What makes a hospital ‘baby-friendly’?

Gone are the days when you’d stand at a window and gaze at 15 babies lined up in bassinets in a hospital nursery. Nurseries for healthy babies are disappearing from hospitals across the country, including ours.  

Instead, moms and babies now stay together in the same room 24/7. The main driver behind this trend is the Baby-Friendly Hospital Initiative (BFHI). There are plenty of benefits to this program, but the main one is that it promotes breastfeeding.  

We were proud to receive this prestigious designation in June 2017 after spending the past couple years implementing new policies, curriculum, action plans and training, as well as completing a rigorous on-site assessment.

In fact, Baby-Friendly designation is more than a 'seal of approval.' It requires extensive engagement and education of the staff. We had more than 200 nurses in our Labor and Delivery, Mother/Baby and Infants’ Services units who received extensive additional lactation training.

What’s a Baby-Friendly hospital?

The World Health Organization and United Nations Children’s Fund launched the Baby-Friendly Hospital Initiative in 1991 to encourage hospitals to create environments that promote mother/baby bonding and support women who choose to breastfeed.  

Facilities that achieve the Baby-Friendly designation have successfully implemented the 10 steps to successful breastfeeding, which include:

  • Have a written breastfeeding policy that is routinely communicated to all health care staff.
  • Inform all pregnant women about the benefits and management of breastfeeding.
  • Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  • Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  • Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.  

Many healthcare organizations have endorsed these steps, including the American College of Obstetricians and Gynecologists, American Academy of Pediatrics and U.S. Preventive Services Task Force. Over the past two years, this philosophy has become a part of our culture and what we do. 

"Promoting mother/baby bonding and breastfeeding is part of our culture." via @MedStarWHC

What we did to become a Baby-Friendly hospital

As we examined our longstanding policies and procedures over the past few years, we identified three areas in particular that we could adjust to better encourage successful breastfeeding: nursery, formula and pacifiers.

Nursery

In the past, when mom wasn’t feeding her baby, the baby was in the nursery. This proved to be a barrier to breastfeeding.

We used to encourage feeding every three to four hours. Now, we promote breastfeeding on cue. In general, moms are feeding their newborns eight to nine times a day. Having the baby in the room with you 24/7 facilitates easier breastfeeding and helps mothers learn their baby’s feeding cues. If separated, mothers have a harder time learning to identify the early signs the baby is ready to nurse.

“Rooming in helps moms learn their baby’s feeding cues and make it easier to breastfeed." via @MedStarWHC

Some women ask us, “I have two toddlers at home and I just want to get some sleep before I go home. Can the baby go to the nursery?” In these cases, we gently tell mom that we can’t take the baby to the nursery. We explain the benefits of sleeping when the baby sleeps. We also recommend asking a family member to stay and help so mom can get some sleep.  

We make sure to talk to our moms before they have their babies about what to expect and explain why we do what we do.  

We haven’t gotten rid of the nursery altogether. Some newborns need additional monitoring, but not the advanced care given in the neonatal intensive care unit (NICU). In those cases, they may spend time in the nursery. We also may do some exams or minor procedures in the nursery, but many exams are done right in the room so we don’t have to separate mom and baby.  

Formula

It used to be routine for a nurse to say, “Mom is sleeping and I don’t want to wake her, so I’ll give her baby a bottle.” We don’t do that anymore.  

We don’t use formula unless mom requests it or there is an issue with the baby’s or mom’s health. If you don’t want to breastfeed, we may ask you why to address any concerns you may have. We want you to understand your options and the benefits of breastfeeding. However, if you choose not to breastfeed, we will respect your decision.  

Pacifiers

Artificial nipples such as pacifiers can interfere with breastfeeding, so we no longer use them in the hospital. Latching and sucking on a pacifier is different than sucking on a breast. We don’t want to confuse baby in the first few days of learning to breastfeed.  

You tell us: What Baby-Friendly elements did you enjoy at your hospital, or what would you like to see in the future? Connect with us through Facebook and Twitter.  

The benefits of breastfeeding

We made these changes because we know that breastfeeding has great benefits for the health of baby and mom.  

Research has shown that breastmilk:

  • Provides an optimal mix of nutrients
  • Contains antibodies that protect newborns from certain illnesses
  • Is easier to digest than formula
  • Lowers the risk of sudden infant death syndrome (SIDS)

Breastfeeding also makes it easier for mom to lose the weight gained during pregnancy and may reduce her risk of breast cancer and ovarian cancer.

