1. Continuity of Care for Breastfeeding Families Birth & Beyond California: Breastfeeding Training & QI Project With funding from the federal Title V Block Grant 1

2. Objectives Identify three pre-discharge infant breastfeeding issues requiring follow up care Identify three pre-discharge maternal breastfeeding issues requiring follow up care Identify two follow-up resources available for breastfeeding families 2

3. Pre-Discharge Breastfeeding Assessment – Baby Issues Excessive weight loss Lack of output Difficulty with latch Difficulty with suckling Lethargy 3

4. Pre-Discharge Breastfeeding Assessment – Baby Issues Jaundice Preterm/late preterm Anatomical concerns Health concerns 4

5. Pre-Discharge Breastfeeding Assessment – Mother Issues Sore nipples Unusual nipple size/shape Engorgement Questionable milk supply History of breastfeeding problems History of breast surgery History of infertility Health concerns 5

6. Pre-Discharge Breastfeeding Assessment – Mother Issues Lack of social support Maternal-infant attachment concerns Potential for postpartum depression Lack of confidence Inability to breastfeed without help 6

7. Follow Up Care Avoid “Zone of No Professional Contact” Infants and mothers with identified pre- discharge breastfeeding issues need a documented plan of care and discharge follow up All breastfeeding women and infants should receive contact within the first week 7

8. Pediatric Appointment “ All breastfeeding newborn infants should be seen by a pediatrician, or other knowledgeable and experienced health care professional, at 3 to 5 days of age.” AAP, Breastfeeding and the Use of Human Milk, 2005 8

9. Breastfeeding Resources Activity Create a list of resources in your community –WIC Agency –Public Health Department –Home Visitation Nurses –Pediatric Clinics/Pediatricians –OB Clinics/CPSP/OBs –Mothers’ Support Groups –Lactation Clinics/Lactation Consultants –OT/PT/RD –Sweet Success –Urgent/Emergency Care –Others 9

10. Online Resources La Leche League –www.lalecheleague.orgwww.lalecheleague.org International Lactation Consultants Association –www.ilca.orgwww.ilca.org California Department of Public Health –www.cdph.ca.gov/programs/breastfeedingwww.cdph.ca.gov/programs/breastfeeding Office on Women’s Health –www.womenshealth.govwww.womenshealth.gov Breastfeeding Task Force of Greater Los Angeles –www.breastfeedla.orgwww.breastfeedla.org 10

11. Breastfeeding Support Groups “Foster the establishment of breastfeeding support groups and refer mothers to them on discharge” 11 Model Hospital Policy Recommendations, 2005 http://cdph.ca.gov/Breastfeeding

12. Safe Discharge for Breastfeeding Mothers and Babie s Prevent a cascade of breastfeeding complications Pre-discharge assessment Appropriate referr als 12