1. Golden Start Breastfeeding Initiative Leslie Anderson RN, PHN Laura Pearson RN, PHN

2. Overview Public Health Agencies in 9 counties and 10 Hospitals in our region have partnered together to form the Golden Start Initiative Public Health Agencies in 9 counties and 10 Hospitals in our region have partnered together to form the Golden Start Initiative Becker, Clay Douglas, Grant, Otter Tail, Pope, Stevens, Traverse, and Wilkin Becker, Clay Douglas, Grant, Otter Tail, Pope, Stevens, Traverse, and Wilkin

3. Grant Region

4. Education This project focuses on educating healthcare staff, in order to provide families with current, correct, evidence-based information regarding feeding their babies This project focuses on educating healthcare staff, in order to provide families with current, correct, evidence-based information regarding feeding their babies Evergreen Perinatal Evergreen Perinatal Two 3-day courses Two 3-day courses Over 120 nurses trained Over 120 nurses trained One 5- day Train-the-trainer One 5- day Train-the-trainer Ability to reach 42,000 women of childbearing age Ability to reach 42,000 women of childbearing age Clinic education Clinic education

5. Policies This project focuses on developing or enhancing lactation friendly policies in the clinic, hospital, and public health arenas by encouraging our partners to work towards achieving the “Ten Steps” of the Baby Friendly Hospital Initiative and the Breastfeeding Friendly Public Health Department project This project focuses on developing or enhancing lactation friendly policies in the clinic, hospital, and public health arenas by encouraging our partners to work towards achieving the “Ten Steps” of the Baby Friendly Hospital Initiative and the Breastfeeding Friendly Public Health Department project

6. Businesses and Daycares This project focuses on connecting with local businesses in order to assist them in complying with state and federal statutes regarding lactating employees Business Case for Breastfeeding Business Case for Breastfeeding All partner counties have PHNs trained All partner counties have PHNs trained Will connect with businesses and daycares in region Will connect with businesses and daycares in region

7. History of Golden Start The Golden Start Intervention, which was fashioned after a NICU study done by Paula Meier @ Rush University, encourages & supports mothers to commit to at least 4 weeks of mother’s milk for their infants

8. 10 Steps to Successful Breastfeeding Step 1. Maintain a written breastfeeding policy that is routinely communicated to all health care staff. Step 1. Maintain a written breastfeeding policy that is routinely communicated to all health care staff. Step 2. Train all health care staff in skills necessary to implement this policy. Step 2. Train all health care staff in skills necessary to implement this policy. Step 3. Inform all pregnant women about the benefits and management of breastfeeding. Step 3. Inform all pregnant women about the benefits and management of breastfeeding. Step 4. Help mothers initiate breastfeeding within one hour of birth Step 4. Help mothers initiate breastfeeding within one hour of birth Step 5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants Step 5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants

9. 10 Steps - continued Step 6. Give infants no food or drink other than breastmilk unless medically indicated Step 6. Give infants no food or drink other than breastmilk unless medically indicated Step 7. Practice rooming-in – allow mothers and infants to remain together twenty-four hours a day Step 7. Practice rooming-in – allow mothers and infants to remain together twenty-four hours a day Step 8. Encourage breastfeeding on demand Step 8. Encourage breastfeeding on demand Step 9. Give no pacifiers or artificial nipples to breastfeeding infants Step 9. Give no pacifiers or artificial nipples to breastfeeding infants Step 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic Step 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

10. The Golden Start Rush University Study + 10 Steps to Successful Breastfeeding = Golden Start Initiative

11. Influences on Healthcare Setting Hospitals Hospitals Baby Friendly Assessment Baby Friendly Assessment www.babyfriendlyusa.org www.babyfriendlyusa.org www.babyfriendlyusa.org Public Health Departments Public Health Departments Breastfeeding Friendly Assessment Breastfeeding Friendly Assessment Wisconsin Division of Health Wisconsin Division of Health www.dhs.wisconsin.gov/health/Nutrition/Breastfeeding/departments.pdf www.dhs.wisconsin.gov/health/Nutrition/Breastfeeding/departments.pdf www.dhs.wisconsin.gov/health/Nutrition/Breastfeeding/departments.pdf Assessment posted on MBC website Assessment posted on MBC website

12. More Steps Count Maternity care practices: implications for breastfeeding Maternity care practices: implications for breastfeeding DiGirolamo AM, Grummer-Strawn LM, Fein S. Center for Disease Control DiGirolamo AM, Grummer-Strawn LM, Fein S. Center for Disease Control Conclusion: “Increased Baby-Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 months.” Conclusion: “Increased Baby-Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 months.”

13. Baby/Breastfeeding Friendly Most important steps Most important steps Step 3. Inform all pregnant women about the benefits and management of breastfeeding. Step 3. Inform all pregnant women about the benefits and management of breastfeeding. Step 4. Help mothers initiate breastfeeding within one hour of birth Step 4. Help mothers initiate breastfeeding within one hour of birth Step 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic Step 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

14. Golden Start Intervention Prenatal intervention at first WIC appointment Prenatal intervention at first WIC appointment Golden Start Brochure given and discussed Golden Start Brochure given and discussed Prenatal intervention at third trimester WIC appointment Prenatal intervention at third trimester WIC appointment Colostrum Brochure given and discussed Colostrum Brochure given and discussed Follow-up Phone Calls Follow-up Phone Calls Immediate post-partum Immediate post-partum 10 days after first call 10 days after first call

15. Golden Start Intervention Originated in Otter Tail County WIC population Originated in Otter Tail County WIC population Shared at PH Directors meeting Shared at PH Directors meeting Other counties wanted to replicate Other counties wanted to replicate Grant application written to include 9 counties Grant application written to include 9 counties

17. Brochures Golden Start Brochure Golden Start Brochure Colostrum Brochure Colostrum Brochure www.noodlesoup.com www.noodlesoup.com www.noodlesoup.com Distribution Times Distribution Times WIC appointments WIC appointments Clinic visits Clinic visits Hospitals – post-partum teaching Hospitals – post-partum teaching Post-partum PH contact Post-partum PH contact

18. Golden Start Focus Support Support Follow-up Follow-up Connection with resources in the community Connection with resources in the community Customized brochures for each county with contact phone numbers Customized brochures for each county with contact phone numbers

19. Evaluation Focus Groups Focus Groups Clinic Surveys Clinic Surveys Baby Friendly Hospital Initiative Assessments Baby Friendly Hospital Initiative Assessments Breastfeeding Friendly Public Health Department Assessments Breastfeeding Friendly Public Health Department Assessments Pre-training surveys Pre-training surveys

20. Connection/Networking MN Breastfeeding Coalition MN Breastfeeding Coalition SHIP Conference & QI Collaborative SHIP Conference & QI Collaborative Believers in Breastfeeding—Douglas County Believers in Breastfeeding—Douglas County Becker County Breastfeeding Coalition Becker County Breastfeeding Coalition Fargo/Moorhead Breastfeeding Coalition Fargo/Moorhead Breastfeeding Coalition

21. Golden Start Initiative Laura Pearson, RN, PHN Laura Pearson, RN, PHN Leslie Anderson, RN, PHN Leslie Anderson, RN, PHN Project Coordinators 218-736-8625 712 Cascade St. S. Fergus Falls MN 56537 goldinit@lrhc.org