EPIC-BEST Speaker S Notes

EPIC-BEST Speaker’s Notes

Speaker: PHYSICIAN
•  Introduce the training team
•  Hello and welcome to the EPIC-BEST program.
•  Educating Physicians In their Communities – Breastfeeding Education, Support, & Training is designed to inform and educate physicians and their staff about steps that can be taken in the office setting to complement practices being implemented in the hospital setting to improve breastfeeding outcomes.
The Louisiana Department of Health & Hospitals
Office of Public Health
Bureau of Family Health
The WIC Program &
The LBC
Have partnered to provide education to HCPs about breastfeeding support.
The faculty, planners and speakers of this program have no relevant financial relationships.
IMPORTANT: To help us determine the effectiveness of this training, please take a few minutes to complete the pre-test. There is no need to spend a lot of time on it, just put down the first answer that comes to mind.
Note: Be sure that name and e-mail are LEGIBLE on sign-in sheet
HOUSEKEEPING: length of program (~90min), location of restrooms
The objectives of this program are to:
•  Discuss the importance of breastfeeding and national recommendations and policies promoting breastfeeding
•  Identify strategies & resources for physician offices that support breastfeeding
•  Identify community breastfeeding resources for patient referrals
Breastfeeding…is it really important? Does it really make a difference? These are some of the questions that many people have and that we hope to address today.
Speaker’s Note: To engage the audience, you could ask them what they think or know about breastfeeding. This may help you get an idea of the knowledge and attitudes that your audience has related to breastfeeding.
Remember that breastfeeding is NORMAL in the human world, in the animal kingdom, and it has been throughout all of history. All mammalian mothers and babies are hard wired to breastfeed.
As mammals, we make perfect nutrition for our newborns. The protein, carbohydrate & fat content changes dynamically as the baby grows for the perfect meal every time. Why would we stifle such a primitive survival instinct of our body to protect our young? It’s innate.
This image demonstrates the differences between human breastmilk & formula ingredients.
•  Mother’s milk contains many more ingredients than formula and is custom-made for her baby’s needs.
•  Everything in formula comes from cows or soy plants or some other non-human source.
Human milk contains: living cells…(see slide)
It also contains:
•  Compounds with unique structures that cannot be replicated in infant formula.
Breastfeeding Reduces:
•  Economic burden to society, which pays $600 million for “Free” infant formula through WIC.
•  Environmental burden for the disposal of formula cans and bottles, and
•  Energy expenditure in the production and transport of formula
The latest breastfeeding statement of the American Academy of Pediatrics clearly states the risks of not breastfeeding.
·  The 1st table: When breastfeeding doesn’t occur, infants and mothers are more at risk for illness and disease. This is a table from an AHRQ publication in which the authors reviewed the evidence on the effects of breastfeeding on short- and long-term infant and maternal health outcomes in developed countries.
·  Among infants who are NOT breastfed, there is an excess/increased risk for the listed diseases and conditions
·  The 2nd table: Addresses excess risk for disease and illness among preterm infants and mothers who do not breastfeed.
This slide depicts how obesity in the U.S. has evolved in an alarmingly short period of time.
In 1990, some states had obesity rates over 10 percent (the darker blue), but none exceeded 15%.
In 2000, data show Louisiana has been joined by many other states who share obesity rates in more than 20% of their adults
In 2010, about 60 million adults, or 30 percent of the adult population, are now obese
•  This represents a doubling of the rate since 1980.
In 2011, a CDC Vital Signs report stated that breastfeeding for 9 months reduces a baby’s odds of becoming overweight by more than 30%.
•  Breastfeeding’s mechanism for lowering the risk of obesity is still unclear but is thought to be due to hormones in the breast milk itself which direct the formation of the child’s metabolism AND the self-regulation that a baby learns when he nurses naturally at the breast.
•  Babies who breastfeed eat when they are hungry and stop when they are full.
•  In contrast, bottle-fed babies are often scheduled and encouraged to finish the bottle even after they have shown signs of being full.
CDC Vital Signs. (2011, August). Hospital support for breastfeeding. p.1. Retrieved from http://www.cdc.gov/vitalsigns/Breastfeeding/
See slide
•  911 children’s lives could be saved yearly
•  More than $13 billion health care dollars would be saved annually in pediatric health care.
