nurses like all health care providers, play a crucial role in implementing breastfeeding. OB nurses have a special opportunity to allow immediate skin to skin contact between mom and baby to occur.

Fortunately, when nurses have the opportunity to learn about the significance of skin to skin, they’re excited to apply it.

“I see this every time I teach,” Richter says of the CLC course. “Nurses will come up to me after the week and say, ‘If I only would have known about the Magical Hour and its importance, my practice would have been different.’”

I nearly drop dead again when Richter tells me that because of our litigation culture, nurses are encouraged to become certified in advanced fetal monitoring. The lactation counselor certification isn’t promoted nearly as much.

Why is a certification for a hospital practice that heightens the likelihood of c-sections promoted over a certification that has only positive results for mom and baby?

Richter says she believes breastfeeding education and fetal monitoring competence are equally as important.

Encouraging breast over bottle

The evidence is clear that breastfeeding is more beneficial than breast milk feeding. (For instance, babies fed from a bottle are less likely to self-regulate milk intake.) But because of our culture’s obsession with technology, moms also become caught up in the use of unnecessary devices.

Patients then potentially become barriers to nurses’ ability to provide breastfeeding education, Richter says. It’s sometimes difficult for well-educated providers to explain the possible dangers of introducing technology to a breastfeeding relationship if a mother is insistent on a “quick fix”.

Trainings like the CLC course offer professionals effective, gentle and respectful communication tools when presented situations like these.

Perhaps the most common device requested is the breast pump. Pumps can be vital to maintaining a breastfeeding relationship especially when and if mom must return to work.

However breast pumps should not be offered before a breastfeeding relationship is established. Mom’s milk production generally will not respond to a mechanical device the same way it will to her warm newborn. Mom might also become discouraged to see healthy but small amounts of colostrum.

“In reality, moms don’t know how much work pumping really is,” Richter explains. No one is claiming that breastfeeding is effortless, but it is certainly the most efficient infant feeding choice.

Richter says normalizing skin to skin will help get babies to breast versus to breastmilk bottle because moms will continually desire baby at breast.

“There is so much else going on with breastfeeding that a pump can’t replace,” Richter explains. “It’s a sacred time that no one else can duplicate.”

When technology triumphs

Technology is the antithesis of breastfeeding, as Richter puts it.

“What we need to do now is look at any kind of technology to use for the promotion and support of breastfeeding.”

Once mom and baby have established a comfortable breastfeeding relationship, technology can be used to offer continued support. For instance, emailing and text messages offer quick responses when moms need instant answers.

“This is a really big frontier that we need to explore,” Richter says of text messaging. “There is evidence that using the cell phone will be very important in maintaining that relationship.”

(Read more about text messaging and breastfeeding support at:

Online breastfeeding communities may also be helpful in extending support. They allow mother to connect any time of day and encourage relationships between mothers in similar situations.

Still, these communities present the risk of rapid spread of misinformation.

“I want to make sure online communities are monitored so that correct information is given,” Richter expresses concern.

She says mothers need to be cautioned about the information they act on. However providing mothers with reliable resources will better suit them to make informed choices.

Even though Kangaroo Mother Care is an effective way to promote breastfeeding in low birth weight babies, technology can play an important role when mother must be separated from her baby.

For instance, Richter encourages mothers to pump until she becomes reunited with her child.

She says it gives mom something to focus on when she feels helpless and alone.

“Pumping helps empower her so she knows that she can do something for her fragile child.”

Following Dr. Koop’s footsteps

One day while traveling, an elderly woman holding a suitcase turned and said to a fully uniformed government employee, “Put this up for me, will ya Sonny?” The uniformed man gladly did.

Shortly after while checking into a Holiday Inn, the government employee was asked for identification although still adorned in uniform. He handed the woman ID proving his status. She picked it up with two fingers, slapped it back and said almost disgustedly, ”Don’t you have a driver’s license?”

Healthy Children Project’s Karin Cadwell, PhD, RN, FAAN, ANLC, IBCLC remembers these illustrations of former Surgeon General Charles Everett Koop (1982 to 1989.) Cadwell first knew Dr. Koop as a pediatric surgeon at Children’s Hospital of Philadelphia where she also worked.

Photo courtesy of Geisel School of Medicine at Dartmouth.
Photo courtesy of Geisel School of Medicine at Dartmouth.

Cadwell remembers Dr. Koop as “amazingly human,” hoisting luggage and harrassed for second forms of ID.

