1. Assessing Readiness to Breastfeed in the Prenatal Visit Perinatal Services Coordination Family,Maternal & Child Health Programs Public Health Nancy Hill, MS, RD, IBCLC Nutrition and Lactation Consultant

2. Assessing Readiness to Breastfeed in the Prenatal Visit  At the end of this presentation participants will be able to:  List two common barriers to exclusive breastfeeding readiness.  Describe a brief intervention for clinicians to use during prenatal visits to assess and promote breastfeeding readiness  Describe some tools that would help them to promote breastfeeding during prenatal visits  List one resource for breastfeeding support for low- income women in Contra Costa.

3. Assessing Readiness to Breastfeed in the Prenatal Visit  What do you think about promoting breastfeeding during prenatal medical visits?

4. Assessing Readiness to Breastfeed in the Prenatal Visit  Clinician promotion of breastfeeding is effective  Structured prenatal breastfeeding education is recommended in a recent USPS Task Force report.  The CDC Guide to Breastfeeding Intervention: http:www.cdc.gov/breastfeeding

5. Assessing Readiness to Breastfeed in the Prenatal Visit 1.Have a written breastfeeding policy that is routinely communicated to all health care staff. 2.Train all health care staff in skills necessary to implement this policy. 3.Inform all pregnant women about the benefits and management of breastfeeding. 4.Help mothers initiate breastfeeding within 1 hour of birth. 5.Show mothers how to breastfeed and maintain lactation, even if separated from infants. Hospital Policies to Support Breastfeeding

6. Assessing Readiness to Breastfeed in the Prenatal Visit 6.Give newborn infants nothing other than breastmilk, unless medically indicated. 7.Practice rooming-in 24 hours a day. 8.Encourage breastfeeding on demand. 9.Give no artificial nipples or pacifiers. 10.Foster the establishment of breastfeeding support groups. Hospital Policies to Support Breastfeeding

7. Assessing Readiness to Breastfeed in the Prenatal Visit  CCRMC “Baby Friendly  In-hospital practices Skin-to-Skin Reducing supplementation  Staff education  Patient and family prenatal education  Coordination of outpatient breastfeeding services  Policies and procedures

8. Assessing Readiness to Breastfeed in the Prenatal Visit  Why is it so hard to get women to exclusively breastfeed?  What have you heard patients say about breastfeeding in your practice?

9. Assessing Readiness to Breastfeed in the Prenatal Visit  Common obstacles to breastfeeding  Lack of confidence  Early breastfeeding problems/pain  Depression  Return to work  Hospital supplementation  Embarrassment ( breastfeeding in public)

10. Assessing Readiness to Breastfeed in the Prenatal Visit You can do it. You can do anything. Women just like you breastfeed. It is the thing to do. CONFIDENCE

11. Assessing Readiness to Breastfeed in the Prenatal Visit  What opportunities do you have to promote breastfeeding during the prenatal visits?

12. Assessing Readiness to Breastfeed in the Prenatal Visit  Perform breast examination.  Discuss normal anatomy and physiology.  Assess previous surgeries, scars, biopsies.  Talk about previous breastfeeding experiences.  Provide positive support for benefits of breastfeeding.

13. Assessing Readiness to Breastfeed in the Prenatal Visit  What kind of tool would help you talk with patients about breastfeeding?

14. Assessing Readiness to Breastfeed in the Prenatal Visit Personal commitment: “How do you feel about breastfeeding?” Knowledge “What have you heard about breastfeeding?” Environmental support “What does your family/partner think about breastfeeding this baby?”

15. Assessing Readiness to Breastfeed in the Prenatal Visit Medical issues Does the pregnant woman have hormonal, surgical or medical conditions that affect breastfeed or for which breastfeeding is contraindicated?

16. Assessing Readiness to Breastfeed in the Prenatal Visit How can you document breastfeeding promotion in the medical visit?

17. Assessing Readiness to Breastfeed in the Prenatal Visit  Breastfeeding support resources for your patients  WIC Breastfeeding support  Clinic services Public Health Field Nursing  CCRMC lactation consultants

18. Assessing Readiness to Breastfeed in the Prenatal Visit

19. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

20. Assessing Readiness to Breastfeed in the Prenatal Visit  Breastfeeding is preferred feeding for almost all infants.  Mothers should be informed of the benefits of breastfeeding.  Supplementation is rarely indicated and interferes with successful lactation.  Breastfeeding should be actively supported and promoted in the medical community and society.  Women should feel comfortable continuing to breastfeed for as long as desired. Copyright © 2003, Rev 2005 American Academy of Pediatrics AAP recommendations