A Call to Action:
Improving
Breastfeeding
Initiation and
Duration in the
Hudson Valley
Stephanie Sosnowski
Deputy Director, Maternal-Infant Services Network
Chair, New York Statewide Breastfeeding Coalition
Disclosure: I have no actual or potential declarations to make in
relation to this program
Maternal-Infant Services Network
www.misn-ny.org
Objectives
• Describe NYS DOH Breastfeeding
Promotion Initiatives
• Describe how to increase breastfeeding in
the Hudson Valley, including cesarean
birth mothers
Maternal-Infant Services Network
www.misn-ny.org
Breastfeeding:
A National Public Health Priority
CDC 2007 National survey:
MPINC
Maternity Practices in Infant Nutrition and Care
Maternal-Infant Services Network
www.misn-ny.org
2007 Breastfeeding Rates (%)
90
80
70
60
50
40
30
20
10
0
NYS
National
HP 2010
Ever BF
6 mos.
12 mos.
Exclusive at Exclusive at
3 mos.
6 mos
Source: CDC, NIS, provisional data, 2007 births
Maternal-Infant Services Network
www.misn-ny.org
Exclusive Breastfeeding
• As defined by Joint Commission National
Quality Core Measures
www.manual.jointcommission.org/releases/TJC2010A/DataEleme0273.html
“Newborn receiving only breast milk and no other
liquids or solids except for drops or syrups
consisting of vitamins, minerals, or medicines.”
Maternal-Infant Services Network
www.misn-ny.org
Breastfeeding, by Race, NYS
80
70
60
50
White, not Hispanic
40
Black, not Hispanic
30
20
10
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
0
Maternal-Infant Services Network
www.misn-ny.org
2008 % BF, by race
90
80
70
60
50
40
30
20
10
0
% ever Bf
6 mos.
Multiple
races
Asian/Pacific
Islander
Am. Indian/Alaskan
Hispanic
Black
White,
12 mos
Source: NYS PedNSS, 2010
Maternal-Infant Services Network
www.misn-ny.org
Hudson Valley
NYS 2008 PedNSS Breastfeeding %
Ever BF
6 mos.
12 mos.
3 mos.
W
es
tc
he
st
er
te
r
Ul
s
Su
lliv
an
an
d
Ro
ck
l
Pu
tn
am
6 mos
O
ra
ng
e
Du
tc
he
ss
100
90
80
70
60
50
40
30
20
10
0
Source: NYS DOH 2008 Pediatric Nutrition Surveillance
Maternal-Infant Services Network
www.misn-ny.org
2009 Breastfeeding Rates by
Hospital (county averages)
100
90
80
70
60
50
40
30
20
10
0
Fed any BM
Exclusive BM
Du
tc
he
ss
Co
un
O
ra
ty
ng
e
Co
Ro
un
ck
ty
la
nd
Co
un
Ul
ty
st
er
W
es
Co
tc
un
he
HV
ty
st
e
av
rC
er
ou
ag
nt
e
y
(7
co
un
tie
s)
BM supplemented with
formula
Source: NYS DOH Maternity Information Leaflet
Maternal-Infant Services Network
www.misn-ny.org
2009 NYSDOH Call to Action
• Provide information on website and in
Maternity Information leaflet about infant
feeding practices at each hospital
• Increase visibility of individual hospital
performance measures related to initiation
and exclusivity.
Maternal-Infant Services Network
www.misn-ny.org
NYSDOH Call to Action, cont.
• Called on healthcare providers to:
-Talk with prenatal patients and new
moms
-Refer women to appropriate resources;
to WIC if eligible
Maternal-Infant Services Network
www.misn-ny.org
Call to Action, cont.
Called on maternity services hospitals to:
• Review hospital policies to ensure they are in
compliance with NYS Perinatal Regulations.
• Provide staff training, designate staff to attend
NYSDOH training opportunities.
• Review hospital policies to ensure that formula is
only provided to breastfed infants when
medically indicated, and that educational
material provided to mothers is free of
commercial interest.
