Transcript Exclusive Breastfeeding

Supporting
Breastfeeding
in the Hospital
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
•Encourage the establishment of support
groups for breastfeeding mothers
EPIC Breastfeeding
Program Partners
• Georgia Chapter – American
Academy of Pediatrics
• Georgia OB/GYN Society
• American Academy of Family
Physicians
• Georgia Department of Community
Health, Div. of Public Health
• Centers for Disease Control (CDC)
Faculty Disclosure Information
• In accordance with ACCME*
standards, 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
Supportive Research
• Healthy People 2010
• 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
Benefits for Mom
• Reduces risk of postpartum
hemorrhage
• Promotes uterine involution and
weight loss
• Decreases incidence of
breast and uterine cancer
• Enhances bonding
• Saves money
• Decreases postpartum
depression
Formula-fed babies have a
greater risk for:
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Infectious morbidity
Obesity
Type 1 & type 2 diabetes
SIDS
Ear infections
Respiratory infections
Allergies
Necrotizing entercolitis
Obstacles to Breastfeeding
• Lack of knowledge among parents and
staff
• Inconsistent messages/advice
• Disruptive hospital policies
Breastfeeding Policy
• Clearly written
• Research based
• Publicly displayed
• Includes strategies for implementation
Making Changes
• Get buy in from staff
• Listen to staff comments
– “We’ve always done it that way”
– “Moms don’t want their babies with them”
– “Our moms don’t breastfeed”
• Think of ways to educate
Stakeholders
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Physicians
Labor and delivery staff
Postpartum staff
Administrators
Lactation staff
Health educators
Quality assurance
personnel
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
• 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
Breastfeeding Champions
• Reward staff who assist the
breastfeeding mothers/babies
– certificates
– breastfeeding buttons
– special recognition
• Celebrate World Breastfeeding Week
• Designate nurse for each shift to be
the breastfeeding champion
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
– prevents hypoglycemia
– procedures done skin to skin
– delay non essential tasks
– assist with breastfeeding
Delay Procedures
The Warm Chain
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Warm delivery room
Immediate drying of infant
Skin to skin
Breastfeeding
Bathing and weighing delayed
Appropriate clothing
– hat
– booties
• Warm transportation
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
Getting Started
• Assist with breastfeeding at delivery
• Teach mother:
– positioning
– latch
– feeding cues
– hand expression
– signs of sufficient intake
AAP Recommends
Breastfeeding Exclusively
Research shows that infants who feed
7-11 times in the first 24 hours of life
receive 54% more milk on day 3 than
infants who nurse <6 times.
Yamanouchi 1990
Exclusive Breastfeeding
Exclusive breastfeeding is the
reference or normative model
against which all alternative
feeding methods must be
measured with regard to growth,
health, development, and all other
short- and long-term outcomes.
(According to the Academy of Pediatrics Policy statement)
Exclusive Breastfeeding
• No food or drink other than breastmilk
• Mothers own milk is the first choice
• No promotion of breast milk
substitutes, bottles or pacifiers given
to parents.
• Supplement only when necessary
Teaching Effective
Breastfeeding
• Audible swallowing
• Appropriate output (i.e. poops and pees)
• Appropriate weight gain after 5-6 days
Documentation
• Observe a feeding once per 8 hours
• Record LATCH score
• Ask mom, “How does it feel”
• Check wet diapers and stools
What makes more milk????
Milk
Removal!
Verbal support
• Verbal praises are important
– “You’re doing a great job”
– “It takes a while to learn to breastfeed”
– “Don’t give up”
– “Breastfeeding is important”
– “It does get easier”
Reasons to supplement
• Medications
– Very rare
– Weigh benefit vs. risks of meds
• Excessive weight loss
• Hypoglycemia
• Jaundice
Maternal Medications
• Hale’s Medication and Mother’s Milk
• Rarely is it necessary to interrupt
breastfeeding
• Short list of contraindicated medications
Amiodarone
Chemotherapy agents
Chloramphenicol
Drugs of Abuse
Ergotamine
Gold salts
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
– Pump rental information
Hand expression has been
proven to increase milk supply
Infant in NICU
• Encourage skin-to-skin (Kangaroo)
– promotes better oxygen levels
– increases mom’s milk production
– baby’s temperature is
regulated
Dads can do “Kangaroo”
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
• Frequent feedings are
necessary
– 8-12 feedings in 24 hours
– cluster feeding
Follow-up
• Provide telephone number for
breastfeeding help
• Baby has appointment with the
pediatrician 1-2 days after discharge
• Provide information about breast pump
rental for working moms
Postpartum Support
• Encourage support groups after
discharge
– WIC program
– La Leche League
– hospital support groups
– peer counselors
• Phone numbers for community
support
• Staff calls patient after discharge
WIC Formula feeding package
WIC Breastfeeding Mothers Food
Package
What do you say to the
mother who wants her
baby to stay 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?
What do you say to the
mother who says that
her infant is always
fussy and feeds
frequently in the late
afternoon?
“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