-
Wednesday WebinarBecoming a Breastfeeding-Friendly Office
Practice
November 29th, 201712:00pm- 1:00pm (central time)
Lori Feldman-Winter, MD, MPHProfessor of Pediatrics
CMSRUDivision Head, Adolescent Medicine
Children’s Regional Hospital at Cooper University Hospital
Remember to mute your line by pressing *6. Please do not press
hold. Unmute is #6.
COPYRIGHTED
-
CHAMPS 4-hour Clinical Skills Trainings
Training Updates:• To date, CHAMPS has hosted 49 trainings in 21
hospitals and has trained
over 900 MS-based clinicians!
Upcoming Trainings: • (4-hour) Wayne General Hospital – November
30th
• (4-hour) Northwest Mississippi Regional Medical Center –
December 6th
• (4-hour) Merit Health Natchez – December 7th
• (4-hour) Merit Health Central – December 8th• (4-hour)
Magnolia – January 15th (afternoon) & January 16th
(morning)
Check our website for updates and to register:
cheerequity.org/trainings.html
COPYRIGHTED
http://www.cheerequity.org/trainings.html
-
SAVE THE DATE
Mississippi CHAMPS ConferenceDate: Wednesday, April 11th,
2018
Location: Courtyard by Marriott Gulfport Beachfront1600 E Beach
Blvd
Gulfport, MS
COPYRIGHTED
-
Upcoming Wednesday Webinar
Webinars are held in collaboration with the Mississippi State
Department of Health and are scheduled on Wednesdays from 12p-1p
(CST)
Fall 2017 Schedule• December 6th: Understanding the
Baby-Friendly USA Fair Market
Price Requirements- Lora L. Elston, BSN, RNC-NIC, IBCLC
Clinical Director, Baby-Friendly USA, Inc.
ALL ARE WELCOME TO ATTEND! For log-in information,
visit:http://www.cheerequity.org/webinars.html
Slides and recordings are posted the CHEERequity.org
website.
COPYRIGHTED
http://www.cheerequity.org/webinars.html
-
Becoming a Breastfeeding-Friendly Office Practice
Lori Feldman-Winter, MD, MPHProfessor of Pediatrics
CMSRUDivision Head, Adolescent Medicine
Children’s Regional Hospital at Cooper University Hospital
COPYRIGHTED
-
Learning Objectives
1. Understand why physicians matter in breastfeeding
2. Describe the challenges physicians have in supporting
breastfeeding
3. Delineate the AAP and ABM guidelines to develop a
Breastfeeding-Friendly Office Practice
COPYRIGHTED
-
Why Physicians matter?• Encouragement from health care providers
is associated
with breastfeeding initiation• Lu MC, Lange L, Slusser W,
Hamilton J, Halfon N. Provider
encouragement of breast-feeding: evidence from a national
survey. Obstet Gynecol.2001; 97 :290 –295
• …and continuation• Taveras EM, Capra AM, Braveman PA, Jensvold
NG,
Escobar GJ, Lieu TA. Clinician support and psychosocial risk
factors associated with breastfeeding discontinuation.
Pediatrics.2003; 112 :108 –115
COPYRIGHTED
-
Why Pediatricians Matter?• Specific practices and opinions of
pediatricians were associated
with continuation of exclusive breastfeeding
• Clinicians who recommended formula supplementation or who
think their advice is NOT very important may be sending signals
that exclusive breastfeeding is NOT something that mothers should
value highly
• Many clinicians do not feel confident in their skills to
support breastfeeding and may have limited time to address the
issue during preventive visits.
