First Feeding at Breast - A Simple Change in Process Results in Significant Improvement
Title: First Feeding at Breast - A Simple Change in Process Results in Significant Improvement
- The learner will be able to describe benefits of human milk feedings that are particularly advantageous for the sick/premature babies admitted to the Neonatal Intensive Care Unit (NICU).
- Discuss at least one nursing intervention that contributes to improved rates of breast milk feedings at discharge from the NICU.
- Identify at least three unique challenges many NICU mothers face that contribute to lower rates of breast milk feeding at discharge from NICU.
Pumping to establish and maintain a milk supply requires tremendous dedication. Many NICU moms pump for weeks or even months before their baby is physically/developmentally ready to attempt oral feedings. In 2009-2011 at Winnie Palmer Hospital for Women & Babies 85% of NICU mothers initiated breast pumping and were still supplying MBM for their baby on day of life seven. However, by the baby’s discharge, this rate fell to less than 40%. The NICU's Breast is Best Committee implemented a First Feeding at Breast initiative as a nursing measure to improve rates of babies still on MBM at discharge.
Proposed change: As a department, the NICU would prioritize the first oral feeding to be a breast feeding for all NICU infants whose mother desired to breastfeed. NICU policy states a nipple feeding can be a bottle nipple or a breast feeding. Individual nursing care practice ultimately determines route of initial oral feeding.
Implementation, outcomes and evaluation: Mothers who were pumping were asked if they would like for their baby's first oral feeding to be a breastfeeding. If the mother agreed (and most did) then a small sign was attached to the crib indicating mom's desire to breastfeed for baby's first nipple feeding. This visual cue reminded mom of her ultimate goal and encouraged staff to support her efforts.
When this initiative began, the rate of first feeding at breast was zero and the portion of babies receiving MBM at discharge was approximately 40%. Within six months of implementation the rate of first feed at breast was up to 92% and within this cohort 92% were discharged on MBM. In contrast, during this same time period, the cohort of MBM babies whose first oral feeding was not a breastfeeding, the rate of MBM at discharge was 40% before the initiative and 36% after.
Implications for nursing practice: This nurse driven initiative essentially cost nothing other than interest and a willingness to alter individual practice routines. Nursing's collaboration with the mother regarding a first oral feeding also highlighted the mother's expanding role in the daily care of her infant. The NICU experience by its very nature robs parents of so many facets of parenting – at least for a time. The First Feeding at Breast initiative returned one big “first” to mom.
Keywords: NICU, breat milk, breast feeding, discharge, mother