1. EPIC Breastfeeding Program
EPIC Breastfeeding Program
Breastfeeding Education

2. EPIC Educating Physicians and Practices In Their Community
Educating Physicians and Practices In Their Community
Began in 2007
Peer-to-Peer Physician Breastfeeding Education
Patterned after the EPIC Immunization Program
EPIC Breastfeeding Program hopes to mirror it’s success

3. EPIC Breastfeeding Program Partners
Georgia Department of Public Health
Georgia Chapter –American Academy of Pediatrics
Georgia Ob/Gyn Society
Georgia Academy of Family Physicians
Centers for Disease Control and Prevention

4. Goals of EPIC Breastfeeding Program
Educate physicians & their office staff on breastfeeding
Give reasons why physicians play a critical role
Teach evidence - based standards on how to encourage, promote and support breastfeeding
How to access lactation and support services in the community
How to access patient education resources
Inform physicians of WIC services for breastfeeding mothers

5. CDC Breastfeeding Report Card
Georgia
2007
2009
2010
2012
2013
2014
Breastfeeding Initiation
68.2%
62.5%
62.8%
70.9%
70.3%
6 months
38%
36.4%
33.5%
40.8%
31.8%
40.1%
Breastfeeding
@ 12 months
16.8%
18.1%
17.9%
17.6%
12.9%
20.7%
Exclusive 6 months
11%
14.8%
9.7%
6.2%
14.5%
Baby Friendly Hospitals 3
CDC started the MPINC project – Maternity Practices in Infant Nutrition and Care in 2007 to monitor how hospitals are doing. They monitor skin-to skin, supplementing, breastfeeding assistance, separation of mother and baby, staff training, documentation, and discharge care. You get a score. Georgia’s score in 2007 was 56 with a ranking of 46. In 2013, Georgia’s score was 69 and with a ranking of 45.

6. Why is educating physicians on breastfeeding important?
“[women] typically receive minimal advice about breastfeeding from a physician.” Freed et al
“Physicians lack the necessary clinical skills to provide lactation management” Taveras et al.
“Pediatricians are ideally situated to positively influence the breastfeeding experiences of the mother and young infant.” Hillenbrand et al.

7. Challenges for Physicians
Not aware of benefits/management
Lack of time
Concerns about reimbursement
Not comfortable examining breasts
No knowledge of community
resources
Make sure that OB know that they need to know about breastfeeding and how to help manage breastfeeding problems and help a mother with her milk supply. The pediatrician needs to be able to observe a baby breastfeeding to watch for milk transfer.

8. Breastfeeding Advisory Group
Eight members
Meet quarterly
Develop the curriculum
Annual updates to curriculum
Develop additional programs as needed
Provide expert resource
Pediatric chair, another pediatrician, an OB, family physician, WIC breastfeeding coordinator, state breastfeeding coordinator, CDC representative, and a breastfeeding expert.
We have since added Tammy Fuller and some in this room.
They also are brought together and informed of anything going on with breastfeeding such as the Surgeon Generals Call to Action.

9. EPIC Trainers Physicians, Nurses, Dieticians & Lactation Consultants
Must be skilled with breastfeeding management
Complete a train the trainer education module
Can be done with group or individual
Covers curriculum, set-up, maintenance of equipment and other logistics
Physicians and a lactation specialist are a team and are paired to deliver the program
Trainers meet twice a year with the EPIC director
Trainers receive feedback and evaluations of their performance
Discuss any updates and offer suggestions for curriculum changes
Trainers are given modest stipend and travel reimbursement

10. EPIC Program Goal is 6 programs a month
One hour EPIC Breastfeeding Program
Delivered through PowerPoint Presentation with script
Presented in
Doctors office
Hospitals
Residencies
Health Departments/WIC
Goal is 6 programs a month
Resource materials are left behind for the office to encourage, promote & support breastfeeding

11. Resources Each office or program receives breastfeeding resources
Books
Handouts
Coding information
WIC information
List of community
resources

12. Target Counties Bibb Laurens Richmond Clayton DeKalb Fulton Cobb
Thomas
Gwinnett
Muscogee
Chatham
Target counties given to us by DHR. We have to have at least 50% of our trainings in these counties and at least one training in each county per year.

