Mass. Baby-Friendly
Collaborative
Welcome!!
Background
• Informal Collaborative since 2008
• Mother-Baby Summit since 2009
• DPH Baby-Friendly Trainings Spring 2008
Our Faculty today
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Roger Edwards, ScD
Mary Ellen Boisvert, RN, MSN, CLC, CCE
Lucia Jenkins, RN, IBCLC
Mary Foley, RN, IBCLC
Judy Fayre, BS, RN, IBCLC
Melissa Bartick, MD, MSc
Today’s agenda
• Part I: Information (didactic)
• Part II: Hospital working groups
• Part III: Based on your feedback on index card,
breakout groups based on topics of most
interest
Future meetings
Eastern Mass
• Feb 28, 4:30-6:30
• April 4, 4:30-6:30
Western Mass
• Holyoke Hospital
• March 21, 4:30-6:30
• Axilliary Conf. Room
• Both at Somerville Hospital
Cafeteria Conf. Room
Whole State Meeting: Thursday, May 2, approx 5:30-7:30
Log Cabin Conference Center, Holyoke MA
Thank you to:
UMMMC
Mass. Breastfeeding Coalition
Mass. DPH
Our faculty and staff
Website
• www.massbreastfeeding.org/collaborative
– Meetings times and places & directions
– Resources
Baby-Friendly
Why it matters
Melissa Bartick, MD, MSc
Cambridge Health Alliance, Harvard Medical School
Mass. Breastfeeding Coalition
United States Breastfeeding Committee
Patient-Centered Care
60% of women do not meet THEIR OWN
breastfeeding goals.
– CDC/FDA Infant Feeding Practices Survey II, 2008
Ten Evidence-based Steps
1)
Written breastfeeding policy & communicate it to staff.
2)
Train all health care staff to implement the policy.
3)
Inform all pregnant women about benefits & management of breastfeeding.
4)
Initiate breastfeeding within an hour of birth.
1)
Show mothers how to breastfeed, and how to maintain lactation.
2)
Give newborn infants no food or drink other than breast milk, unless medically indicated.
3)
Practice rooming-in– allow moms and babies to be together 24 hours a day.
4)
Encourage breastfeeding on demand.
5)
Give no artificial teats or pacifiers to breastfeeding infants.
6)
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge
from the hospital or clinic
The 10 Steps: Do they work?
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• CDC/FDA Infant Feeding Practices Study II
• 1,907 women who intended to bf> 2 months
• Measured: Breastfeeding termination at 6
weeks
DiGirolamo A, Grummer-Strawn L, Fein S. Pediatrics 2008;122:S43–S49
Surveyed moms on 6 steps:
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Breastfeeding within 1 hour of birth
Giving only breast milk
Rooming in
Breastfeeding on demand
Not using pacifiers
Fostering breastfeeding support groups
Results . . .
Compared with mothers who experienced
all 6 steps . . .
mothers who experienced no steps were
13 times
more likely to stop breastfeeding by 6 weeks.
DiGirolamo A, Grummer-Strawn L, Fein S. Pediatrics 2008;122:S43–S49
Most important steps:
• Breastfeeding within the first
hour of birth
• No formula
• No pacifiers
DiGirolamo A, Grummer-Strawn S, Fein S. Pediatrics 2008;122:S43–S49
This confirms earlier work
Most important predictors of weaning by 6
weeks in IFPS I were:
• Delayed 1st feed beyond the first hour after birth
• Giving formula without a medical reason
From IFPS I, 1993-94
DiGirolamo A, Grummer-Strawn L, Fein S BIRTH 28:2 June 2001
PROBIT
• Promotion of Breastfeeding Intervention Trial
• Kramer et al randomized hospitals and
associated clinics in Belarus
• Some had usual care; others implemented
BFHI type intervention
PROBIT results
• Baseline group/usual care
• had 6.4% exclusive breastfeeding at 3 months
• Intervention hospitals had 43% exclusive
breastfeeding rates at 3 months
EBF @ 3 mos
Baby-Friendly
Control hospitals
EBF @ 3 mos
Did it make a difference to
population health?
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>17,000 infants enrolled
Decreased infant gastroenteritis
Decreased eczema
Significant increase in school performance, IQ
• Even though less than half of all infants were
exclusively breastfeed x3 months
Kramer et al, Arch Gen Psychiatry. 2008;65(5):578-584
Kramer et al, JAMA, January 24/31, 2001—Vol 285, No. 4
Baby-Friendly makes a difference
• Hospital practices affect breastfeeding for
months
• First Hour is vitally important
• Avoiding Supplements is Important
• Avoiding pacifiers is important
Why it matters
• Patient-Centered Care
• Population health
–(babies and likely mothers)
Size matters
Other resources
• www.massbreastfeeding.org/collaborative
• Resource page
• Link to videos on Vimeo.org
MassBreastfeeding Coalition
Password: Skin2Skin
www.zipmilk.org