Learn about what to expect when breastfeeding, common problems and concerns, tips for successful breastfeeding and how to avoid sore nipples by registering for one of our breastfeeding classes.  

Breastfeeding is not always easy. But by providing an environment that facilitates and supports breastfeeding immediately after birth, we hope to help you achieve your goal.   

How many people should be in the delivery room?

Most of the time, welcoming a life is a beautiful, amazing moment. I understand the urge to want to share that with family and friends, and we’re good about accommodating delivery room guests. But I’ve had expecting moms ask if they can have upwards of 10 people in the delivery room with them.  

I’ve seen women invite parents, in-laws, siblings, aunts, cousins and best friends. I guess their thought is the more the merrier.  

Before you gather a support squad to witness your baby’s debut, consider these tips and safety guidelines for the delivery room.  

Check your hospital’s delivery room policy  

Every hospital has its own rules about how many people are allowed in the delivery room. Many only allow two or three people to be with mom. You may want to double check if your partner and doula count in that number. Some hospitals allow a certain number of people to be in the room during labor, but fewer during the actual delivery.  

We allow up to seven people to be on the guest list, but only five people to be in the room at any time during labor and delivery. Our rooms are pretty large, so while five people can be a tight fit, it’s doable. Hopefully everyone likes each other! We do ask everyone to step out of the room during exams and the epidural.  

If you want your older child to see the birth of their new baby brother or sister, ask for your hospital’s policy about allowing children in the room. We allow children in the room as long as there is an adult other than the expecting mother present to take care of them.  

Talk to your doctor, midwife and nurses about what they expect from your visitors, and listen to what they say. They’re thinking of your comfort and safety. We want to be able to deliver the safest care possible while you are able to have your loved ones close.  

Cesarean sections, however, are a whole other story. Most hospitals, including ours, allow only one person in the operating room with you. The rest of your family can stay in your room or the waiting room. We’ll keep them updated on what’s happening. 

"We allow up to 5 guests in the delivery room for most births." via @MedStarWHC

Prepare your loved ones for labor and delivery

The day you give birth is one of the most important days of your life. Think carefully about who you want to share it with. If you’re concerned that your mother-in-law or another family member will add tension, don’t invite them. Feel free to blame it on the doctor’s policy!  

Once you’ve decided who you want in the room, lay down the ground rules. Don’t be shy about expressing what you’re comfortable with. Do you want everyone near the head of the bed, or are you fine with some people getting an up-close look at the “miracle of life”? Do you want everyone there during labor, but only your partner present during and immediately after the birth?  

It’s also a good idea to give everyone a rundown of your birth plan. This way, they’re not questioning your decisions on the big day.  

Ask your doctor or midwife about any rules your loved ones need to know about. For example, when we roll in the delivery cart, it will be covered with a blue sterile sheet. We’ll ask everyone in the room to stay back and not touch anything blue. We find most people intuitively know when to get out of the way, but it never hurts to give a warning.  

If at any point during labor and delivery you change your mind and want everyone to leave, just tell us. Don’t worry about hurting anyone’s feelings; we’re happy to take the blame and do it for you.    

Keep your loved ones safe in the delivery room

I’ve had the biggest of the biggest men pass out and hit the floor during delivery. It may sound funny, but it can be serious. I’ve seen one dad pass out during delivery and need to go to the emergency room. Another family member had a cardiac event.  

I’ve gotten into the habit of quickly scanning the delivery room to make sure everyone looks OK. I usually can tell if they’re feeling hesitant or beginning to sweat. I’ll prop a chair next to them and tell them to sit down if they need to.  

I tell delivery room guests there’s no shame in the game; I’ve had pro football players hit the ground! Hearing this usually makes people chuckle and feel more at ease about needing to sit down.  

Set rules for after birth

Think about who you want in the room after you give birth. Those first few hours of bonding are precious, and you’ll likely be exhausted. Are you going to feel up to entertaining?

I know everyone is excited to meet the new baby, but they can wait. Tell your partner and healthcare team if you don’t want visitors, or if you only want specific people to visit. Let them be the enforcers!

Childbirth is one of the most important stops along the journey of motherhood. It’s up to you whether you want it to be a private experience between you and your partner or a more public event surrounded by family and friends. Neither choice is wrong. But a little planning will allow you to focus on what matters most: welcoming your new family member. 

