Transcript Supporting Breastfeeding in the Hospital

Supporting Breastfeeding
in the Hospital
Breastfeeding Education
Copyright © 2007 Georgia Chapter, American Academy of Pediatrics. All rights reserved.
Faculty Disclosure
In accordance with ACCME* standards for
commercial support, all faculty members
are required to disclose to the program
audience any real or apparent conflict(s) of
interest to the content of their presentation.
I would like to disclose the following:
*
Accreditation Council for Continuing Medical Education
Program Objectives
•Examine current hospital breastfeeding
policies and promote the use of evidence
based guidelines
•Emphasize mother/ infant bonding by
avoiding separation of mother and baby
•Define the 10 steps to successful
breastfeeding.
EPIC Breastfeeding
Program Partners
• Georgia Chapter – American Academy of
Pediatrics
• Georgia Department of Public Health
• Georgia WIC
• Georgia OB/GYN Society
• American Academy of Family Physicians
• Centers for Disease Control (CDC)
Supportive Research
• Healthy People 2020
• Baby Friendly Initiative
• CDC’s Guide to Breastfeeding
Interventions
• Academy of Breastfeeding Medicine
• Policy Statements
– American Academy of Pediatrics
– OB/GYN Society
– Family Practice Physicians
• Surgeon General’s “Call to Action” to
Support Breastfeeding
Benefits for Mom
• Reduces risk of postpartum hemorrhage
• Reduced risk of cardiovascular disease
• Promotes uterine involution and weight
loss
• Decreases incidence of
breast and uterine cancer
• Enhances bonding
• Decreases postpartum
depression
• Saves money
CDC’s Breastfeeding Report Card
2014
Ever breastfed Breastfed at 6
months
Breastfed at
12 months
Exclusively
breasted at 6
months
National
rates
79.2%
49.4%
26.7%
18.8%
Georgia
rates
70.3%
40.1%
20.7%
14.5%
Childhood Illness and Disease Risk
Reduction with Breastfeeding
Obstacles to Breastfeeding
• Lack of knowledge among parents and
staff
• Inconsistent messages/advice
• Disruptive hospital policies
• Lack of adequate follow-up
Baby Friendly 10 Steps
1. Have a written breastfeeding policy that us routinely
communicated to all health care staff.
2. Train all healthcare 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 one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation,
even if they are separated from their infants.
10 steps - continued
6. Give newborn infants no food or drink other than breastmilk, unless
medically indicated.
7. Practice “rooming-in” – allow mothers and infants to remain
together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and
refer mothers to them on discharge from the hospital or clinic.
You need buy-in from staff
Stakeholders
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Physicians
Midlevel providers
Labor and delivery staff
Postpartum staff
Lactation staff
Health educators
Quality assurance
personnel
• Administrators
Joint Commission
• Exclusive breastfeeding is a “Core
Measure”
– document breastfeeding exclusivity
– supplement ONLY if medically indicated
– mother “changing her mind” is not cause
to abandon exclusive breastfeeding but
highlights need for breastfeeding support
Prenatal Breastfeeding Education
• Monitor breast changes and provide
encouragement
• Advise mother and her support person to
attend breastfeeding classes
• All providers are responsible for
encouraging breast milk feedings
• Breastfeeding classes for mom and her
support person
• Breastfeeding materials, free of formula
advertisements
Staff Training
• Policy training for all new staff
• Periodic breastfeeding trainings
– lunch and learns
– online breastfeeding education
– conferences/workshops
• 18 hours of training for mother/baby
staff
• Three hour physician training
Breastfeeding Champions
Breast or Formula
• What does the mom really want to do?
– breastfeed
– formula feed
– both?
After Delivery – Skin-to-Skin
Skin-to-Skin
• Educate staff & parents on benefits
• Baby placed between the breasts
– better temperature regulation
– normalizes breathing and heart rate
– procedures done skin to skin
– prevents hypoglycemia
– assist with breastfeeding
www.skintoskincontact.com
Delay Procedures
Rooming-in
• 24 hour rooming-in is encouraged
• Physicals, weight checks, hearing
screenings are done in mother’s room
– facilitates questions from the mother
– minimal infant separation
• Limit visitors
Some hospitals have a quiet time, no visitors for
several hours in the afternoon so that mom and
baby can get rest and practice breastfeeding.
