1. Learning and Teaching Breast-Feeding Skills: An Interactive Seminar Scott Hartman Elizabeth H Naumburg Elizabeth Loomis STFM 2014

2. Breast is best

3. Formula feeding as a health risk 3.6 fold risk of hospitalization for respiratory tract infections in first 12 months 2.8 times more likely to develop a GI infection Two fold risk for Otitis Media in the first year 1.6-2.1 increase in the risk of SIDS 1.6 fold risk for developing Type 2 Diabetes 1.4 to 1.7 fold risk of Asthma

4. Recommendations ACOG - 6 months of exclusive breastfeeding. AAP and AAFP- 6 months exclusive plus at least through the infant’s first birthday, and as long thereafter as is mutually desired. WHO recommends at least 2 years of breastfeeding for all infants. The USPSTF recommends interventions during pregnancy and after birth to promote and support breastfeeding. (B)

5. Baby Friendly Hospital initiative 1.Have a written breastfeeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in the 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. 6. Give infants no food or drink other than breast-milk, 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 birth center.

7. Prenatal Care Feeding intent is one of strongest predictors of BF. Prenatal maternal education makes a difference in adoption and duration of BF Prenatal provider knowledge/attitudes have a “dose dependent impact” on BF. Providers should discuss BF each trimester, ideally discuss at every 3 rd visit Structured BF classes, lactation visits and peer counseling have strongly positive impact.

8. Intrapartum care Doulas or the constant presence of a close companion enhance BF initiation and duration. Early cessation of BF is associated with analgesia use and surgical intervention. Intrapartum analgesia, regardless of type, may have an impact on breastfeeding. ** Epidural analgesia, intramuscular opioids, exogenous oxytocin, and ergotamine have all been associated with lower rates of BF initiation.

9. Immediate post partum period Skin to skin contact until after the first feeding Drying and Apgar/Assessment while being placed with the mother. Other procedures can be delayed. Skin to skin regardless of method of delivery. The Golden Hour: BF in 1st hour strongly predictive of initiation and duration.

10. Post partum care Mother-baby rooming in on a 24 hours basis. Interdisciplinary support critical in initiation and duration of BF. RN and provider commitment, knowledge and attitudes all critical (multiple studies). Supplemental feeding should not be given to breastfed infants unless there is a medical indication.

11. Evaluating breast feeding Timing Latch : -Nose to Nipple -Gape -Nipple Position -Seal Satiety Hold Frequency

12. Resources www.bfconsortium.org. Free training for clinicians (offers CME/CEUs) on breastfeeding topics.www.bfconsortium.org www.kellymom.com. Good info on breastfeeding and newborn topics.www.kellymom.com http://newborns.stanford.edu/Breastfeeding/ Great info and videos on manual expression, etc.http://newborns.stanford.edu/Breastfeeding/ www.lowmilksupply.org. Excellent reference on maternal and newborn feeding difficulties. http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositionp aper.htmlAAFP breasteeding position paper.www.lowmilksupply.orghttp://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositionp aper.html American Academic of Pediatrics Policy Statement: Breastfeeding and the use of human milk. Pediatrics 2005; 115(2):496-506. Mentions formula as harmful, importance of 6 months exclusive breastfeeding. ABM Clinical Protocol #5: Peripartum Breastfeeding Management for the Healthy Mother and Infant at Term, Revision 2013. BREASTFEEDING MEDICINE. Volume 8, Number 6, 2013. http://www.surgeongeneral.gov/library/calls/breastfeeding/ World Health Organization/UNICEF. Baby Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care. World Health Organization, UNICEF, 2009. http://www.unicef.org/newsline/tenstps.htmhttp://www.unicef.org/newsline/tenstps.htm The Risks of Not Breastfeeding for Mothers and Infants. Alison Stuebe, MD, MSc. Reviews In Obstetrics & Gynecology, Vol., no. 4, 2009