3 questions to ask before downloading a pregnancy app

If you Google “pregnancy apps,” there’s no shortage of articles with titles such as “10 best pregnancy apps” or “Must-have apps during pregnancy.” According to a 2015 study, 7 percent of the 165,000 available health-related apps were related to women’s health and pregnancy. That’s more than 11,000 apps!

And we’re just seeing the tip of the iceberg in healthcare apps’ potential. As more healthcare providers begin to use apps in their practices, as we do in ours, women will begin to expect and demand them. As that happens, we’ll begin to see more high-quality apps that provide better, more accurate information.

"We’re just seeing the tip of the iceberg in healthcare apps’ potential." #digitalhealth via @MedStarWHC

There’s no doubt about it: Pregnancy apps are here to stay. This means healthcare providers need to stay up-to-date on quality apps, and women need to talk with their doctors and be savvy about which apps provide accurate information and which are just for fun.

Tips to choose pregnancy and fertility apps

Simple pregnancy apps send you notifications about your baby’s growth week by week or help you choose a baby name. More complex apps offer help with listening to your baby’s heartbeat or timing your contractions. Before you download an app, ask yourself these three questions:

1. Who developed the app?

There are apps that let you listen to your baby’s heartbeat – if they’re used in conjunction with a home Doppler. But if the app claims that all you need to do is put your phone against your belly and listen, don’t believe it. If you put the phone on your desk, you’ll likely hear the same sound!

This is why it’s important to look at who developed the app. Was a reputable healthcare source involved? For example, the American Congress of Obstetricians and Gynecologists (ACOG) launched an estimated due date calculator in January 2016. Unlike due date calculators from non-healthcare organizations, this one takes more into account than the first day of your last period.

You wouldn’t go to someone other than your doctor or midwife for pregnancy treatment, so don’t rely on health advice from a non-medical group’s app. And if an app promises to do something that seems impossible, like letting you listen to your baby’s heartbeat, ask your doctor first!

2. How accurate is the app?

A study published in the July 2016 issue of Obstetrics & Gynecology looked at 33 fertility calculator apps and found that only three accurately predicted a woman’s “fertile window.”

If you’re using one of these apps to help you conceive – or avoid getting pregnant – that’s a problem. Fertility is not as simple as these apps would lead you to believe. For one thing, not everyone’s menstrual cycle is the same, so you may not ovulate as consistently as the app’s algorithms would lead you to believe.

Even apps that track babies’ benchmarks week by week may not be entirely accurate. Three apps could tell you three different things about how big your baby is and which organs are forming in a particular week. Was a healthcare professional involved in creating one of them? If so, that one is more likely to be accurate. But don’t forget that your baby may not follow those growth timelines exactly.

3. What’s the privacy policy?

You wouldn’t give out your personal health information to just anyone. But that’s what you may be doing when you download and use some pregnancy apps.

Before you download a health app, read the disclaimer so you understand what it will do with your information, including whether it will be shared with third-party sites.

"Before you download a health app, read the disclaimer so you know who will see your health information." via @MedStarWHC

Which pregnancy apps did you find reliable and useful during your pregnancy? Connect with us through Facebook and Twitter.

The pregnancy app we use

We use the Babyscripts app to help us monitor our low-risk pregnant patients between appointments.

Women who participate receive a Bluetooth-enabled blood pressure cuff and weight scale. When they take their blood pressure and weigh in, the information is sent to their doctor or midwife. Abnormal results trigger an alert for the doctor, who can then request that you come in.

Some MedStar practices have been using this app for about a year and a half, and we’re seeing good results. In fact, we had one patient whose high blood pressure reading led her doctor to ask her to come in. When she did, we discovered she had preeclampsia, a potentially dangerous complication. Had the app not alerted her doctor to the blood pressure reading, it’s possible the condition may not have been diagnosed until it was advanced.

The other nice thing about this app is that it can be tailored to each practice. For example, if I recommend my patients not travel after 29 weeks, I can put it in the app. Women have told me that it makes them feel like they have a doctor in their pocket.

Not all healthcare apps are the “digital snake oil” some have been made out to be. But we do need to proceed with caution. And the medical community is beginning to work more closely with patients to do that. For instance, the American Medical Association in November 2016 approved principles to promote the use of safe, effective healthcare apps.