“He had a wonderful sense of humor,” she says. Although he held great status, he recognized that he was also an ordinary person.

Breastfeeding champion Dr. Ruth Lawrence attributes our government’s interest in infant nutrition to Dr. Koop’s initial work with breastfeeding, a not-so-ordinary accomplishment.

In 1984, Dr. Koop convened the first Workshop on Breastfeeding and Human Lactation. The workshop resulted in several important recommendations including:

As a result of the workshop, two follow-up reports describing breastfeeding promotion activities were released. You can read them here and here.

Dr. Koop established the first neonatal intensive care unit in the United States in the mid 50s. He also focused much of his work on infants born with congenital anomalies.

He recognized the importance of breastfeeding into toddlerhood and young childhood.

“It is the lucky child who still breastfeeds past two years old,” Dr. Koop is quoted on Best for Babes’ Facebook page.

Cadwell reaffirms that he cared passionately about babies and children.

“I think his religious beliefs influenced his passion for breastfeeding and wanting the best for mother and baby.”

Referring to him as a servant leader, Cadwell tells me she always felt that Dr. Koop’s work was in god’s service.

“You just knew that he had charisma,” she says. “There was something very noble about him. He was kind and powerful.”

While many refer to Dr. Koop as “America’s family doctor,” Cadwell says she thought of him more of an old fashioned practitioner.

“You could imagine him as a member of the community getting in his horse and buggy and sitting with a laboring woman or a dying person.”

Dr. Koop served under the Reagan administration in a politically conservative climate. But Dr. Koop’s agenda was less than conservative; he issued The Health Consequences of Smoking: Cancer: A Report of the Surgeon General, an account telling the dangers of tobacco use.

Later, he focused on creating dialogue around HIV/AIDS which “once again…upset the applecart by rejecting ideas such as quarantine and insisting that AIDS be treated as a medical and not a moral issue,” according to Geoff Watts of The Lancet.

While Cadwell doesn’t believe the political landscape directly affected the work Dr. Koop did around breastfeeding, she does describe some political barriers he was up against.

In his breastfeeding workshop, Dr. Koop managed to include enactments of the World Health Organization’s (WHO) International Code of Marketing Breast-milk Substitutes, which Cadwell says was “very political.”

She tells me President Reagan refused to sign the legislation after speaking with highly influential formula companies.

“Reagan’s point of view was to not regulate things,” she explains.

It wasn’t until 1994 President Clinton delegation voted for the World Health Assembly Resolution, “which reaffirmed the 1981 WHO Code and called for an end to free and subsidized breastmilk substitutes in all parts of the health care system,” according to the New Hampshire Department of Health and Human Service’s and the New Hampshire Breastfeeding Task Force’s New Hampshire Breastfeeding Resource Guide.

Furthermore, when the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) began, breastfeeding support wasn’t included in its financial plans. In the 1970s during the  initial writing of WIC, all of the funding was based on artificial baby milk provision.

Cadwell explains that the program was primarily created to combat anemia; with the amount of people using homemade baby formula, their children weren’t getting enough iron.

It wasn’t until nearly two decades later when a separate line item for breastfeeding was added to the program. Cadwell attributes this accomplishment to Dr. Koop bringing breastfeeding “into the light.”

“Unfortunately, Dr. Koop didn’t see the immediate results of his work,” she says. “But we have the benefit of the foundation he laid.”

Dr. Koop’s belief that we can make change and progress if we go about it in a thoughtful and caring way is something all lactation professionals can commit to.

Cadwell says she is inspired by his engagement of the entire community in the process of moving breastfeeding forward.

“It’s not something to be legislated or mandated,” she says. “You have to bring people along.”

Commendable contributions to the field of lactation

There are an estimated 300 billion stars in our galaxy. The collective twinkle of the thousands of stars visible to the human eye makes the night sky magnificent. But in a seemingly infinite galaxy, there are stars that always stand out. Polaris for example is famous for virtually standing still in the night sky. It serves as a celestial navigator in our endless sky.

Our Milky Way is made up of thousands of luminous stars working to promote, protect and support breastfeeding.  Like our night sky, the beauty of Our Milky Way is the collective, brilliant energy of all lactation professionals working toward a common goal. However, like Polaris our celestial guide, there are certain lactation professionals that serve to inspire upcoming lactation stars.

Dr. Naylor receives coin for her protection, promotion and support of breastfeeding at US Breastfeeding Committee meeting in August of 2010.
Dr. Naylor receives coin for her protection, promotion and support of breastfeeding at US Breastfeeding Committee meeting in August of 2010.