Taveras E. et al. 2004. Pediatrics. 113(4):e283-e290
COPYRIGHTED
-
Physicians’ Knowledge and Attitudes: Historical Perspective
Hollen BK Freed GL
Schanler RJ
Graph data modified from the Mother’s Survey, Ross Products
Division of Abbott, and CDC NIS
03 05 07 09
Feldman-Winter
These guys taught
These guys who taught
These guys/gals
COPYRIGHTED
-
Knowledge and Attitudes
• Sometimes it is what physicians don’t say or are “too vague”
in saying• Physicians need to show that they care
• Sometimes it’s not what docs say… but what docs do • Docs give
out formula company literature and portray bottle feeding as
the
norm in the office setting
COPYRIGHTED
-
Pediatricians’ Recommendations from 1995-2014
46
71
87
93
92
33
67
71
89
67
24
62
49
80
44
0 10 20 30 40 50 60 70 80 90 100
NO PACIFIERS IN HOSPITAL
UNRESTRICTED BREASTFEEDING
ROOMING-IN 24 HOURS/DAY
GIVE NOTHING BUT BREASTMILK UNLESS MEDICALLY INDICATED
BREASTFEED WITHIN 1 HOUR OF DELIVERY
Multivariable Results Using Predicted Values*
1995 2004 2014
*% Pediatricians adjusted for personal experience, age, gender,
practice experience and hours per week of work
Results from AAP Periodic Surveys #30, #57, and #89. Source:
Feldman-Winter L , et a. Pediatrics. 2017;140(4):e20171229.
ФФ
Ф
Ф
Ф Ф
ФФ
Ф= statistically different from2014, p
-
Pediatricians’ Attitudes from 1995 to 2014
81
24
41
50
57
83
25
45
58
62
83
33
44
70
70
0 20 40 60 80 100
Confidence in ability to competentlymanage breastfeeding
problems
Formula fed infants are just as healthy asbreastfed infants
Breastfeeding and formula feeding areequally acceptable
Benefits of breastfeeding outweigh thedifficulties
Almost any mother can be successful ifshe keeps trying
Multivariable Results Using Predicted Values*
1995 2004 2014
*%Pediatricians adjusted for personal experience, age, gender,
practice experience and hours per week of work
Ф
Ф
Ф
Ф= statistically different from 2014, p
-
Pediatricians’ Confidence and Practice Patterns- Related to
Experience
Feldman-Winter L. et al. Arch Pediatr Adol Med.
2008;162:1142-1150.
COPYRIGHTED
-
Confidence in Breastfeeding Care by Age
P
-
Pediatric Workforce and Breastfeeding
Feldman-Winter L. et al. Pediatrics. 2017
COPYRIGHTED
-
Pediatricians’ Personal Experience with Breastfeeding During
Residency
Dixit et al. JHL 2015"Frustrated," "depressed," and "devastated"
pediatric trainees: US academic medical centers fail to provide
adequate workplace breastfeeding support. COPYRIGHTED
-
Pediatricians’ Personal Experience with Breastfeeding During
Residency
Dixit et al. JHL 2015COPYRIGHTED
-
Risks of Not Having a Breastfeeding-Friendly Office Practice
•More Baby-Friendly hospitals means more babies will leave the
hospital exclusively breastfeeding
•Problems happen•Poorly managed breastfeeding leads to
devastating results (as we have learned from the FIB group)
•Most problems may be overcome, but not all•Breastfeeding
management is in the physicians’ scope of practice
COPYRIGHTED
-
Does Physician Education Help?
Labarere J. et al. Pediatrics. Feb 2005;115(2):e139-e146
COPYRIGHTED
-
AAP Residency Curriculum
•Trained residents (PEDS, OB/GYN, FM) - significant
improvement•Intervention vs Control groups
•Knowledge •OR 2.8 (95% CI 1.5 – 5.0)
•Confidence•OR 2.4 (95% CI 1.4 – 4.1)
•Practice patterns related to BF•OR 2.2 (95% CI 1.3 – 3.7)
Feldman-Winter et al, Pediatrics 2010; 126:289-297
COPYRIGHTED
-
AAP Residency Curriculum
Feldman-Winter et al, Pediatrics 2010; 126:289-297
Increased Exclusive Breastfeeding
0
5
10
15
20
25
30
Intervention Intervention
BeforeAfter
Control Control
Exclusive BF at 6 mo Before and After Study
Exclusive BF at hospital discharge Before and After Study
*
*
**
**
%
* p < 0.01
COPYRIGHTED
-
Traditional vs. Competency-based Education
Frenk J. et. al. Lancet 2010.
What are the most pressinghealth system needs
regardingbreastfeeding in 2017?
