1. Baby Friendly USA! & The ‘REAL’ World of Lactation

2. Breast Feeding Conference 2010

3. The Baby Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). BFHI promotes, protects and supports breastfeeding through ‘The Ten Steps to Successful Breastfeeding for Hospitals’.

4. Working through the process… All 10 SIMPLE STEPS!

5. EDUCATION ALL DOCTORS AND NURSES IN MATERNAL/CHILD AREAS ARE REQUIRED TO TAKE A BREASTFEEDING COURSE ALL CORPSMAN IN L&D ATTEND A BREASTFEEDING CLASS

6. Breastfeeding Education Options http://www.breastfeedingtraining.org Excellent option for Providers – offered free and CME’s are included “The Curriculum in Support of the Ten Steps to Successful Breastfeeding” - offered by Healthy Children’s Project, Inc. - MOST COST EFFICIENT OPTION FOR RN STAFF www.healthychildren.cc “Ten Steps to Successful Breastfeeding” – available through Jones and Bartlett Publishing $$ COSTLY BUT EXCELLENT CURRICULUM

7. BREASTFEEDING POLICY FOLLOWING THE 10 STEPS FOR SUCCESSFUL BREASTFEEDING Many Sample policies that meet the Baby-Friendly requirements are available online

9. PATIENT EDUCATION BEGIN BREASTFEEDING EDUCATION EARLY IN PREGNANCY PUT BABY TO BREAST AS SOON AS POSSIBLE AFTER DELIVERY KEEP BABY SKIN-TO- SKIN FOR FIRST HOUR OF LIFE PROVIDE POST- PARTUM SUPPORT

10. BABY FRIENDLY ON- SITE SURVEY The Baby Friendly USA team visited our hospital for two full days focusing on: Interviewing staff and patients Reviewing policies and statistics Auditing charts Reviewing educational literature

11. Obstacles Encountered Staff education: constant staff turn-over makes education a continuous process; now included in initial orientation to the unit. Patient Education: T here is a big difference between education offered and pt’s perception of education related to breastfeeding. Supplementation: Only when medically indicated, education of staff, providers and patients is essential.

12. Benefits of MTF’s Early follow-up appointments by RN/Lactation consultant. Orders can be given and must be carried out. Younger mind-set of providers Constantly in learning mode Most cost effective way to achieve healthier population Networking – why reinvent the wheel!

13. Support System Many mom’s are away from family, husband’s deployed, feel alone, breastfeeding is not her family’s norm. MOM CONNECTION: weekly breastfeeding support group *** so important to long term success with breastfeeding.*** Access to Lactation Consultant Establish an environment where breastfeeding is seen as the norm, prenatally, ante-partum, and post-partum, and in the clinics

14. Robert E. Bush Naval Hospital Recognized the long term health benefits of promoting breastfeeding Invested in an optimal level of care to encourage breastfeeding Strive to provide the best possible care to our smallest patients

15. Robert E Bush Naval Hospital The first and only Naval Hospital worldwide that has achieved accreditation as a Baby-Friendly Facility

16. New Changes For Baby- Friendly Re-Certification All Baby-Friendly Facilities are now required to do two Performance Improvement projects every year to maintain certification.

17. Joint Comission and Orxy ‘Exclusive Breast Milk Feeding’ Only maternal medical conditions are acceptable: HIV,substance abuse,TB, Chemo or radiation, active vericella, HSV with breast lesions. Must be documented clearly in the chart.

18. PER JOINT COMMISSION QUALITY CORE MEASURES The ‘ONLY’ acceptable reason for a baby to NOT be exclusively breastfed, per Joint Commission and Oryx, are maternal medical indications.... a mother’s choice not to breastfeed is NOT an acceptable reason for the baby to get anything other than breastmilk

19. WHAT CAN WE DO?? STRESS IMPORTANCE OF EXCLUSIVE BREASTFEEDING TO PARENTS DOCUMENT EDUCATION IN CHART DOCUMENT REASONS FOR SUPPLEMENTATION IF NEEDED

20. NATIONAL AVERAGE BASED ON THE NEW STRINGENT GUIDELINES- THE NATIONAL AVERAGE IS NOW CONSIDERED 30% EXCLUSIVE BREASTFEEDING RATE

21. Lactation Consults Perceived vs actual low milk supply. Usually it is a perceived problem, education and thorough assessment are key. Many mom’s returning to the workplace that rely on pumping to maintain their supply may encounter a decreased milk volume. Reglan works quite well in most cases to increase production. Reglan 10mg: 1 tab on day one; 1 tab BID day two; days 3-10, 1 tab TID; days 11 & 12, 1 tab BID, days 13 & 14, 1 tab daily. Total: 33 tabs Some working mom stay on 1 tab per day throughout duration of breastfeeding

22. Cont…. Necessary to have access to hospital grade pump and allowed time and space to pump at work. There are OPNAV, BUMED, MCO/ instructions protecting active duty breastfeeding mothers Tri-care does cover hospital grade pumps for mothers of premature infants (code E0604) Some hospitals have electric pump loaner programs or can refer pt to rental station

23. Thrush La Leche League International quotes research stating the increased use of antibiotics in the OB setting has increased the cases of ductal yeast. Tx of GBS+ moms Routine antibiotic use with C- sections

24. Symptoms and Tx If mom is symptomatic burning itching deep radiating pain in nipples or breast traces of white fungus in the folds of nipple shiny, blistery, cracked, red appearing nipples mom has vaginal yeast infection R/O OTHER POSSIBILITIES, ie: latch/positioning

25. Tx cont… Treat mom with Diflucan “Medications and Mothers’ Milk” Thomas Hale, PhD. Recommended therapy: Diflucan 200-400mg loading dose then 100-200mg per day times 14 days Encourage natural treatment in conjunction with medication; acidophilus bifidus and grapefruit seed extract

26. Tx cont… Jack Newman’s All Purpose Nipple Cream: Mupirocin 2% (15g) Betamethasone 0.1% (15g) Miconazole powder (brining the final concentration to 2% miconazole) Apply sparingly to nipples/areolae after each feeding, do not wash or wipe it off before feeding.

27. BREASTFEEDING COUPLET – BOTH PARTNERS, MOM AND BABY, HAVE TO BE TREATED Many times the baby is asymptomatic. Symptoms include: White patches in the mouth Diaper rash Whitish sheen to inside of lips/saliva Baby not nursing well because mouth is sore.

28. Thrush Tx cont… Nystatin: Most effective Tx is to treat after every feeding One dropper full, half in each cheek Treat for 2 weeks Instruct mom to sterilize pacifier, bottle nipples, anything that baby puts in the mouth

29. Nipple Shields Nipple shields are an awesome tool when used appropriately Rarely should they be introduced during the first 24 hours of life Lactation Consultant should be notified if use of a shield is initiated This “quick fix” can create weeks/months of issues for the nursing couplet

30. Indications for Nipple Shields Premature baby that is not fully effective at the breast Latch problems after 24 hours of life Neurologic problems, weak suck, tongue thrusting or retracting Mother with truly inverted nipples

31. Inappropriate use of Nipple Shield Sore nipples; rather than mask the issue, identify the problem and correct the latch. Sleepy baby in the first 24 hours; allow baby time to adjust to extra-uterine like Poor latch; contact lactation consultant to assess couplet

32. Questions?