Oregon hospitals are trying to encourage more mothers to breast-feed, after researching showing that it reduces the risk to babies of developing obesity, diabetes and asthma later in life.

But accreditation as a Baby-Friendly hospital comes with some big changes, including breast-feeding lessons immediately after birth, no more hospital nursery and no pacifiers.

Helen Phillips, the director of women’s service at Legacy Health Systems, said that a few years ago, visitors would have been able to see lots of newborns through the hospital’s nursery window. Now, there are no babies in the room.

“Today, I’m told we have five new babies here on the unit. But all five of those babies are out, with their moms, in mom’s room, which is typically where they’ll spend their time,” Phillips said.

Encouraging mother-baby “together time” is just one of 10 ten steps hospitals have to take to become accredited as Baby-Friendly.

The World Health Organization started the Baby-Friendly hospital campaign in 1991 to encourage more breast-feeding.

The USA Baby-Friendly accreditation program started shortly afterwards, and several Oregon hospitals are now pursuing it – including six in the Legacy Health System.

Phillips says the other steps to becoming Baby-Friendly include not giving newborns anything other than breast milk _ so no formula unless it’s medically necessary _ and helping mothers initiate breastfeeding within one hour of birth.

“There’s a lot of very solid research around how that experience contributes to initiating breastfeeding within that hour. It’s kind of fascinating, there are studies and actually some videos on how the infant just seems to find the breast by instinct,” Phillips said.

To make sure a baby is fine and its airways aren’t plugged by mucus, Phillips said staff do an immediate assessment. But they don’t use a bulb syringe to clean the baby up, unless there are excessive amounts of mucus. Instead, the focus is on getting the baby into its mother’s arms as soon as possible.

Some of the other steps to become Baby-Friendly include training staff and having a written breast-feeding policy. But Phillips says one of the biggest steps _ and the one her hospitals have yet to take _ is to cut the use of the pacifier.

“There’s data to show that until breastfeeding is established, so not forever, but in those early few weeks, you have for most kids better initiation of breastfeeding and breast milk supply for mom, if, rather than giving the baby a pacifier when they’re fussy and maybe hungry, to just breastfeed that baby,” she said.

She said Legacy plans to use pacifiers only to calm babies during painful procedures, like shots.

While the federal government is encouraging breast-feeding, the Affordable Care Act does not link payments to it. But Phillips thinks that may be coming.

“Breast-feeding at discharge is a metric that’s being more and more measured. And I think in the future this is going to be a factor around reimbursement,” Phillips says.

Breast-feeding is already relatively popular in Oregon, where about 24 percent of babies are exclusively breast-fed by six months, as opposed to the national average of 16 percent.

Denise Johnson, the health education coordinator with Care Oregon, says the Affordable Care Act also promotes breast-feeding. It requires insurance companies to cover breast-feeding counseling and the rental of breast pumps, she says.

“Also the wage laws have been changes so that there’s protection for the rights of nursing women in the workplace,” Johnson said.

The push for breast-feeding doesn’t end when parents and babies leave the hospital, either. Violet Larry, a community health nurse with the Healthy Birth Initiatives Program in Multnomah County, says things have changed over her 23 years of service.

“I go into the client’s homes and do an assessment and provide information and education,” she said. “We would talk about do you plan to breast-feed and if they said ‘No,’ it wasn’t a big deal. You go on and do your formula and move forward. But in the last five years the push has been really strong. And we’d start on that first visit with: ‘You are planning to breast-feed aren’t you?’ And they say: ‘No.’ I say, ‘Yes you are planning to breast-feed aren’t you?’ “

One of the mothers who Violet Larry visits is Portlander Shavantee Scott. She has 10-month-old twins who she’s happy to show-off.

She says in the nine years between the births of her twins and her eldest, she’s noticed substantial changes in the way hospitals deal with breast-feeding.

“It’s a big difference for me because they advocate for it more,” Scott said.

She says she’s being told to breast-feed the twins until they’re a year old.

But she’s not so sure.

“I personally can’t do it because of the teeth thing. And that’s what I’m having right now is teeth coming in. So this is not fun,” Scott said.

The U.S. Breast-feeding Committee’s Healthy People 2020 goal is to increase the percentage of infants who are exclusively breast-fed for six months nationwide from 16 percent, to 25 percent.

This story originally appeared on Oregon Public Broadcasting.