Maternal-Infant Services Network
www.misn-ny.org
NYSDOH Breastfeeding
Publications
Breastfeeding - Simply the Best, Pocket Guide for
Health Care Providers: #2963
Breastfeeding Your Baby Simply the Best Brochure,
English: #2961
Breastfeeding Your Baby Simply the Best Brochure,
Spanish: #2962
Mail, E-mail or Fax Orders (limit 200) to:
NYSDOH Distribution Center
21 Simmons Lane
Albany, NY 12204
E-mail: b0019w@health.state.ny.us
Fax: 518-465-0432
Breastfeeding…
For My Baby…
For Me Campaign
• http://www.youtube.com/watch?v=qjoWW
UYDKQM
• http://www.youtube.com/watch?v=Vyxh8R
nuK3U
• http://www.youtube.com/watch?v=OclFqV
1hb14
Maternal-Infant Services Network
www.misn-ny.org
Breastfeeding and Cesareans
Source:
Percentage of mothers who had a cesarean delivery
without complications who began to breastfeed
in the recovery room by perinatal designation.
Percentage of mothers who had a vaginal delivery without complications who
began to breastfeed in the delivery room by perinatal designation.
NYS DOH 2009 Hospital Survey
17
Breastfeeding Committee
Recommendations
• Baby Friendly®
www.babyfriendlyusa.org
• Academy of Breastfeeding Medicine
Clinical Protocol #7: Model Breastfeeding
Policy (Revision 2010)
www.bfmed.org
Maternal-Infant Services Network
www.misn-ny.org
Breastfeeding - Just 10 Steps!
The Baby-Friendly® Way
•Have a written breastfeeding policy that is routinely communicated to all
health care staff
•Train all health care staff in skills necessary to implement this policy
•Inform all pregnant women about the benefits and management of
breastfeeding
•Help mothers initiate breastfeeding within one hour of birth
•Show mothers how to breastfeed, and how to maintain lactation even they
should be separated from their infants.
Maternal-Infant Services Network
www.misn-ny.org
10 Steps, cont.
•Practice rooming in - allowing mothers and infants to remain together 24 hours a day.
•Encourage breastfeeding on demand.
•Give newborn infants no food or drink other than breastmilk unless
medically indicated.
•Give no artificial teats or pacifiers to breastfeeding infants
•Foster the establishment of breastfeeding support groups and refer
mothers to them on discharge from the hospital or clinic.
Maternal-Infant Services Network
www.misn-ny.org
ABM Policy #7 (rev. 2010)
Best Practices for Breastfeeding Support
Following Cesarean Delivery
1. Early mother-infant contact. Avoidance of separation unless dictated by
medical indications
2. Early breastfeeding <1 hour after delivery. Can occur in delivery suite or
recovery room.
3. Regional anesthesia for cesarean delivery.
4. Infant Positioning to minimize incision discomfort. Use of side-lying,
football breastfeeding position. Use of pillow to protect incision site.
5. Use of regional medication after cord clamping to decrease the need for
postoperative narcotics.
Maternal-Infant Services Network
www.misn-ny.org
ABM Policy #7 (rev. 2010)
Best Practices for Breastfeeding Support Following Cesarean Delivery, cont.
6. Preferential use of narcotics with less adverse effects on neonatal
behavior
7. Frequent breastfeeding and rooming-in such as would be routine for
vaginal delivery.
8. Protocols for early breast pumping and expression if infant separation is
dictated because of medical indication such as prematurity. Should be
initiated day of delivery.
9. Easy availability of lactation expert for further support and assistance if
needed.
10. Monitoring for delayed onset of lactation in mother and excessive weight
loss in the newborn.
11. Education and encouragement of family members in methods of
supporting breastfeeding in the new family.
Thank you
• “We need to direct even more effort toward
making sure mothers have the support
they need in hospitals, workplaces and
communities to continue breastfeeding
beyond the first few days of life, so they
can make it to those 6 and 12 month
marks.”
William Dietz, MD, PhD, Director of CDC’s Division of Nutrition,
Physical Activity and Obesity.
Maternal-Infant Services Network
www.misn-ny.org
Next meeting
Thursday, December 2, 2010
9 am – Hudson Valley Hospital Center
Educational Offering: Implementing the Joint
Commission Perinatal Care Core Measure on
Exclusive Breastfeeding
For more information:
ssosnowski@misn-ny.org
Maternal-Infant Services Network
www.misn-ny.org