Texas has almost 400,000 births a year, accounting for a whopping 10 percent of all births in the country. Because breastfeeding—specifically, exclusive breastfeeding for six months or more—has a host of health benefits, hospitals and birth centers around the country have begun to change their policies and procedures to better support mothers who want to breastfeed and reverse current low rates of breastfeeding. Texas has made a significant commitment to drive change through its Texas Ten Step Star Achiever program.
NICHQ recently spoke with the State Breastfeeding Coordinator and Women’s and Perinatal Health Nurse Consultant for the Texas Department of State Health Services (DSHS), Julie Stagg, MSN, RN, IBCLC, to learn how Texas has been able make progress on improving its breastfeeding rates.
What are the biggest hurdles to supporting breastfeeding?
Getting moms through the first few days of exclusive breastfeeding is our first hurdle. State data from the Texas Women, Infants and Children (WIC) program show that more than 83 percent of mothers who are enrolled in WIC during pregnancy begin to breastfeed their infants; however, more than half of WIC moms report that they are unable to breastfeed as long as they’d like. Even though most moms choose to breastfeed, only 42 percent of Texas babies will leave the hospital still exclusively breastfed. This rate is even lower among the WIC population. We know that families who experience recommended care (from the WHO/UNICEF’s Ten Steps to Successful Breastfeeding) during their hospital stay will have much better infant feeding outcomes.
Returning to work—and facing barriers in the workplace—is that next huge hurdle and the leading reason working moms stop breastfeeding early or don’t initiate breastfeeding at all. The other piece that needs improvement is the continuity of care: making sure that moms are prepared during pregnancies with the information they need to get off to a good start with breastfeeding and then have access to systems of support once they’re discharged from the hospital to help them navigate any problems or barriers that may otherwise hinder their ability to meet their breastfeeding goals.
What is Texas doing to support breastfeeding?
Texas has a solid history of focused efforts to address barriers to breastfeeding, including the award-winning Breastmilk: Every Ounce Counts Campaign, the Texas Mother-Friendly Worksite Program (which was recently nationally recognized as a practice-tested intervention), and the Texas Ten Step program, which encourages hospitals to implement a bundle of evidence-based practices shown to support breastfeeding—such as encouraging skin-to-skin contact between the mother and infant right after birth; removing pacifiers and free formula samples; and allowing the infant to room-in with the mother rather than go to a nursery.
We’ve partnered with NICHQ to expand the program’s successes by implementing the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative. This project is aimed at helping Texas facilities that are already aware, and motivated to address, how maternity care policies and practices shape infant health outcomes and the ability of patients to meet their personal infant feeding goals. The learning collaborative is designed to accelerate these facilities’ improvements toward implementation of the Ten Steps bundle. DSHS’ Texas WIC Program funds this project because, with improvements in hospital practices, exclusive breastfeeding will be easier for WIC participants and other Texas families to achieve. We’ve been really excited to watch the first cohort of teams in North Texas become engaged and make those rapid cycle improvements to increase their skin-to-skin contact, rooming-in and other practices, as well as their overall breastfeeding rates.
How has Texas’ ongoing success inspired or been inspired by other states’ efforts?
We actually were inspired by work in other states, including California, Massachusetts and others, to implement the learning collaborative model. We ultimately focused our plans based on conversations with New York State about the work they and NICHQ did previously. We’ve also had several states approach us about our toolkits and learn more about the work. We’re always eager to share with and learn from other states, and we take advantage of opportunities to join in both formal and informal collaborative activities that foster connectivity between states around improving breastfeeding.
National initiatives, including those from the Centers for Disease Control and Prevention, the Office of the Surgeon General, and many others provide focal points that bring states together to learn from each other. There’s a growing network of folks who are testing or refining approaches that have been effective elsewhere to improve public health problems. More and more, I see states thinking about breastfeeding support as a critical public health issue. States all working in a similar capacity helps to integrate breastfeeding back into our national culture.
What tips would you give to other local and state-wide efforts to improve breastfeeding support?
First, I recommend focusing on assessment: you need to know what’s happening in your state and you’re able to illustrate what the need is, why it’s important and how it’s affecting your populations. Seeing the numbers can be very motivating.
Secondly, it’s important to foster collaboration early. Connect with programs across your public health department, community organizations, professional coalitions and other stakeholders. It’s really important to build a team of support to move initiatives forward in a meaningful way and also to have all of those different perspectives to help you refine your priorities. Also, the more stakeholders you can engage, the better your buy-in and the better you can leverage the kinds of resources you need.