1. Strategies to Improve Breastfeeding Outcomes in Your Hospital and Community (and why it matters in the infant mortality conversation)

2. Tina Cardarelli BS IBCLC State Breastfeeding Coordinator tcardarelli@indianaperinatal.org

3. A Brief History Of Breastfeeding

5. 99.7% Thousands of Years

6. Bottom Line Benefits: From the Beginning of Time

7. So….How can we improve breastfeeding and mortality?

10. Innocenti Declaration, 8/1990 “ Protection, Promotion and Support of Breastfeeding” “Recognize breastfeeding is a unique process that: Provides ideal nutrition for infants and contributes to their healthy growth and development, reduces incidence and severity of infectious diseases, thereby lowering infant morbidity and mortality. “Contributes to women's health by reducing the risk of breast and ovarian cancer, and by increasing the spacing between pregnancies Provides social and economic benefits to the family and the nation”

11. “a global goal for optimal maternal and child health and nutrition”

12. Breastfeeding is one of the most effective ways to ensure child health and survival. If every child was breastfed within an hour of birth, given only breast milk for their first six months of life, and continued breastfeeding up to the age of two years, about 800,000 child lives would be saved every year. WHO

13. Inappropriate feeding practices, sub-optimal or no breastfeeding and inadequate complementary feeding remain the greatest threat to child health and survival globally “Celebrating Innocenti 1990-2005: Achievements, Challenges and Future Imperatives”, 22 November 2005, Italy

14. The Clinical Data

15. 2007 The Agency for Healthcare Research and Quality (AHRQ) reviewed the evidence on the effects of breastfeeding on short-and long-term infant and maternal health Conclusion: Breastfeeding is associated with a reduced risk of many diseases in both infants and mothers AHRQ Evidence Report Number 153

17. When Babies Don’t Breastfeed… 17 56% higher risk of SIDS 35% higher risk of Asthma (no family history) 67% higher risk of Asthma (with family history) 100% higher risk for Ear Infections 178% higher risk for Diarrhea & Vomiting (Gastrointestinal Infections) 64% higher risk for Type 2 Diabetes 23% higher risk for Acute Lymphocytic Leukemia 138% higher risk for Necrotizing Enterocolitis (NEC) in preemies Risk of lower I.Q. – Average of 8 points lower Agency for Healthcare Research and Quality (AHRQ,2007)

18. When Women Don’t Breastfeed... 18 They recover more slowly after birth Have Increased risk of: Breast CancerOvarian Cancer Endometrial CancerCardiovascular Disease OsteoporosisType 2 Diabetes High Blood Pressure Metabolic Syndrome Anemia Postpartum Depression The longer a woman breastfeeds, the more her risk of breast cancer goes down

19. “Given the short and long term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice” AAP, 2012 “One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed” Surgeon General, 2011 Professional Endorsements

20. POLICY BABY FRIENDLY MPINC Improved Hospital Practices Baby Friendly Designation Model Hospital Policy mPINC Survey LINC

21. “If we truly understand that breastmilk is the best first food for babies—and our polling shows Americans do— then our institutions and communities need to make it easier for all mothers to nurse……we believe whether a woman breastfeeds shouldn’t be dictated by the quality of health care she receives.” Dr. Gail Christopher VP W.K. Kellogg Foundation

23. 52 questions  36 question categories  7 Dimensions of Care Points value for every question  Higher points given to supportive breastfeeding practices  Sub scores categories  Total score  Rank mPINC: Quality Improvement Tool

24. Indiana’s Maternity Practices in Infant Nutrition and Care (mPINC) Scores, 2007 – 2013 Since 2007, Indiana’s mPINC score has continued to rise! Great Job Indiana! Source: Centers for Disease Control and Prevention, mPinc State Reports by year

26. Where In The World Did “Baby Friendly” Come From ? 1990 Innocenti Declaration Global effort to implement practices that protect, promote and support breastfeeding to reduce infant mortality worldwide 1991 Baby Friendly launched by WHO and UNICEF

27. …And Around The World

30. Ten Steps to Successful Breastfeeding 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 an hour after birth. 5) Show mothers how to breastfeed and how to maintain lactation even if they are separated from their infants.

