Promoting the Promoting the BestBest

Julie Pham, DOJulie Pham, DO

ObjectiveObjective

Share Goals for My Community Share Goals for My Community Medicine Project to Promote Medicine Project to Promote Breastfeeding Breastfeeding

Identify Points of Influence to Identify Points of Influence to Promote BreastfeedingPromote Breastfeeding

Review Barriers to Initiate and Review Barriers to Initiate and Continue BreastfeedingContinue Breastfeeding

Discuss Clinical Experiences on Discuss Clinical Experiences on Perceived Obstacles and Ways to Perceived Obstacles and Ways to Promote BreastfeedingPromote Breastfeeding

Community Medicine Community Medicine ProjectProject

Breast is BestBreast is Best 3 part series3 part series

Data CollectionData Collection Literature ReviewLiterature Review Confirm with Medical Professionals and Confirm with Medical Professionals and

MothersMothers Analysis and DevelopmentAnalysis and Development ImplementationImplementation

BreastfeedingBreastfeeding

Healthy People 2010 Goal:Healthy People 2010 Goal: Initiation – 75%Initiation – 75% At 6 months – 50At 6 months – 50%%

At 12 months – 25%At 12 months – 25%

American Academy of Pediatrics American Academy of Pediatrics Recommendation:Recommendation:

Exclusively breastfeeding for 6 months Exclusively breastfeeding for 6 months Continue with appropriate food through first Continue with appropriate food through first

yearyear

DefinitionDefinition

ExclusiveExclusive WHO: breast milk from the mother or a WHO: breast milk from the mother or a

wet nurse, or expressed breat milk and wet nurse, or expressed breat milk and no other liquids or solids no other liquids or solids

Initiated immediately after birthInitiated immediately after birth Until 6 mos of life and continue up to 2 Until 6 mos of life and continue up to 2

yrsyrs PartialPartial

Supplement breast milk with formulaSupplement breast milk with formula

Benefits of BreastfeedingBenefits of Breastfeeding For InfantFor Infant

Decrease risk of infectious diseaseDecrease risk of infectious disease Complete nutrition for growth and hydrationComplete nutrition for growth and hydration Developmental and psychosocial benefitsDevelopmental and psychosocial benefits Reduce chronic diseaseReduce chronic disease Decrease SIDS and tooth decayDecrease SIDS and tooth decay

For MotherFor Mother Reduce risk of chronic diseaseReduce risk of chronic disease Help with recovery after birthHelp with recovery after birth Psychosocial benefitsPsychosocial benefits

Benefits of BreastfeedingBenefits of Breastfeeding

For FamiliesFor Families Healthier infant Healthier infant

less health care expenseless health care expense less time off workless time off work

Lower food costLower food cost For SocietyFor Society

Saved $ for Saved $ for formulaformula health carehealth care

EpidemiologyEpidemiology

Before 20Before 20thth century – nearly 100% century – nearly 100% 1930’s – rise in popularity of artificial milk1930’s – rise in popularity of artificial milk By Early 1970’s – 25% initiated; 5% at 6 By Early 1970’s – 25% initiated; 5% at 6

monthsmonths Starting 1970’s – increase rate and Starting 1970’s – increase rate and

durationduration Less medically intrusiveLess medically intrusive More natural birthMore natural birth

1998 – All time high of 64.3%1998 – All time high of 64.3%

EpidemiologyEpidemiologyBF among women in the Maternal and Infant Health BF among women in the Maternal and Infant Health

Assessment (2005-2006)Assessment (2005-2006)

San Francisco Bay Area

0

20

40

60

80

100

Ever BF Any BF at 2mos Exclusive BF at 2mos

California

Ever BF Any BF at 2mos Exclusive BF at2mos

African-American

Asian/Pacific Islander

Latina - US born

Latina - not US born

White

EpidemiologyEpidemiology

Social BarriersSocial Barriers

Not Social NormNot Social Norm ““It’s hard to BF in public with people It’s hard to BF in public with people

watching.”watching.” “…“…I don’t want to see [women feeding her I don’t want to see [women feeding her

baby]…something you do in private…it baby]…something you do in private…it shocked me because I’ve never seen that, shocked me because I’ve never seen that, no in public”no in public”

Lack SupportLack Support ““At the hospital…I didn’t really know At the hospital…I didn’t really know

whether I wanted to BF or not, so they just whether I wanted to BF or not, so they just went ahead and right away gave him the went ahead and right away gave him the bottle.”bottle.”