Dr. Audrey J. Naylor, MD is Clinical Professor of Pediatrics at the University of Vermont. Her distinguished career and humorist approach are both something to look up to.

While studying in San Diego, Naylor completed a clowning course with the local clown club.

“Somehow, when you get into clown make-up with a red nose it changes who you are!” she exclaims. “I have always carried a red nose with me. You never know when it will be useful.”

That clown nose is something remembered by lactivists everywhere, like Ryan Comfort of Milk for Thought.

With a lifetime interest in illness prevention, Naylor says she was quickly convinced of the power of breastfeeding after only attending a few hours of a breastfeeding seminar in 1976.

“Neither medical school nor pediatric residency taught me anything about breastfeeding,” Naylor says. Since then, Naylor has completed Healthy Children’s Certified Lactation Counselor training and agrees that there is always something more to learn.

On a mission to educate physicians and maternity care facilities around the world improve breastfeeding practice, Naylor and her colleague Ruth Wester founded Wellstart International in the 1980s.

In 15 years, Wellstart has educated 655 professionals from 55 countries including the U.S.

“They all did something significant,” Naylor says of the Wellstart Associates.

Stressing the importance of collaboration between professionals, Naylor explains that the Wellstart program’s design brings multidisciplinary teams of healthcare providers together including obstetricians, pediatricians, family practitioners, nurses, nurse midwives and nutritionists.

While collaboration isn’t always easy, it’s essential when it comes to serving mothers and babies.

Colonel Roseanne Warner, US Air Force presents Dr. Naylor with medal.
Colonel Roseanne Warner, US Air Force presents Dr. Naylor with medal.

Naylor offers this advice to beginning lactation professionals on how to work with medical clinicians in the care of breastfeeding moms and babies: “Know that the medical clinicians are very interested in the wellbeing of the patient,” she says. “Many know nothing about lactation and breastfeeding but can’t admit it.”

Naylor suggests staff review Wellstart International Self-Study Modules Level I. She says this approach does not offend the medical clinician’s lack of basic knowledge.

Through its trainings and other involvement in the medical community, Wellstart has “changed the care given to mother-baby pairs in hundreds of hospitals, modified curriculum in a significant number of professional training programs, contributed to hundreds of thousands of secondary training events and contributed to the global expertise regarding lactation management.” [Retrieved from:]

Naylor’s activity in many groundbreaking breastfeeding events is equally inspiring.

She was present at the Innocenti Declaration, a WHO/UNICEF policymakers’ meeting that declared specific actions to be taken to protect, promote and support breastfeeding around the world.

She attended the 1984 Surgeon General’s Workshop on Breastfeeding and Human Lactation which described several infant feeding recommendations for our nation and resulted in various breastfeeding promotion activities.

She was also involved in the founding of the United States Breastfeeding Committee. After conducting an intensive needs assessment of breastfeeding activities in the U.S., the National Alliance for Breastfeeding Advocacy (NABA) and Healthy Children Project convened to satisfy one of the four operational targets set by the Innocenti Declaration “to establish a multi-sectoral national breastfeeding committee composed of representatives from relevant government departments, non-governmental organizations, and health professional associations in every country.” [Retreived from:]

Service women from Aviano Air Force Base (a US base in Italy) who breastfeed exclusively for a specified time period also receive this coin for their commitment.
Service women from Aviano Air Force Base (a US base in Italy) who breastfeed exclusively for a specified time period also receive this coin for their commitment.

At the August 2010 meeting of the US Breastfeeding Committee, Colonel Roseanne Warner of the US Air Force awarded a coin to Dr. Naylor on behalf of Aviano Air Force Base in Italy in recognition of her ceaseless efforts to protect, promote and support of breastfeeding.

Among the many landmark events Naylor has been involved in, she’s unable to pinpoint one in which has influenced her most deeply.

“They have all had their place in the work that I have done,” she says.

New habits; achieving Baby-Friendly status through Best Fed Beginnings project

A while back I read this really cool New York Times article about creating new habits.

Author Janet Rae-Dupree writes, “…brain researchers have discovered that when we consciously develop new habits, we create parallel synaptic paths, and even entirely new brain cells, that can jump our trains of thought onto new, innovative tracks.”

Because habits often carry negative connotations, like fingernail biting, junk food eating and arriving late, this is such a revolutionary way to think about routine.

Rae-Dupree continues, “the more new things we try — the more we step outside our comfort zone — the more inherently creative we become, both in the workplace and in our personal lives.”

