Transcript Strategies to Improve Breastfeeding Outcomes in Your Hospital and Community (and why it matters in the infant mortality conversation)

Strategies to Improve Breastfeeding Outcomes
in Your Hospital and Community
(and why it matters in the infant mortality conversation)
Tina Cardarelli BS IBCLC
State Breastfeeding Coordinator
[email protected]
A Brief
History
Of
Breastfeeding
•
•
99.7%
Thousands of Years
Bottom Line Benefits:
From the Beginning of Time
So….How can we improve
breastfeeding and mortality?
Innocenti Declaration, 8/1990
“Protection, Promotion and Support of Breastfeeding”
“Recognize breastfeeding is a unique process that:
Provides ideal nutrition for infants and contributes to
their healthy growth and development, reduces
incidence and severity of infectious diseases, thereby
lowering infant morbidity and mortality. “Contributes to
women's health by reducing the risk of breast and ovarian
cancer, and by increasing the spacing between pregnancies
Provides social and economic benefits to the family and the
nation”
“a global goal for optimal
maternal and child health and
nutrition”
Breastfeeding is one of the
most effective ways to ensure
child health and survival.
If every child was breastfed
within an hour of birth, given
only breast milk for their first
six months of life, and
continued breastfeeding up to
the age of two years, about
800,000 child lives would
be saved every year.
WHO
Inappropriate feeding practices,
sub-optimal or no breastfeeding
and inadequate complementary
feeding remain the greatest
threat to child health and
survival globally
“Celebrating Innocenti 1990-2005: Achievements,
Challenges and Future Imperatives”, 22 November 2005, Italy
The Clinical Data
AHRQ Evidence Report Number 153
• 2007 The Agency for Healthcare Research
and Quality (AHRQ) reviewed the evidence
on the effects of breastfeeding on short -and
long-term infant and maternal health
• Conclusion: Breastfeeding is associated
with a reduced risk of many diseases in both
infants and mothers
When Babies Don’t Breastfeed…
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 56% higher risk of SIDS
 35% higher risk of Asthma (no family history)
 67% higher risk of Asthma (with family history)
 100% higher risk for Ear Infections
 178% higher risk for Diarrhea & Vomiting




(Gastrointestinal Infections)
64% higher risk for Type 2 Diabetes
23% higher risk for Acute Lymphocytic Leukemia
138% higher risk for Necrotizing Enterocolitis (NEC) in
preemies
Risk of lower I.Q. – Average of 8 points lower
Agency for Healthcare Research and Quality (AHRQ,2007)
When Women Don’t Breastfeed...
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 They recover more slowly after birth
 Have Increased risk of:
Breast Cancer
Endometrial Cancer
Osteoporosis
High Blood Pressure
Anemia
Ovarian Cancer
Cardiovascular Disease
Type 2 Diabetes
Metabolic Syndrome
Postpartum Depression
 The longer a woman breastfeeds, the more her
risk of breast cancer goes down
Professional Endorsements
“Given the short and long term medical and
neurodevelopmental advantages of breastfeeding,
infant nutrition should be considered a public
health issue and not only a lifestyle choice”
AAP, 2012
“One of the most highly effective preventive measures
a mother can take to protect the health of her infant
and herself is to breastfeed”
Surgeon General, 2011
Improved Hospital Practices
POLICY
BABY FRIENDLY
MPINC
Baby Friendly Designation
mPINC Survey
Model Hospital Policy
LINC
“If we truly understand that breastmilk is the best first
food for babies—and our polling shows Americans do—
then our institutions and communities need to make it
easier for all mothers to nurse……we believe whether a
woman breastfeeds shouldn’t be dictated by the
quality of health care she receives.”
Dr. Gail Christopher VP W.K. Kellogg Foundation
mPINC: Quality Improvement Tool
52 questions
36 question categories
 7 Dimensions of Care

Points value for every question
Higher points given to supportive breastfeeding
practices
 Sub scores categories
 Total score
 Rank

