Every Week Counts Learning Collaborative July 13, 2012

Preparing for a Lifetime, It’s Everyone’s Responsibility Breastfeeding Workgroup

Breastfeeding Workgroup Co-Leads Nancy Bacon, MS, RD/LD, CDE MCH Nutrition Consultant Maternal and Child Health Service Oklahoma State Department of Health nancyb@health.ok.gov 405-271-4480 Adrianna Halstead, RD/LD WIC Breastfeeding Peer Counseling Specialist WIC Service Oklahoma State Department of Health adriannah@health.ok.gov 405-271-4676 or 1-888-655-2942 Will add brief info here re the workgroup history

Breastfeeding Workgroup Purpose Increase the % of mothers who breastfeed their infants at 6 months of age. Outline specific breastfeeding activities that will improve maternal & infant outcomes. Coordinate with WIC to plan and promote the annual WIC Breastfeeding Conference. Provide consistent breastfeeding messages.

Breastfeeding Workgroup Purpose Maintain the Breastfeeding Website http://bis.health.ok.gov Support the OK Breastfeeding Hotline 1-877-271-MILK (6455) Support the OK Hospital Breastfeeding Education Project Increase the number of Baby-Friendly hospitals in Oklahoma

Oklahoma Hospital Breastfeeding Education Project Leader Rebecca “Becky” Mannel, BS, IBCLC, FILCA Clinical Instructor Department of OB/GYN University of Oklahoma Health Sciences Center rebecca-mannel@ouhsc.edu 405-271-4350 Since 2008, the OSDH has partnered with the OUHSC Dept of OB/GYN to provide a statewide breastfeeding hotline for nursing mothers and families, expectant parents, and health care providers (1 877-271-MILK (6455). In Oct of 2010, this partnership was expanded to create Oklahoma’s Hospital Breastfeeding Education Project. This project provides birthing facilities in Okla. assistance to help assess their current level of breastfeeding care and identify areas to improve. Becky Mannel, Lactation Services Manager and Clinical Instructor with OUHSC’s Dept. of OB/GYN, is the project coordinator. She offers in-person evidence-based staff trainings, individual train the trainer sessions, ongoing technical support, and additional staff education and resources as needed. Since the project’s launch, 42 of our 59 delivering hospitals are participating .

Surgeon General’s Call to Action: Health Care System Ensure that maternity care practices around the United States are fully supportive of breastfeeding. Provide education and training in breastfeeding for all health professionals who care for women and children.

CDC’s Breastfeeding “Report Card” Maternity Practices & Infant Nutrition/Care (mPINC) Survey 2009 US Average: 65 out of 100 Oklahoma score: 55 Staff breastfeeding education: 51 out of 100 Oklahoma score: 38 These are failing grades! How did your hospital score?

New Breastfeeding Goals from Healthy People 2020 Objective U.S. Baseline HP 2020 Goal Worksite Lactation Support Programs 25% of employers 38% of employers Reduce Formula Supplementation in 1st 2 days of life 24.2% of breastfed newborns 14.2% of breastfed newborns Increase # of Baby-Friendly Hospitals 4% of U.S. hospitals 8.1% of US hospitals

Oklahoma Hospital Breastfeeding Education Project Purpose Increase breastfeeding initiation and duration rates through change in breastfeeding related maternity care policies and practices in Oklahoma hospitals

Activities to Date Contract approved Oct 2010 CDC “ARRA” funding Title V funding Ongoing curriculum review/development Data collection and collaboration Office of Perinatal Quality Improvement OK Hospital Association Rising Star Education’s Breastfeeding Continuing Education Program (BCEP)

Activities to Date Initial phase launched in Dec 2010 13 Site visits conducted 42 participating birthing hospitals 7 BCEP trainer sessions provided 520 BCEP books provided to 42 hospitals Full day staff training class provided statewide Website developed Resources – modules, videos, policies Recognition for hospitals www.oumedicine.com/breastfeeding http://iio.health.ok.gov – For Hospitals 8 of 20 hospitals responded initially

Hospital Stories “We put our formula in the supply pyxis” Implementing skin to skin in first hour “most of our nurses did this at previous jobs!” “We have changed our HR policy so our staff can use break times for milk expression” “We have provided BCEP to ALL our staff and our doctors” We have decided to pursue Baby-Friendly!”

