director, the breastfeeding center, boston medical center ... · anne merewood phd mph ibclc ....
TRANSCRIPT
Anne Merewood PhD MPH IBCLC
Director, the Breastfeeding Center, Boston Medical Center
Assoc. Prof. of Pediatrics, Boston University School of Medicine
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Out with the old…..
Who to teach
What to teach
How to teach
Who will teach
How to pass!
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The Pathway to Baby-Friendly Designation
Hospital Breastfeeding
Policy
Readiness Interview
Implement QI Plan
Collect Data
Train Staff
Data Collection
Plan
Prenatal/Postpartum Teaching Plans
Staff Training Plan
On-Site Assessment
Start
Discovery
Development
Dissemination Designation
BF Committee Or Task Force
BFHI Work Plan
Register with Baby-Friendly USA
Obtain CEO Support Letter
Complete Self Appraisal Tool
Baby-Friendly Designation
Bridge to Development Phase-
Registry of Intent Award
Bridge to Designation Phase
Dissemination Certificate of Completion
Bridge to Dissemination
Phase- Development- Certificate of
Completion
© 2012 Baby-Friendly USA, Inc..
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Inform all pregnant women about the benefits and management of breastfeeding
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Obviously, all prenatal settings shouldoffer breastfeeding anticipatoryguidance
What sort of breastfeeding ed dowomen get?
When do they get it; who delivers it?
What about high risk clients?
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Are you going to breastor bottle feed? “Bottle feed” – ends discussion
Mom annoyed if brought upover and over
Breastfeeding class 1-time event – who attends?
1 session of childbirth ed
Or…no-one really bringsit up at all….
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‘Discuss’ breastfeeding/infant feeding
Health benefits of breastfeeding
Give out a ton of printed info
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Handouts
Breastfeeding management
Positioning
Latch
Frequency of feeds
“Every 3 hours for 10 mins on each side…”
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For BF compliance:
You are only responsible for clinician ed amongclinicians who see patients between admit inlabor to discharge with baby
Any clinician on the unit on assessment daycould be interviewed
Mind the gap!
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You are only responsible for prenatal ed forpatients from hospital-owned settings
When BF USA comes, they will onlyinterview YOUR pregnant women aboutprenatal care in any depth
No prenatal care – no expectation reinterviews
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Well educated clinicians who can educatewell
A plan for when prenatal ed will be taughtin your clinic/setting
Outreach to prenatal settings that send youmothers
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Women prepared for skin to skin when theyarrive in labor
Women know about rooming in (howdescribed??)
Helps to put pressure/”encourage” your hospitaldelivery service
Helps women to advocate for optimal MCH care
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Baby-Friendly USAGuidelines and Criteria
http://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria
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Skin to skin at birth (all moms)
Rooming in in hospital (all moms)
Frequency of feeds: “feeding on cue andrecognizing cues”; “8-12 x in 24 hours”
Exclusive breastfeeding
Specifically – not supplementing
Formula prep 1 on 1 postpartum (not ingroup setting; not prenatal)
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Class
Waiting room
Peer counselors
Appointmenttime
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Usually taught by ‘specialist’ (notintegrated, unless Centering Pregnancystyle class)
Advantage – lot of control over content
Disadvantage – not all women come,women who don’t may be ones you mostwant to reach
Class fine but not optimal; cannot standalone
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Advantages:
Pictures!
No provider needed if youuse video loop
Captive audience
Disadvantages
Impersonal/no questions
No way to assess whosaw/understood what
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Peer counselors sit with moms (Moms did notapproach IBCLCs at a table)
Moms pick a poster and get a raffle ticket
Poster winners announced and moms drawn for aprize
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Handouts OKbut thinkpictures!
If handouts,discuss
Make sure up todate
Health literacyand languageconcerns
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Use photos of your patients
Use catchy words and pictures (think – advertising!!)
Be creative! Apps? Computer games? Etc.
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Integrate into prenatal care visits
Research shows, women more likely toremember if info is repeated
Create a system where provider presentsinfo in ‘bundled’ form
Regular and comprehensive
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Info broken down fore.g. at 2nd, 4th, 6th visit(by trimester?*)
*Needs to be“complete” by 3rd
trimester
Premature birth plus BFUSA!
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Regular prenatal provider should dothis
Any other system open to problems
How can IBCLC/childbirth ed/RDpossibly see all patients (unless v. smallfacility)
What if that person moves or is away?
Not good practice to have regularproviders reliant on a “special” person
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MDs may need >3 hours
Prompts – index cards, notes in chart,handouts “equipment” – dolls, breastsetc
Prompts in EMR/chart
“But I don’t have time”
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Documented staffeducation
Patient responses
Can momsanswer questionsin the Step 3 audittool?
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We are not doing it
We are not doing it in any systematic way
We give them all the info on their 1st
prenatal visit
We are not documenting it
Patients are getting handouts but not theteaching to go with them
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Over to you…….
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