Visualizing the Continuum of Care for Transfers: Where are my patients? NMBTF 4th Annual Maternity Care and Infant Feeding Summit Antoinette Kleiner, RN, BSN, MSN, IBCLC November 16, 2017

Objectives- Identify potential barriers to the continuity of lactation care Identify the continuum of lactation care services Illustrate the network of services and resources available

Barriers to continuity of lactation care Geographic Physical Experience/expectations Education/resources Cultural Systems

The continuum of lactation care services Mother & baby Community hospital Tertiary hospital Specialty clinics WIC, Home visiting programs Insurance & payment sources Primary care clinics Primary care clinics- prenatal, pediatric, family medicine Delivery facility Transfers for Care Specialty clinics Community/Public Health support Primary care clinics Insurance and payment sources Family Community Community Family Family Community

Building a Lactation Care Network Organization Contact info Services provided Refer to Receive from Northwest Region Northern Navajo Medical Center -IHS Antoinette Kleiner, IBCLC 505-368-7071 Inpatient: OB, Neonatal Stabilization Unit, some Level II, Pediatric wards Outpatient: OB/GYN, Centering, Pediatric, Family Medicine clinics Public Health: home visits for all deliveries, IBCLC/PHN for hi-risk Community outreach and education Manual breast pumps Facilitate/referrals for electric breast pumps UNM & Presbyterian- antepartum/intrapartum hi-risk or NICU transfers for care SJRMC- some Level II, some patients choose to deliver there Specialty care (i.e. Cleft) Navajo Nation WIC, BPC NM WIC, BPC Home visiting programs: NM & CO Public Health, First Born, Family Spirit Other IHS/Tribal facilities Returns from tertiary care Returns from SJRMC Northeast Region Metro Region Southeast Region Southwest Region

References Bixby, C., Baker-Fox, C., Deming, C, Dhar, V., & Steele, C. (2016). A multidisciplinary quality improvement approach increases breastmilk availability at discharge from the neonatal intensive care unit for the very-low-birth-weight infant. Breastfeeding Medicine, 11, (2). DOI: 10.1089-bfm.2015.0141 Briere, C., McGrath, J., Cong, X., & Cusson, R. (2014). An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization. JOGNN, 43, 272-281. DOI: 10.111/1552-6909.12297 Evans, A., Marinelli, K., Taylor, J. (2014). ABM Clinical protocol #2: Guidelines for hospital discharge of the breastfeeding term newborn and mother: “The going home protocol”, revised 2014. The Academy of Breastfeeding Medicine. Breastfeeding Medicine, 9, (1). DOI: 10.1089-bfm.2014.9996 United States Breastfeeding Committee (2013). Continuity of care connections: Initial status report toolkit. Retrieved from http://www.usbreastfeeding.org/p/cm/ld/fid=100 Wight, N. (2015). Breastfeeding the NICU infant: What to expect. Clinical Obstetrics and Gynecology, 58, (4), 840-854. DOI: 10.1097/GRF.0000000000000140