Mass. Baby-Friendly Collaborative Welcome!!. Background Informal Collaborative since 2008 Mother-Baby Summit since 2009 DPH Baby-Friendly Trainings Spring.

Mass. Baby-Friendly Collaborative

Welcome!!

Background

• Informal Collaborative since 2008• Mother-Baby Summit since 2009• DPH Baby-Friendly Trainings Spring 2008

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

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

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 5:30-7:30Log Cabin Conference Center, Holyoke MA

Thank you to:

UMMMCMass. Breastfeeding Coalition

Mass. DPHOur faculty and staff

Website

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

Baby-Friendly

Why it mattersMelissa Bartick, MD, MSc

Cambridge Health Alliance, Harvard Medical SchoolMass. Breastfeeding Coalition

United States Breastfeeding Committee

Patient-Centered Care60% of women do not meet THEIR OWN

breastfeeding goals.

– CDC/FDA Infant Feeding Practices Survey II, 2008

Ten Evidence-based Steps1) 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.

5) Show mothers how to breastfeed, and how to maintain lactation.

6) Give newborn infants no food or drink other than breast milk, unless medically indicated.

7) Practice rooming-in– allow moms and babies to be together 24 hours a day.

8) Encourage breastfeeding on demand.

9) Give no artificial teats or pacifiers to breastfeeding infants.

10) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

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

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

Results . . .

Compared with mothers who experienced

all 6 steps . . .

mothers who experienced no steps were

13 timesmore likely to stop breastfeeding by 6 weeks.

DiGirolamo A, Grummer-Strawn L, Fein S. Pediatrics 2008;122:S43–S49

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

This confirms earlier work

Most important predictors of weaning by 6 weeks in IFPS I were:

• Delayed 1st 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

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

PROBIT results

• Baseline group/usual care• had 6.4% exclusive breastfeeding at 3 months• Intervention hospitals had 43% exclusive breastfeeding rates at 3 months

Control hospitals

Baby-Friendly

EBF @ 3 mos

EBF @ 3 mos

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):578-584Kramer et al, JAMA, January 24/31, 2001—Vol 285, No. 4

Baby-Friendly makes a difference

• Hospital practices affect breastfeeding for months

• First Hour is vitally important• Avoiding Supplements is Important• Avoiding pacifiers is important

Why it matters

• Patient-Centered Care• Population health –(babies and likely mothers)

Size matters

Other resources

• www.massbreastfeeding.org/collaborative• Resource page• Link to videos on Vimeo.org

MassBreastfeeding CoalitionPassword: Skin2Skin

www.zipmilk.org