•  The economic cost to society for women who breastfeed less than recommended is predicted at over $17.6 billion per year related to
•  Heart attacks
•  Hypertension
•  Breast cancer
•  Premenopausal ovarian cancer
•  Type 2 Diabetes
•  Low US breastfeeding rates are associated annually with
•  5,000 cases of breast cancer
•  54,000 cases of hypertension
•  14,000 heart attacks in women
For a summary of this article, go to: http://massbreastfeeding.org/2013/07/10/landmark-study-highlights-effect-of-breastfeeding-on-womens-health/
As health care professionals (HCPs), according to the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists and the American Academy of Family Physicians, HCPs should:
•  Support exclusively breastfed for 6 months, with no supplementation (unless medically necessary) or introduction of solid food until 6 months.
•  Support and encourage mothers who wish to go beyond that, hopefully at least until 1-2 years or longer, as long as the mom and baby want to breastfeed. (The World Health Organization recommends continued breastfeeding for at least 2 years).
The Joint Commission (TJC) accredits hospitals and allows them to stay open and collect reimbursements.
One reason hospitals are interested in increasing BF rates:
•  Starting Jan 1, 2016 all JC-accredited hospitals with >300 births/yr will be required to collect data on the number of Healthy Term Infants who leave the hospital having been exclusively fed human milk.
The following qualifies as “Exclusive”…(see slide)
Some of the key actions outlined in the Surgeon General Report relate specifically to health care providers and systems.
For example:
Action 6 – Ensure that the marketing of infant formulas is conducted in a way that minimizes its negative impacts on exclusive breastfeeding (The WHO Code)
Action 7- Ensure that maternity care practices throughout the United States are fully supportive of breastfeeding.
Action 8 – Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care setting in the community
Action 9 – Provide education and training in breastfeeding for all health professionals who care for women and children
The new health care law has a requirement for employers to provide lactation support through reasonable break times and accommodations for expressing milk.
•  Applies to employees covered under the Fair Labor Standards Act or Non-Salaried employees
•  The pumping space has to be private and NOT a bathroom.
Pumping supplies including pumps are now covered under some insurance plans and are available through WIC.
Ask yourself:
•  What do you do for your employees if they need to breastfeed?
•  Has your office had an employee who requested pumping breaks?
This slide outlines the national Healthy People 2020 goals for breastfeeding.
Not only are goals set for increasing the proportion of infants who are breastfed, but also for:
•  Increasing workplace support for breastfeeding
•  Decreasing formula supplementation for breastfed babies and
•  Increasing the proportion of births that occur in facilities that provide optimal care (Baby-Friendly Designated facilities).
Although this isn’t a current map, the trends in breastfeeding initiation rates remain the same, with the lowest breastfeeding rates in the Southern region of the US. It’s interesting to note the similarity in this map and the obesity maps we showed in the beginning of this presentation.
•  Many of the strategies and best practices that we will talk about today can help lessen the racial and ethnic disparities.
•  There are many things that we can do as providers to remove barriers to breastfeeding.
This graph represents racial/ethnic differences in breastfeeding rates among LA babies who were born in 2006.
•  There is a clear disparity between Blacks and their White and Hispanic counterparts.
•  Initiation rates for Blacks are approximately 30%(approximately half the rate of Hispanics and Whites)
•  While Hispanics and Whites are approx. 58%
•  At 6 and 12 months, Blacks continue to lag behind by almost 50%.
Speaker: LACTATION CONSULTANT
•  Almost ALL women can and should breastfeed.
•  With information, assistance and support, more women would breastfeed.
•  Many women in low risk pregnancies are able to breastfeed during their next pregnancy, with their obstetrician’s OK.
•  Some contraception methods do not interfere with BF if started after BF is well established. However, some do decrease or eliminate a mother’s milk supply, so mothers need correct information.