COPYRIGHTED
-
Competency-based Education• Health System needs
• Need to improve physician knowledge, skills and attitudes to
support exclusive breastfeeding
• Competencies• Skills in taking history, doing assessments
and
counseling• Outcomes
• Increased Exclusive Breastfeeding; Eliminate Disparities•
Assessment of Outcomes
• Measure rates• Assessment of Competencies
• Tools• Direct observation, OSCE
• Develop curriculum You determine what your docs need to
learn
COPYRIGHTED
-
AAP Clinical Report 2017
Meek et al. Pediatrics 2017COPYRIGHTED
-
ABM Clinical Protocol
• Evidence-based guidelines for Breastfeeding-Friendly Office
Practices• Levels of evidence: I, II-1, II-2, II-3, and III
COPYRIGHTED
-
ABM Protocol in Office Setting
Corriveau et al. Pediatrics 2013
COPYRIGHTED
-
Office Based Protocol
ABM protocol1. Establish a written
office policy (III)2. Encourage exclusive
breastfeeding (I, III)3. Culturally competent
care (III)4. Offer a prenatal visit
(I, II-1, II-2, II-3, III)
Operationalized1. Team formed-(docs nurses and
LC’s), policy manual with ABM clinical protocols
2. Staff training to encourage/support exclusive breastfeeding,
physicians had to complete AAP approved training
3. Spanish interpreters trained in breastfeeding support and
mother’s cultural beliefs supported
4. Prenatal class offered by practice and monthly meet and greet
offered to new patients
ABM Protocol BFMed 2013
COPYRIGHTED
-
Advocate for Exclusive Breastfeeding…And Be Able to Solve
Problems
•Risk/Benefit Assessment•Understand the consequences of not
breastfeeding exclusively
•Know where there are gaps in research•Practice Evidence Based
Medicine (EBM)
•Become educated in the benefits and management of
breastfeeding
COPYRIGHTED
-
Culturally Competent/Sensitive Care
•Define Disparities•Address common barriers: breastfeeding in
public, acculturation, language and literacy
•Understand spheres of support•Increase cultural
knowledge•Develop an approach to counseling•Use peer counselors
Hedberg. MCN Am J Matern Child Nurs. 2013
Jul-Aug;38(4):244-9
COPYRIGHTED
-
Breastfeeding Disparities- National
Data source CDC National immunization Survey COPYRIGHTED
Chart1
White/NHWhite/NHWhite/NHWhite/NHWhite/NH
HispanicHispanicHispanicHispanicHispanic
BlackBlackBlackBlackBlack
AsianAsianAsianAsianAsian
AI/ANAI/ANAI/ANAI/ANAI/AN
2 or more2 or more2 or more2 or more2 or more
overall
6 months
12 months
3 mo exclusive
6 mo exclusive
2014 Breastfeeding in the US
85.7
60
37.8
51.5
27.9
84.8
52.5
31.7
45.5
24.5
68
41.5
21.5
32.7
15
80.7
61.9
37.5
44.3
27.6
79.5
52.8
29.7
51.2
26.5
79.9
53.4
32.8
42.5
21.2
Sheet1
overall6 months12 months3 mo exclusive6 mo exclusive
White/NH85.76037.851.527.9
Hispanic84.852.531.745.524.5
Black6841.521.532.715
Asian80.761.937.544.327.6
AI/AN79.552.829.751.226.5
2 or more79.953.432.842.521.2
-
Geographic Disparities 2014Exclusive Breastfeeding Through 6
months
Data source CDC National immunization Survey
COPYRIGHTED
-
Understand Support System-Don’t Stereotype
COPYRIGHTED
-
Provide Culturally and Linguistically Competent Care
•Use interpreters or phones for translation
•Understand common cultural practices
•Use open ended questions to identify specific and individual
beliefs and practices
•Use MI to encourage optimal feeding
COPYRIGHTED
