Though Ann Calandro recently retired from a career as a nurse specializing in maternal child nursing at several hospitals for more than 40 years (30 of those years as a lactation consultant), to say that she is a breastfeeding expert is quite an understatement. Before coming to the Women’s Health department at MUSC Lancaster in South Carolina in 2019, Calandro had spent decades volunteering and in private practice as a lactation consultant. She also served on the La Leche League International Board of Directors (serving as chair for two years) and the IBLCE Board of Directors.

Making It to the Halfway Point
MUSC Lancaster started the Baby-Friendly process in 2016. When Calandro joined the hospital three years later, they were on their second attempt on the third stage (D3) out of four. Though the head nurse was helping in the process, most of the responsibility fell to Calandro. This was also the time when she started working with
the ENRICH Carolinas program.

Before going to MUSC Lancaster, Calandro worked in hospitals in higher-income areas. These mothers knew a lot about breastfeeding when they came into the hospital. “They read books. Maybe they took birthing classes. They learned a lot ahead of time,” she said.

Ann Calandro

Ann Calandro

MUSC Lancaster was a different experience. Many of the mothers had not prepared for childbirth. There was a much lower breastfeeding rate than she was used to. “That’s where ENRICH Carolinas came in,” Calandro said. “I was very excited, because I was the only lactation consultant there and I needed a lot of support. It was super helpful to have them there to prepare our hospital for working on the Baby-Friendly designation.”

ENRICH, housed within the Carolina Global Breastfeeding Institute at UNC Chapel Hill, provides direct technical assistance to hospitals and communities engaged in improving maternity care. This project aims to increase the number of births in the Carolinas occurring in facilities working to improve maternity care practices through Baby-Friendly designation or a similar state recognition program. ENRICH also helps Baby-Friendly facilities work on sustainability and redesignation.

Using Data to Get Back on Course
ENRICH breastfeeding specialist Michelle Hendricks started working with Calandro. “They had to do another year in D3, because they ran out of time. They needed more help,” said Hendricks. “They were very motivated, but they lacked a lot of the technical assistance.”

Then COVID-19 hit. All in-person facility visits from ENRICH breastfeeding specialists were cancelled. These meetings were important, because the breastfeeding specialist spent the whole day at the hospital. “I never got to tour their facility and meet their entire team onsite. When COVID hit, facilities were just trying to survive,” said Hendricks. She setup virtual monthly check-ins with her facilities where they reviewed data and discussed pressing issues.

Calandro credits ENRICH for kick-starting the hospital’s Baby-Friendly process, particularly the program’s Qualtrics discharge surveys. “We could now see how we were doing month by month on all the different steps that you need to become Baby-Friendly,” she said. “We could see where we’re getting better and where we weren’t. So, we knew where to work on our goals of making the Baby-Friendly requirements.”

For example, they weren’t doing well with moms with C-sections starting breastfeeding. Qualtrics data allowed the hospital staff to see their numbers, and then work on improving them. “We went from hardly anybody to 100 percent, and a lot of it had to do with encouragement from ENRICH and keeping the stats,” said Calandro.

“Those of us who live in North and South Carolina are lucky that we have ENRICH.” — Ann Calandro, MUSC Lancaster

Each month, the hospital submitted birth experience surveys from birthing parents to ENRICH through Qualtrics. The data documents the changes over many months. “Hearing mom say ‘No one talked to me about how to do hand expression’ at the beginning, and toward the end you can see an increase in more and more moms saying ‘Yes, I was taught hand expression.’ That shows that things are sticking and the hospital is making changes in the right areas,” said Hendricks.

Collecting data, and reviewing charts and surveys lets the facility know how they stand before a Baby-Friendly assessor comes to the hospital. This information allows the hospital to better prepare for the final part of the accreditation process.

ENRICH also provided MUSC Lancaster with various training supplies, such as baby doll and breast models of multiple skin shades, pamphlets and booklets for patients. Calandro is glad the ENRICH put her in touch with other facilities that had successfully been through the Baby-Friendly process. “That was very useful to me, because you don’t really know. It’s all kind of hush hush,” she said. “They were able to have some lactation consultants and nurses share their experiences. It kind of took away some of the fear.”

The Destination Is Within Sight
“I think Michelle’s cheerleading was very helpful. She would read the reports and say ‘Yes, look how you’re coming up here, you’re doing great!’ At times when you felt like you’re not, she was always there to just say yes,” said Calandro. “And, if you had a question and you didn’t know the answer, she would find it out for us.”

“I believe ENRICH helped keep them on track and within the scope. Ann is a very excited and motivated individual who thinks big and wants to solve everything,” said Hendricks. “So, I tried to keep her on track by doing things more methodically one little bit at a time to get to that end result.”

MUSC Lancaster entered D4 in May 2021. They had their Baby-Friendly site visit in March 2022 and received Baby-Friendly designation early June.

“You know it really is helpful. Hospitals are always worried about the bottom line, and there’s really no charge to do it,” said Calandro. “I don’t see any downsides for the help that ENRICH gave us. Those of us who live in North and South Carolina are lucky that we have ENRICH.”

“I think that ENRICH helped lay out the road map for them to get to where they needed to be. And, keep them moving forward,” said Hendricks. “It makes me feel like a proud parent, because we came up with a timeline and a goal together, and we were able to keep with the timeline and the goal.”

Learn more about ENRICH Carolinas and the Carolina Global Breastfeeding Institute.

The Duke Endowment is the primary funder for ENRICH Carolinas. Based in Charlotte and established in 1924 by industrialist and philanthropist James B. Duke, The Endowment is a private foundation that strengthens communities in North Carolina and South Carolina by nurturing children, promoting health, educating minds and enriching spirits. Since its founding, it has distributed more than $4 billion in grants. The Endowment shares a name with Duke University and Duke Energy, but all are separate organizations.

— By Robert A. Poarch

Phone: (919) 966-3774
Fax: (919) 966-0458
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Carolina Global Breastfeeding Institute
Department of Maternal and Child Health
135 Dauer Drive
422 Rosenau Hall, CB #7445
Chapel Hill, NC 27599-7445