If you’re looking for a fun way to pick a name for your baby, go ahead and download that app. But if you’re looking for more in-depth pregnancy information or advice, talk to your doctor or midwife first. They may have their own app for that!

 

Not your mom’s IUD: Renewed focus on LARCs

I often speak with women who are curious – and sometimes apprehensive – about birth control. This gives me the opportunity to clear up misconceptions about various contraceptive methods, especially because I’ve found that many women have ideas about these contraceptives that don’t match today’s reality.

I see many women in Washington, D.C., who have demanding careers and busy lives. The last thing on their minds is having a baby. That isn’t to say they never want to have children, but they certainly want to have control over when that happens.

These women might be missing out on birth control options that would work great for their lifestyle simply because they don’t have all the facts or even know that these options exist.  

Which is more effective: birth control pills or an intrauterine device (IUD)?

The answer is a bit tricky. In theory, the birth control pill can be just as effective as the IUD: preventing pregnancy more than 99 percent of the time. But you need to take the pill every day, at the same time each day, and every missed dose reduces its effectiveness. The “typical” effectiveness of the pill – or how effective it is during measured, actual use that accounts for incorrect and inconsistent doses – is only 91 percent.

Things come up. Life happens. You forget to pack your pills before leaving on a trip or become overwhelmed with school or work and forget to take them. Regardless of the reason, many women find it a hassle to stick to the birth control pill. Unfortunately, not enough women know enough about their options – or even know they have options beyond the pill and condoms.

Benefits of long-acting reversible contraception

Long-acting reversible contraception (LARC) refers to birth control methods that are inserted, implanted or injected into the body and don’t require a woman to actively manage her contraception. LARCs can block pregnancy for extended periods of time – up to 10 years depending on the method.

LARCs include:

  • IUDs: Intrauterine devices are inserted into the uterus and can prevent pregnancy for up to 10 years. Your doctor can insert the IUD right in their office. There’s no need for an operating room. There are two types: a hormonal IUD and a copper IUD, which does not contain hormones.   
  • Birth control implants: Implants such as Nexplanon consist of a rod inserted under the skin of the arm that periodically releases hormones to prevent pregnancy. They last up to three years.
  • Injections: Contraceptive injections such as Depo-Provera contain the hormone progestogen and last up to three months.

The great thing about LARCs is that using them “perfectly” is effortless. Once the device is inserted, it prevents pregnancy with no further work on your part.

“Using long-acting reversible #contraception ‘perfectly’ requires no additional effort from the woman." via @MWHC

As the “reversible” part of the name suggests, these devices are not permanent. If you want to become pregnant, we’ll simply remove the LARC and your fertility will return almost immediately. 

Clearing up the misconceptions about IUDs

 

copper IUD

As I mentioned earlier, I hear a lot of misconceptions about different kinds of birth control, and particularly IUDs. IUD use became more widespread in the mid-20th century, but they have changed dramatically since then, particularly in two ways:

Safety: You may have heard from your grandmother or mother that IUDs are not safe. This is mostly because of the Dalkon Shield, which was commonly used in the 1970s and resulted in serious complications, even death, for the women who used it. Today’s IUDs are much safer, and serious side effects are rare.

Who can use them: In the past, IUDs were only recommended for women who had already given birth. Today, they can be used in women as young as 16 and through the perimenopausal years.

IUDs are a safe, effective method of birth control for nearly all women. I’m glad to see this reality reflected in the number of women who are choosing to use an IUD.

In 1995, just .8 percent of women on birth control used an IUD for contraception. By 2012, that number had grown to 10.3 percent, or nearly 4 million women. That’s almost a 1,200 percent increase!

"The percentage of women using an IUD for birth control has grown almost 1,200% since 1995." via @MedStarWHC

The birth control pill is still the most popular contraceptive method, but it’s encouraging to see more women realize they have other options available. In fact, I prescribe fewer prescriptions for oral contraceptives and insert more LARCs every year.

Discuss your birth control options, including LARCs, with your Ob/Gyn during your annual exam. Generally speaking, LARCs are a great option for women who don’t want to get pregnant for three years or longer. However, as with any contraceptive method, there can be side effects, so make sure you understand the possible complications.

I’m thrilled to see LARCs find a renewed place and purpose in women’s reproductive care. In the future, I hope to see even more outreach in traditionally underserved communities so that more women have the opportunity to access these safe, effective and long-lasting contraceptives.

