State of the State 2013
Breastfeeding in Oklahoma
Becky Mannel, BS, IBCLC, FILCA
Clinical Instructor, OUHSC
Becoming Baby-Friendly in
Oklahoma Project Lead
Chihuly, OKC Art Museum
CNMC
OSDH
Pioneer Group Meeting
10-10-13
OSDH
Oklahoma Health
Oklahoma ranks:
 39th for infant mortality
 43rd for diabetes
 45th in obesity
th
 46 in preterm births
th
 46 in teen birth rates
 39th in smoking
 43rd in overall health ranking

America’s Health Rankings, 2012
OSDH
Obesity Trends Among U.S. Adults
Between 1985 and 2010
Definitions:
• Obesity: Body Mass Index (BMI) of 30 or
higher.
• Body Mass Index (BMI): A measure of an
adult’s weight in relation to his or her height,
specifically the adult’s weight in kilograms
divided by the square of his or her height in
meters.
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2000
1990
2010
No Data
<10%
10%–14%
15%–19%
20%–24%
Source: Behavioral Risk Factor Surveillance System, CDC.
25%–29%
≥30%
Diabetes
Smoking
OK’s Leading Cause of Preventable
Death
Smoking kills more Oklahomans
than:
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Alcohol
Auto accidents
AIDS
Suicides
Murders
Illegal drugs
#1 Cause of Preventable Death
Births By Ethnicity
OK (%)
US (%)
White
63.6
53.6
Black
9.3
14.8
AI
11.2
1.0
Asian
2.4
5.8
Hispanic
13.3
24.7
Oklahoma Birth Statistics
Teen Birth Rate
Per 1000
Preterm Birth
Per 1000
Low Birth Weight
Per 1000
% C/S
OK
US
60.1
39.1
13.8
12.2
8.4
8.2
34.6
32.9
Oklahoma Breastfeeding Rates
2009 (CDC)
National
Oklahoma
Ranking
Ever
breastfed
77%
71%
38th
Any Bfdg
at 6 months
47%
33%
43rd
EBF
at 6 months
16%
10%
45th
Oklahoma Breastfeeding Rates
2010 (CDC)
National
Oklahoma
Ranking
Ever
breastfed
77%
74%
31st
Any Bfdg
at 6 months
49%
39.6%
38th
EBF
at 6 months
16%
16.6%
24th
Exclusive Breastfeeding at 6 months
ABOVE THE
NATIONAL
AVERAGE!!
Kellogg Foundation
Define Best Practice
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CDC mPINC data
The Joint Commission:
Exclusive Breast Milk Feeding
at Discharge
The Baby-Friendly Hospital
Initiative
AAP Sample Hospital
Breastfeeding Policy
mPINC
mPINC
Quality Improvement and
Breastfeeding Support
CDC’s Breastfeeding Report Card
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mPINC = Maternity Practices in Infant
Nutrition and Care
Biennial survey of ALL US birthing hospitals
Launched in 2007
Data from 2007 and 2009 surveys
2011 data just reported
mPINC
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Labor and delivery care
Feeding of breastfed infants
Breastfeeding assistance
Mother/infant contact
Facility discharge care
Staff training
Structural/Organizational
71
62
55
64
62
64
52
2009
mPINC
77
64
62
69
66
66
55
2011
mPINC
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Initial skin to skin contact
◦ w/in 30 minutes after vaginal birth
◦ w/in 2 hours after cesarean birth

Initial breastfeeding
◦ w/in 1 hour after vaginal birth
◦ w/in 2 hours after cesarean birth

24%
37%
Routine procedures while skin to skin 4%
UNICEF Chile
On Toronto Subways
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Initial feeding is breast milk
69%
Supplemental feedings are rare
8%
Water and glucose water are not used 54%
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Infant feeding decision documented = 98%
Staff provide instruction, teach feeding cues,
observe/assess feedings
69-75%
Staff teach NOT to
limit suckling time 14%
Staff rarely provide
pacifiers
22%

Couplets room-in at night
74%

Not separated for postpartum tx
45%

Not separated during hospital stay
28%
Infant procedures, care, assessment
in room
0%



Staff provide referrals
and other support
14%
Discharge packs with
formula samples and
marketing products NOT given
18%

