Hospital Practices Influence Breastfeeding Rates:

The Data Tell the Story

Birth & Beyond California: Breastfeeding Training & QI ProjectWith funding from the federal Title V Block Grant

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Objectives

• Name the source of in-hospital breastfeeding data for California

• Describe the trends in California for ‘any’ and ‘exclusive’ in-hospital breastfeeding from 1992- 2007

• Identify three hospital practices that can discourage breastfeeding

• List three hospital practices that increase breastfeeding duration

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In-Hospital Breastfeeding Data Source:Newborn Screening Program

• Administered by the Genetic Disease Screening Program (GDSP)

• Primary purpose is to collect infant blood samples to screen for genetic diseases

• Staff complete the forms following the instructions provided by GDSP

• Summary data is sent to the Epidemiology staff of the Maternal, Child and Adolescent Health Program and made available yearly on-line

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California Department of Public HealthMaternal, Child, and Adolescent Health Division

Breastfeeding Categories

• Any breastfeeding– Includes infants fed only human milk and

infants fed a combination of human milk and formula

• Exclusive breastfeeding– Infants fed only human milk– Recommended by American Academy of

Pediatrics, American College of Obstetricians and Gynecologists, Academy of Family Physicians, American Dietetic Association

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California Any and Exclusive In-Hospital Breastfeeding: 1994-2007

43%43%44% 44% 43% 44% 44% 44% 43% 43% 43% 42% 42% 42%

87%87%86%86%86%85%84%84%83%82%80%79%77%77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Exclusive Breastfeeding Any Breastfeeding

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Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

The “GAP” is Growing

Percent Any/Exclusive In Hospital Breastfeeding: 2007

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Gap

Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

2007 California’s BestAny/Exclusive Breastfeeding

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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Any BF Exclusive BF

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Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

Best LA HospitalsExclusive Breastfeeding 2007

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Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

Percent Any/Exclusive In Hospital Breastfeeding: 2007

Closing the Gap

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Closed the Gap

Closed the GapClosing

Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

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Hospital Practices that Influence Breastfeeding

• Strongly encouraging

• Encouraging

• Discouraging

• Strongly discouraging

HHS, Blueprint for Action on Breastfeeding, 2000

Practices that Discourage Exclusive Breastfeeding

• No written policy to keep healthy mothers and infants from being separated

• Lack of staff training

• Routine formula supplementation

• Delay of first feeding

• Breastfeeding assessments not recorded

• Mothers told to limit time breastfeedingHeinig, UC Davis, 2006

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Hospital practices are associated with breastfeeding continuation at 8 weeks

0 25 50 75 100

Baby breastfed in 1st hour after birth

Baby fed only breastmilk in hospital

Baby stayed in same room with mother

Baby did not use pacifier in hospital

Hospital gave mother phone number to call forbreastfeeding help

Percent

No

Yes

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Murray, Birth, 2007

• Providing Breastfeeding Support: Model Hospital Policy Recommendations

• Model Hospital Policy Recommendations Toolkit

www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Pages/MainPageofBreastfeedingToolkit.aspx

….or link to these by entering the url: http://cdph.ca.gov/Breastfeeding

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The Ten Steps To Successful Breastfeeding

Baby Friendly Hospital Initiative

• More than 19,000 hospitals worldwide• 79 in United States• 23 in California

As of March 2009www.babyfriendlyusa.org

Policy and Practice Changes

• What barriers to changes in policy & practices do you see?

• What do you think should be done to address those barriers?

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Birth & Beyond California

• Quality Improvement– Support for your QI team– Policy revision technical assistance– Technical assistance and tools for data collection

and analysis tailored to your hospital• BBC Regional QI Network meetings

– Monthly• Training

– 2 hour Decision Maker – 16 hour Learner Workshop– 16 hour Train the Trainer

The Physiologic Norm is Easier

• Skin to skin triggers – Infant competence – Appropriate maternal responses

• Exclusive breastfeeding in the early days promotes a cascade of breastfeeding successes

• Mother/baby togetherness in the early days enhances parental competence

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Moore, Cochrane Review, 2007

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Day One Conclusions

• Mother/baby attachment – Is supported by skin–to–skin contact

• Risks of not breastfeeding – A public health concern

• Nurses can teach parents – To recognize predictable newborn patterns

• Breastfeeding rates– Reflect maternity care policies & practices

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Assignment Prior to the Next ClassClinical Experiences

• Observe a newborn placed skin-to-skin with mother for 20 minutes

• Observe an infant breastfeeding and listen for suck and swallow sounds

• Observe the cluster feeding pattern of the breastfeeding newborn

Thank you

• Complete evaluation

• Bring your syllabus next time

• See you then!

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Welcome Back

Birth and Beyond California

Day 2

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Assignments

• Observe a newborn placed skin to skin with mother for 20 minutes

• Observe an infant breastfeeding and listen for sucks and swallows

• Observe the cluster feeding pattern of the breastfeeding newborn

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Objectives

• Demonstrate three positions mothers may use to breastfeed

• List at least three signs of an effective latch

• Identify two signs of milk transfer from the breast to the infant

• Identify three in-hospital strategies for early breastfeeding management