1. INCREASING EXCLUSIVE BREASTFEEDING RATES AT BRIDGEPORT HOSPITAL BY DELAYING THE NEWBORN BATH BREAST IS BEST!

2. I have no disclosures Disclosures

3. TEAM MEMBERS Harris Jacobs MD Mary Christoffersen MBA, RN Theresa Davis BSN, RN, C-EFM Kelley Reddington MSN, RNC Elizabeth Cunningham MSN, RNC, CNL Melissa Alvarez BSN, RN, IBCLC Susan Marsh BSN, RN, IBCLC Liz Seaman BSN, RN, IBCLC, CCE Nickia Jackson MSN, RN Staff of Labor & Delivery and Women’s Care Center

4. OUR AMAZING TEAM

5. OBJECTIVE To increase the exclusive breastfeeding rate in the Women’s Care Center to 50% in 6 months (October 2015) by delaying newborn bathing and promoting no separation of the mother/infant couplet

6. BACKGROUND In 2014 the Joint Commission established Perinatal Core Measure PC05 which states that the newborn should be exclusively breast milk fed during the entire hospitalization unless the mother specifically chooses otherwise upon delivery The rates at our institution for exclusive breast milk feeding have increased from 2% to 35% but remain low

7. BACKGROUND Traditional, routine practices such as early bathing followed by re-warming under a radiant warmer create a barrier to successful mother and newborn interaction It is during this period of the first 1 to 2 hours of life that the newborn is most receptive to self attachment to the breast (Bramson, et al, 2010)

8. METHODS The Plan, Do, Study, Act model is utilized to conduct a process improvement intervention 50 newborns who meet the inclusion criteria will be selected randomly each month for six months Exclusive breast milk feeding rates as reported by the Yale New Haven System Abstractors for the last six months will be used to measure improvement

9. METHODS Newborns will not be separated from their mothers following delivery The newborn bath will be delayed until the newborn has achieved 3 feedings that are rated as fair or better by the mother or until the newborn has reached 12 hours of age Nursery staff will record the date and time of delivery and the date and time of the initial bath

10. Breastfeeding & Diaper Record We asked parents to rate their breastfeeding sessions. Once 3 feedings rated “Fair” or better are achieved, or newborn reaches 12 hours of age, newborn is bathed

11. CRITERIA Inclusion: o Newborns admitted to the well-baby nursery o Singleton deliveries o Prior to the first feed, Mom chooses to exclusively breastfeed her newborn during the hospital stay o Newborn has experienced skin to skin care within 1 hour of delivery regardless of mode of delivery

12. CRITERIA Exclusions: o Newborns who are fed formula and breastmilk o Mom is HIV or Hepatitis B or C antigen positive, or active HSV o Mom requests early bathing o Unplanned NICU admission o Mom has known or suspected TB

13. How We Identified If Newborn Bathed I had my bath on: ________at______am/pm I have not had my bath yet

14. RESULTS The exclusive breast feeding rates from the six months prior to the start of this project (August 2014- January 2015) ranged from 25% to 41% with an average of 33% In the five full months since instituting the delayed bath (April-September, 2015) there has been an average exclusive breastfeeding rate of 53%

15. RESULTS Additionally, the overall rate for any breastfeeding was 63% for the same five month period The newborn bath was delayed from 4 to 13 hours with an average delay of 9.5 hours

16. IMPLICATIONS The American Academy of Pediatrics (2012) recommends exclusive breastfeeding as the gold standard for infant nutrition for the first six months of life and the Joint Commission (2014) has established Perinatal Core Measure PC-05 for all hospitals

17. IMPLICATIONS Any hospital that has policies or standard routines, such as bathing, that may act as a barrier to the successful initiation of exclusive breastfeeding could benefit from the results of this project Bridgeport Hospital is part of the Connecticut Perinatal Quality Collaborative: Human Infants with Mother’s Own Milk (HI-MOM) and plans to continue with this project

18. Post Implementation Exclusive Breastmilk Feeding Rates

19. Additional Barriers Discovered Exclusively breastfeeding mothers may give one bottle of formula in L&D or on the last evening or night of their inpatient stay The amount of formula new parents (& staff) feed newborns is excessive Still have physicians and some nurses giving inappropriate breastfeeding advice

20. New Teaching Tool for Parents and Staff

21. Scripting Developed to Assist Staff L&D Staff Mother has indicated preference for exclusive breastfeeding or breast/bottle and not yet delivered “ That’s excellent. We strongly encourage exclusive breastfeeding for at least one week in normal babies because it is better for the baby and you. Just so you know, it is normal for a baby to eat very little in the first day and may take nothing for the first 12 hours or so. If you have any problems, we have trained nurses and lactation consultants who can help you. Please ask for help before reaching for a bottle of formula.” Women’s Care Center Staff Mother has indicated preference for exclusive breastfeeding or breast/bottle and now requests a bottle “I can certainly bring a bottle of formula for the baby, but are you having trouble with nursing?...” or “ We strongly encourage exclusive breastfeeding for at least one week in normal babies because it is better for the baby and you. Just so you know, it is normal for a baby to eat very little in the first day and may take nothing for the first 12 hours or so. Perhaps I or our lactation consultant can help you before you give the baby a bottle.”