promoting, protecting and supporting breastfeeding in ... · promoting, protecting and supporting...

C.Sullivan, E.Chetwynd, PHC, 11/2012 1

Promoting, Protecting and

Supporting Breastfeeding

in North Carolina

Ellen Chetwynd RN, BSN, IBCLC, MPH

North Carolina Breastfeeding Coalition-Secretary

Mid South Lactation Consultant Association-Chair

[email protected]

Catherine Sullivan, MPH, RD, LDN, IBCLC, RLC

State Breastfeeding Coordinator

NC Division of Public Health

[email protected]

1974 • American Public Health Association

• Multiple breastfeeding statements, most recently updated in 2007 and 2011

1989 • American Academy of Family Physicians

• Updated in 2008

1992 • American College of Nurse Midwives

• Updated in 2004 and 2011

1997 • American Academy of Pediatrics


1997

• Academy of Nutrition and Dietetics (formerly American Dietetic Association)


2007 • American Congress of Obstetricians and Gynecologists

• Not yet updated

Professional Organizations Agree


2000 • HHS Blueprint for Action on Breastfeeding • First comprehensive framework on breastfeeding for the Nation

2005

• The CDC Guide to Breastfeeding Interventions • Provides state and local community members information on breastfeeding

intervention strategy

2010 • The Joint Commission: Perinatal Care Core Measures • Added exclusive breast milk feeding to the Perinatal Care Core Measures

2011

• The Surgeon General’s Call to Action to Support Breastfeeding

• With this Call to Action, the Surgeon General seeks to make it possible for every mother who wishes to breastfeed to be able to do so by shifting how we as a nation think and talk about breastfeeding

2012

• Affordable Care Act • “Comprehensive lactation support and counseling, by a trained provider during

pregnancy and / or in the post partum period, and costs for renting breastfeeding equipment”

Circle of Support

Mother-Baby Dyad

Health Care System

Family

Support

Public Health Infrastructure

Employment

Community

Support

Research


CDC Report Card-N.C. Trends

CDC Report Card-N.C. Trends


Percentage of Mothers with Reason for Stopping Breastfeeding Being:

Went Back to Work or School

¯60 0 6030 Miles

Legend

Percent

17.3 %- 19.36 %

19.361 %- 21.42 %

21.421 % - 23.48 %

23.481 %- 25.54 %

25.541 % - 27.6 %

Data source: North Carolina Pregnancy Risk Assessment

Monitoring System (PRAMS) Data [2006-2008]: State Center

for Health Statistics, Raleigh NC

Federal Law-Worksites Patient Protection and Affordable Care Act (P.L. 111-148)

Eligibility

– Employees subject to the Fair Labor

Standards Act (FLSA)

– Nursing mothers until infant reaches 12

months of age

Businesses with less than 50 employees must

show undue hardship to avoid compliance


NC Office of State Personnel

(OSP)

Work/Life Balance • Lactation Policy effective July 1, 2010

– “It is the policy of North Carolina State

Government to assist working mothers with the

transition back to work following the birth of a

child by providing lactation support. A lactation

support program allows a nursing mother to

express breast milk periodically during the work

day”


Workplace

Accommodations

Ask

What is an IBCLC: Training

300-1000 hours of supervised, lactation

specific, clinical experience

90 hours of didactic education in human

lactation

Another health care license or 14 general

education classes in health science

THEN

An internationally administered, proctored,

certification exam


What is an IBCLC?

Function like a physical therapist for breastfeeding

Problem based breastfeeding assessment and management

60-90 minute appointments

Most commonly treat – Difficulty with latch or oral motor skills

– Pain with breastfeeding

– Milk supply issues

– Breast infections

Effectiveness of IBCLCs

Witt, Mason, et al 2012



Bonuck, Trombley, et al 2005


Su, Chong, et al 2007

Relative Risk of Exclusive Breastfeeding in Post Partum Lactation Consultant Group vs Control

Relative Rate & Confidence Interval

Number Needed to Treat

At discharge from hospital 1.48 ( 0.89 – 2.47) At 2 weeks 1.82 (1.14 – 2.90) 6

At 6 weeks 1.85 (1.11 – 3.09) 7 At 3 months 1.87 (1.03 – 3.41) 9 At 6 months 2.12 (1.03 – 4.37) 11


75% of Mothers Choose to Breastfeed

Chantry 2011


Baby Had Difficulty Nursing

¯60 0 6030 Miles

Legend

Percent

20 %- 21.94 %

21.941 % - 23.88 %

23.881 %- 25.82 %

25.821 % - 27.76 %

27.761 %- 29.7 %






Breastmilk Alone Did Not Satisfy Baby

¯60 0 6030 Miles

Legend

Percent

31.8 % - 33.96 %

33.961 %- 36.12 %

36.121 %- 38.28 %

38.281 %- 40.44 %

40.441 % - 42.6 %





Nipples Sore, Cracked or Bleeding

¯60 0 6030 Miles

Legend

Percent

18.6 %- 20.98 %

20.981 % - 23.36 %

23.361 %- 25.74 %

25.741 % - 28.12 %

28.121 % - 30.5 %





IBCLC’s in North Carolina

Reimbursement Ask

ACA lactation services

coverage required as of

Aug 2012

Support IBCLC’s as the

preferred provider of

lactation services


Why Licensure?

Regulatory effort to protect the public from

potential harm

– Encourages quality

– Assigns responsibility

– Raises professional standards of practice

– Defines practice guidelines

– Allows for regulation of those who practice

within a profession, and outside of it

http://www.ilca.org/files/USLCA/Resources/Publications/Licensure_FAQs_for_IBCLCs.pdf

Benefits of Licensure

Forms the basis for autonomous practice

Provides transparency within the health

care system

Is the framework on which the US health

care system bases the structure of its

workforce

Improves the process of reimbursement

for services

http://www.ilca.org/files/USLCA/Resources/Publications/Licensure_FAQs_for_IBCLCs.pdf


Licensure for IBCLCs will not restrict lactation

support, but instead:

‘Ensure access to the services provided by

IBCLCs’ without disparities

Define IBCLC scope of practice commensurate

with our training and expertise

Should IBCLCs Be Licensed?


Moving Forward

Find an existing board to house IBCLC

Defining exemptions: other qualified

professionals and volunteers may still

support lactation

Drafting the Lactation Practice Act

States Currently in Pursuit of

Licensure

Making Progress:

Massachusetts

North Carolina

Georgia

Pennsylvania

New York

Indiana

Hawaii

Florida

Initial Discussions:

Connecticut

Virginia

Washington

Rhode Island

Arizona

Kansas

Utah


Licensure Ask

Creating a Lactation Practice Act

Letter of Support

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