New habits may have proven positive results, but the process of creating them isn’t always so easy.

The National Initiative for Children’s Healthcare Quality (NICHQ) recently released Working Toward Baby-Friendly: Improving Breastfeeding Support in US Hospitals, a video that follows the stories of four hospitals work to achieve Baby-Friendly status through NICHQ’s Best Fed Beginnings quality improvement project.

Find the video below at or


The Best Fed Beginnings project launched in June 2012. NICHQ recruited 89 hospitals through an application process to participate in a 22 month learning collaborative to improve breastfeeding support in U.S. hospitals through Baby-Friendly designation.

The video highlights hospitals working through the challenges of creating new habits-system-level changes to maternity care practices.

For instance, Missouri’s Barnes-Jewish Hospital strives for more patient-centered care in a large facility, New Mexico’s Presbyterian Hospital works to increase skin-to-skin contact even after c-sections, Delaware’s Christiana Hospital focuses on staff buy-in and the University of Alabama at Birmingham Hospital engages its community by changing misconceptions about breastfeeding. [Retrieved from:]

(NICHQ makes sure to disclaim that because the hospitals were filmed during the process of becoming Baby-Friendly, some of the video’s images do not represent Baby-Friendly standards.)

Although creating change is difficult at times, staff members report excitement about their involvement in the project. They also report extremely positive patient satisfaction.

“We hope it will inspire and motivate other hospitals to take on this work,” NICHQ’s Senior Director of Marketing and Communications Jonathan Small says of the video.

Best Fed Beginnings emphasizes a collaborative approach that staff members also appreciate.

Small calls it all teach, all learn.

“This is hard work and it’s good to know you are not alone,” he says.  “…Everyone can learn from the successes and failures of all participants.  This accelerates the learning exponentially.”

Because a major concern of hospitals working toward Baby-Friendly designation is staff training, NICHQ offers many options which include:

  • working with staff lactation specialists to conduct the training

  • working with local/state public health departments that offer lactation courses

  • and offering CE credits or the equivalent for physicians to get the required hours of training.

Participating staff members also express concern about disinterested employees. Small says that this is where leadership comes in.

“All affected staff members need to understand the reason for the change and why it’s ultimately beneficial to the patient,” he says.  “It’s about everyone having a shared vision.  Change is hard, but it becomes much easier when there’s a clear benefit to the patient.”

In fact, Small says that NICHQ has pioneered this idea of engaging patients and families on the collaborative team.

“Their first-hand experiences and unique perspectives completely change the conversations on these teams and their contributions to improvement work are invaluable,” he explains. For more information about this approach visit:

Through the course of the project, participating hospitals collect process and outcome measures.  Process measures track the implementation of the steps involved (such as the percent of infants rooming in or the percent of mothers given formula samples).  Outcome measures follow the success of the ultimate goals (such as the percent of infants fed only breast milk), Small explains.

While the collaborative is scheduled to conclude in March 2014, Small says there will be an effort to continue the program.

“The general approach is that the “graduates” of a learning collaborative become expert resources and sometimes faculty for subsequent efforts,” he says. “So their experience becomes expertise for spreading the lessons learned.”

For more information about Best Fed Beginnings, please visit:

To learn more about the Baby Friendly Hospital Initiative, visit:

To Our Milky Way Readers,

Please take a moment to review the changes made to “Children’s hospital changes breastfeeding culture” posted on April 14, 2013 as well as comments left by our readers.

The article is based on an interview with Elizabeth Froh, PhD(c), MS, RN focusing on the work and research she is involved in as a N/IICU staff nurse at the Children’s Hospital of Philadelphia (CHOP) as well as her research as a doctoral candidate.

The original post spotlighted Dr. Diane Spatz, PhD, RN-BC, FAAN as being mainly responsible for the breastfeeding culture shift at CHOP when she was hired as head of the hospital’s lactation program 12 years ago.

While Dr. Spatz’s work is undeniably significant, the post did not adequately celebrate the work of the collaborative team including nurses, physicians, researchers, administrators and other health care professionals that have made CHOP’s lactation programs successful.

My intention in writing the post was certainly not to insult. I would like to offer my sincere apologies to anyone who was offended by the original post and I hope that the changes made to the article better reflect the collaborative approach that was and is so important to making changes for our breastfeeding moms and babies.

Our Milky Way welcomes any further comments or concerns you may have about this post or previous ones.

Your time and readership are greatly appreciated.