http://www.google.com/url?sa=i&rct=j&q=spanish+mom+breastfeeding&source=images&cd=&cad=rja&docid=hL1DLG2U2GZzYM&tbnid=ibhUvP5W0kXwFM:&ved=0CAUQjRw&url=http://www.michigan.gov/mdch/0,1607,7-132-2942_4911_34593---,00.html&ei=4A7eUeihJIv-4AOGsYHAAw&psig=AFQjCNHdWZC5qZ-MexQN0OxXGFqZRkQtXg&ust=1373593670828768http://www.google.com/url?sa=i&rct=j&q=spanish+mom+breastfeeding&source=images&cd=&cad=rja&docid=hL1DLG2U2GZzYM&tbnid=ibhUvP5W0kXwFM:&ved=0CAUQjRw&url=http://www.michigan.gov/mdch/0,1607,7-132-2942_4911_34593---,00.html&ei=4A7eUeihJIv-4AOGsYHAAw&psig=AFQjCNHdWZC5qZ-MexQN0OxXGFqZRkQtXg&ust=1373593670828768
-
Physicians should make referrals to WIC Peer Counselors
•WIC peers•Hospital doulas•Community health workers
COPYRIGHTED
http://www.google.com/url?sa=i&rct=j&q=peer%20counselors%20breastfeeding&source=images&cd=&cad=rja&docid=50mcABOFTVsklM&tbnid=5Qy3XEGno42xeM:&ved=0CAUQjRw&url=http://www.houstontx.gov/health/WIC/breastfeeding.html&ei=s2sLUp_uGqPkyQG6pYCICg&bvm=bv.50723672,d.aWc&psig=AFQjCNHtMhKOmLPsd-h2mzaSe4ZVbdmG_Q&ust=1376566570394240http://www.google.com/url?sa=i&rct=j&q=peer%20counselors%20breastfeeding&source=images&cd=&cad=rja&docid=50mcABOFTVsklM&tbnid=5Qy3XEGno42xeM:&ved=0CAUQjRw&url=http://www.houstontx.gov/health/WIC/breastfeeding.html&ei=s2sLUp_uGqPkyQG6pYCICg&bvm=bv.50723672,d.aWc&psig=AFQjCNHtMhKOmLPsd-h2mzaSe4ZVbdmG_Q&ust=1376566570394240http://www.google.com/url?sa=i&rct=j&q=peer%20counselors%20breastfeeding&source=images&cd=&cad=rja&docid=r2UneRAWmOIB6M&tbnid=Cen-WL6UBP9M2M:&ved=0CAUQjRw&url=http://www.nal.usda.gov/nal_web/wicworks/resources/images-download.html&ei=6WsLUvXTM4bmyQGTuYDwBw&bvm=bv.50723672,d.aWc&psig=AFQjCNHtMhKOmLPsd-h2mzaSe4ZVbdmG_Q&ust=1376566570394240http://www.google.com/url?sa=i&rct=j&q=peer%20counselors%20breastfeeding&source=images&cd=&cad=rja&docid=r2UneRAWmOIB6M&tbnid=Cen-WL6UBP9M2M:&ved=0CAUQjRw&url=http://www.nal.usda.gov/nal_web/wicworks/resources/images-download.html&ei=6WsLUvXTM4bmyQGTuYDwBw&bvm=bv.50723672,d.aWc&psig=AFQjCNHtMhKOmLPsd-h2mzaSe4ZVbdmG_Q&ust=1376566570394240
-
Pediatric Providers Can Offer a Prenatal Visit
•Meet and greet session with physician and team•Discuss the Ten
Steps•First visit with baby•Answer questions
about breastfeeding
COPYRIGHTED
http://www.google.com/url?sa=i&rct=j&q=AAP+prematal+visit&source=images&cd=&cad=rja&docid=WP5qCapOvPIlSM&tbnid=QhhAWMVdBePD_M:&ved=0CAUQjRw&url=http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html&ei=sBDeUfeRAdK64APV54CgDw&psig=AFQjCNGvarW3ZdSMPSGUZg5PkGChaUEvDA&ust=1373593911531885http://www.google.com/url?sa=i&rct=j&q=AAP+prematal+visit&source=images&cd=&cad=rja&docid=WP5qCapOvPIlSM&tbnid=QhhAWMVdBePD_M:&ved=0CAUQjRw&url=http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html&ei=sBDeUfeRAdK64APV54CgDw&psig=AFQjCNGvarW3ZdSMPSGUZg5PkGChaUEvDA&ust=1373593911531885
-
Office Based ProtocolABM Protocol5. Collaborate with local
hospital and community6. First visit within 48 hours
from hospital discharge and provide access to a lactation
consultant
7. Provide educational resources (I)
8. Encourage breastfeeding in the office (II-2, II-3)
9. Discourage formula marketing (II-2, II-3)
Operationalized5. Raise awareness about what is
offered to local hospitals and Obstetricians
6. Mothers scheduled for up to 1 hr of direct LC support with an
RN/IBCLC during first visit and F/U visits as requested by mom
7. Handouts from AAP and ILCA8. Breastfeeding in waiting
room
supported and space available if privacy desired
