Breastfeeding and Environmental Change:

A Focus on Maternity Care Practices

The Massachusetts Experience

Rachel Colchamiro, MPH, RD, LDN, CLCState Breastfeeding Coordinator

Massachusetts Department of Public HealthNutrition Division

Breastfeeding in Massachusetts (2005 data)

79% breastfeeding initiation rate

45% breastfeeding at 6 months; 25% breastfeeding at 12 months

43% exclusively breastfeeding at 3 months; 17% exclusive at 6 months

Why Focus on Maternity Care?

Time-sensitive nature of breastfeeding success

Evidence of positive impact of “breastfeeding-friendly” hospital practices

Significant impact of supplementation on later breastfeeding duration and exclusivity

It’s All About Timing…

Perinatal Hospital Licensure Regulations

Purpose:

Improve quality of care for all women giving birth in Massachusetts and their newborn infants

Improve perinatal outcomes – maternal and infant

Better serve Massachusetts families

More efficiently provide services to mothers and newborns in Massachusetts

Need for Revision

Regulations initially promulgated in mid 1970’s and revised in the late 1980’s

Part of a multi-faceted strategy to reduce mortality

Health care delivery changes and technology have changed environment resulting in need to update existing regulations

Research informs best practices to promote positive health outcomes

Massachusetts Breastfeeding Coalition

Rejuvenated in 2000 by a consumer/physician

Made up of advocates, health professionals, hospitals and health departments, community organizations, consumers and parents

Includes many prominent individuals in breastfeeding arena

Membership eager and willing to work for change

Excellent website and history of social marketing campaigns

Our Hopes and Dreams

Increase breastfeeding duration and exclusivity

Mandate a level of lactation support in the maternity setting

Improve initiation of breastfeeding by keeping dyad together

Regulate documentation related to feeding

Improve staff knowledge and ability

Eliminate marketing practices that negatively affect breastfeeding

Process - Revision to Regulations

Began January, 2004

Joint process between two bureaus – Center for Quality Assurance and Control and Center for Community Health

Development of Advisory Committee and Sub-Committees--Massachusetts Breastfeeding Coalition leaders active on committees

Lengthy review and approval process including:

Public Health Council

Public comment hearings

Department of Public Health review of comments and revisions

Review by governor and his cabinet

Our Successes:

Key Changes to Regulations

Promoting Breastfeeding

Availability of a Lactation Consultant

Strengthening of patient care policies related to lactation

Documentation of infant feeding care & progress

Discharge planning

Staff education/training in lactation

Significant Sections Related to Breastfeeding

Each hospital, at a minimum, must provide each mother advanced lactation support with consultation from an International Board Certified Lactation Consultant (IBCLC) or an individual with equivalent training and experience

Patient care policies must include:

• Encouragement of breastfeeding as soon after birth as baby is interested

• Encouragement of skin-to-skin care• Safe storage and handling of infant

feedings (labeling and identification)

Significant Sections Related to Breastfeeding

Maternal/newborn record includes infant feeding method, plan of care/progress and documentation of lactation care/services provided

Newborn record must include documentation of at least 2 successful feedings and discharge instruction sheet related to feeding plan, referrals an follow-up care signed by infant’s practitioner

Significant Sections Related to Breastfeeding

Each hospital must provide provision of resources to assist mother/family after discharge including community-based lactation resources and availability of breast pumps

All nursing staff shall receive orientation and periodic in-service education related to initiation and support of lactation

Significant Sections Related to Breastfeeding

What about the bags?

Original languageSample formula and/or formula equipment distributed to breastfeeding mothers only when an individual physician order is written or on the request of the mother

Coalition Tactics

Press

Online petition

Looking at the issue from another angle

Ad placement

Demonstration at State House

Buy-in from major teaching hospital

The Loss…and the Wins

Language regarding sample formula in regulations unchanged

Successes…14 birthing hospitals in Massachusetts no longer distribute bags

Creation of Ban the Bags campaign

Impact nationwide

Challenges of Making Change with Perinatal Regulations

Trickle-down of knowledge

Staffing and funding for reviews

Regulations vs. guidelines

Issues with evaluation

Power of Coalitions

Advocate power

State agency power

Researcher power

Health professional power

Future Steps for Massachusetts

Birth certificate

Peer counselors in hospitals

Legislation

Follow-up to regulations