Breast is best. Experts agree that no method of feeding infants provides the physical and emotional benefits of nursing.
A 2009 study of Australian mothers found that in addition to its other benefits, “breastfeeding may also help to protect against maternally-perpetrated child maltreatment, particularly child neglect.”
What’s more, breastfeeding is free, while infant formula can cost new parents as much as $1,500 to $2,000 for the first year of life.
With more than 80 percent of new mothers intending to breastfeed, according to the Centers for Disease Control, hospitals in Nevada and elsewhere are succumbing to pressure to provide so-called “baby-friendly” accommodations for moms and newborns.
“Most hospitals have eliminated their newborn nurseries,” in favor of 24-hour “rooming-in” with the mother, says Corinne Flatt, a La Leche League leader in Las Vegas for two decades. “We campaigned for that for a long time. Now they’ve been converted to Neonatal Intensive Care Units. The evil dark side is in order to have these units, you have to have babies in them and more babies are going in than maybe need to.”
In 2010, health insurance experts pegged the average daily cost of NICU treatment at $3,000, slightly more than the cost at the time of the average labor, delivery and hospital stay for a birth with no complications. Today, a hospital delivery and stay is about $3,500, according to the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project.
Is the push for breastfeeding backfiring and causing babies to be needlessly separated from their mothers during the critical first days of life?
A study published in the Journal of Pediatrics looked at 3.3 million newborns of all weights and found 7.2 percent were admitted to neonatal intensive care units, an increase of several percentage points over recent decades.
Among babies with low-birth weight, the study found no correlation between the availability of NICU beds and admissions. However, babies weighing five pounds eight ounces or more in hospitals with “the highest bed supply were significantly more likely to be admitted to a NICU than those in regions with the lowest.”
“Among larger newborns, we find evidence of supply-sensitive care, raising concerns about the potential overuse of expensive and unnecessary care,” the study said.
Another study of some 18 million live births found admission rates in NICUs increased from 6.4 to 7.8 percent from 2007 to 2012.
“Between 2007 and 2012, higher birth weight newborns were increasingly admitted in the NICUs and by 2012, approximately half of all NICU admissions were for normal-birth-weight infants or those born at 37 weeks gestation or older… The implications of these trends are not clear, but our findings raise questions about how this high-intensity resource is being used,” the study concludes.
“If hospitals want to argue that NICUs are necessary, they will need to prove that the need exists, especially in light of the increasing share of infants admitted who are at or near full term,” wrote Aaron E. Carroll, M.D., of the Indiana University School of Medicine. “If hospitals are unable to demonstrate that NICUs are necessary, then it is very likely that, at some point in the near future, policies will force them to reduce those admissions, which will have major implications for NICU and hospital finances.”
Dr. Madeleine Sigman-Grant, a Maternal and Child Health and Nutrition Specialist and former Professor Emeritus with the University of Nevada, cautions against judgments that those admissions are unnecessary, but questions the wisdom of closing newborn nurseries as a method of increasing breastfeeding.
“Let’s get real,” says Sigman-Grant, who equates the practice to throwing out the baby with the bathwater. “Not every mom will be able or want to nurse her baby. So when you close a nursery, what is that recovering mom supposed to do if she doesn’t have a friend, partner or other help?”
The Journal of Pediatrics estimates seven to eight percent of newborns in the U.S. are admitted to a NICU.
Hospitals in Nevada report higher NICU admission rates than the national average.
In 2017, 9.9 percent of the 34,858 babies born in the state were admitted to NICUs, according to the Division of Health. That’s up slightly from 9.5 in 2016 and 9.4 in 2015. NICU admissions, however, are substantially higher in some hospitals.
A spokeswoman for St. Mary’s Regional Medical Center in Reno says 12 percent of its newborns were admitted to the NICU in 2017. The rate so far in 2018 is also 12 percent.
Renown Medical Center in Reno has a 39-bed NICU. A hospital spokeswoman says 13 percent of newborns were admitted to the NICU in 2017 and the hospital is on track to admit the same percentage this year.
Renown provides mothers of NICU patients with a video feed of their baby, which assists moms in pumping breast milk.
Sunrise Hospital in Las Vegas is the “largest provider of Medicaid services in Nevada and the only hospital in the state fully equipped to treat Nevada’s smallest and sickest babies in the NICU and other critical care areas,” says spokeswoman Jennifer McDonnell. “Our standard is in-room care with the mother. Our healthy newborn nursery is reserved for procedures and special situations.”
Twenty percent of babies born at Sunrise are admitted to the NICU, well-above the national average.
McDonnell, also a spokeswoman for Hospital Corporation of America’s other facilities in Las Vegas, says the standard of care at HCA’s MountainView Hospital is also “in-room care with the mother. Our healthy newborn nursery is reserved for special situations.”
In addition to its Level II NICU, the hospital expects to add a Level III NICU early next year.
MountainView’s NICU admission rate is 19 percent, according to McDonnell.
The NICU admission rate at HCA’s other Las Vegas hospital, Southern Hills, is 14 percent.
“We do have a healthy newborn nursery for special situations. We focus on couplet care with the mother and infant, utilizing our Level II NICU for any special procedures and babies who need additional care,” says McDonnell.
A spokeswoman for University Medical Center, Danita Cohen, says the NICU admission rate at Southern Nevada’s only public hospital is 17 percent, a figure Cohen attributes to UMC’s “patient population.”
Universal Health Services, which owns six hospitals in Southern Nevada under the banner of the Valley Health System, declined to provide admission rates for its NICUs.