Request an appointment to discuss your birth control options with a gynecologist.

2 reasons we’re seeing more high-risk pregnancies in D.C.

We care for about 3,500 pregnant women every year. While that number has remained fairly steady over the past decade, the number of those women with high-risk pregnancies increases every year.  

Because “high-risk pregnancy” is a catch-all term that includes factors such as age and chronic health problems, it can be difficult to determine exactly how many of these women there are. But my colleagues and I can tell you that we’re treating more women who fall into this category than ever before.  

The most severe pregnancy complications – such as eclampsia, heart failure and hemorrhage – are referred to as severe maternal morbidity. The Centers for Disease Control and Prevention reports that the severe maternal morbidity rate has more than doubled from 2000 to 2010, and now affects 650,000 women in the United States every year.  

Many factors contribute to this increase, but the two we see most often in the District of Columbia are obesity and advanced maternal age. 

1. How obesity can complicate pregnancy  

Nearly one in four U.S. women was considered obese when they became pregnant in 2014. While the rate of pre-pregnancy obesity in D.C. was lower than the national average at about one in five women, we still feel the effects of this epidemic.

 Obesity is defined as having a body mass index greater than 29.9, and it can increase the risk of problems during pregnancy, including:

  • Birth defects
  • Gestational diabetes
  • Preeclampsia
  • Preterm birth or stillbirth  

Excess body fat also can make it difficult to analyze an ultrasound and monitor fetal heart rate.  

Obesity also increase a person’s risk for health problems such as diabetes, high blood pressure and heart conditions. Our patients are not nearly as healthy going into pregnancy as they once were. I commonly find myself caring for patients with a condition that requires me to collaborate with a specialist such as a cardiologist.  

The number one thing you can do to decrease the risk of obesity-related pregnancy complications is to lose weight before you become pregnant. Talk with your doctor about lifestyle changes you can make to reach a healthier weight.  

Also, talk to your Ob/Gyn or a maternal-fetal medicine specialist before you become pregnant about what to expect if you have a heart condition or another chronic health problem such as obesity. 

2. More D.C. women delaying pregnancy until 35 or older

Not even 15 years ago, I would have exclaimed, “Whoa! You have a 45-year-old patient who’s pregnant?” These days, we don’t blink an eye at a pregnant woman in her 40s.  

The District of Columbia is somewhat unique in that we have more professional women who delay having children until they are older.  

  • The birth rate for D.C. women age 35 to 39 was 72.7 births per 1,000 women in 2015, compared with 51.8 nationwide.
  • The birth rate for D.C. women age 40-44 was 21.8 births per 1,000 women in 2015, compared with 11 nationwide.
  • The birth rate for D.C. women age 45-49 was 2.5 births per 1,000 women in 2015, compared with 0.8 nationwide.  

It’s wonderful to have the option to wait to have children until you’re in your late 30s and early 40s. However, it does increase certain risks for mom and baby, including:

  • Birth defects
  • Gestational diabetes
  • High blood pressure  
  • Miscarriage
  • Premature birth  

We may recommend additional testing and screening if you are 35 and older to detect certain birth defects. The best thing you can do if you’re 35 or older and want to get pregnant is to talk with your Ob/Gyn about your specific risk factors and how to go into pregnancy as healthy as possible. 

Reduce and manage pregnancy risks

Obesity and advanced maternal age are just two factors for the increase in high-risk pregnancies. Thanks to advances in science, we’re also caring for more women who are having multiples (twins or more), have had organ transplants or are cancer survivors. We also see a number of pregnant women who have HIV.  

With proper preparation, we’re better able to manage the increased risks of these health factors. Request an appointment with an Ob/Gyn or maternal-fetal medicine specialist to discuss your unique challenges. The doctor can help you prepare for pregnancy and manage your and your baby’s health during pregnancy, labor and delivery.  

Don’t be afraid to ask your doctor questions. These can include:

  • How can I get healthier before I become pregnant?
  • What type of prenatal testing will be done?
  • Should I stop or adjust my medications?
  • Will I need extra ultrasounds to monitor my baby’s health?
  • Will I need additional prenatal appointments?  

We may care for high-risk pregnancies more often, but each pregnancy is different and comes with its own challenges. We want the same thing for every woman: to go home with a healthy baby.