13. Marketing our Program GA AAP Board meetings Blastfaxes
Exhibiting at conferences
Send out mailings to previous program recipients to take a different program
Trainers and Advisory members encourage programs
Close ties with the WIC and Health Departments
Word of Mouth
Started off by informing our members.
Exhibit at PEDS, OB’s, Family Physician conferences
Emory breastfeeding conference

14. Evaluation Pre-program survey Program survey
Assessing physician knowledge and practices
Program survey
Participant evaluation form
Evaluate curriculum
Evaluate trainer effectiveness
Seek areas of interest
Post- program survey (60 day F/U)
Access program quality and content
Access knowledge gained
Changes in practice behavior
We plan on adding breastfeeding rates in physicians offices. We will have follow up survey at 6 months to see if a practice has had an increase in breastfeeding mothers since they took our EPIC training.

15. EPIC Breastfeeding Programs
“Breastfeeding Fundamentals”
“Supporting Breastfeeding in the Hospital Setting”
“Advanced Breastfeeding Support”
Future EPICS????
Breastfeeding in the NICU
Help improve neonatal outcomes
Training for NICU staff in protocols for handling breast milk and how to store.
When to start PO feedings
Importance of skin to skin
Where and how to purchase human milk
How to increase fat and protein of human milk –lacto-engineering

16. Breastfeeding Fundamentals
Challenges for Physicians
Realistic expectations
Racial disparities
Benefits of breastfeeding
Latch
Positioning
Milk transfer

17. Fundamentals Breastfeeding at delivery Most common problems
Prenatal visit (emphasis on the OB’s role)
Postpartum routine
Most common problems
Sore nipples
Mastitis
Maternal emotions
Medications
Postpartum depression

18. Fundamentals Hot Topics Questions Co-sleeping Milk sharing Pacifiers
Supplementing
Contraception
Starting solids
Questions

19. Supporting Breastfeeding in the Hospital
Benefits of breastfeeding
Obstacles to breastfeeding
Baby Friendly
10 steps
Policy
Joint commission and mPINC scores
After delivery
Skin to skin
Exclusive breastfeeding
Documentation

20. Hospital Program Separation of mom and baby Barriers WIC
Pumping/hand expression
Kangaroo Care/NICU
Barriers
Discharge bags
Follow-up and support
WIC
Food packages
Services for breastfeeding mothers
Community Resources

21. Advanced Breastfeeding Support
How do you know if a mother is producing enough milk?
Breast changes
Urine and stool output
How can a mother increase her milk supply?
Evaluating a feeding
Pumping/hand expression
Galactogues/medications
What can mothers do to prevent or treat sore nipples?
LATCH
Engorgement
Nipples problems
Baby cues are discussed

22. Advanced Program
When supplements are indicated, how does a mother supplement without interfering with breastfeeding?
Maternal issues
Infant factors
When to supplement
When
How
Methods
How does the pre-term infant differ in their ability to breastfeed?
Define pre-term infant
Feeding issues

23. Results 548 programs 1,590 physicians trained 24.3% are physicians
6,889 total trained
29% held in focus counties
99.3% of practices would recommend the training to other physicians
I was able to present our program for ICLA the International Lactation Consultants Association at they annual Breastfeeding confenfernce in San Diego to over 900 people.

24. Future ideas of EPIC® Three hour hospital curriculum NICU curriculum
Infant feeding curriculum
More emphasis on OB’s and breastfeeding support/WIC referrals
Need more physician data on breastfeeding rates
Working with businesses to set up lactation rooms

25. Questions?