Increasing Exclusive Breastfeeding Rates in a Predominantly African-American Patient Population

INCREASING EXCLUSIVE BREAST FEEDING RATES IN A PREDOMINANTLY AFRICAN AMERICAN PATIENT POPULATION                                                                                      

Background: Exclusive breastfeeding provides infants with ideal nutrition as well as optimal health and developmental outcomes.  Human milk protects children from certain illness and childhood conditions.  Research demonstrates that breastfed infants are at lower risk for Sudden Infant Death Syndrome (SIDS), gastrointestinal infections, respiratory illnesses, ear infections, allergies, childhood obesity and diabetes.   African American babies consistently have lower breastfeeding rates from birth to a year old compared to White and Hispanic babies (Centers for Disease Control, 2013). The CDC identified that African American women are the least likely to have the support network to breastfeed and have identified that hospitals in neighborhoods with mostly African American residents do less to promote breastfeeding than those in areas with more White residents.  To increase breastfeeding rates, one must increase community awareness of the benefits of human milk and the importance of family support of the breastfeeding mom. Developing hospital routines and policies that support the breastfeeding mom and infant bonding will facilitate an increase in breastfeeding rates.

Aim:  Through the Maternal Child Health Nurse Leadership Academy (MCH) sponsored by Sigma Theta Tau International and Johnson & Johnson I embarked on an 18 month leadership journey that included a triad of faulty mentor, leadership mentor and fellow.  By utilizing the support, expertise, and practical wisdom of my faulty mentor, Diane Spatz, PhD, RN-BC, FAAN, my leadership mentor, Florence Jones, DNP, RN, NEA-BC, FACHE and the following the Kouzes and Posner approach to leadership I was able to reenergize my leadership with new knowledge and skills. This leadership journey through MCH has centered on becoming successful in leading a change team by recognizing strengths and weaknesses and cultivating decision-making capabilities. In our exclusive breastfeeding project our team’s aim was to increase exclusive breastfeeding rates in a predominately African American patient population. The goal was to increase exclusive breastfeeding rates from 4% to 15% by September 2015. 

Methods:  A two-step approach was used to educate, encourage and support this clientele with breastfeeding. The first step to meeting the goal was to provide awareness and education to childbearing women and their supporting families on the benefits and importance of human milk. Newborn admission processes after vaginal deliveries were modified to minimize separation of the mother and infant allowing time for the promotion of skin to skin and the initiation of breastfeeding in the first hour of life.

Results:  Community activities included two focus groups with 6 pregnant women in the community to understand cultural barriers that impact their success. Our team participated in two community health fairs, which focused on family and family support of breastfeeding women and one health fair at a community college in which the emphases was on the benefits of breastfeeding. We had three appearances, August 2014, February 2015 and April 2015 on two different local radio talk shows with an estimated listening audience of 75,000 to100,000 families. We set up informational booths at a local mall, apartment complex, and physician office in which 200 pieces of educational literature was distributed.  We spoke to 34 different women individually about the benefits of breastfeeding at these locations.  The second step focused on the hospital setting. At the beginning of the project a 4 hour mandatory class was completed by 47 RNs and 9 obstetrical technicians to ensure that they had the knowledge and resources to encourage and support mothers who wished to exclusively breastfeed.

Observing 411 new mothers from July 2014 through December 2014 exclusive breastfeeding rates ranged from 9% to 16% with an average of 13.4%. In the next 5 months from January 2015 to May 2015 observing 332 new mothers, exclusive breast feeding rates ranged from 0% to 13% with an average of 9.2%.  The overall average for the 9 month period from July 2014 to May 2015 was 11.2%. In trying to determine a possible reason for the decrease in exclusive breast feeding rates, mode of delivery was examined for the two time periods. There was an average of 18.3 cesarean sections per month in the first time period, July 2014 to December 2014 which accounted for 26% of the total deliveries. In the second time period, January 2015 to May 2015 there was an average of 20.2 cesarean sections per month which accounted for 29.7% of the total deliveries. There was a 10% increase in cesarean rates in the second time period. Not having well established processes for decreasing separation of mother and infant after surgical deliveries impacted our ability to promote skin to skin and the initiation of breastfeeding in the first hour of life. This could explain the decrease in exclusive breastfeeding rates during the second period.

Conclusion:  Changing community culture through education on the benefits of human milk combined with shaping our hospital culture to decrease separation of mother and infant after delivery will help us reach our goal of increasing exclusive breastfeeding rates to 15% by September of 2015.