Social BarriersSocial Barriers

Lacking Role ModelLacking Role Model ““I didn’t know what was going on with my I didn’t know what was going on with my

breast and milk and things like that. I breast and milk and things like that. I really didn’t know too much so I just really didn’t know too much so I just stopped. I asked my mother-in-law but she stopped. I asked my mother-in-law but she didn’t know. “didn’t know. “

Lack Supportive Working EnvironmentLack Supportive Working Environment ““I work, so I can’t BF. I don’t have time.I work, so I can’t BF. I don’t have time. ““You have to stay home, you can’t go You have to stay home, you can’t go

anywhere or do anything else.”anywhere or do anything else.”

Personal BarriersPersonal Barriers

Painful, Sore nipplesPainful, Sore nipples Perceived inadequate milk supplyPerceived inadequate milk supply Maternal fatigueMaternal fatigue AnxietyAnxiety DepressionDepression Prior breastfeeding experiencePrior breastfeeding experience ConfidenceConfidence Negative attitudeNegative attitude

Cultural BarriersCultural Barriers

AcculturationAcculturation Recent immigrants vs US born/Years in Recent immigrants vs US born/Years in

USUS TraditionsTraditions

FoodFood PracticesPractices TimingTiming

Role of personal support systemRole of personal support system

NOT a barrierNOT a barrier

Awareness/KnowledgeAwareness/Knowledge ““BF is healthier for the baby…babies get less sick”BF is healthier for the baby…babies get less sick” ““[Babies] grow faster and fatter.”[Babies] grow faster and fatter.” ““I felt [my baby] close to me… I bonded a lot better I felt [my baby] close to me… I bonded a lot better

with her.”with her.” “”“”It makes babies healthier less cranky, and they It makes babies healthier less cranky, and they

get fewer earaches.”get fewer earaches.” Contained more “vitamins” than formula; babies Contained more “vitamins” than formula; babies

are smarterare smarter BF “because I could lose weight faster”BF “because I could lose weight faster” ““Your uterus shrinks up faster when BFYour uterus shrinks up faster when BF

Points of InfluencePoints of Influence

Points of Influence:Points of Influence:Preconception/InterconceptPreconception/Interconcept

ionion Knowledge development and planningKnowledge development and planning

Birth controlBirth control PregnancyPregnancy Parenting StrategiesParenting Strategies

Annual visits Annual visits Opportunity to provide benefits, Opportunity to provide benefits,

address misconceptions or address misconceptions or concerns/questionsconcerns/questions

Point of Influence:Point of Influence:AntenatalAntenatal

Period of high interestPeriod of high interest Frequent clinic visitsFrequent clinic visits Making behavior and health decisionsMaking behavior and health decisions Counseling on EBF correlates with Counseling on EBF correlates with

higher rate of EBFhigher rate of EBF Help define intention to EBFHelp define intention to EBF Address counterforce: misconceptions, Address counterforce: misconceptions,

formula advertisements, etcformula advertisements, etc

Point of Influence:Point of Influence:Perinatal (Birth)Perinatal (Birth)

Period when birthing process can Period when birthing process can affect initiation, duration and affect initiation, duration and exclusivity of BFexclusivity of BF

Babies born in Baby-Friendly Hospitals Babies born in Baby-Friendly Hospitals are 28% more likely to EBF and 2x the are 28% more likely to EBF and 2x the rate of duration from 6-12wks. rate of duration from 6-12wks.

