Transcript BABY FRIENDLY FACILITY

Baby Friendly
USA!
&
The ‘REAL’ World
of Lactation
Breast Feeding Conference
2010
The Baby Friendly Hospital Initiative
(BFHI) is a global program sponsored
by the World Health Organization
(WHO) and the United Nations
Children’s Fund (UNICEF).
BFHI promotes, protects and supports
breastfeeding through
‘The Ten Steps to Successful
Breastfeeding for Hospitals’.
Working through the
process…
All 10 SIMPLE STEPS!
EDUCATION
• ALL DOCTORS AND
NURSES IN
MATERNAL/CHILD
AREAS ARE REQUIRED
TO TAKE A
BREASTFEEDING
COURSE
• ALL CORPSMAN IN
L&D ATTEND A
BREASTFEEDING
CLASS
Breastfeeding Education Options
• http://www.breastfeedingtraining.org
• Excellent option for Providers – offered free
and CME’s are included
• “The Curriculum in Support of the Ten Steps to
Successful Breastfeeding” - offered by Healthy
Children’s Project, Inc. - MOST COST
EFFICIENT OPTION FOR RN STAFF
• www.healthychildren.cc
• “Ten Steps to Successful Breastfeeding” –
available through Jones and Bartlett Publishing
• $$ COSTLY BUT EXCELLENT CURRICULUM
BREASTFEEDING
POLICY
FOLLOWING THE 10 STEPS
FOR SUCCESSFUL
BREASTFEEDING
Many Sample policies that
meet the Baby-Friendly
requirements are available
online
12- HOUR BREASTFEEDING DECISION TREE
Feeding Recommendations for (Sleepy/ Difficult to Arouse) Baby: To be used for infant who has not nursed within 12 hrs of birth
Wake baby & put to
breast
If suckles well but
LESS than 10 min,
nurse again in 1 hr
Continue hourly
feedings until suckling
well for at least 10
min q feed
If does NOT
suckle, wake again
to nurse in 1 hour
If suckles well at least
10 minutes, nurse
again in 2 hrs.
Nurse q 2 hrs during the day and q 3
hrs at night. (Wake as necessary until
arousing well by self)
If does NOT
suckle, give
15 cc
expressed
breastmilk if
available or
formula
Start again in
2 hrs.
PATIENT EDUCATION
• BEGIN
BREASTFEEDING
EDUCATION EARLY IN
PREGNANCY
• PUT BABY TO BREAST
AS SOON AS
POSSIBLE AFTER
DELIVERY
• KEEP BABY SKIN-TOSKIN FOR FIRST HOUR
OF LIFE
• PROVIDE POSTPARTUM SUPPORT
BABY FRIENDLY ONSITE SURVEY
• The Baby Friendly
USA team visited
our hospital for two
full days focusing
on:
• Interviewing staff
and patients
• Reviewing policies
and statistics
• Auditing charts
• Reviewing
educational
literature
Obstacles Encountered
• Staff education: constant staff
turn-over makes education a
continuous process; now included in
initial orientation to the unit.
• Patient Education: There is a big
difference between education
offered and pt’s perception of
education related to breastfeeding.
• Supplementation: Only when
medically indicated, education of
staff, providers and patients is
essential.
Benefits of MTF’s
• Early follow-up appointments by
RN/Lactation consultant.
• Orders can be given and must
be carried out.
• Younger mind-set of providers
• Constantly in learning mode
• Most cost effective way to
achieve healthier population
• Networking – why reinvent the
wheel!
Support System
• Many mom’s are away from family,
husband’s deployed, feel alone,
breastfeeding is not her family’s norm.
• MOM CONNECTION: weekly breastfeeding
support group *** so important to long
term success with breastfeeding.***
• Access to Lactation Consultant
• Establish an environment where
breastfeeding is seen as the norm,
prenatally, ante-partum, and post-partum,
and in the clinics
Robert E. Bush Naval
Hospital
• Recognized the long term health
benefits of promoting
breastfeeding
• Invested in an optimal level of
care to encourage
breastfeeding
• Strive to provide the best
possible care to our smallest
patients
Robert E Bush Naval
Hospital
The first and only Naval Hospital
worldwide that has achieved
accreditation as a
Baby-Friendly
Facility
New Changes For BabyFriendly Re-Certification
All Baby-Friendly Facilities
are now required to do two
Performance Improvement
projects every year to
maintain certification.
