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Dr. Jones: As I was getting out of the elevator on the second floor, next to the postpartum and maternity ward, I saw a certificate. I saw a framed certificate that said "Baby-friendly hospital. Now, what is that? This is Dr. Kirtly Jones from Obstetrics & Gynecology at �㽶��Ƶ of Utah Health Care. And we're going to talk about being baby-friendly today on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health' with Dr. Kirtly Jones on The Scope.

Dr. Jones: Today in The Scope studio, we have Mary Erickson, who helps us in the postpartum floor establish an environment that's baby friendly. And there is a certificate. So Mary is going help us understand what baby-friendly certificate and what being baby-friendly really is. So, Mary, I saw this certificate that's framed. And I said, "Well, that's cool." But what does that mean, baby-friendly? Does it mean that we label them right or we send them home with car seats or I mean we're all baby-friendly, aren't we? We are just like . . . they are so cute.

Mary: Yeah. Interesting enough, the term "baby-friendly" was chosen because it could be translated in many languages better than any other titles.

Dr. Jones: So in terms of our certification here at the �㽶��Ƶ of Utah Hospital, what kinds of criteria did they look at to say that we were good enough to be a baby-friendly hospital?

Mary: Basically what it is, is it states that at the �㽶��Ƶ Hospital, we do our best to make sure that babies are going home being best prepared to succeed in breastfeeding.

Dr. Jones: Okay. Is it just breastfeeding? Is it car seats? Is it anything other than breastfeeding? Is the breastfeeding the number one goal for being baby-friendly?

Mary: Yes. It actually is. Yeah. So there are several steps involved in becoming baby-friendly. And most of them . . . not most of them, all of them are evidence-based practices that make a breastfeeding mom and baby as successful as they possibly can be as far as breastfeeding.

Dr. Jones: So let's try to take about a couple of those. So give me one evidence-based practice that helps mom succeed and the baby succeed in this dual, complicated but natural process called breastfeeding. So give me one thing that you make sure that moms and babies can do before they leave the hospital.

Mary: After the baby is born, we do our darnedest to try and keep them together. So we do what is called skin-to-skin. And that means that after the delivery, the baby is put right on the mother's chest. Even with our C-sections, if mom and baby are both stable, we try and get the baby to her chest as soon as possible. That doesn't mean that she has to breastfeed right after delivery, but it, as a natural process, does happen. But we do try and get the mom and the baby to do skin-to-skin.

And there is a lot of evidence that shows that it's a very good transition place for the baby to transition from being in the uterus or in utero to the outside world. So, very good for the mom and the baby and it happens to be a very valuable step in initiating that breastfeeding process.

Dr. Jones: Right. Well, so getting the baby close to your skin on your chest means the baby can maybe hear your heartbeat or feel it and baby can smell your skin. So the baby's first smell . . . When you think about baby taking their first breath, they're also taking their first smell. I never really thought about that till right now. So their very first smell won't be antiseptic or Betadine. It might be their mom's skin.

Mary: Exactly.

Dr. Jones: That would be so great.

Mary: Yeah.

Dr. Jones: Okay. What's another thing that we do, aside from getting baby right skin-to-skin with the mom?

Mary: The other thing is we try and keep moms and babies together. So we don't have a central nursery. The baby stays at the bedside the majority of their hospital stay. So that means that the pediatricians are going to come to mom's room to examine the baby. The lab work will all be done in mom's room. And even sometimes when babies need something extra, like perhaps they need to go under phototherapy, we try and do that in mom's room.

Dr. Jones: That's new because always, I remember the babies all in the line in the little intermediate nursery with their sun goggles on. So to be able to do that with the mom, so mom can hear the baby and baby can hear the mom talking and . . . that's a great idea.

Mary: Right. So we try and keep them together as much as possible.

Dr. Jones: How about the breastfeeding part? Anything that we make sure that the moms and babies can do or at least they know, knowing that they often leave the hospital before their breastmilk even comes in? So they have to be encouraged to know how to hold the baby and latch on, even though their milk isn't coming out yet.

Mary: So a lot of what we do is assisting moms with the positioning to get baby and the best relation to get that nipple in correctly because that's key as far as sore nipples, which can be a big problem. We want to make it as easy for the mom as possible. And also, in doing that, we make it easier for the baby. So there are practices that make it easier or some practices that mothers do naturally that make it a little more difficult. So we try and help mom through that process and learn how to help her baby do the best job that they can do.

Dr. Jones: So at the �㽶��Ƶ Hospital, does every mom get that kind of teaching? New moms, of course, are the ones that really struggle the most because successful moms who have already breastfed at least have a clue. But does every new mom get a nurse, either an educator or a consultant, to come in to talk to her about that?

Mary: Actually all of the staff has had additional training. We do a lot of extra training. Everyone that is hired on that's going to be working with mom or baby will spend a day with me. Plus, they have other things that they need to do as far as breastfeeding training. So everyone has had additional training above and beyond what normally you might find in other hospitals. And then if there are any concerns, then they will be addressed by a lactation consultant.

Dr. Jones: You're right. Well, I know women often, unfortunately, think it's their obstetrician or the resident who is an OB/GYN resident who knows about breastfeeding. But we try really hard to educate our residents and our faculty about evidence-based practices. But, quite frankly, I think, they often say, "Oh, you know, well, the lactation consultant will talk to you about that." So it's good to have you on board. Any other thing that we do as a baby-friendly hospital and have the certification for that to help us along?

Mary: Okay. There is one thing that, I think, is sometimes a misconception is that we are anti-formula. We are not anti-formula. What we are is we want to make sure that moms are making good and informed decisions. And basically, a lot of what I do is I help moms to figure out what is their feeding goal, what is it that they want to accomplish, what are their plans for once they leave the hospital?

Then I try and come up with a plan for them that will help them meet that goal best. And sometimes, quite frankly, it's that they want to pump and bottle feed. So if that's the case, then we set up a plan for them so that she can feel that she is successful in her feeding plan.

Dr. Jones: I think that's a great idea because so many women feel that if they don't exclusively breastfeed, they failed. Whereas, in fact, there are a lot of ways to success in the mother-baby dyad. And sometimes, it includes the dad or grandma who might be around or another carer who is going to be feeding maybe pumped breast milk. So finding ways to get the baby as much of a good thing as they can is really important.

Mary: Yeah. I would totally agree. That would be my goal, is that, first of all, the mom feels that she's successful. I never want a mom to feel that she is a failure. So sometimes, you just have to focus on what you can do, not on, "Well, I didn't do the same as someone else," but, "What is it that I can do," and understand that everything that you do do, every little drop of colostrum, every little drop of breast milk is going to benefit your baby.

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