1. Public Health Breastfeeding Policy Initiative Hospital Policy Matters April 7, 2010 Silvia Prieto, MD, MPH Area Health Officer East and South Bay Service Planning Areas

2. 2 Hospital Policy & Practices Impact Breastfeeding Duration Breastfeeding at 6 months was associated with –Exclusive breastfeeding in hospital –Not receiving a gift pack with formula at hospital discharge Dabritz, J Hum Lact, 2009

3. Service Planning Area Map

4. 4 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) In-hospital Exclusive Breastfeeding, 2007 Service Planning Area 1 (Antelope Valley)

5. 5 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) In-hospital Exclusive Breastfeeding, 2007 Service Planning Area 2 (San Fernando)

6. 6 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) In-hospital Exclusive Breastfeeding, 2007 Service Planning Area 3 (San Gabriel)

7. 7 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) In-hospital Exclusive Breastfeeding, 2007 Service Planning Area 4 (Metro)

8. 8 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) In-hospital Exclusive Breastfeeding, 2007 Service Planning Area 5 (West)

9. 9 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) In-hospital Exclusive Breastfeeding, 2007 Service Planning Area 6 (South)

10. 10 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) In-hospital Exclusive Breastfeeding, 2007 Service Planning Area 7 (East)

11. 11 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) In-hospital Exclusive Breastfeeding, 2007 Service Planning Area 8 (South Bay)

12. 12 Hospital Policy is Key Administrative prioritization of breastfeeding support drives the hospital practices that lead to improved breastfeeding Hospitals with written policy have better breastfeeding outcomes at 2 weeks Monitor improvements in breastfeeding support over time to track policy implementation Rosenberg, Breastfeeding Medicine, 2008

13. 13 Hospital Policy & Practices: Associated with breastfeeding duration Breastfed within first hour of birth Baby did not use pacifier Stayed in same room with mother Exclusive breastfeeding in hospital Hospital gave mother a phone number to call Murray, Birth, 2007

14. 14 Hospital Policy & Practices: Affect all ethnicities & income levels Breastfeeding rates in US Baby-Friendly Hospitals exceed state and regional rates across all ethnicities and income levels Breastfeeding rates are high in these hospitals even among populations who do not traditionally breastfeed Merewood, Pediatrics, 2005

16. Quality Improvement is Essential Evaluate current practices Adopt new policies and practices Monitor improvements over time 1

17. The road ahead… This is a lengthy journey Strive for incremental changes We’re here to help!

18. Works Cited California Department of Public Health, Maternal, Child and Adolescent Health Program. “California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database, 1994-2007.” Available at: http://www.cdph.ca.gov/DATA/STATISTICS/Pages/BreastfeedingStatistics.aspx http://www.cdph.ca.gov/DATA/STATISTICS/Pages/BreastfeedingStatistics.aspx Dabritz HA, Hinton BG, Babb J. Evaluation of lactation support in the workplace or school environment on 6-month breastfeeding outcomes in Yolo County, California. J Hum Lact 2009;25(2):182-93. DiGirolamo AM, Grummer-Strawn LM, Fein SB. Effect of maternity-care practices on breastfeeding. Pediatrics 2008;122 Suppl 2:S43-9. Merewood A, Mehta SD, Chamberlain LB, Philipp BL, Bauchner H. Breastfeeding rates in US Baby-Friendly hospitals: results of a national survey. Pediatrics 2005;116(3):628-34. Murray EK, Ricketts S, Dellaport J. Hospital practices that increase breastfeeding duration: results from a population-based study. Birth 2007;34(3):202-11. Rosenberg KD, Stull JD, Adler MR, Kasehagen LJ, Crivelli-Kovach A. Impact of hospital policies on breastfeeding outcomes. Breastfeed Med 2008;3(2):110-6.