Joint Comission
and Orxy
•‘Exclusive Breast Milk Feeding’
• Only maternal medical conditions
are acceptable: HIV,substance
abuse,TB, Chemo or radiation,
active vericella, HSV with breast
lesions.
•Must be documented clearly in
the chart.
PER JOINT COMMISSION
QUALITY CORE
MEASURES
• The ‘ONLY’ acceptable reason for a baby to
NOT be exclusively breastfed, per Joint
Commission and Oryx, are maternal
medical indications.... a mother’s choice
not to breastfeed is NOT an acceptable
reason for the baby to get anything other
than breastmilk
WHAT CAN WE DO??
• STRESS IMPORTANCE OF
EXCLUSIVE BREASTFEEDING
TO PARENTS
• DOCUMENT EDUCATION IN
CHART
• DOCUMENT REASONS FOR
SUPPLEMENTATION IF NEEDED
NATIONAL AVERAGE
• BASED ON THE
NEW STRINGENT
GUIDELINESTHE NATIONAL
AVERAGE IS NOW
CONSIDERED 30%
EXCLUSIVE
BREASTFEEDING
RATE
Lactation Consults
• Perceived vs actual low milk supply.
• Usually it is a perceived problem, education
and thorough assessment are key.
• Many mom’s returning to the workplace that
rely on pumping to maintain their supply
may encounter a decreased milk volume.
Reglan works quite well in most cases to
increase production.
• Reglan 10mg: 1 tab on day one; 1 tab BID day two;
days 3-10, 1 tab TID; days 11 & 12, 1 tab BID, days
13 & 14, 1 tab daily. Total: 33 tabs
• Some working mom stay on 1 tab per day
throughout duration of breastfeeding
Cont….
• Necessary to have access to hospital grade
pump and allowed time and space to pump at
work.
• There are OPNAV, BUMED, MCO/ instructions
protecting active duty breastfeeding mothers
• Tri-care does cover hospital grade pumps for
mothers of premature infants (code E0604)
• Some hospitals have electric pump loaner
programs or can refer pt to rental station
Thrush
• La Leche League International
quotes research stating the
increased use of antibiotics in
the OB setting has increased
the cases of ductal yeast.
• Tx of GBS+ moms
• Routine antibiotic use with Csections
Symptoms and Tx
• If mom is symptomatic
•
•
•
•
•
burning
itching
deep radiating pain in nipples or breast
traces of white fungus in the folds of nipple
shiny, blistery, cracked, red appearing
nipples
• mom has vaginal yeast infection
• R/O OTHER POSSIBILITIES, ie:
latch/positioning
Tx cont…
• Treat mom with Diflucan
• “Medications and Mothers’ Milk”
Thomas Hale, PhD. Recommended
therapy:
• Diflucan 200-400mg loading dose then
100-200mg per day times 14 days
• Encourage natural treatment in
conjunction with medication;
acidophilus bifidus and grapefruit
seed extract
Tx cont…
• Jack Newman’s All Purpose Nipple
Cream:
• Mupirocin 2% (15g)
• Betamethasone 0.1% (15g)
• Miconazole powder (brining the
final concentration to 2%
miconazole)
• Apply sparingly to nipples/areolae
after each feeding, do not wash or
wipe it off before feeding.
BREASTFEEDING COUPLET –
BOTH PARTNERS, MOM AND
BABY, HAVE TO BE TREATED
• Many times the baby is
asymptomatic.
• Symptoms include:
• White patches in the mouth
• Diaper rash
• Whitish sheen to inside of
lips/saliva
• Baby not nursing well because
mouth is sore.
Thrush Tx cont…
• Nystatin:
• Most effective Tx is to treat after
every feeding
• One dropper full, half in each
cheek
• Treat for 2 weeks
• Instruct mom to sterilize pacifier,
bottle nipples, anything that baby
puts in the mouth
Nipple Shields
• Nipple shields are an awesome tool
when used appropriately
• Rarely should they be introduced
during the first 24 hours of life
• Lactation Consultant should be
notified if use of a shield is initiated
• This “quick fix” can create
weeks/months of issues for the
nursing couplet
Indications for Nipple
Shields
• Premature baby that is not fully
effective at the breast
• Latch problems after 24 hours
of life
• Neurologic problems, weak
suck, tongue thrusting or
retracting
• Mother with truly inverted
nipples
Inappropriate use of
Nipple Shield
• Sore nipples; rather than mask
the issue, identify the problem
and correct the latch.
• Sleepy baby in the first 24
hours; allow baby time to adjust
to extra-uterine like
• Poor latch; contact lactation
consultant to assess couplet
Questions?