While many health care professionals deem breast milk as the “perfect first food,” a number of medical and social barriers contribute to the United States’ astoundingly low breastfeeding rates.

According to the Center for Disease Control’s (CDC) Breastfeeding Report Card 2010, only 13.3 percent of babies born in the United States are exclusively breastfed for six months as recommended by the World Health Organization (WHO) and the American Pediatric Association (APA).  The United States trails behind Canada, the Netherlands and Norway.

Dr. Paula Schreck and Kim Ronnisch at St. John’s Hospital are working to breakdown those barriers in Detroit.

As medical director of St. John Hospital and Medical Center's breastfeeding support services and practicing pediatrician, Dr. Paula Schreck understands firsthand the effects proper nutrition and care have on a child’s long-term health and well-being. Dr. Schreck, along with Kim Ronnisch, registered nurse and Women’s Services clinical practice manager, is leading a major initiative at St. John to address the multitude of breastfeeding barriers that metro Detroit mothers face.

“It’s rewarding to know we’re working to make a lifelong impact on a child’s health,” said Ronnisch.  “We know there is a huge disparity in breastfeeding rates among our privately insured patients and low income families (with little to no health care). We have to recognize that challenge and work to close the gap, so that every child has the chance for optimal health.”

Nurturing the Problem

“We’re working to change the culture of nursing in our community and within our hospital to increase breastfeeding rates and provide an optimal breastfeeding environment for babies and moms,” Ronnisch said.

The results of their efforts are apparent as more than 60 percent of moms who have received support through St. John’s Hospital Women’s Support Services programs subsequently attempt to breastfeed their newborn.

Although Schreck, Ronnisch and the entire Women’s Services team have made tremendous strides, they want to do more to increase breastfeeding rates, exclusivity and duration among metro Detroit moms.

The heartbreaking facts show that for every 1,000 Michigan live births, approximately eight infants die before reaching their first birthday. And in Detroit, 166 infants under the age of one year, resulting in an infant mortality rate of 14.8 per 1,000 live births as stated in a report by the Michigan Department of Community Health (MDCH). The startling Detroit statistics double the average Michigan infant mortality rate and are higher than those in some developing nations.

 “One of the factors that contribute [to high infant mortality rate in Detroit] is the very low breastfeeding rates in the vulnerable, low income population,” says Dr. Schreck. “We would like to bring our breastfeeding rate up to at least the [national] Healthy People 2010 parameters, which is 75 percent. And, we want to close the socioeconomic and racial disparities that exist.”

Healthy People 2010 is a U.S. Department of Health and Human Services initiative that promotes breastfeeding as one of many ways to improve Americans’ health.  The program includes objectives to increase the number of mothers who breastfeed at early postpartum, six months and 12 months. For 2010, the target rates for mothers who breastfeed are 75 percent at early postpartum, 50 percent at six months, and 25 percent at 12 months.

“Breast milk is the first and best preventative medicine,” Schreck said. “It not only improves the health of the child but also the mother. For the baby, it’s the optimal nutrition. It decreases infant mortality by decreasing infections as serious as meningitis and as simple as ear infections. It also decreases Sudden Infant Death Syndrome (SIDS) and the lifetime risk of obesity, hypertension, asthma, allergy, diabetes among other things.”

Other factors that may explain why children in Detroit, and especially African-American children, face extraordinarily high levels of infant mortality are inadequate prenatal care, high rates of teen pregnancy, delayed immunizations and inadequate screening for lead levels.

“Education is the key,” said Ronnisch. “Support is important, too, because when mothers have the information and support, they often choose to breastfeed.”

Steps Toward Michigan’s First Baby-Friendly Hospital

In an effort to expand services, St. John Hospital and Medical Center made a commitment in April 2010 to pursue the Baby-Friendly Hospital Designation, a prestigious status created in 1991 by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) as part of their global Baby-Friendly Hospital Initiative (BFHI). BFHI was launched to implement practices that protect, promote and support breastfeeding worldwide.

Knowing St. John Hospital Women’s Support Services’ commitment to metro Detroit women and children, and the hospital’s mission to achieve a Baby-Friendly Hospital Designation, W. K. Kellogg Foundation reached out to support this shared vision and expand St. John’s breastfeeding support services.

 “It was clear when we met with the Kellogg Foundation that they were also dedicated to changing breastfeeding perceptions in the community for the betterment of moms and babies,” says Schreck.

“Working with the Kellogg Foundation, we realized our responsibility to our community to educate, establish a breastfeeding culture and build the support of breastfeeding services that extend way beyond our hospital walls,” said Ronnisch.

And the new St. John Mother Nurture Project’s aim is to do just that.

The St. John Mother Nurture Project is a three-year initiative that aids St. John Hospital and Medical Center in achieving the Baby Friendly designation, which would make it one of the first hospitals in the state to achieve this prestigious accreditation. The Project will equip mothers with the knowledge, optimal clinical and community support needed to increase the likelihood they will breastfeed. The three-year project, supported by a 1.2 million dollar Kellogg Foundation grant also includes the creation or expansion of three other programs: 

• St. John Obstetrics Clinic: Lactation consultants from Breastfeeding Support Services will be present in St. John obstetrics Clinic for a total of eight hours a week to provide counseling and pro-breastfeeding support.
• St. John Mother Nurture Club: St. John Breastfeeding Support Services set to open in October 2011, will create and sponsor a weekly post-delivery breastfeeding support group using the breastfeeding peer counselor model.
• Neonatal Intensive Care Unit (NICU) Follow-up Clinic: All NICU graduates receiving human milk will be seen in follow-up in the grant-sponsored NICU Breastfeeding Follow-up Clinic. To facilitate increased human milk use in the NICU the NICU lactation coverage will be expanded to five days a week.

 While success at the end of the three-year project will be measure in overall percentages and outcome, Dr. Schreck finds reward one mother at a time.

“Seeing pride in a mother’s eye when we help her successfully breastfeed her baby, and knowing the benefits of that, is amazing.”