1. Breastfeeding: Supporting Hospital Birth Practices & Active Support After Discharge Sonja Dahl RN, IBCLC Lactation Coordinator September 9, 2015

2. THRIVE Early Learning. Every Child. Our Future.

3. / Healthy Development Similar Benefits * Strong parent- child bond * Healthier mother & baby * Positive parenting * Higher rate of IQ *Lower rates of abuse & neglect * Impacts 2 people at same time

4. / Presentation Title4 Objectives The learner will be able to state 3 hospital practices that influence breastfeeding rates The learner will be able to list 3 resources to use in the community to help support continues breastfeeding The learner will be able to state 3 benefits of breastfeeding The learner will be able to state 3 risks of not breastfeeding

5. / What Makes Breast Milk Unique? More bio-available to baby Changes to meet infant’s needs Unique compounds not found in formula

6. / Benefits to Breastfeeding *Lowers rate of ear infections *Lowers rate of respiratory infections *Lowers rate of obesity & diabetes *Lowers rate of SIDS

7. / Benefits for Breastfeeding *Lower rates of maternal breast & ovarian cancer *Lower rates of maternal type 2 diabetes *Lower rates of blood loss *Lower rates of abandonment

8. / Risks of Not Breastfeeding Higher risk of allergy & asthma Higher risk of diarrhea Higher risk of ear infections Higher risk of heart disease Higher risk of obesity Higher risk of diabetes Higher risk of lower IQ Higher risk of exposure to chemicals

9. / Exclusive Breastfeeding Matters for 6 months *$13 Billion saved in the USA Reduce 911 deaths If 90% were breastfeeding for 6 months

10. / Breastfeeding Data *CDC Survey 2012 Births *National Immunization Survey St. Joseph Medical Center 2012 ­90% BF ­64% BF in 1 st hour ­58% Exclusive in first 2 days Presentation Title10

11. / Maternity Practices Matter FY 2012 Births St. Joseph Medical Center 3,747 St. Francis 1,114 St. Elizabeth295 Highline 929 Harrison- Silverdale 1,982 8,067 Births 9.8 % of WA State Hospital Births

12. / Hospital Maternity Practices *mPINC 2007 *St. Joseph Medical Center Presentation Title12

13. / Joint Commission Exclusive BF Rates Started in January 2014 St. Joseph Medical Center ­FY 2015 ­Exclusive BF rates=79% ­Increased 21 % in 3 years

14. / Baby-Friendly Hospital Initiative USA *Quality Improvement Project *10 Steps *Process usually takes 3 years or more *5 Hospitals in WA State & 1 more pending * St. Joseph started in 2013

15. / Six Maternity Practices that Improve Breastfeeding 1. Skin-to-Skin 2. Early & Frequent Breastfeeding 3. Rooming- In 4. Avoid routine formula supplementation 5. Delay pacifier for 3-4 weeks 6. Active follow-up after discharge Presentation Title15

16. / Skin-to-Skin Immediately After Birth Benefits for Increasing Breastfeeding *Early establishment *Longer duration *Increased Exclusivity

17. / Skin-to-skin Immediately After Birth Benefits for Neonate *Improved cardio-respiratory *Improved temperature *Improved health outcome *Bonding improved *Colonize gut flora *Decreased crying

18. / Skin-to-Skin for at least 60 minutes Place baby skin-to-skin immediately after delivery and keep until after the completion of the first feeding Delay birth weight Allow time with mom

19. / C-Section Skin-to-Skin C-Section can be done! Resume as soon as possible

20. / Skin-to-Skin Dad’s can help with skin-to-skin

21. / Early and Frequent Feeding Most breastfeed in the first hour SJMC 2012= 64% SJMC 2015=90%

22. / Early and Frequent Breastfeeding Offer whenever baby shows feeding cues At least 8 times in 24 hours Cluster feedings common Growth spurts common @ 10 days and 3, 6, 9 weeks

