Surprise! Breastfeeding Happens Outside The OB Unit: An Education Initiative For ED and Med/Surg R.N.'s To Be Baby-Friendly

Sunday, June 15, 2014

Title: Surprise! Breastfeeding Happens Outside The OB Unit: An Education Initiative For ED and Med/Surg R.N.'s To Be Baby-Friendly

Angel Cook, MSN, RNC-OB, c-EFM , Family Birthing Center, Mercy Health- West Hospital, Cincinnati, OH
Robin L. Hirth, M.Ed., B.S., I.B.C.L.C. , Family Birthing Center, Mercy Health- West Hospital, Cincinnati, OH

Discipline: Childbearing (CB), Newborn Care (N)

Learning Objectives:
  1. Identify common medical conditions which cause a mother to be cared for in a hospital unit other than obstetrics.
  2. Recognize the key elements of a education program for nurses who may care for these patients.
  3. Assess the applicability to their own work site.
Submission Description:
Purpose for the program: The most recent statistics available from the Centers for Disease Control and Prevention indicate that 77% of mothers initated breastfeeding in the year 2009 in the United states.  In 2012 the American Academy of Pediatrics recommended breastfeeding for 1 year or longer as mutually desired by mother and infant.  Consequently we have increased the length of time when a breastfeeding woman may experience a hospitalization either related or unrelated to her childbirth or lactation status. During hospital care mothers may be needlessly instructed to "pump and dump" their breastmilk due to lack of evidenced based practice.  The purpose of the progam was to close the education gap for RN's who may care for a breastfeeding patient on a non-maternity unit. 

A needs assessment found that the most common medical needs of breastfeeding mothers receiving care in the Emergency Department and Med/Surg units of four midwestern Mercy Health Hospitals included conditions

  • Unrelated to childbirth, such as injuries, gall bladder, asthma, ear infections, etc.
  • Related to childbirth, such as postpartum hypertension, uterine infection, c-section incision complications, spinal headaches, deep vein thrombosis, pulmonary embolism, post partum hemorrhage, etc.
  • Related to lactation, such as engorgement, plugged ducts, mastitis, abscess, fungal infection

Our program had the added challenge of providing education in the midst of closing two hospitals to move to a new hospital, adding maternity services for the first time, and implementing Baby-Friendly Hospital Initiative guidelines.

Proposed change: The proposed change was to provide breastfeeding education to all RN's on Emergency Department and Med/Surg units.

Implementation, outcomes and evaluation : Implementation included providing a 60 minute power point lecture during 13 inservices over a one month period.  The lecture introduced breastfeeding related policy, equipment, medication safety, and resources.

Outcomes and evaluation included short and long term data.  Short term data inlcudes evaluation collected immediately post lecture.  Long term data includes the number and type of consults RN's caring for breastfeeding patients requested from lactation or obstetric providers.

Implications for nursing practice: Could your hospital benefit from a program targeted to meet these needs?

Keywords:  RN education, Breastfeeding, Non-maternity hospital units

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The Association of Women's Health, Obstetric and Neonatal Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.