Reflections from labor, delivery, and postpartum

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August was National Breast Feeding Awareness month so I wondered what has changed and what is the same in maternal and child health, including breast feeding practices.  I am the Executive Director at the Institute for Community Health, a nonprofit consulting organization that provides participatory evaluation, applied research, planning, and data services to hospitals, government and community-based agencies.  I interviewed an expert, Alison Sekelsky, MSN, RNC, who is Director of Maternal and Child Health (MCH) at Anna Jaques Hospital in Newburyport. I asked her many questions about changes in MCH over the years.  Alison has been in the field for 17 years, starting as a labor and delivery nurse, moving to Clinical Educator, and is now the Director.  She has been at AJH for 19 years where she oversees a wide range of services including labor and delivery, postpartum care, neonatal care, pediatrics, and lactation and prenatal education.  She graduated from St. Anselm College in 1999 with a BSN and from Sacred Health University in 2017 with an MSN.

We talked about the changes in Maternal Child Health (MCH).  When she started:

  • Babies were kept in the nursery through the night and into the morning. Now, typically they stay with the parents unless there is a medical condition that needs care.  Parents are encouraged to get to know their baby prior to going home.
  • A woman who had a c-section might not hold her baby for two hours. Now, all deliveries are treated the same way.  The baby goes skin-to-skin with the mother as soon as possible and stays there through the first feeding.
  • Pediatricians didn’t examine the baby in front of the parents and now they do, which encourages parents to ask questions and helps them get to know their baby.
  • Babies were taken for a bath soon after birth. This practice sometimes caused breast feeding to be more difficult and babies would get cold.  Now, babies are encouraged to stay with parents.  The (unwashed) smell of the baby and mom encourages the baby to feed, the baby stays warm by being close to mom, and mom loves the way it feels!

Other changes include the availability of donor breast milk to babies who need supplementation. Donor milk provides the nutrients to the baby and signals to the mother that breastmilk is important.

Rates of breast feeding have increased, in general, and increased substantially at Anna Jaques.  In 2006 about 80% of AJH mothers breastfed during their hospital stay, similar to the national average of 83.2% in 20151, the last year with available national rates.  In the last rolling 12-month period, 90% of AJH mothers breastfed. And, use of exclusive breastmilk (no formula) increased from 51% to 72% in this time period.  The Joint Commission (JC)2 Goal is 70% so they have exceeded this goal!

Changes that Alison would like to see:

  • The American Academy of Pediatrics recommends that infants be exclusively breastfed for about the first 6 months with continued breast feeding alongside introduction of complementary foods for at least 1 year. There needs to be more support for moms in the postpartum period so that they can meet their breast feeding goals.
  • Push for reduction of primary c-sections.
  • Push for more comprehensive care for mental health, substance use disorders, and others.


There have been big shifts in MCH over the last twenty years.  Hospitals are more family-focused and have made changes that positively impact the health of babies and their parents.  More is needed and Anna Jaques is working on these improvements.  We need forward-thinking leaders like Alison in the forefront of medicine!


2 An independent, not-for-profit organization, The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

Lise E. Fried DSc, MS

Executive Director