Breastfeeding Care Comes “Full Circle” for Baby-Friendly Pioneer

The Story of Boston Medical Center, Bobbi Philipp, and Her First Grandchild…

Anyone who knows Bobbi Philipp knows she is a tireless change agent, a never-say-never advocate for patients, and one of the pioneers and foremost champions of Baby-Friendly practices. A pediatrician and former director of the Mother-Baby Unit at Boston Medical Center (BMC), an inner-city, safety net hospital in Boston’s South End, Philipp was the primary driver that led BMC to become one of the first Baby-Friendly designated facilities in the US in 1999.

20 years later, BMC was recently re-designated for a third time, meaning their designation status is extended through 2024, a quarter century after their initial designation.

In addition to this incredible achievement and the sustained excellence under her leadership, these days Philipp is mostly focused on another accomplishment – the birth of her first grandchild. Anthony was born to Philipp’s daughter Jessica and son-in-law Phillip in April 2019, in the very Mother-Baby Unit that Philipp once supervised and helped to transform into the top-notch maternity facility that it is today.

But before we go there, let’s go back to the beginning of BMC’s Baby-Friendly journey – way, way back to the end of the last century…

“Almost Nobody Was Breastfeeding Here”

BMC’s Baby-Friendly journey began well before anyone there had even heard of Baby-Friendly.

“It all started back in 1997,” says Philipp. “It just struck me that almost nobody was breastfeeding here. It felt odd because we take care of a lot of poor women who have challenges in their lives and I thought if any group of women should be trying to breastfeed, it should be our mothers.”

At the time, Philipp was running the outpatient clinic at the hospital, but part of her job was to be the attending physician in the newborn nursery for a certain number of weeks every year.

“I’d go over there and I’d say, ‘There’s nobody breastfeeding here. What’s going on?’” she remembers.

So, she and two other colleagues decided to form a Breastfeeding Task Force.

“The funny thing was we just appointed ourselves co-chairs. I mean, there wasn’t like a vote or anything,” she chuckles.

The Task Force initially focused on the issues Philip calls “The Big Three: (1) babies were in the nursery all the time, (2) staff had not been trained on breastfeeding, and (3) the formula industry had a strong presence in the hospital.”

“Those discharge bags with free formula always bugged me,” she says. “Plus, we had formula company reps roaming around the hospital. It just wasn’t right.”

So the Task Force went to work. “We met and we helped each other learn,” says Philipp. “We were so naïve. We were going to make all these changes.”

“What’s Baby-Friendly?”

But after eight months, nothing had changed. “Like nothing, zero had happened,” she says, laughing now.

It was then that they heard about Baby-Friendly, which was still a fledgling movement in the US. Evergreen Hospital in Kirkland, Washington, had become the first designated facility in the US only two years earlier.

“Someone on the Task Force said, hey, while we’re doing this, we should try to become Baby-Friendly,” Philipp recalls. “I remember I was sitting at the head of the table and literally asked, ‘What’s Baby-Friendly?’”

So they learned about Baby-Friendly, and she recalls they initially believed it would be easy to achieve.

“Oh heck, we can do that,” she remembers feeling. “It’s only ten things you’ve got to do. What could be so hard about that?”

When reality set in, they spent many hours on the phone with Molly Pessl, Jeanne Tate and others at  Evergreen Hospital, asking for their advice.

“They were a huge help because they had just been through it themselves,” she says. “The whole thing was so new.”

“But We Didn’t Have a Breastfeeding Center”

A key breakthrough came when the Task Force began discussing the possibility of opening a Breastfeeding Center at the hospital and a colleague who was connected with state politics said she could get the Lieutenant Governor to come to the hospital for the opening ceremony. The Lieutenant Governor at the time was Jane Swift, who had run her campaign for office while pregnant with twins, so she was known for her focus on maternity issues.

“Then literally a day later, I got a call from my colleague saying the Lieutenant Governor is coming,” she recalls. “I said, ‘But we don’t have a breastfeeding center. We don’t even have a place to put it!’”

So, Philipp called the president of the hospital and told her they needed to create a breastfeeding center STAT because the Lieutenant Governor was coming to open it.

“They found us this space,” she says. “it was kind of like a storage closet as you got off the elevator on the 5^th floor of one of the buildings. And within like five seconds, all of these workers were coming over and they were fixing the stains in the ceiling and all the rest – because the Lieutenant Governor was coming. We had a cake. We had a ribbon-cutting event. The chairman of the board came from Phoenix. And that’s how we got the breastfeeding center.”

“The Right Thing to Do”

From that point on, their efforts started to pick up steam as they progressed through a series of what Philipp describes as “internal battles.”

The biggest breakthrough came over the issue of paying for formula.

“The Task Force was plugging along,” Philipp remembers. “We were doing skin-to-skin, we were doing rooming-in, we were doing education, and we thought we were OK. Then someone said we should probably look and see if we’re paying for our formula. I was sure we did, but come to find out, we were getting our formula for free.”

There was a rumor circulating at the hospital that it would take $100,000 per year to pay for formula. But Philipp knew this was not the case.

“I said there’s no way we need $100,000 per year for formula – because, with all the changes we were making, there were now many more mothers nursing at the hospital.”

She and her team counted how many bottles were used throughout the hospital for a week and came up with an estimated cost of only $25,000 per year. She took that information to the president of the hospital who agreed it was the right thing to do.