Some studies show SVD babies are Some studies show SVD babies are 1.5x more likely to initiate EBF vs. C/S1.5x more likely to initiate EBF vs. C/S

Report states receiving epidurals have Report states receiving epidurals have significance in earlier cessation of EBFsignificance in earlier cessation of EBF

Point of Influence:Point of Influence:Perinatal (Birth)Perinatal (Birth)

Baby Friendly Hospitals: Ten Steps to Successful Baby Friendly Hospitals: Ten Steps to Successful BreastfeedingBreastfeeding

1.1. Maintain a written BF policy that is routinely Maintain a written BF policy that is routinely communicated to all staffcommunicated to all staff

2.2. Train all staff skills necessary to implement policyTrain all staff skills necessary to implement policy3.3. Inform all pregnant mom about benefits and Inform all pregnant mom about benefits and

management of BFmanagement of BF4.4. Help moms initiate BF w/in 1 hr of birthHelp moms initiate BF w/in 1 hr of birth5.5. Show moms how to BF and maintain lactation, Show moms how to BF and maintain lactation,

even if mom/baby are separted.even if mom/baby are separted.6.6. Give babies no food or drink other than Give babies no food or drink other than

breastmilk, unless medically indicatedbreastmilk, unless medically indicated7.7. Practice “rooming-in” for 24hrs a dayPractice “rooming-in” for 24hrs a day8.8. Encourage unrestricted BFEncourage unrestricted BF9.9. Give no pacifiers or artificial nipples to BF babiesGive no pacifiers or artificial nipples to BF babies10.10. Foster the establishment of BF support groups Foster the establishment of BF support groups

and refer moms on D/C.and refer moms on D/C.

Point of Influence:Point of Influence:Immediate PostpartumImmediate Postpartum

This period is highly associated with This period is highly associated with initation and duration of BFinitation and duration of BF

Creating relationship with mother and Creating relationship with mother and infantinfant

Overcome factors that can interrupt Overcome factors that can interrupt immediate BF: immediate BF, skin-to-skin immediate BF: immediate BF, skin-to-skin contactcontact

Supplemental formula without indication Supplemental formula without indication unsuccessful EBFunsuccessful EBF

Avoid use of pacifierAvoid use of pacifier BF counseling BF counseling greater effect on EBF greater effect on EBF

Point of Influence:Point of Influence:Days 3-12Days 3-12

Milk “comes in”Milk “comes in” Adaptation after dischargeAdaptation after discharge

Establishing routines Establishing routines Mother-Infant bondingMother-Infant bonding Family/Friends supportFamily/Friends support

Decrease contact with medical Decrease contact with medical professionalsprofessionals

Questions, concernsQuestions, concerns Adequate wt gain, Milk insufficiency, Adequate wt gain, Milk insufficiency,

BF problemsBF problems

Point of Influence:Point of Influence:Day 12 – Week 6Day 12 – Week 6

Rate of EBF drops significantly Rate of EBF drops significantly during this time periodduring this time period

Establish mother/baby interaction Establish mother/baby interaction Sufficiency of milk productionSufficiency of milk production Subject to societal normsSubject to societal norms Planning to return to work Planning to return to work

Point of Influence:Point of Influence:Weeks 6 – 12Weeks 6 – 12

Maintenance of sufficient milk Maintenance of sufficient milk productionproduction Misconception of supplemental food by 3 Misconception of supplemental food by 3

months of agemonths of age Misperception that formula = breast milkMisperception that formula = breast milk

Lactational Amenorrhea MethodLactational Amenorrhea Method Conception will not occur in 1Conception will not occur in 1stst 6 wks 6 wks Frequent infant suckling Frequent infant suckling suppression of suppression of

ovulation ovulation delay the return of menses in delay the return of menses in postpartum periodpostpartum period

99.5% effective with perfect use; 98% with 99.5% effective with perfect use; 98% with typical use during 1typical use during 1stst 6 wks 6 wks

Returning to workReturning to work

Point of Influence:Point of Influence:Months 4 - 6Months 4 - 6

Critical period in continuation of EBFCritical period in continuation of EBF Drop-off in rates of EBFDrop-off in rates of EBF

Misperception of infants’ nutritional Misperception of infants’ nutritional needsneeds

Adaptation to social influences and Adaptation to social influences and health worker inputshealth worker inputs Return to work - 80% return to workReturn to work - 80% return to work Day careDay care

Share Your ExperienceShare Your Experience

What are the points of influence What are the points of influence you’ve used to promote BF? you’ve used to promote BF?

What are the barriers from your What are the barriers from your experience?experience?

Have a great day!Have a great day!

Thank youThank you