Baby-Friendly Oklahoma Purpose: Provide OK Birthing hospitals support to work toward Baby-Friendly Hospital designation Offer a statewide Baby-Friendly Hospital Summit (winter 2013) to educate maternity care leaders and promote steps toward the Baby-Friendly designation Goals: Improve exclusive breastfeeding rates at hospital discharge Improve duration rates Reduce Oklahoma infant mortality and child/adult obesity rates

Baby-Friendly Hospital = Optimal Breastfeeding Care Two main components: Ten Steps to Successful Breastfeeding No marketing of breastmilk substitutes in the hospital Baby-Friendly hospitals do not accept or distribute free or low-cost supplies of breastmilk substitutes, nipples or pacifiers. We’re also working to increase the number of baby-friendly certified hospitals in OK, and have received funding to continue these efforts. We’re currently working to identify 10 birthing hospitals that will to work toward achieving the Baby-Friendly Hospital designation by beginning implementing 4 of the 10 Steps to Successful Breastfeeding

Ten Steps to Successful Breastfeeding Every facility providing maternity services and care for newborn infants should: Have a written breastfeeding policy that is routinely communicated to all health care staff. Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about the benefits and management of breastfeeding. Help mothers initiate breastfeeding within one hour of birth. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.

Ten Steps to Successful Breastfeeding Give newborn infants no food or drink other than breastmilk, unless medically indicated. Practice rooming-in – allow mothers and infants to remain together – 24 hours a day. Encourage breastfeeding on demand. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Baby-Friendly Oklahoma July 2012 – June 2013 Year One - Recruit first group of 10 hospitals Hospitals will: Sign a commitment letter to implement 4 of the 10 Steps in 1st year Participate in kickoff conference call/webinar Complete Baby-Friendly USA Discovery phase (1st 2 months) Register, CEO support letter, self-assessment Begin Baby-Friendly USA Development phase Policy, staff training, patient education Baby-Friendly Oklahoma provides: Website Resources Model Policy Baby-Friendly Curriculum (15 nursing contact hours) Regional Train the trainer skills labs (verify competency) Regularly scheduled conference calls for hospital teams Complete Baby-Friendly USA Discovery phase (1st 2 months)

Baby-Friendly Oklahoma (Year 1) Hospital Maternity Leadership Summit – Winter 2013 Nationally known speakers Hospitals invited to send a MCH Leadership team (up to 3) to learn ways to implement the 10 Steps Participating Hospitals receive: $500 travel reimbursement for team attending Summit $3,000 stipend for part of Baby-Friendly Fees Ongoing support, resources, and breastfeeding education for all healthcare staff to promote adoption of evidence- based breastfeeding policies On site and regional trainings, and regularly scheduled conference calls

Baby-Friendly Hospital Initiative (Year 2 ) July 2013- June 2014 Recruit second group of 10 hospitals Repeat first year steps First group of 10 hospitals to complete Development and Dissemination phases Collect data and address gaps in implementation of 10 steps Baby-Friendly Oklahoma Provides team for mock surveys Calculates fair market value of formula/supplies purchasing for hospitals

Baby-Friendly Hospital Initiative (Year 3 ) July 2013 - July 2014 1st group of hospitals will complete Designation Phase Schedule readiness telephone interview with Baby-Friendly USA Conduct mock surveys with OK Baby-Friendly team Schedule Baby-Friendly USA assessment Recruit third group of 10 hospitals Repeat first and second year steps

Oklahoma Hospitals Doing the Right Thing Join your peers in eliminating the negative practice of giving commercial formula “gift” bags to new families! Bag-Free Going Bag-Free Interested Great Plains Regional Claremore Indian Duncan Regional Jackson County Memorial Deaconess Hillcrest Medical Center OU Medical Center, OKC ALL Integris Hospitals Mercy Health Center OU Medical Center, Edmond Mercy Memorial Norman Regional Healthplex system Weatherford Regional OSU Medical Center St. John’s St Anthony’s Unity Health Center

Oklahoma Hospitals Doing the Right Thing To join the effort, contact Becky Mannel or OPQI office Goal: Bag free in August for US Breastfeeding Month/World Breastfeeding Week Get your hospital included in the press release which is sure to generate national attention! Hospitals should market health, and nothing else!