1. CPQC-HI MOM (Helping Infants with Mother’s Own Milk) Antenatal Platform Presentation November 10, 2015 Jodi Palmieri BSN, IBCLC St. Vincent’s Medical Center Bridgeport CT Jodi Palmieri BSN, IBCLC St. Vincent’s Medical Center Bridgeport CT

2. Exclusive breastmilk feeding is an important public health initiative with long term health benefits for both mothers and newborns.

3. Goal of the Perinatal Core Measures: to improve the quality and safety of care for both mothers and newborns Perinatal Core Measure-05 looks at exclusive breast milk feeding while in the hospital setting Included in the denominator Babies >37 completed weeks gestational age Not admitted to Special Care/NICU Included in the denominator Babies >37 completed weeks gestational age Not admitted to Special Care/NICU

4. TJC wants a performance rate of 70 percent on PC-05 “It is an achievable target that hospitals should strive for”

5. 2015 Rates Exclusive Breastfeeding Rate (Retired)PC-05a where mother’s choice for exclusivity is taken into account Family Birthing Center Approx 1000 births/year Baby Friendly Hospital Designation since 2010 PC-05 48% 67%

6. Baby Friendly Hospital Initiative 5 Year Re-Designation Step 3: Inform all pregnant women about the benefits and management of breastfeeding Less than 80% of our surveyed population reported they had been instructed on the importance of exclusive breastfeeding during their pregnancy From audit checks it was determined: We needed Improvement From audit checks it was determined: We needed Improvement

7. Not enough pregnant women understand the importance of exclusive breastfeeding HCPs just not providing the education in the prenatal care setting Lack of Community support Pervasive Marketing of Infant Formula Concerns regarding infant/mother separation (e.g. mom back to work in 6 weeks) Healthcare providers not understanding the IMPORTANCE of their role in educating patients Lack of initiatives towards establishing and maintaining donor milk banks

10. Health care providers can influence a mother’s decision to breastfeed through appropriate and culturally sensitive education * Statement from the CDC’s National Center for Chronic Disease and Management 2013. Also found in The Surgeon General’s Call to Action to Support Breastfeeding 2011

11. Midwifery Model of Care Initial Visit Breastfeeding plans Impact of medical conditions 14-20 weeks Breastfeeding plans Breast growth 24-28 weeks Recommend birthing /breastfeeding classes Reinforce breastfeeding decision 34-36 weeks Review of the ten steps of successful breastfeeding per Baby Friendly Hospital Initiatives Reinforce prenatal classes 36+ weeks Review knowledge Encourage Pediatrician interview where lactation support is explored Family planning including contraception and its role in regards to breastfeeding 6 week post partum visit Most are continuing the EXCLUSIVE (>90%) breastfeeding relationship Midwifery Model of Care Initial Visit Breastfeeding plans Impact of medical conditions 14-20 weeks Breastfeeding plans Breast growth 24-28 weeks Recommend birthing /breastfeeding classes Reinforce breastfeeding decision 34-36 weeks Review of the ten steps of successful breastfeeding per Baby Friendly Hospital Initiatives Reinforce prenatal classes 36+ weeks Review knowledge Encourage Pediatrician interview where lactation support is explored Family planning including contraception and its role in regards to breastfeeding 6 week post partum visit Most are continuing the EXCLUSIVE (>90%) breastfeeding relationship

13. “Preparing to Breastfeed” Class Learning Objectives Importance of early skin to skin contact Initiation of breastfeeding within the “golden hour” Rooming in Feeding on demand No artificial nipples/and why formula supplements hinder the establishment of a good breastfeeding relationship Importance of frequent milk removal and its role in stimulating production Effective positioning and attachment Importance of exclusive breastfeeding for 6 months and that breastfeeding is still recommended for one year and beyond

14. Antenatal Testing Unit 1 st Trimester Screening Asking about feeding choices Exploration of why exclusive breastfeeding is recommended At 20 week ultrasound Pamphlet given regarding the benefits of breastfeeding and how our staff will encourage and assist with exclusive breastfeeding A script given to our scheduler for her to advise on registering for a prenatal breastfeeding class

15. The Golden Ticket Thinking about giving your baby the best start? You are invited to Preparing to Breastfeed Class Held the 2 nd Saturday of Each Month At St. Vincent’s Medical Center 10-12noon Breastfeeding works when you have knowledge and support. Significant others welcome! Call: Email: Jodi.Palmieri@StVincents.Org or Call: (203)576-6087 to Register

16. “ Everyone!” I said without a maybe… “I am on the Lactation Support Team and I speak for the babies!”