23. / Early and Frequent Feeding Increased feeding frequency on day 2 Moms need to know what is normal baby behavior Feed whenever have feeding cues

24. / Mothers Need Assistance to Learn about feeding Mother’s perception of insufficient milk is #1 reason for early weaning Mother’s need support during perceived difficulty Offering support & assistance if needed

25. / Offer Assistance if needed Hands on help if needed

26. / Rooming-In Keep mom & baby together 24/7 Family centered care promotion

27. / Rooming-In Benefits Increased Skin-to-skin opportunities Increased breastfeeding Reduces exposure to infection Mom learns normal baby behavior Babies cry less Higher maternal-infant attachment

28. / Recommendations for Length of Breastfeeding Exclusive breastmilk for the first 6 months Adding nutritious food around 6 months Continue breast milk feedings for at least 1 year

29. / Avoid Routine Formula Supplementation Exclusive breast milk feeding recommended for first 6 months Give expressed milk first Assist with changing cultural beliefs Medical indications are sometimes needed

30. / Discharge Bags SJMC removed in Formula Discharge Bags in 2008 Hospital should market health only Hospital should follow WHO Code of Marketing

31. / Donor Breastmilk St. Joseph Medical Center Donor Breastmilk in NICU-started in December 2014 Donor Breastmilk will be started on the Mother-Baby unit in Fall 2015 @ St. Joseph Medical Center

32. / Delay Pacifier Until 4 weeks AAP recommends delaying pacifier use until after breastfeeding is well established ( 3-4 weeks) Use whenever baby placed on back to sleep to reduce SIDS

33. / Pacifier Use Early use may be associated with less successful breastfeeding ­Can interrupt the frequency of BF ­Mom may miss feeding cues ­Can reduce feeding intensity ­Mechanics of sucking differ

34. / Pacifier Use Consider other soothing methods ­Breastfeeding again ­Skin-to-Skin

35. / Active Follow-Up After Discharge Need follow up in 1-3 days post discharge

36. / Lactation Consultants Specialized & trained to assess breastfeeding Outpatient setting at local hospitals, public health clinics, home visit, medical offices

37. / WIC Local WIC clinic support breastfeeding Ask to talk to *Breastfeeding Promotion staff person* Loan breast pumps for medical or work reasons

38. / WIC Partnership Contact local WIC office and create liaison 2008- St. Joseph created a partnership with local WIC offices ­Outpatient lactation clinic can loan breast pumps ­4 WIC offices in partnership ­Over 250 women served

39. / Mother-to-Mother Support Groups La Leche League ­Seattle/Eastside (206) 522-1336 ­Spokane (509) 534-3674 ­Snohomish Co. (425) 610-8511 ­Vancouver (360) 514-6773

40. / Mother-to-Mother Support Group Breastfeeding USA ­Invite support group to meet at your site ­Facebook Tacoma Chapter ­Sarah (515) 201-6418 Whatcom Chapter ­Elizabeth (360)474-7286

41. / Working & Breastfeeding Business Case for Breastfeeding Need Employer Support ­Talk with employers to find solutions ­Discuss the Laws protecting working moms

42. / National BF Hotline 1-800-994-9662 Monday-Friday 9am-6pm Eastern Time English & Spanish

43. / Public Health Department Contact local public health departments

44. / Written Material for Breastfeeding Support Medline Plus ­Written material for BF support ­14 languages

45. / Free Teaching Resource Registered Nurses’ Association of Ontario ­Breastfeeding Best Practices Guidelines for Nurses ­Free Teaching Tool for Nurses

46. / LACTMED On-line resource for medications during lactation

47. / Post Partum International of WA Find local support group 1-888-404-7763 Changing name to Perinatal Support Washington

48. / Breastfeeding Laws in WA 2001 Breastfeeding in public is not considered indecent exposure RCW 43.70. 9A.88.010 2009 Breastfeeding mothers are protected under state anti- discrimination law. She can breastfeed in public. No one can tell her to leave or cover up. RCW 49.60.030 and 49.60.215