9. Formula only provided if there is a medical need. Formula and
ads for formula not displayed
ABM Protocol BFMed 2013
COPYRIGHTED
-
Newborn Hospital Follow Up within 48 hours of D/C
•Periodic Survey data (AAP survey of Fellows) indicate
nationally only 38% of pediatricians follow AAP recommendation for
F/U within 5 days of life (
-
Newborn Follow-up
Source: NJ PRAMS 2010COPYRIGHTED
-
Office Environment/Support
• Pictures of breastfeeding• “Breastfeeding Welcome
Here” decals• Knowledgeable and
supportive reception and office staff
• Acceptance of public breastfeeding
• Private space for breastfeeding
COPYRIGHTED
-
• Most medications compatible with breastfeeding
• Evidence-based resources– Lact MED– AAP Policy Statements–
Medications and Mother’s
Milk, by T. Hale, PhD
Check It Out Before Saying No!Medications and Breastfeeding
COPYRIGHTED
-
Family Centered Care
COPYRIGHTED
-
Everyone Has A Role In Supporting Breastfeeding
•Front Desk•Office Staff•Nursing Staff•PCP
•Clinical Management•Identify appropriate referrals
COPYRIGHTED
-
Discourage Formula Marketing
•AAP ALF resolution: Divesting from Formula Marketing in
Pediatric Care-passed 2012
…that the AAP advise pediatricians not to provide formula
company gift bags, coupons, and industry-authored handouts to the
parents of newborns and infants in office and clinic settings.
COPYRIGHTED
-
Office Based Protocol
ABM Protocol10.Telephone Support (I)11.Commend breastfeeding
(I, II-1, II-2, II-3)12.Recommend exclusive
breastfeeding to 6 months (III)
13.Develop worksite lactation policy (II-2, III)
14.Establish community resources (I, II-3, III)
Operationalized10.A Warm line available for mothers to call
and questions answered by IBCLC (trained provider) within 24
hours
11.Staff trained to offer praise and acknowledgement for
continued breastfeeding
12.The ABM guideline for exclusive breastfeeding for 6 months is
provided to all parents
13.Worksite policy developed and described as part of the
Breastfeeding Policy Manual Space and break time provided for all
employees to pump and store milk
14.Weekly support group offered and families provided with list
of other local community resources
ABM Protocol BFMed 2013
COPYRIGHTED
-
Telephone Support
•Warm line•Train staff•Provide evidence-based information
•Ensure follow-up
COPYRIGHTED
http://www.google.com/url?sa=i&rct=j&q=Bunik+telephone+triage+breastfeeding&source=images&cd=&cad=rja&docid=SLoflP_NEl-7vM&tbnid=heplZdRZ2GbtsM:&ved=0CAUQjRw&url=http://www.betterworldbooks.com/breastfeeding-telephone-triage-triage-and-advice-id-9781581107449.aspx&ei=qBfeUdy2IpG24AOwk4BY&bvm=bv.48705608,d.aWc&psig=AFQjCNG4_juITSbmvB2pVBCdhNgiBtm0sA&ust=1373595942422334http://www.google.com/url?sa=i&rct=j&q=Bunik+telephone+triage+breastfeeding&source=images&cd=&cad=rja&docid=SLoflP_NEl-7vM&tbnid=heplZdRZ2GbtsM:&ved=0CAUQjRw&url=http://www.betterworldbooks.com/breastfeeding-telephone-triage-triage-and-advice-id-9781581107449.aspx&ei=qBfeUdy2IpG24AOwk4BY&bvm=bv.48705608,d.aWc&psig=AFQjCNG4_juITSbmvB2pVBCdhNgiBtm0sA&ust=1373595942422334
-
Worksite Policy on Breastfeeding
COPYRIGHTED
-
Refer to Support Groups
• On site support group
• La Leche League Leaders– Provide basic
information and encouragement through: Support groups Telephone
warm
lines
• WIC peer counselors• Baby Cafés
COPYRIGHTED
-
Office Based ProtocolABM Protocol15. Insurance and Billing 16.