“She took it to the Board of Directors and they voted yes,” Philipp recalls. “Nobody else in the state was paying for formula at this time, so we became the first. That was the switch. When the hospital finally made the commitment to pay for formula, that was when it really started to take shape.”

A few months later, in December of 1999, Boston Medical Center passed its assessment and became the first Baby-Friendly designated facility in Massachusetts.

“The Key Is Education”

Ultimately, Philipp says, the key to Baby-Friendly is education.

“The huge difference for us now – huge – is the amount of education our nurses have. Our nurses are so good. They are so good. And they have great clinical judgment,” she says.

“Almost everyone I talk to believes breastfeeding is important. But they don’t really walk the walk in a lot of cases. When you sit down and really talk to them, they start to get it and they do the right thing. It was just like when I learned about breastfeeding. I hadn’t really gotten any training on breastfeeding, but when I learned about it, I was like, oh my god, how can we not be doing this at our hospital?”

“Lightyears from Where We Were”

BMC’s commitment to Baby-Friendly has been renewed three times, as they were re-designated in 2007, 2014 and most recently in 2019. According to Philipp, they’ve never once considered moving forward without the formal designation.

“We passed our first designation, but it was obvious that we could slide back and you’ve got to really stay on it,” she stresses. “There’s a lot of adrenaline excitement when you get your designation. And then you get new staff, you might get a new nurse manager and you start to slip a bit. It was just important to many of us that we continue to do it because we saw how much better our practice was because of the designation process.”

“We just keep getting better and better,” she continues. “I call it ‘Baby-Friendly Plus.’ We’re doing all kinds of cool things like the Early Bloomer Program for late preterm babies, swaddle baths, and a 180 degree turn on how we care for babies exposed to narcotics. Baby-Friendly is the base and now we’re doing so many more things because the feeding is going easier and the nurses are so experienced and people have bought into things.”

Philipp also points to Ginny Combs, BMC’s nurse manager, as a “monstrous advocate for mothers and babies. With her on board, it’s like everyone’s in the crew boat rowing the same way and we’re flowing fast.”

The results have been impressive. Breastfeeding initiation rates at BMC jumped from 58% in 1995 to 87% in 1999 to 92% in 2019 and exclusive breastfeeding rates have increased six-fold.

“You Need a Network and a Support System”

Philipp’s pride in her facility’s accomplishments came full circle this past April when her daughter, Jess, gave birth to her first child at BMC.

“Wouldn’t you know it that of all the mothers I’ve helped breastfeed over these years, my daughter would be among the ones that would have the most troubles,” Philipp reflects. “She was very successful in the end, but it was really hard.”

“It was hard,” confirms Jess. “I hate the posters that make it look so easy, that the baby just pops right on. That may be the case for some moms, but for the majority of people, it’s a skill and you need a network and a support system to help you learn the skill and to help the baby learn the skill.”

Jess definitely felt like she was in the right place to get that support.

“The nursing staff at BMC was tremendous,” she recalls. “There was no problem that felt daunting. It felt like I was in this nest where I felt safe and where everyone was helping me figure it out. They were so patient and so understanding of moms and babies.”

Jess needed every ounce of that support. “It was painful. I really didn’t want to do it,” she says.

But she was committed to breastfeeding.

“I learned about breastfeeding from hearing my mom talk about her work when I was a kid,” Jess remembers. “I knew it was best for him. And I had a ton of support. They kept on saying, ‘It will get better, just hang in there.’”

And she did. She tried donor milk and used a Supplemental Nursing System (SNS) and depended on a nipple shield for the first two months of Anthony’s life.

“He didn’t latch on for a long time,” she says. “It was too painful and he wasn’t able to get a good suck. It turns out he had a posterior tongue tie.”

Ultimately, she got the final push she needed at a Baby Café she went to every week for the first few months.

“The woman who led the Café where I went was super experienced and she said, ‘Maybe it’s time to try without the nipple shield,’” says Jess. “So I gave it a try. I guess he had matured enough and I had learned the skill enough that he finally latched on after two months.”

“A Really Hearty Baby”

Looking back, Jess says she has no regrets and feels it was worth the effort.

“He’s fought off a lot of potential illnesses. He hasn’t had one ear infection and he’s been a super healthy kid. I think that’s due to the breastmilk,” she says.

Jess’s husband Phil agrees and experienced the benefits first-hand when he and Anthony were both exposed to the measles before Anthony was vaccinated.

“My stress level was reduced because I knew his mom’s immunity would help him through that,” Phil says. “He’s a really hearty baby. “I attribute that to breastfeeding.”

“It Made Me Feel So Proud of Her”

For Jess, one of the most durable memories of this milestone event for her and her family was the pride she felt of her mom.

“Usually it’s the parents who say they’re proud of their kids,” she reflects. “But I felt proud of her, which was a weird feeling. You don’t usually recognize what your parents do at work and here I was living, breathing evidence of it.

“We had talked about what she was working on at our family dinners when I was a kid. And then to see it play out in front of my eyes for me and my new baby, it was tremendous. It made me feel so proud of her.

“To be able to be in the unit and see what she had built and feel how her energy disseminates to the staff, it was palpable. Everyone there is supportive of moms and babies in a positive way. And it felt like that vibe was from my mom.”

True to her nature, her mom, who has now stepped down from her role as director of the unit so she can spend more time with her grandson, spreads the credit around.

“I just want to emphasize that it takes a lot of people to do what we’re doing at our hospital,” says Philipp. “It takes a village to do this. And I’m still the biggest Baby-Friendly cheerleader out there.”