2. Elements of a Successful Breastfeeding Program San Marcos, California 760-752-4324

3. NCHS WIC Agency Profile 5 permanent sites and 3 satellite clinics throughout Northern San Diego County. 35 Full and Part Time Staff. Participation: 10,654 (2/08)  English 41.5%, Spanish 57.8% and <1% other Languages. Number of Infants: 2358 (2/08) 1 Part-time IBCLC 10 CLE’s and 6 more in training

4. Staff Training, Pump Loan and Other Elements  Extensive Staff Training Yearly in-house trainings for all other staff. Thorough training for new staff. Brought CLE training to our agency.  Breast Pump Loan Program Over 200 electric breast Pumps to lend.  Breastfeeding Friendly Environment  Referral Systems WIC staff can refer complex BF problems to the CLE or IBCLC. NCHS providers refer BF problems back to WIC.  Breastfeeding promotion is everyone’s job!

5. Comprehensive Participant Education and Support  Two prenatal breastfeeding classes. A “Why To BF” and a “How To BF”.  All prenatal ppts. are made aware of our “No formula in the first month” policy.  Early post-partum BF support phone calls to ALL new mothers.  Breastfeeding Warm-Line for ppts to call with questions.  Breastfeeding support groups.

6. No Formula in the First Month  Set a date 9 months in advance to start policy.  Begin with extensive staff training, so all are comfortable discussing and supporting breastfeeding.  Start telling all pregnant women at enrollments, trimester checks and classes that WIC doesn’t routinely give formula to breastfed babies less than one month old.  Enroll baby then recertify post partum mother the following month, so they receive two contacts of BF support.  If they want to combo feed, tell them they can after exclusively breastfeeding for the first month.  We find after they get through the first month, they often don’t need the formula in the second month.  Formula is only given in extenuating circumstances with supervisor approval.

7. Early Postpartum Phone Call Study  Hypothesis: WIC mothers who received an early postpartum phone call to offer BF support will be more likely to exclusively breastfeed and breastfeed for a longer period of time than a control group.  Babies born to NCHS WIC from 10/03 and 11/03 were in study and FI’s were followed for a year.  Half received phone calls (intervention) and half did not (control).

8. Our Study Population Intervention N =86 Control N = 92 EthnicityHispanic = 75 (87%)Hispanic 79(85%) Primary LanguageSpanish = 59 (69%)Spanish = N/A Prior Experience Breast Feeding 42 (49%)N/A Calls Made Within First 14 days 62 (73%)N/A Average Age of Infant at Second Call 22 days oldN/A Average Age of Infant at Enrollment Appointment 20 days old16 days old

9. We Made a Difference! Age at which 25% are still Exclusively Breastfeeding (or Excl. BF w/solids) 315 days old (10 ½ months) 194 days old (6½ months) Statistically Significant at.05 InterventionControl Breastfeeding Exclusively at First month 72/86 (84%)68/92 (74%) Breastfeeding Exclusively at Second month 49/86 (58%)45/92 (42%)

10. Why it Worked Connected with Mothers at their time of need  The calls were beyond the normal WIC “clinic” services  They were reached at a “vulnerable” time in breastfeeding. Mothers had 100% of our attention,  Staff were given time to make call, build rapport with women.  The intervention was individual and personal. Well-trained staff  Open ended & closed questions were asked that allowed us to educate, guide and reassure.  WIC is a trusted resource.

11. Conclusion  Early phone intervention helped the group of mothers have a better breastfeeding experience, and prevented them from quitting prematurely.  Using early postpartum phone intervention calls, we increased breastfeeding exclusivity and duration.  Early postpartum phone intervention fits within the “scope of WIC services”.  The calls could be easily replicated in other settings.

12. NCHS WIC Program Policies and Procedures