1. Hospital Practices Influence Breastfeeding Rates: The Data Tell the Story Birth & Beyond California: Breastfeeding Training & QI Project With funding from the federal Title V Block Grant 1

2. Objectives Name the source of in-hospital breastfeeding data for California Describe the trends in California for ‘any’ and ‘exclusive’ in-hospital breastfeeding from 1992- 2007 Identify three hospital practices that can discourage breastfeeding List three hospital practices that increase breastfeeding duration 2

3. In-Hospital Breastfeeding Data Source: Newborn Screening Program Administered by the Genetic Disease Screening Program (GDSP) Primary purpose is to collect infant blood samples to screen for genetic diseases Staff complete the forms following the instructions provided by GDSP Summary data is sent to the Epidemiology staff of the Maternal, Child and Adolescent Health Program and made available yearly on-line 3 California Department of Public Health Maternal, Child, and Adolescent Health Division

4. Breastfeeding Categories Any breastfeeding –Includes infants fed only human milk and infants fed a combination of human milk and formula Exclusive breastfeeding –Infants fed only human milk –Recommended by American Academy of Pediatrics, American College of Obstetricians and Gynecologists, Academy of Family Physicians, American Dietetic Association 4

5. California Any and Exclusive In- Hospital Breastfeeding: 1994-2007 5 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) The “GAP” is Growing

6. Percent Any/Exclusive In Hospital Breastfeeding: 2007 6 Gap Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

7. 2007 California’s Best Any/Exclusive Breastfeeding 7 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

8. Best LA Hospitals Exclusive Breastfeeding 2007 8 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

9. Percent Any/Exclusive In Hospital Breastfeeding: 2007 Closing the Gap 9 Closed the Gap Closing Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

10. 10 Hospital Practices that Influence Breastfeeding Strongly encouraging Encouraging Discouraging Strongly discouraging HHS, Blueprint for Action on Breastfeeding, 2000

11. Practices that Discourage Exclusive Breastfeeding No written policy to keep healthy mothers and infants from being separated Lack of staff training Routine formula supplementation Delay of first feeding Breastfeeding assessments not recorded Mothers told to limit time breastfeeding Heinig, UC Davis, 2006 11

12. Hospital practices are associated with breastfeeding continuation at 8 weeks 12 Murray, Birth, 2007

13. Providing Breastfeeding Support: Model Hospital Policy Recommendations Model Hospital Policy Recommendations Toolkit www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/P ages/MainPageofBreastfeedingToolkit.aspx ….or link to these by entering the url: http://cdph.ca.gov/Breastfeeding 13

14. 14 The Ten Steps To Successful Breastfeeding Baby Friendly Hospital Initiative More than 19,000 hospitals worldwide 79 in United States 23 in California As of March 2009 www.babyfriendlyusa.org

15. Policy and Practice Changes What barriers to changes in policy & practices do you see? What do you think should be done to address those barriers? 15

16. 16 Birth & Beyond California Quality Improvement –Support for your QI team –Policy revision technical assistance –Technical assistance and tools for data collection and analysis tailored to your hospital BBC Regional QI Network meetings –Monthly Training –2 hour Decision Maker –16 hour Learner Workshop –16 hour Train the Trainer

17. The Physiologic Norm is Easier Skin to skin triggers –Infant competence –Appropriate maternal responses Exclusive breastfeeding in the early days promotes a cascade of breastfeeding successes Mother/baby togetherness in the early days enhances parental competence 17 Moore, Cochrane Review, 2007

18. 18 Day One Conclusions Mother/baby attachment –Is supported by skin–to–skin contact Risks of not breastfeeding –A public health concern Nurses can teach parents –To recognize predictable newborn patterns Breastfeeding rates –Reflect maternity care policies & practices

19. 19 Assignment Prior to the Next Class Clinical Experience s Observe a newborn placed skin-to-skin with mother for 20 minutes Observe an infant breastfeeding and listen for suck and swallow sounds Observe the cluster feeding pattern of the breastfeeding newborn

20. Thank you Complete evaluation Bring your syllabus next time See you then! 20

21. Welcome Back Birth and Beyond California Day 2 21

22. Assignments Observe a newborn placed skin to skin with mother for 20 minutes Observe an infant breastfeeding and listen for sucks and swallows Observe the cluster feeding pattern of the breastfeeding newborn 22

23. 23 Objectives Demonstrate three positions mothers may use to breastfeed List at least three signs of an effective latch Identify two signs of milk transfer from the breast to the infant Identify three in-hospital strategies for early breastfeeding management