1. A Pilot Study to Increase Breastfeeding Rates in a WIC Population Mary Sammer, MS, RD Nutrition Services/WIC Director North County Health Services San Marcos, California

2. WIC Refresher Federally funded supplemental nutrition program for low to moderate income women, infants and children Program Benefits – Nutrition & breastfeeding education – Vouchers for nutritious foods – Referrals for healthcare & other community programs

3. Impact of WIC Program California – WIC serves 1.3 million participants/month – Over 60% of infants born in California on WIC National – WIC serves 8 million participants/month – 47% of infants born in US on WIC

4. California WIC Program’s Breastfeeding Mission Statement “The California WIC Program promotes, supports and protects exclusive breastfeeding for approximately the first six months of life, and continued breastfeeding for at least the first year.”

5. WIC Program Transitioning to Obesity Prevention WIC strategically positioned to make a significant impact on childhood obesity Strategic areas: Encouraging breastfeeding and appropriate infant/toddler feeding

6. Rationale for Phone Intervention Study To increase exclusive breastfeeding rate Up to 50% of breastfed infants are weaned in the first 14 days postpartum (Loughlin, et al. 1985). History of a some early phone contacts, though not routine. Able to fund intervention with “Revitalization of Nutrition Services” money

7. Study Preparation 1.Developed a Contact Form * – Early feeding assessment (weight, I/O, adequacy) – Provide targeted education – Anticipatory guidance (growth spurts, feeding cues) * Used ILCA’s “Evidence-Based Guidelines for Breastfeeding Management During the First 14 Days” www.ILCA.orgwww.ILCA.org 2.Staff Training – Well trained staff (CLE’s, in-house specialty training) – Specific training on interviewing with questionnaire 3.Random Assignment of Pregnant Moms to Intervention or Control group

8. Hypotheses WIC mothers who receive an early postpartum phone call will be more likely to exclusively breastfeed, and breastfeed for a longer period of time than a control group. * * Measured by: Infant’s monthly WIC food prescription from birth to 1 year

9. Our Study Population Intervention N = 86Control N = 92 EthnicityHispanic = 75 (87%)Hispanic = 79 (85%) Primary LanguageSpanish = 59 (69%)Spanish = N/A Prior Experience Breast Feeding 42 (49%)N/A Calls Made Within First 14 days 62 (73%)N/A Average Age of Infant at Second Call 22 days oldN/A Average Age of Infant at First WIC Visit 20 days old16 days old

10. We Made a Difference! Age at which 25% are still Exclusively Breastfeeding 315 days (10 ½ months) 194 days old (6 ½ months) Statistically Significant at.05 InterventionControl Breastfeeding Exclusively at First month 72/86 (84%)68/92 (74%) Breastfeeding Exclusively at Second month 49/86 (58%)45/92 (42%)

11. Infant’s Age at First Call

12. Trend in % of Total Cohort Reporting Exclusive Breastfeeding

13. What Happens Over Time: Trend in Breastfeeding for Intervention Group

14. What Happens Over Time: Trend in Breastfeeding for Control Group

15. Why it Worked Connected with Moms at their time of need Beyond the normal WIC “clinic” services Reached them at a “vulnerable” time in breastfeeding Moms had 100% of our attention, Staff were given time to make call, build rapport with women Intervention was individual and personal Well-trained staff Asked open & closed ended questions that allowed us to educate, guide and reassure WIC is a trusted resource

16. Staff’s Report of Calls Overwhelmingly POSITIVE Newborn care concerns/questions Confidence and reassurance of what’s “normal” with breastfed infant Empower mothers not to give formula unnecessarily. Common breastfeeding concerns Referrals

17. Conclusion Early phone intervention helped the group of moms who wanted to breastfeed, but who may have quit prematurely for a variety of reasons Using early postpartum phone intervention calls, we increased breastfeeding exclusivity and duration Early postpartum phone intervention fits within the “scope of WIC services” And could be easily replicated in other settings

18. For Additional Information North County Health Services WIC Program 150 Valpreda Road, Suite 150 San Marcos, CA 92069 (760) 752-4324 Mary Sammer Lori Hill