31. Ten Steps to Successful Breastfeeding 6) Give newborn infants no food or drink other than breast milk unless medically indicated 7) Practice rooming-in: allow mothers and infants to stay together, 24 hours a day. 8) Encourage breastfeeding on demand. 9) Give no artificial nipples or pacifiers to breastfeeding infants. 10) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.

32. Funded by The Department of Nutrition and Physical Activity @The Indiana State Department of Health

33. Are You Doing All that You Can to Build a Supportive Breastfeeding Environment in Your Community?

34. 1.5 hour online continuing education tutorial is designed to meet needs of pediatric primary care providers team http://www.northeastern.edu/breastfeedingcme/

35. Physician Training

36. 36 Pharmacist Education www.neurxce.org/user/login www.neurxce.org/user/login

38. State Coalition Clinical and Community Call

40. Community Drop-In Centers

41. IU Methodist Tele-Lactation

42. Racial Inequity

43. 43

44. Child Care Training

45. One of the easiest things you can do… Instead of asking: “Are you going to breast or bottle feed?” Ask: “How can we help you to breastfeed?”

46. “It is everyone’s role to make breastfeeding easier” Surgeon General’s Call to Action to Support Breastfeeding,2011

47. Feldman-Winter, L., Procaccini, D., & Merewood, A. (2012). A Model Infant Feeding Policy for Baby-Friendly Designation in the USA. Journal of Human Lactation, 28(3), 304-311. doi: 10.1177/0890334412440626 · Hawkins, S. S., Stern, A. D., Baum, C. F., & Gillman, M. W. (2013). Compliance with the Baby-Friendly Hospital Initiative and impact on breastfeeding rates. Arch Dis Child Fetal Neonatal Ed. doi: 10.1136/archdischild-2013-304842 · Perrine, C. G., Scanlon, K. S., Li, R., Odom, E., & Grummer-Strawn, L. M. (2012). Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention. Pediatrics, 130(1), 54-60. doi: 10.1542/peds.2011-3633 · Saadeh, R. J. (2012). The Baby-Friendly Hospital Initiative 20 years on: facts, progress, and the way forward. J Hum Lact, 28(3), 272-275. doi: 10.1177/0890334412446690 Sadacharan, R., Santana, S., Sanchez, E., Matlak, S., Grossman, X., Makrigiorgos, G., & Merewood, A. (2012). Are you Baby-Friendly? Knowledge deficit among US maternity staff. J Hum Lact, 28(3), 359-362. doi: 10.1177/0890334412437039 · Venancio, S. I., Saldiva, S. R., Escuder, M. M., & Giugliani, E. R. (2012). The Baby-Friendly Hospital Initiative shows positive effects on breastfeeding indicators in Brazil. J Epidemiol Community Health, 66(10), 914-918. doi: 10.1136/jech-2011- 200332 References

48. · · · Merewood, A., Patel, B., Newton, K. N., MacAuley, L. P., Chamberlain, L. B., Francisco, P., & Mehta, S. D. (2007). Breastfeeding duration rates and factors affecting continued breastfeeding among infants born at an inner-city US Baby- Friendly hospital. J Hum Lact, 23(2), 157-164. doi: 23/2/157 [pii] · 10.1177/0890334407300573 [doi] · Newton, K. N., Chaudhuri, J., Grossman, X., & Merewood, A. (2009). Factors associated with exclusive breastfeeding among Latina women giving birth at an inner-city baby-friendly hospital. J Hum Lact, 25(1), 28-33. doi: 25/1/28 [pii] · 10.1177/0890334408329437 [doi] · Parker, M., Burnham, L., Cook, J., Sanchez, E., Philipp, B. L., & Merewood, A. (2013). 10 Years after Baby-Friendly Designation: Breastfeeding Rates Continue to Increase in a US Neonatal Intensive Care Unit. Journal of Human Lactation. doi: 10.1177/0890334413489374