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Hiking the Mountain: One Step at a Time

The Path to Baby FriendlyThe Path to Baby-FriendlyKaren Peters, MBA, RD, IBCLC

August 2013

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Karen Peters Disclosures

• No financial disclosures

• Represents BreastfeedLA

• Does NOT represent – Baby-Friendly USA

– The Joint Commission

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Ten Steps to Successful Breastfeeding

1. Policy

2. Staff Education

6. Exclusive breast milk

7. Rooming in

3. Prenatal Education

4. Skin-to-skin

5. Hand expression

8. Cue based feeding

9. No artificial nipples/pacifiers

10.Follow up care

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Ten Steps to Successful Breastfeeding

1. Policy

2. Staff Education

3. Prenatal Education

6. Exclusive breast milk*

7. Rooming in*

8 C b d f di4. Skin-to-skin*

5. Hand expression

*Colorado Can Do 5!

8. Cue based feeding

9. No artificial nipples/pacifiers*

10.Follow up care*

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Los Angeles County

57 birthing hospitals

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Approx. 130,000 births in

2011

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Baby-Friendly:Continuous Quality Improvement

• Evaluate current practices

• Adopt new policies and practices

• Monitor improvements over time

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Baby-Friendly

Baby-Friendly Hospitals

13Not pursuing Baby-Friendly

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Currently

18%of our births are at Baby-Friendly hospitals

Pursuing Baby-Friendly

Designation29

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LA Baby-Friendly Hospitals

• Glendale Memorial Hospital and Health Center• Harbor UCLA Medical Center• Henry Mayo Newhall Memorial Hospital• Kaiser Permanente Medical Center, Baldwin Park• Kaiser Permanente Medical Center, Downey• Kaiser Permanente Medical Center Los Angeles• Kaiser Permanente Medical Center, Los Angeles• Kaiser Permanente Medical Center, South Bay• Kaiser Permanente Medical Center, Panorama City• Kaiser Permanente Medical Center, West Los Angeles• Kaiser Permanente Medical Center, Woodland Hills• LAC+USC Medical Center• Providence Holy Cross Medical Center• Valley Care Olive View- UCLA Medical Center

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Exclusive Breastfeeding Increased

40%

50%

60%

70%

0%

10%

20%

30%

40%

Harbor UCLA LAC+USC Olive View

2010

2011

2012

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Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Data

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Baby-Friendly -A Greater Piece of the Pie

Baby-Friendly Hospitals

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15 5 Year Projection

Pursuing Baby-Friendly

Designation29

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76%Of our births will be at Baby-Friendly hospitals

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Impact of Baby-Friendly Hospital Policies

• Higher breastfeeding rates

• Even among populations that p pdo not traditionally breastfeed

Merewood, Pediatrics, 2005

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Logic Model

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Multi-disciplinary Committee

Essential As needed

• Administration• Nursing

– L&D

• IT• Nutrition• Pharmacy– L&D

– Mother/Baby

• Physicians• Quality Improvement• Purchasing• Lactation

Pharmacy• OT• Clinics• Marketing• Social Work• Others?

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Sub-Committees

• Policy

• Education

• Practices

• Community

• Purchasing

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Sub-Committees

• Policy Step 1

• Education Step 2

• Practices Steps 4 - 9

• Community Steps 3 & 10

• Purchasing WHO Code

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How to Run Your Committee

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Meeting Frequency

• Monthly – whole team

• Weekly - subcommittees

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Prioritize Practice Changes

• Step 3

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Prioritize Practice Changes

• Step 3– Prenatal Education

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Prioritize Practice Changes

• Step 4

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Bundle Practice Changes

• Step 4– Skin to skin

– Breastfeed with in first hour

St 7• Step 7– Rooming in

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Next Steps

• Step 6

• Step 9

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Next Steps

• Step 6– Exclusive breastfeeding

• Step 9Al i f di d i– Alternative feeding devices

• Supplementation

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Clinical Competencies

• Step 5

• Step 8

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Clinical competencies

• Step 5– Show mothers how to breastfeed

– Hand expression

Support lactation during separation– Support lactation during separation

• Step 8– Feeding on demand

– Teach feeding cues

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Purchasing Formula

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Fair Market Value40

Purchasing formula

• Development– Calculate fair market value

– Begin contract negotiations

Di i ti• Dissemination– Choose timeline

• Designation– Three months of receipts are required

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Keeping Score42

Scorecard

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Change Vital Behaviors

• http://www.youtube.com/watch?v=o-N57TtyToE

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Why Teach Hand Expression?48

Why Teach Hand Expression?

• To provide supplementation with own mother’s milk • Softens areola for easier latch• Assists with milk transfer

– instruct mother to hand express directly into the baby’s mouthmouth

• The skin to skin contact of hand expression provides stimulation for milk production and letdown

• Reinforces to mother that every drop is valuable.

Mannel, Core Curriculum for Lactation Consultant Practice, 2007

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How to Do Hand Expression

DVD:

Breastfeeding Management, Teaching Tools for Physicians and Other Professionals

J M MDJane Morton, MD

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Harness Peer Pressure

• Identify influential leaders/preceptors– Watch one

– Do one

Teach one– Teach one

• Shift reports• Rounding

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Strength in Numbers

• Buddy system

• Super users

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Hand Expression Environment

• Policy– Prenatal education

– Postpartum

E i• Ensure privacy

• Use breast models

• Post hand expression rates– Celebrate success!

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Hand Expression Accountability

• Demand accountability after implementing intrinsic and social motivators– Competencies

Audit the mothers– Audit the mothers

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Leverage Many Sources

• 4 or more sources

• Yields 10 times the success

Hospital Practices: Can They Impact Breastfeeding?

Karen Peters

August 2013

Breastfeeding Initiation and Duration, LACHS 2011

72.5

87.479.7

66.861.3

51.4 48.7 44.960

80

100Exclusive Any

nt(%

)

36.3 34.1 30.921.6 16.9

9.9

34.0 31.4 27.6 23.2 21.8 19.9

0

20

40

Perc

en

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Breastfeeding Initiation and Duration, LACHS 2011

72.5

56.260

80

100Exclusive

cent

(%)

51.3

45.445.145.1

43.243.2

41.836.9 36.3

0

20

40

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30

Perc

Days

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Hospital Practices

• Breastfeed in 1st hour

• Only fed breast milk

• Rooming-in

• Given phone number for help

Hospital Practices & Any Breastfeeding, LACHS 2011

100.0

61.9

83.4

708090

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All 4 Practices None or some of the Practices

%)

29.139.7

16.8

0102030405060

Initiation Breastfed 6+ Months Breastfed 12+ Months

Perc

ent (

%

Hospital Practices & Exclusive Breastfeeding, LACHS 2011

98.792.4

78.8

64.1708090

100All 4 Practices None or some of the Practices

t (%

)

27.422.2

0102030405060

Exclusively Breastfed 1st day Exclusively Breastfed 1+ Week

Exclusively Breastfed 1+ Month

Perc

ent

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Hospital Practices Impact Breastfeeding

• Increased initiation

• Longer any breastfeeding duration

• Longer exclusive breastfeeding duration

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Breastfeeding levels the playing field

Breastfeeding is a natural "safety net" against the worst effects of poverty ...it is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the

injustice of the world into which it was borninjustice of the world into which it was born.

James P. Grant Former Executive Director UNICEF