Assist with workplace
support (II-2, III)17. Formal staff training and
on-site IBCLC services (I, II-2, II-3)
18. Mentor health care providers including residents (II-2,
II-3)
19. Data tracking
Operationalized15.Lactation consultant visits are billed
to insurance using AAP Breastfeeding CPT and ICD-10 codes
16.“Going back to work” class offered to mothers and taught by
the IBCLC
17.Support staff trained in the breastfeeding-friendly office
environment specific to their roles, physicians all completed
Wellstart on line program
18.Physicians act as preceptors to residents, NP students, PA’s
and medical students.
19.Breastfeeding rates are tracked for surveillance and entered
into a database by a team member
COPYRIGHTED
-
AAP ICD-10 Coding booklet
COPYRIGHTED
-
Support Moms Returning to Work or School
Influencing factors• Type of work• Worksite accommodations:
Support, Time, Education, Private space
• Baby’s age upon return• Family, health provider
and/or community support • Child care arrangements
that support continued breastfeeding
COPYRIGHTED
-
Breastfeeding and Health Care Reform
•2010 Patient Protection and Affordable Care Act
•Section 7(r) of the Fair Labor Standards Act – Break Time for
Nursing Mothers Provision •reasonable break time to express breast
milk after the birth of her child.
•The amendment also requires that employers provide a place for
an employee to express breast milk.
COPYRIGHTED
-
USBC Model Policy to Guide Implementation of the ACA
COPYRIGHTED
-
Alternative Workplace
COPYRIGHTED
-
Train HCP’s:USBC Core Competencies for all Health Care
Professionals
•Endorsed by the AAP and other health care organizations
•Multidisciplinary competencies•Consistent care models
Feldman-Winter L Evidenced-based Interventions PCNA 2013
COPYRIGHTED
-
Providing Anticipatory Guidance
COPYRIGHTED
http://www.google.com/url?sa=i&rct=j&q=AAP%20breastfeeding%20billing%20coding%20booklet&source=images&cd=&docid=ux7mvyTmP6JH5M&tbnid=Ai9ymumyhSgdLM:&ved=0CAUQjRw&url=https://www.facebook.com/AAPSectionOnBreastfeeding&ei=VxneUcS3CpLj4AP454GoBA&psig=AFQjCNHe6An9rdU64y-gnkca1k7UmAKvVA&ust=1373596372494423http://www.google.com/url?sa=i&rct=j&q=AAP%20breastfeeding%20billing%20coding%20booklet&source=images&cd=&docid=ux7mvyTmP6JH5M&tbnid=Ai9ymumyhSgdLM:&ved=0CAUQjRw&url=https://www.facebook.com/AAPSectionOnBreastfeeding&ei=VxneUcS3CpLj4AP454GoBA&psig=AFQjCNHe6An9rdU64y-gnkca1k7UmAKvVA&ust=1373596372494423
-
First Pediatric Visit
• Ask open-ended questions• How is breastfeeding going? • Tell
me about your baby’s latch.• What are your expectations?• Who is
your support system?
• Reinforce that frequent feeding is not an indicator of
insufficient milk supply.
• Remember Vitamin D!
Give Encouragement, Support and Praise!
Chart feeding method
COPYRIGHTED
-
2-Week Pediatric Visit
1. Assess current feeding regimen and plans2. Explain normal
“cluster feedings” which occur in
early evening3. Reassess weight and concerns for low milk
supply4. Inquire about mother’s medications , birth control
plans , and plans to return to work5. Ask about other caregivers
and whether they help to
feed the baby6. Discuss bottle use and expressing breast milk7.
Reinforce use of Vitamin D.
Give Encouragement, Support and Praise!
Chart feeding method
COPYRIGHTED
-
One Month Pediatric Visit
• Continue to ask open-ended questions• Review safe
breastfeeding/sleeping
environment• Assess back-to-work or school issues
• Assess current feeding regimen and plans• Discuss change in
stooling pattern• Provide positive messages!!
Give Encouragement, Support and Praise!
