Scripps Memorial Encinitas is working on becoming Baby Friendly Certified. This certification embodies a philosophy whereby breastfeeding is considered the norm and is protected, promoted, and supported from pregnancy to weaning. The process involves following the ten steps proposed by the World Health Organization and UNICEF. By following the 10 steps we will be eliminating many of the breastfeeding obstacles that are inadvertently created by our health care system. We have already achieved 7 of the steps.

Our goal is to ensure that every woman's prenatal visits include ongoing breastfeeding education and support. One of our aims is to have obstetricians and midwives refer pregnant women with lactation risk factors to our lactation clinic or to our support group before delivery. We also plan to offer doctors' offices "luncheon breastfeeding presentations," to keep the doctors and their office staff current with breastfeeding information and to show them how we can all work together to provide our patients optimum continuum of care. Finding a company to sponsor our breastfeeding gift bags has been somewhat challenging, but we are hopeful to have this settled soon. Recognizing our part in formula promotion has been a long, but positive journey. With the help of the San Diego Breastfeeding Coalition's lanyards and retractable badge holders, we are now promoting breastfeeding instead of formula.

We are currently in the process of educating staff. This includes all nurses, midwives, obstetricians and pediatricians. The focus is on providing 'evidence-based' breastfeeding management practice rather than one based on myths, cultural and personal experience, and beliefs. The 18-hour educational requirement is a tough one. We have been able to creatively offer five 3-hour in-services (1 hour self-study from each) and then an additional 3-hour clinical, whereby each nurse needs to write up a lactation consultation on one of their patients. The nurses clock up many hours of clinical experience helping mothers breastfeed.

There are so many obstacles preventing hospitals from becoming Baby-Friendly, however, the process of change should not be underestimated. Human beings are creatures of habit and change, but even positive change, can be met with resistance at first. Creating a taskforce group to implement such a change is imperative. Having the hospital administration, at least one doctor, and the nursing manager supporting the Baby-Friendly Initiative is a vital key to accomplishing this project. The nursing staff needs representation in the taskforce group, to be part of the change and to be able to voice concerns along the way.

The Regional Perinatal System (RPS) is the contractor for managing the distribution and evaluation of the Kit for New Parents on behalf of the San Diego County Children and Families Commission. Thanks to the enthusiasm and hard work of 350 Distribution Partners, over 40,000 parents in San Diego County received the free Kit for New Parents between January and June, 2002. The new fiscal year began July 1. At that time our county was allocated another 43,000 Kits for our new parents. The current distribution plan places a priority on pregnant families and those with a child up to twelve months of age. In order to have enough Kits for new parents throughout the year, the ordering and distribution process will be limited to Partners serving that population.

Many of our Distribution Partners will be participating with us to evaluate the various distribution strategies and San Diego County's parents' response to the Kit. Parents will be asked if they would like to participate in a survey prior to receiving the Kit and if they would consent to a follow up phone call about six weeks later to give their impressions. The data will be analyzed in January of 2003. Visit www.regionalperinatalsystem.org/welcome_baby.htm or call toll-free: 800-543-7025 or 800-506-4667 for more information on the Kit. For additional information on becoming a Distribution Partner, call the Welcome Baby Program at RPS: 858-467-4990.