“We have newborn nurseries, but at all our hospitals with maternity care, the focus is on mother-baby (couplet) care where the baby stays with the mom/parents in the mom’s room around the clock for bonding, and the nurses concentrate on mother-baby patient care, assisting with breastfeeding, teaching, helping new parents to recognize their baby’s cues (hunger, cold, wet), etc.,” says Valley Health’s spokeswoman Gretchen Papez.
The company’s Henderson Hospital opened a level II NICU this year, according to Papez. Centennial Hills, Spring Valley and Summerlin hospitals have Level II and Level III NICUs. Valley Health’s other two hospitals do not offer maternity care.
Papez says NICU admissions are based on criteria “which assesses the acuity of the patient.”
‘Patients need to speak up’
Are Nevada healthcare providers doing all they can to foster nursing?
Exclusive breastfeeding for six months by 90 percent of American mothers would prevent more than 900 deaths and save $13 billion a year in medical costs, says a 2010 study by the Cambridge Health Alliance and Harvard Medical School.
While 80 percent of mothers start out breastfeeding, only one in five will exclusively nurse for at least the recommended six months, according to the CDC.
Nicola Lippetti is one of the four in five who don’t succeed.
Lippetti is a first-time mom who gave birth to her son at Summerlin Hospital. She says she received little assistance in nursing and opted for the bottle.
“Looking back, I think the nurses just cared about whether he was eating. They didn’t care where from. They were just checking how many ounces,” says Lippetti, who even made a call to a private lactation consultant. “I didn’t end up seeing the consultant, but I did call one.”
Lactation consultants are expensive, a luxury few young families can afford.
Some hospitals have consultants on staff, but new mothers are often hesitant to ask for help doing something they expect to come naturally.
“I had one lactation consultant from the hospital come by and say ‘I’m here if you need me,’ but she didn’t show me anything. They didn’t go over anything. I wasn’t as encouraged as I probably should have been,” says Lippetti.
Given the critical nature of the first few days of life to breastfeeding success, experts say the onus is on hospitals to encourage and support mothers by keeping them with their babies.
Nevada officials are encouraging hospitals to take part in the state’s Baby-Friendly Hospital initiative, a World Health Organization project designed to increase support and encouragement for breastfeeding moms. Only three Nevada hospitals have received the designation – Carson Tahoe Regional Medical Center in Carson City and the St. Rose Dominican San Martin and Siena campuses in Las Vegas.
Participating hospitals are required to adhere to ten steps to improving breastfeeding outcomes, including giving up a valuable perk – the freebie formula supplied by Big Formula, now a $2.3 billion industry in the U.S., according to market research firm IBISWorld.manufacturers.
“If you look at it ethically, the hospitals are taking money. They are taking freebies,” says Rosemarie Casillas, an International Board Certified lactation consultant, who trains healthcare workers on the particulars of the state breastfeeding initiative. “What do the formula companies expect in return? They expect me to give all my patients free formula when they go home.”
“We do receive free formula in some cases, and also purchase formula, however that does not impact our practice to support breastfeeding,” says McDonnell of HCA, which owns Sunrise, MountainView and Southern Hills hospitals. “It does support our goal to provide individualized care for each of our families by taking into account their specific medical needs and personal preferences.”
“The International Code of Marketing Breast Milk Substitutes was put in place in the early 1970s. The Baby-Friendly Hospital Initiative does not include any hospital that doesn’t support the code.” says Casillas.
Nationally, only 17 percent of babies born in 2016 were given formula within the first two days, compared with 24 percent in Nevada. That’s down from 28 percent in 2008, according to the Centers for Disease Control.
The CDC reports in 2018, only 16.3 percent of babies born in Nevada came into the world at facilities with the “baby-friendly” designation.
Some advocates say the stringent requirements of the initiative are turning off hospitals.
Division of Health spokeswoman Martha Framsted cites the cost of achieving the designation as a “common reason for nonparticipation.”
“It’s thousands of dollars to even start the process,” says Lorrie Meiron, Obstetrics Nurse Manager at Humboldt General in Winnemucca. “Then you have to get ready for their inspection, pay for them to come out and pay an annual fee. We’re trying hard to meet the criteria without obtaining the designation.”
“The hardest step to take is the education of all staff, including the physicians. That’s where the push back is,” says Sigman-Grant, who authored a study on attitudes among medical professionals in Las Vegas about breastfeeding. “They don’t want to be told what to do. And they have to continuously train nurses and new hires. That means paying them to come in for training. So you are paying them when they are not on the floor. That’s not an insignificant cost. It would be ludicrous to expect that to be feasible in all facilities.”
An alternative, says Sigman-Grant, is the less-intensive, less-demanding “Baby Steps to Breastfeeding Success” program.
The training provides breastfeeding education and recommends policy and procedure best practices which support breastfeeding in the hospital setting.
“By offering this training to birthing hospitals across the state, the Nevada WIC and the Nevada Title V Maternal and Child Health Programs promote and support breastfeeding even if the Baby Friendly Hospital Initiative designation is not being pursued,” says Framsted of the Division of Health.
The program focuses on breastfeeding support during the first hour of life; exclusive feeding of breast milk for infants; rooming-in for mom and baby; and follow up with moms after leaving the hospital.
“The information has been out there for quite awhile,” says Zena Gresham, IBCLC. “I used to give the nurses the benefit of the doubt but the truth is, until the hospital puts teeth behind the policies, until they hire nurses who are eager to encourage breastfeeding, you’ll always have those who will discourage.”
Ultimately, she says, patient education is the key.
“Patients are wondering why they need help doing something so natural. They don’t feel they have any rights because they don’t know,” she says. “Patients need to speak up.”