I've worked in two hospitals providing breastfeeding support, and I can tell you that no two words invoke more fear among hospital staff than "Joint Commission."
The Joint Commission (formerly JCAHO), is a non-profit organization which accredits and certifies thousands of health care organizations and programs in the United States. A hospital that loses its accreditation can lose its state license to operate and ability to collect Medicaid reimbursement, so the flat out panic they cause is probably justified.
I attended a training in advance of one of a Joint Commission visits, and one of the directions the hospital gave was (I'm not making this up), "If you see a Joint Commission representative do not run away." I'll admit that it had occurred to me.
So, while I was heartened to see that the Joint Commission recently published a brochure on breastfeeding, I had to scratch my head about why the focus was to get moms to "speak up" for appropriate breastfeeding care. The brochure tells moms to request skin-to-skin time, delaying of procedures until after the first feeding, and rooming-in, among other evidence-based practices.
If the Joint Commission has the power to force hospitals to finally adopt evidence-based breastfeeding policies, why don't they do it, instead of telling individual moms to fight the power?
Of course, everyone is for patients (moms) taking responsibility for their care, and it's true that moms can vote with their feet, but let's just consider for a minute who has more influence here:
On one hand we have an exhausted, sleep deprived mother who may be in some pain and who is basically in shock over what has just transpired. Oxytocin - the love hormone - is flooding her body, and 'advocacy' is not really in her vocabulary. She is barely clothed.
On the other hand we have a national organization responsible for ensuring that hospitals provide evidence-based health care. They scare the bejeezus out of hospital administrators. They are wearing suits.
Ample evidence exists that hospitals are not following evidence-based practices when it comes to breastfeeding, and progress is slow. Shouldn't we be using the most powerful tool at our disposal to move things along?
The bottom line: These issues should be a matter of policy, not maternal request. And don't even get me started on the disparities that result from relying on moms to advocate for themselves.
Who has the most power to compel hospitals to adopt these policies nationally? Not the CDC. Not the U.S. Department of Health and Human Services. Not Michelle Obama. The Joint Commission does.
The Joint Commission recently adopted exclusive breastfeeding as a (optional) performance measure, and that's a significant move in the right direction. But while moms will certainly try to do their part to change the status quo, what we really need is for the Joint Commission to "speak up" for us.