Stony Brook University Hospital

Changing the culture of maternity care, in a hospital and an island

In 2010 Stony Brook University Hospital (SBUH) joined 11 other hospitals in the New York State Breast Feeding Quality Improvement in Hospital Learning Collaborative to make evidence-based changes in maternity care. The state collaborative included a focus on improving rates for exclusive breastfeeding, an area in which New York lagged. By introducing a new culture of maternity care, SBUH was able to increase its breastfeeding rates and change delivery room behavior, and has been chosen as one of 90 hospitals nationwide to participate in Best Fed Beginnings, a national effort to increase breastfeeding rates.

State Collaborative

“On Long Island, the culture of maternity care included a lot of separation between mothers and babies,” explains Kathy Van Deventer, MS, RN, PNP, clinical nurse specialist and lactation coordinator at SBUH. “Babies went in the nursery rather than directly into the room with their mothers.” To change this culture, Van Deventer and her team introduced the practice of keeping mothers and babies together, skin to skin, immediately after birth. “We wanted it to be the practice for all babies, whether they are breastfeeding or not.” Once initiated, the team began to slowly admit mothers and stable infants directly into the postpartum room together.

Building on these practices, SBUH also introduced bedside rounding by pediatric providers. Instead of conducting their daily physicals with the babies in the nursery, providers move from room to room and interact with the babies, mothers and families at the bedside. “The interactive nature of bedside rounding has been a wonderful benefit to our families,” says Susan Little, MS, RN, NP, assistant director of nursing for antepartum, labor and delivery, and the mother-baby unit. “And it’s a practice that we have been able to sustain since implementing it during the collaborative.”

Though only one of 12 hospitals in the state collaborative, SBUH took a leadership role in its community to ensure those not involved could also benefit from its experience. By encouraging other hospitals to join in initiatives such as eliminating the practice of giving formula to mothers at discharge, SBUH has changed the culture of care throughout Long Island. And Van Deventer believes this practice will spread even further. “As a large academic center, we’re involving nursing students, residents and medical students in this work, and many of them are going to leave and go on to other institutions – spreading these initiatives on a large scale. They will leave here with this model of care and bring it with them,” she says.

Best Fed Beginnings

Though the state collaborative has ended, SBUH is continuing the work it began there with Best Fed Beginnings. This 22-month learning collaborative is designed to make system-level changes to maternity care practices in pursuit of baby-friendly designation, which verifies that a hospital has comprehensively implemented the 10 Steps to Successful Breastfeeding established by the United Nations Children’s Fund and the World Health Organization. SBUH is the only New York state hospital and one of only two hospitals in the northeastern United States to be chosen for the project. “Our involvement in Best Fed Beginnings really grew out of the state project,” Van Deventer says. “It’s about continuing and sustaining the changes we’ve already made, and then adding a few others.”

For example, SBUH plans to revisit the practice of keeping the baby with the mother for the initial exam (after the initial skin to skin and breastfeed), which they hadn’t yet sustained at the end of the state collaborative. “We’re also changing our model of care,” Little notes. “We’re digging into the literature and evidence and moving toward a very family centered model of care.” In bringing a nonseparation model to SBUH, the organization is recommending family members, particularly the significant other, stay in the hospital overnight to learn the baby’s cues and use the staff as a resource. “We’re focused on working with them as a family as they’re learning how to take care of this new baby,” Little says.

In addition to the goals they’ve set, Van Deventer and Little are also bringing their past experience with them to the project. “We’ve learned from these projects that you can only implement these types of changes with the right leadership team in place,” Van Deventer explains. “And interdisciplinary support,” Little adds. “From OB providers to administrators to midwives and nurses – make sure you have the right stakeholders at the table and they are committed to being involved. These are the people who are helping us implement our pilots, gauge what’s successful and guide where we need to go next.”

And while SBUH has only just begun its work in Best Fed Beginnings, the organization has come miles from where it started with the state collaborative. “In 2010, Long Island on average had only 5 to 10 percent of mothers exclusively breastfeeding,” Van Deventer says. “We went to about 35 percent at the end of the project. We’re trying to maintain that, and we’ve been able to maintain a rate above 30 percent so far.”

For more information about SBUH’s work with the state collaborative and Best Fed Beginnings, please contact:

Kathy Van Deventer, MS, RN, PNP
Clinical Nurse Specialist and Lactation Coordinator
Stony Brook University Hospital
Kathleen.vandeventer@stonybrookmedicine.edu  
(631) 444-2201

Susan Little, MS, RN, NP
Assistant Director of Nursing for Antepartum, Labor and Delivery, and the Mother-Baby Unit
Stony Brook University Hospital
Susan.little@stonybrookmedicine.edu  
(631) 444-2155