1. Mass. Baby-Friendly Collaborative Welcome!!

2. Background Informal Collaborative since 2008 Mother-Baby Summit since 2009 DPH Baby-Friendly Trainings Spring 2008

3. Our Faculty today Roger Edwards, ScD Mary Ellen Boisvert, RN, MSN, CLC, CCE Lucia Jenkins, RN, IBCLC Mary Foley, RN, IBCLC Judy Fayre, BS, RN, IBCLC Melissa Bartick, MD, MSc

4. Today’s agenda Part I: Information (didactic) Part II: Hospital working groups Part III: Based on your feedback on index card, breakout groups based on topics of most interest

5. Future meetings Eastern Mass Feb 28, 4:30-6:30 April 4, 4:30-6:30 Both at Somerville Hospital Cafeteria Conf. Room Western Mass Holyoke Hospital March 21, 4:30-6:30 Axilliary Conf. Room Whole State Meeting: Thursday, May 2, approx 5:30-7:30 Log Cabin Conference Center, Holyoke MA

6. Thank you to: UMMMC Mass. Breastfeeding Coalition Mass. DPH Our faculty and staff

7. Website www.massbreastfeeding.org/collaborative – Meetings times and places & directions – Resources

8. Baby-Friendly Why it matters Melissa Bartick, MD, MSc Cambridge Health Alliance, Harvard Medical School Mass. Breastfeeding Coalition United States Breastfeeding Committee

9. Patient-Centered Care 60% of women do not meet THEIR OWN breastfeeding goals. – CDC/FDA Infant Feeding Practices Survey II, 2008

10. Ten Evidence-based Steps 1)Written breastfeeding policy & communicate it to staff. 2)Train all health care staff to implement the policy. 3)Inform all pregnant women about benefits & management of breastfeeding. 4)Initiate breastfeeding within an hour of birth. 1)Show mothers how to breastfeed, and how to maintain lactation. 2)Give newborn infants no food or drink other than breast milk, unless medically indicated. 3)Practice rooming-in– allow moms and babies to be together 24 hours a day. 4)Encourage breastfeeding on demand. 5)Give no artificial teats or pacifiers to breastfeeding infants. 6)Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

11. The 10 Steps: Do they work?. CDC/FDA Infant Feeding Practices Study II 1,907 women who intended to bf> 2 months Measured: Breastfeeding termination at 6 weeks DiGirolamo A, Grummer-Strawn L, Fein S. Pediatrics 2008;122:S43–S49

12. Surveyed moms on 6 steps: Breastfeeding within 1 hour of birth Giving only breast milk Rooming in Breastfeeding on demand Not using pacifiers Fostering breastfeeding support groups

13. Results... Compared with mothers who experienced all 6 steps... mothers who experienced no steps were 13 times more likely to stop breastfeeding by 6 weeks. DiGirolamo A, Grummer-Strawn L, Fein S. Pediatrics 2008;122:S43–S49

14. Most important steps: Breastfeeding within the first hour of birth No formula No pacifiers DiGirolamo A, Grummer-Strawn S, Fein S. Pediatrics 2008;122:S43–S49

15. This confirms earlier work Most important predictors of weaning by 6 weeks in IFPS I were: Delayed 1 st feed beyond the first hour after birth Giving formula without a medical reason From IFPS I, 1993-94 DiGirolamo A, Grummer-Strawn L, Fein S BIRTH 28:2 June 2001

16. PROBIT Promotion of Breastfeeding Intervention Trial Kramer et al randomized hospitals and associated clinics in Belarus Some had usual care; others implemented BFHI type intervention

17. PROBIT results Baseline group/usual care had 6.4% exclusive breastfeeding at 3 months Intervention hospitals had 43% exclusive breastfeeding rates at 3 months

18. Did it make a difference to population health? >17,000 infants enrolled Decreased infant gastroenteritis Decreased eczema Significant increase in school performance, IQ Even though less than half of all infants were exclusively breastfeed x3 months Kramer et al, Arch Gen Psychiatry. 2008;65(5):578-584 Kramer et al, JAMA, January 24/31, 2001—Vol 285, No. 4

19. Baby-Friendly makes a difference Hospital practices affect breastfeeding for months First Hour is vitally important Avoiding Supplements is Important Avoiding pacifiers is important

20. Why it matters Patient-Centered Care Population health – (babies and likely mothers)

22. Size matters

23. Other resources www.massbreastfeeding.org/collaborative Resource page Link to videos on Vimeo.org MassBreastfeeding Coalition Password: Skin2Skin www.zipmilk.org