Getting Started
• Assist with breastfeeding at delivery
• Provide encouragement
• Teach mother:
– positioning
– latch
– feeding cues
– hand expression
– signs of sufficient intake
Exclusive Breastfeeding
• No food or drink other than breast milk
• Mothers own milk is the first choice
• No promotion of breast milk
substitutes, bottles or pacifiers given
to parents.
• Supplement only when necessary
Risks of Supplementing
• Interferes with the establishment of
maternal milk supply
• Increased risk of engorgement
• May cause nipple confusion
• Alters infant bowel flora
• Undermines maternal confidence in
her ability to provide her baby with
sufficient milk
• Shortened duration of exclusive
breastfeeding
Teaching Effective Breastfeeding
•Audible swallowing
•Appropriate out put – urine/stools
•Adequate weight gain
Staff Documentation
• Observe a feeding once per 8 hours
• Ask mom, “How does it feel”
• Check urine and stool output
• Check LATCH
LATCH Score
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L - latch on
A - audible swallowing
T - type of nipple
C - comfort level
H - hold
Each of these 5 things are rated from
0-2 and then totaled. (Similar to an
Apgar score) If a mother has a score of
≤ 7 the mother will need further
assistance.
What Makes More Milk???
Removing
milk from
the Breasts!
Reasons to Supplement
• Maternal Medication
– Most medications are compatible
– Weigh benefit of breastfeeding vs. risks of
medications
• Excessive weight loss
• Hypoglycemia
• Jaundice
Every hospital should have a written
policy on supplementing
Maternal Medications
• Hale’s Medication and Mother’s Milk
• Lactmed @http://toxnet.nlm.nih.gov/cgibin/sis/htmlgen?LACT
• Poison Control 1.800.222.1222
• Rarely necessary to interrupt breastfeeding
• Short list of contraindicated medications
Amiodarone
Chemotherapy agents
Chloramphenicol
Drugs of Abuse
Ergotamine
Gold salts
Pseudoephedrine
Lithium
Phenindione
Radioactive Compounds
Retinoids
Tetracyclines (chronic use
>3weeks)
Separation of Mother and Baby
• Encourage early and frequent pumping
• Pumping frequency every 2-3 hours
• Bonding is encouraged
– Skin to skin
– Pumping at baby’s bedside
• Hand expression helps to
increase milk supply
(www.newborns.stanford.edu/Breastfeeding/)
• Provide breast pump
information for home use
Infant in NICU
Encourage skin-to-skin (Kangaroo)
– promotes better oxygen levels
– increases mom’s milk production
– baby’s temperature is
regulated
Dad’s Can Do Skin-to-Skin
Barriers
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No buy-in from administration
Lack of staff support
Inconsistent information
Formula distribution/advertisement
Formula bags
Financial costs
Discharge “Gifts”
• Do they have formula samples in them?
• Do they support breastfeeding?
• Ban the Bags
Discharge Instructions
• Instruct mom on signs of sufficient intake
– wet diapers
– changes in stool color
– listen for swallowing
• Frequent feedings are
recommended
– 8-12 feedings in 24 hours
– cluster feeding
• Give mom realistic
expectations
Follow-up
• Baby should see the pediatrician 1-2
days after discharge
• Provide telephone number for
breastfeeding questions
• Provide mom with information about
where and how to get a breast pump
• Provide a list of community lactation
support
– WIC
– LaLeche League
WIC Formula Feeding Package
at Six Months
WIC Breastfeeding Mother’s
Food Package at Six Months
What do you tell a mother
who asks that her baby
remain in the nursery at
night so she can sleep?
What do you say to the
mother who says she
doesn’t have milk or it’s not
sufficient?
Your patient says that she is
going to breastfeed but has to
go back to work and wants to
get her baby used to the bottle.
What is your response to her?
“While breastfeeding may not seem the
right choice for every parent, it is the best
choice for every baby.”
Breastfeeding: Your Guide to a Healthy, Happy Baby, 2005