Breastfeeding: Supporting Hospital Birth Practices & Active Support After Discharge Sonja Dahl RN, IBCLC Lactation Coordinator September 9, 2015

THRIVE Early Learning. Every Child. Our Future.

/ Healthy Development Similar Benefits * Strong parent- child bond * Healthier mother & baby * Positive parenting * Higher rate of IQ *Lower rates of abuse & neglect * Impacts 2 people at same time

/ Presentation Title4 Objectives The learner will be able to state 3 hospital practices that influence breastfeeding rates The learner will be able to list 3 resources to use in the community to help support continues breastfeeding The learner will be able to state 3 benefits of breastfeeding The learner will be able to state 3 risks of not breastfeeding

/ What Makes Breast Milk Unique? More bio-available to baby Changes to meet infant’s needs Unique compounds not found in formula

/ Benefits to Breastfeeding *Lowers rate of ear infections *Lowers rate of respiratory infections *Lowers rate of obesity & diabetes *Lowers rate of SIDS

/ Benefits for Breastfeeding *Lower rates of maternal breast & ovarian cancer *Lower rates of maternal type 2 diabetes *Lower rates of blood loss *Lower rates of abandonment

/ Risks of Not Breastfeeding Higher risk of allergy & asthma Higher risk of diarrhea Higher risk of ear infections Higher risk of heart disease Higher risk of obesity Higher risk of diabetes Higher risk of lower IQ Higher risk of exposure to chemicals

/ Exclusive Breastfeeding Matters for 6 months *$13 Billion saved in the USA Reduce 911 deaths If 90% were breastfeeding for 6 months

/ Breastfeeding Data *CDC Survey 2012 Births *National Immunization Survey St. Joseph Medical Center 2012 ­90% BF ­64% BF in 1 st hour ­58% Exclusive in first 2 days Presentation Title10

/ Maternity Practices Matter FY 2012 Births St. Joseph Medical Center 3,747 St. Francis 1,114 St. Elizabeth295 Highline 929 Harrison- Silverdale 1,982 8,067 Births 9.8 % of WA State Hospital Births

/ Hospital Maternity Practices *mPINC 2007 *St. Joseph Medical Center Presentation Title12

/ Joint Commission Exclusive BF Rates Started in January 2014 St. Joseph Medical Center ­FY 2015 ­Exclusive BF rates=79% ­Increased 21 % in 3 years

/ Baby-Friendly Hospital Initiative USA *Quality Improvement Project *10 Steps *Process usually takes 3 years or more *5 Hospitals in WA State & 1 more pending * St. Joseph started in 2013

/ Six Maternity Practices that Improve Breastfeeding 1. Skin-to-Skin 2. Early & Frequent Breastfeeding 3. Rooming- In 4. Avoid routine formula supplementation 5. Delay pacifier for 3-4 weeks 6. Active follow-up after discharge Presentation Title15

/ Skin-to-Skin Immediately After Birth Benefits for Increasing Breastfeeding *Early establishment *Longer duration *Increased Exclusivity

/ Skin-to-skin Immediately After Birth Benefits for Neonate *Improved cardio-respiratory *Improved temperature *Improved health outcome *Bonding improved *Colonize gut flora *Decreased crying

/ Skin-to-Skin for at least 60 minutes Place baby skin-to-skin immediately after delivery and keep until after the completion of the first feeding Delay birth weight Allow time with mom

/ C-Section Skin-to-Skin C-Section can be done! Resume as soon as possible

/ Skin-to-Skin Dad’s can help with skin-to-skin

/ Early and Frequent Feeding Most breastfeed in the first hour SJMC 2012= 64% SJMC 2015=90%

/ Early and Frequent Breastfeeding Offer whenever baby shows feeding cues At least 8 times in 24 hours Cluster feedings common Growth spurts 10 days and 3, 6, 9 weeks

/ Early and Frequent Feeding Increased feeding frequency on day 2 Moms need to know what is normal baby behavior Feed whenever have feeding cues

/ Mothers Need Assistance to Learn about feeding Mother’s perception of insufficient milk is #1 reason for early weaning Mother’s need support during perceived difficulty Offering support & assistance if needed

/ Offer Assistance if needed Hands on help if needed

/ Rooming-In Keep mom & baby together 24/7 Family centered care promotion

/ Rooming-In Benefits Increased Skin-to-skin opportunities Increased breastfeeding Reduces exposure to infection Mom learns normal baby behavior Babies cry less Higher maternal-infant attachment

/ Recommendations for Length of Breastfeeding Exclusive breastmilk for the first 6 months Adding nutritious food around 6 months Continue breast milk feedings for at least 1 year

/ Avoid Routine Formula Supplementation Exclusive breast milk feeding recommended for first 6 months Give expressed milk first Assist with changing cultural beliefs Medical indications are sometimes needed

/ Discharge Bags SJMC removed in Formula Discharge Bags in 2008 Hospital should market health only Hospital should follow WHO Code of Marketing

/ Donor Breastmilk St. Joseph Medical Center Donor Breastmilk in NICU-started in December 2014 Donor Breastmilk will be started on the Mother-Baby unit in Fall St. Joseph Medical Center

/ Delay Pacifier Until 4 weeks AAP recommends delaying pacifier use until after breastfeeding is well established ( 3-4 weeks) Use whenever baby placed on back to sleep to reduce SIDS

/ Pacifier Use Early use may be associated with less successful breastfeeding ­Can interrupt the frequency of BF ­Mom may miss feeding cues ­Can reduce feeding intensity ­Mechanics of sucking differ

/ Pacifier Use Consider other soothing methods ­Breastfeeding again ­Skin-to-Skin

/ Active Follow-Up After Discharge Need follow up in 1-3 days post discharge

/ Lactation Consultants Specialized & trained to assess breastfeeding Outpatient setting at local hospitals, public health clinics, home visit, medical offices

/ WIC Local WIC clinic support breastfeeding Ask to talk to *Breastfeeding Promotion staff person* Loan breast pumps for medical or work reasons

/ WIC Partnership Contact local WIC office and create liaison St. Joseph created a partnership with local WIC offices ­Outpatient lactation clinic can loan breast pumps ­4 WIC offices in partnership ­Over 250 women served

/ Mother-to-Mother Support Groups La Leche League ­Seattle/Eastside (206) ­Spokane (509) ­Snohomish Co. (425) ­Vancouver (360)

/ Mother-to-Mother Support Group Breastfeeding USA ­Invite support group to meet at your site ­Facebook Tacoma Chapter ­Sarah (515) Whatcom Chapter ­Elizabeth (360)

/ Working & Breastfeeding Business Case for Breastfeeding Need Employer Support ­Talk with employers to find solutions ­Discuss the Laws protecting working moms

/ National BF Hotline Monday-Friday 9am-6pm Eastern Time English & Spanish

/ Public Health Department Contact local public health departments

/ Written Material for Breastfeeding Support Medline Plus ­Written material for BF support ­14 languages

/ Free Teaching Resource Registered Nurses’ Association of Ontario ­Breastfeeding Best Practices Guidelines for Nurses ­Free Teaching Tool for Nurses

/ LACTMED On-line resource for medications during lactation

/ Post Partum International of WA Find local support group Changing name to Perinatal Support Washington

/ Breastfeeding Laws in WA 2001 Breastfeeding in public is not considered indecent exposure RCW A Breastfeeding mothers are protected under state anti- discrimination law. She can breastfeed in public. No one can tell her to leave or cover up. RCW and