Indiana’s Maternity Practices in Infant Nutrition
and Care (mPINC) Scores, 2007 – 2013
80
76
75
68
70
65
62
64
2007
2009
60
55
50
45
40
2011
Source: Centers for Disease Control and Prevention, mPinc State Reports by year
2013
mPINC score
Since 2007, Indiana’s mPINC score has continued to rise!
Great Job Indiana!
Where In The World Did
“Baby Friendly” Come From ?
• 1990 Innocenti Declaration
• Global effort to implement practices
that protect, promote and support
breastfeeding to reduce infant
mortality worldwide
• 1991 Baby Friendly launched by
WHO and UNICEF
…And
Around
The
World
Ten Steps to Successful Breastfeeding
1) Have a written breastfeeding policy that is routinely
2)
3)
4)
5)
communicated to all health-care staff.
Train all health-care staff in the skills necessary to
implement this policy.
Inform all pregnant women about the benefits and
management of breastfeeding.
Help mothers initiate breastfeeding within an hour
after birth.
Show mothers how to breastfeed and how to maintain
lactation even if they are separated from their
infants.
Ten Steps to Successful Breastfeeding
6) Give newborn infants no food or drink other than
breast milk unless medically indicated
7) Practice rooming-in: allow mothers and infants to stay
together, 24 hours a day.
8) Encourage breastfeeding on demand.
9) Give no artificial nipples or pacifiers to
breastfeeding infants.
10) Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge from the
hospital.
Funded by The Department of Nutrition and Physical Activity
@The Indiana State Department of Health
Are You Doing All that You Can to
Build a Supportive Breastfeeding
Environment in Your Community?
1.5 hour online continuing education tutorial is
designed to meet needs of pediatric primary
care providers team
http://www.northeastern.edu/breastfeedingcme/
Physician Training
Pharmacist Education
www.neurxce.org/user/login
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State Coalition
Clinical and Community Call
Community Drop-In Centers
IU Methodist Tele-Lactation
Racial Inequity
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Child Care Training
One of the easiest things you
can do…
Instead of asking:
“Are you going to breast or bottle feed?”
Ask:
“How can we help you to breastfeed?”
“It is everyone’s role to make
breastfeeding easier”
Surgeon General’s Call to Action to Support Breastfeeding,2011
References
Feldman-Winter, L., Procaccini, D., & Merewood, A. (2012). A Model Infant Feeding
Policy for Baby-Friendly Designation in the USA. Journal of Human Lactation, 28(3),
304-311. doi: 10.1177/0890334412440626
·
Hawkins, S. S., Stern, A. D., Baum, C. F., & Gillman, M. W. (2013). Compliance
with the Baby-Friendly Hospital Initiative and impact on breastfeeding rates. Arch
Dis Child Fetal Neonatal Ed. doi: 10.1136/archdischild-2013-304842
·
Perrine, C. G., Scanlon, K. S., Li, R., Odom, E., & Grummer-Strawn, L. M. (2012).
Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention.
Pediatrics, 130(1), 54-60. doi: 10.1542/peds.2011-3633
·
Saadeh, R. J. (2012). The Baby-Friendly Hospital Initiative 20 years on: facts,
progress, and the way forward. J Hum Lact, 28(3), 272-275. doi:
10.1177/0890334412446690
Sadacharan, R., Santana, S., Sanchez, E., Matlak, S., Grossman, X., Makrigiorgos, G.,
& Merewood, A. (2012). Are you Baby-Friendly? Knowledge deficit among US
maternity staff. J Hum Lact, 28(3), 359-362. doi: 10.1177/0890334412437039
·
Venancio, S. I., Saldiva, S. R., Escuder, M. M., & Giugliani, E. R. (2012). The
Baby-Friendly Hospital Initiative shows positive effects on breastfeeding indicators in
Brazil. J Epidemiol Community Health, 66(10), 914-918. doi: 10.1136/jech-2011200332
·
Merewood, A., Patel, B., Newton, K. N., MacAuley, L. P., Chamberlain, L. B.,
Francisco, P., & Mehta, S. D. (2007). Breastfeeding duration rates and factors
affecting continued breastfeeding among infants born at an inner-city US BabyFriendly hospital. J Hum Lact, 23(2), 157-164. doi: 23/2/157 [pii]
·
10.1177/0890334407300573 [doi]
·
Newton, K. N., Chaudhuri, J., Grossman, X., & Merewood, A. (2009). Factors
associated with exclusive breastfeeding among Latina women giving birth at an
inner-city baby-friendly hospital. J Hum Lact, 25(1), 28-33. doi: 25/1/28 [pii]
·
10.1177/0890334408329437 [doi]
·
Parker, M., Burnham, L., Cook, J., Sanchez, E., Philipp, B. L., & Merewood, A.
(2013). 10 Years after Baby-Friendly Designation: Breastfeeding Rates Continue to
Increase in a US Neonatal Intensive Care Unit. Journal of Human Lactation. doi:
10.1177/0890334413489374