Implications for Education and Health in Arkansas

Describe the Baby Friendly Hospital Initiative List 3 benefits of breastfeeding for baby List 3 benefits of breastfeeding for mother List two groups that need education about breastfeeding

Global health initiative to support Breastfeeding WHO UNICEF 10 Steps to Successful Breastfeeding International Code on the Marketing of Breast Milk Substitutes 4 Step Process of developing a curriculum to educate all maternal infant staff and change policies to enhance support of breastfeeding

Endorsed and encouraged as the optimal and normal mode of providing infant nutrition American Academy of Pediatrics World Health Organization American College of Ob/Gyn American Academy of Family Physicians US Surgeon General US Institute of Medicine

Compared to feeding formula breastfeeding: Decreases infant mortality by 21% Decreases risk of Sudden Infant Death Syndrome (SIDS) by 36% (>1 month) to 50% (6 months) Decreases necrotizing enterocolitis by up to 77% Decreases ER and urgent physician visits by 30% Decreases recurrent ear infections 77% Decreases diarrheal illnesses 64% Decreases inflammatory bowel disease 31% Decreases Type 1 and 2 diabetes by 30% and 40% resp. Decreases leukemia and lymphoma 20% and 15%

Formula Increases inflammatory markers in the gut increasing risk of chronic inflammatory conditions like Crohn’s disease, Ulcerative colitis, cancers and NEC Increases induction of autoantibodies such as those that attack the pancreas leading to diabetes Increases vascular inflammation leading to higher and earlier onset of arteriosclerosis and coronary artery disease Increase risk of allergies, asthma and eczema Alters the normal bacteria in the intestine causing altered digestion and absorption of nutrients, higher rates of intestinal and blood stream infections, altered immune function, obesity and abnormal growth….

Breastfeeding benefits Mom too! Decreased risk of post partum hemorrhage Decreased risk of premenopausal breast cancer and ovarian cancer Decreased risk of high blood pressure, high cholesterol, heart disease Significantly decreases risk of developing Type 2 diabetes, by up to 40% if mom was a gestational diabetic! Increases child spacing – so fewer babies are born prematurely

From Pediatrics Vol 103 No S1 April 1999 Of 100o infants in the first year of life evaluating breastfed vs non-breastfed infants relating to 3 illnesses: lower respiratory tract infection, otitis media, and gastrointestinal illness For infants not fed breast milk there were 2033 more doctor’s office visits 212 more days of hospitalization 609 more prescriptions filled These additional healthcare services cost the managed care system between $331 and $475 per never breastfed infant

If 90% of US newborns were exclusively breastfed for the first 6 months of life (Pediatrics Vol 125 No5 May 2010) Healthcare savings totaling over $13 billion annually Saves on average 911 lives, most infant lives Even only 12 weeks of exclusive breastfeeding (M. Labbok, MD – UNC Global Breastfeeding Institute) Net healthcare cost savings of $3.7 billion annually Healthcare savings in four specific diagnoses (J. Riordan J Human Lact June 1997) Diarrhea: $630 million RSV: $31 million Diabetes Mellitus: $72 million Ear infections: $660 million

Arkansas’ children are at higher risk of death in the first year of life than children in 40 other states Arkansas’ children are amongst the least likely to be breastfed in the nation In the United States infant mortality rates are higher than 33 other developed nations, and that ranking is falling… Fewer than 58% of children in Arkansas are ever breastfed

Implementing policies and practices in healthcare settings that support and protect breastfeeding Educating healthcare workers and educators about importance of breastfeeding and management of breastfeeding Educating women and girls EARLY Helping families make an INFORMED decision

Have a written breastfeeding policy that is routinely communicated to all health care staff. Train all health care staff in the 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 are separated from their infants. Give infants no food or drink other than breast-milk, unless medically indicated. Practice rooming in - allow mothers and infants to remain together 24 hours a day. Encourage breastfeeding on demand. Give no pacifiers or artificial nipples to breastfeeding infants. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

20 hour curriculum in Infant Feeding Prenatal education planning Intrapartum management of deliveries Basic physiology of breastfeeding and breast milk Breastfeeding management: cue based feeding, positioning and problem management Formula preparation Contraindications to breastfeeding or breast milk feeds Barriers to breastfeeding

Aims to educate all pregnant women prior to 32 weeks Benefits of breastfeeding Importance of exclusive breastfeeding Non-pharmacologic pain relief in labor Early skin-to-skin contact Early initiation of breastfeeding Importance of rooming-in 24hrs a day Baby-led feedings Importance of good latch and positioning 6 months exclusive breastfeeding and up to 2 years or more with complementary foods

FORMULA ≠ BREAST MILK Breast milk has immune protection for baby Breast milk is easier to absorb Breast milk fed babies have lower risk of death in the first year Breast milk fed premature babies have better long term outcomes than formula fed

Focus on the language “Breast is best or perfect” “The Gold standard” “Breastfeeding is optimal or ideal” All imply that formula is adequate and OK, but breast might be a little better… Breastfeeding is the expected normal manner of providing infant nutrition

Healthcare workers have to know breastfeeding is important first Formula marketing started in the hospital, de- emphasizing formula has to start here too… Improving breastfeeding starts with the professional healthcare workers

TEACH it EARLY! Most women make the decision about infant feeding before they become pregnant or within the first 3 months of their pregnancy From adolescence girls and women need to understand the function of their breasts and that breastfeeding is the normal way to feed a baby

Breastfeeding is most successful when Baby stays with mom Mom and baby are skin to skin very soon after birth and stay that way as much as possible The first breastfeed happens in the first hour of life The baby doesn’t get a bottle or pacifier until breastfeeding is established

Teach Medical students Physicians Nurses Educators Administrators Advocate Help overcome barriers Block formula marketing to susceptible populations Support Informed decision Help from professionals when needed Work place support

Before we can get society to change, we have to change ourselves. If we are not advocates and supporters for breastfeeding women, we cannot expect women to be able to breastfeed successfully nor can we expect society to change its perspective on breastfeeding. Teach, advocate, support. Thank you