There are only a few RARE CONTRAINDICATIONS TO BREASTFEEDING INCLUDING:
•  HIV, Human T-cell lymphotropic virus I or II
•  Active, untreated tuberculosis only
•  Herpes lesions on nipple
•  You can express and feed mother’s milk; babies can be put to breast after 14 days of maternal treatment and negative cultures
•  Active varicella (Chicken Pox)
•  isolate mother, give infant VZIG, express and feed mother’s milk when no breast lesions;resume breastfeeding when no longer contagious
•  Drugs of abuse and alcohol abuse, however, a mother who is on methadone maintenance can breastfeed
•  Maternal medications (very few, fewer than you may think)
•  Later in the presentation I will provide you with references to address concerns about medications and breastfeeding.
•  Infants with Classic form of Galactosemia
•  What can HCPs do to promote/encourage moms to breastfeed?
•  Start with evidence-based care.
•  TheTen Steps to Successful Breastfeedingare:
•  The foundation of the Baby-Friendly Hospital Initiative
•  Developed by a team of global experts
•  Consist of evidence-based practices that have been shown to increase breastfeeding initiation and duration.
•  Baby-Friendly hospitals and birthing facilities must adhere to the Ten Steps to receive and retain, a Baby-Friendly designation.
The Ten Steps are:
1.  Have a written breastfeeding/infant feeding policy that is routinely communicated to all 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 one hour of birth (skin to skin care for all mothers-babies). Continued
5.  Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6.  Exclusive breastfeeding. Giveinfants no food or drink other than breast-milk, unless medically indicated.
7.  Practicerooming in - allow mothers and infants to remain together 24 hours a day (all babies).
8.  Encourage breastfeeding on demand.
9.  Give no pacifiers or artificial nipples to breastfeeding infants.
10.  Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
•  In LA, The LA DHH-OPH-Bureau of Family Health’s GIFT Program provides resources and a framework to help birthing facilities improve breastfeeding outcomes through incremental adoption of the internationally recognized Ten Steps to Successful Breastfeeding.
•  Gift hospital designation recognizes hospitals that are implementing evidence-based maternity care practices that are aligned with progress toward pursuit of the Baby-Friendly™ designation.
•  In June 2015: 27 of 52 LA birthing facilities were Gift designated.
The gold standard for evidence-based maternity care is the BFHI. This is a global initiative of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).
A National hospital designation for excellence in practice that encompasses breastfeeding education/support.
Implemented in the United States by Baby Friendly, USA.
Currently, >250 Baby-Friendly designated hospitals in the U.S.
>20,000 BF Hospitals globally and that number is growing quickly.
•  As of June 2015, 5 hospitals in LA have achieved this designation
•  Many other Louisiana hospitals have entered into Baby-Friendly’s 4-D Pathway towards designation.
In Louisiana, there is a new consumer messaging resource available as part of Louisiana’s Gift Breastfeeding program to help with preparing families for these practices:
Skin to skin care….
It all starts with skin to skin care – An evidence based practice facilitating bonding & breastfeeding. Delaying routine procedures during this time until after the first breastfeeding
Skin to skin care is an important practice even if the mom has made an informed decision not to breastfeed
Safe S2S care requires:
•  Position the infant with head turned to the side with infant’s eyes, nose, and mouth visible.
•  The chin should not be flexed to the infant’s chest
•  The infant should be in the sight of an alert mother or of a support person.
Nursing and medical support of rooming-in with bedside assessments increases maternal confidence in her ability to care for her infant and the confidence a mother has in her infant’s health care providers.
•  Early subtle feeding cues can indicate, “I’m getting ready for my feeding” or “I’m hungry”
•  When put S2S at this time, early communication is reinforced, with the infant learning that when “I need something” or “someone”, I know who will respond.
•  Babies whose early cues are recognized get better at them and parents gain a better understanding of their infants needs, whether it is hunger or comfort that is needed.
•  Parents who are responsive to early infant needs, are building an early trusting relationship with their newborn.
/ If the early cues are not recognized with a response, an infant’s cues will intensify with mid-cues of stretching, increasing movement, and rooting by bringing hands to mouth, etc.
These cues mean “I’m really hungry” and “I’m ready to eat”. These are the most commonly known feeding cues.
Crying, lots of movement and turning red in color are late cues and may indicate “Calm me, then feed me.”
These cues may follow early cues that are not recognized with a response.