Abstract
The weakest link in the Ten Steps has always been #10, which addresses follow-up and community support once the mother leaves the hospital, where she usually spends 48 hours or less. General trends and specific efforts like the campaign of the U.S. Department of Health and Human Services and the Ad Council that generated the slogan “Babies Were Born to Breastfeed” have increased the initiation rates of breastfeeding in hospitals in the last decade, but the rate of continued breastfeeding following the hospital discharge has continued to be abysmal. The Joint Commission's action should ensure continued high initiation rates. A substantive investment of funds needs to be made in follow-up resources available in the community, and not in further hospital efforts. There are several services already in the community that need substantial budget increases to help meet the needs of these mothers. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has made a major philosophical adjustment and now aggressively supports breastfeeding dyads as a matter of policy. WIC is minimizing its investment in free formula. Peer-support counselor programs established by WIC are spreading. The initiative needs money. These peer counselors should be paid for their work and recognized and respected for their invaluable contributions. WIC children are among the most vulnerable in our population and will benefit dramatically from being breastfed. WIC mothers are burdened with many socioeconomic crosses; they too will benefit by breastfeeding. The longer the breastfeeding experience the better.
The American Academy of Pediatrics joins WHO and UNICEF in recommending exclusively breastfeeding for the first 6 months and continued breastfeeding while adding weaning foods for the first year and then as long thereafter as the mother and infant wish. 2 Without a strong personal social structure, women cannot survive the stresses of the first few weeks postpartum at home without help. Other community programs include local organizations, which need budget line items to hire lactation consultants (International Board Certified Lactation Consultants) and peer counselors. This is another area in need of support from the Maternal and Child Health Bureau and the Centers for Disease Control and Prevention: healthcare-based clinics need support to hire lactation-dedicated staff adequately trained and certified to support the breastfeeding dyad.
This mandate by the Joint Commission is a major step toward ensuring that all hospitals that provide maternity care are equipped to provide breastfeeding information, support, and counseling. It is not the time to celebrate! Until resources are provided in the community to continue the support and counseling for all breastfeeding dyads at home, there is work to be done. The United States Breastfeeding Committee and all of the Federal agencies (Maternal and Child Health, Women's Health, Centers for Disease Control and Prevention) need to step up to the plate and develop a strong universal program of breastfeeding support for all communities.