New staff appropriate bfdg ed
6%

Current staff appropriate bfdg ed
22%

Staff had bfdg ed in past year
20%

Competency assessed annually
28%
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Bfdg in prenatal ed, bfdg policy
communicated
63-77%
Designated staff member, documents bfdg
rates, bfdg support to employees 51-55%
Facility does not receive
free formula
0%
Bfdg policy includes
10 Steps to Successful Bfdg
8%
Percentage of breastfed U.S. children who are supplemented
with infant formula, by birth yeara
Congratulations to Claremore
Indian Hospital!!
Oklahoma’s 1st
Baby-Friendly Hospital
$6 Million CDC Funding
240 Hospitals
applied from
around the U.S.
Congratulations to INTEGRIS
Baptist Medical Center!
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Only OK hospital
chosen
Kudos to Hillcrest
Medical Center and
OSU Medical Center
for applying
Oklahoma State
Department of Health
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Hospital-Based Activities
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Every Week Counts
Abusive Head Trauma
Safe Sleep
Prenatal Tobacco Use
Breastfeeding
“We all want Oklahoma’s babies to be safe and healthy”
OSDH Breastfeeding
Support
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OK Breastfeeding-Friendly Worksite
Awards
OK Breastfeeding Hotline
OK Hospital Breastfeeding Education
Project
Becoming Baby-Friendly in Oklahoma
Other states now
wanting to
develop hotlines
OK Hospital Breastfeeding
Education Project

Making Breastfeeding Easier classes
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Statewide, 7.5 contact hours
Inservices, leadership presentations
Technical assistance
Sponsored Breastfeeding Continuing
Education Program (BCEP)
Bag-Free Hospitals in Oklahoma
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Chickasaw Nation Medical Center, Ada
Claremore Indian Hospital, Claremore
Comanche County Memorial Hospital,
Lawton
Deaconess Hospital, Oklahoma City
Duncan Regional Hospital, Duncan
Great Plains Regional Hospital, Elk
City
Hillcrest Medical Center, Tulsa
Integris Baptist Medical Center,
Oklahoma City
Integris Baptist Regional Health
Center, Miami
Integris Bass Baptist Hospital, Enid
Integris Canadian Valley Hospital,
Yukon
Integris Clinton Regional Hospital,
Clinton
Integris Grove Hospital, Grove
Integris Health Edmond, Edmond
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Integris Southwest Medical Center,
Oklahoma City
Jackson County Memorial Hospital,
Altus
Moore Medical Center, Moore
Norman Regional Healthplex, Norman
OU Medical Center, Oklahoma City
OU Medical Center, Edmond
St Anthony’s Hospital, Oklahoma City
St. Anthony’s, Shawnee
St. John’s Medical Center, Tulsa
Weatherford Regional, Weatherford
W.W. Hastings Cherokee Nation
Hospital, Tahlequah
St. Francis Hospital, Tulsa
St. Francis Hospital South, Tulsa
Becoming Baby-Friendly in
Oklahoma Partners
Baby-Friendly environments
reduce disparities
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All babies should have skin to skin contact
All babies should stay with moms
All moms deserve educated staff
All moms deserve commercial-free hospital care
Working as a Team
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“Lactation consultants are too pushy”
“Nurses don’t care”
“Doctors are anti-breastfeeding”
Mode of Feeding Impacts
Intake/Weight Gain
Risk of Bottle-feeding for Rapid Weight Gain During the First Year of Life
Li, et al. Pediatrics 2012
Do Infants Fed From Bottles Lack Self-regulation of Milk Intake Compared With
Directly Breastfed Infants?
Li, et al. Arch Dis Child 2010
Other OK Support

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Breastfeeding laws
OHCA – lactation consults for SoonerCare
moms
WIC Breastfeeding Peer Counselors
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35 BFPCs in 16 counties
WIC Breast Pump Program
WIC-sponsored professional breastfeeding
courses
WIC-sponsored annual conference
Coalition of OK Breastfeeding
Advocates (COBA)
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www.okbreastfeeding.org
Helped pass OK’s breastfeeding laws
Reviews applications for OK Breastfeeding
Friendly Worksite Award program
COBA at national conference of state
coalitions
Received $8300 USBC grant in 2013
COBA Received $8300
USBC grant in 2013
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Capacity building to strengthen state
coalition
Implementation to identify gaps in
community resources
Connect Best Fed Beginnings hospital with
available resources (which helps other
hospitals)
Identify ways to improve resources
Lactation Consultant Certification
Body: IBLCE
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International Board Certified Lactation
Consultants (IBCLCs)
>26,000 IBCLCs in 90 countries
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13,000 in USA
OK has increased from ~80 in 2008 to >150!!
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ILCA now has over 6,000 members in >80
countries
USLCA is national branch of ILCA
NEW: OKLCA chapter 
13th milk
bank in the
U.S.!
For more information:
www.okmilkbank.org
http://www.facebook.com/okmilkbank
Special thank you to
MMBNT for all their
support!
Kellogg Foundation
Did you breastfeed
as long as you
wanted to?
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49% stated they had
51% did not