Chart feeding method
COPYRIGHTED
-
6 Week Maternal Care Visit- Consider Doing Visit at 2 weeks, or
2 Days-4th trimester
•Assess the breast•Contraceptive Visit•Look out for
•Mastitis•Nipple infections•Milk production
Continue to Give Encouragement, Support and Praise!
Chart feeding method
COPYRIGHTED
-
Don't Miss Opportunity to Support Breastfeeding at Sick
Visits
Continue breastfeeding through:• Gastroenteritis• Viral
infections – mother’s milk
helps decrease severity and duration
• Ear infection - less frequent• Urinary Tract Infection (UTI)•
Vaginitis
“Use every patient encounter to promote and support continued
breastfeeding.”
COPYRIGHTED
-
Track Your Progress
• Record feeding at every visit (any breastfeeding, supplemented
breastfeeding, no breastfeeding, and +/- solid food)
• Monitor rates by demographics (race/ethnicity, insurance
status, office location)
• Keep track of changes and how they may have affected rates•
Don’t change everything at once
COPYRIGHTED
-
Summary
•Physicians need to be educated to provide breastfeeding
care•Poor support can lead to bad consequences
•Understand why physicians may have low confidence and lack of
ability to support breastfeeding
•Physician office practices provide many opportunities for
improvement
•Start with one change at a time•Don’t forget teamwork
COPYRIGHTED
-
COPYRIGHTED
-
• Thanks for joining today!• Upcoming webinars
• December 6th : Lora L. Elston, Baby-Friend USA, will talk
about Understanding Baby-Friendly USA Fair Market Price
Requirements
• These slides have been uploaded to our website and a recording
of the webinar will be uploaded there this afternoon.
CHEERequity.org/webinars
COPYRIGHTED
Wednesday Webinar�Becoming a Breastfeeding-Friendly Office
Practice�CHAMPS 4-hour Clinical Skills TrainingsSlide Number
3�Upcoming Wednesday WebinarBecoming a Breastfeeding-Friendly
Office PracticeLearning Objectives�Why Physicians matter?Why
Pediatricians Matter?Physicians’ Knowledge and Attitudes:
Historical PerspectiveKnowledge and AttitudesPediatricians’
Recommendations from 1995-2014Pediatricians’ Attitudes from 1995 to
2014Pediatricians’ Confidence and Practice Patterns- Related to
ExperienceConfidence in Breastfeeding Care by AgePediatric
Workforce and BreastfeedingPediatricians’ Personal Experience with
Breastfeeding During ResidencyPediatricians’ Personal Experience
with Breastfeeding During ResidencyRisks of Not Having a
Breastfeeding-Friendly Office PracticeDoes Physician Education
Help?AAP Residency CurriculumSlide Number 21Traditional vs.
Competency-based EducationCompetency-based EducationAAP Clinical
Report 2017ABM Clinical ProtocolABM Protocol in Office Setting
Office Based ProtocolAdvocate for Exclusive Breastfeeding�…And Be
Able to Solve ProblemsCulturally Competent/Sensitive
CareBreastfeeding Disparities- National�Geographic Disparities
2014�Exclusive Breastfeeding Through 6 monthsUnderstand Support
System-Don’t StereotypeProvide Culturally and Linguistically
Competent CarePhysicians should make referrals to WIC Peer
CounselorsPediatric Providers Can Offer a Prenatal VisitOffice
Based ProtocolNewborn Hospital Follow Up within 48 hours of
D/CNewborn Follow-upSlide Number 39Slide Number 40Family Centered
CareEveryone Has A Role In �Supporting BreastfeedingDiscourage
Formula MarketingOffice Based ProtocolTelephone SupportWorksite
Policy on BreastfeedingSlide Number 47Office Based ProtocolAAP
ICD-10 Coding bookletSlide Number 50Breastfeeding and Health Care
ReformUSBC Model Policy to Guide Implementation of the
ACAAlternative Workplace�Train HCP’s:�USBC Core Competencies for
all Health Care ProfessionalsSlide Number 55Slide Number 56Slide
Number 57Slide Number 586 Week Maternal Care Visit- Consider Doing
Visit at 2 weeks, or 2 Days-4th trimester Slide Number 60Track Your
ProgressSummarySlide Number 63Slide Number 64