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Mass. Baby-Friendly Collaborative. Welcome!!. Background. Informal Collaborative since 2008 Mother-Baby Summit since 2009 DPH Baby-Friendly Trainings Spring 2008. Our Faculty today. Roger Edwards, ScD Mary Ellen Boisvert , RN, MSN, CLC, CCE Lucia Jenkins, RN, IBCLC Mary Foley, RN, IBCLC

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  • Informal Collaborative since 2008
  • Mother-Baby Summit since 2009
  • DPH Baby-Friendly Trainings Spring 2008
our faculty today
Our Faculty today
  • 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
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
Future meetings

Eastern Mass

Western Mass

Holyoke Hospital

March 21, 4:30-6:30

Axilliary Conf. Room

  • Feb 28, 4:30-6:30
  • April 4, 4:30-6:30
  • Both at Somerville Hospital Cafeteria Conf. Room

Whole State Meeting: Thursday, May 2, approx 5:30-7:30

Log Cabin Conference Center, Holyoke MA

    • 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
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
Ten Evidence-based Steps
  • Written breastfeeding policy & communicate it to staff.
  • Train all health care staff to implement the policy.
  • Inform all pregnant women about benefits & management of breastfeeding.
  • Initiate breastfeeding within an hour of birth.
  • Show mothers how to breastfeed, and how to maintain lactation.
  • Give newborn infants no food or drink other than breast milk, unless medically indicated.
  • Practice rooming-in– allow moms and babies to be together 24 hours a day.
  • Encourage breastfeeding on demand.
  • 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
the 10 steps do they work
The 10 Steps: Do they work?


  • 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
Surveyed moms on 6 steps:
  • 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

all6 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
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
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

  • 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
PROBIT results
  • Baseline group/usual care
  • had 6.4% exclusive breastfeeding at 3 months
  • Intervention hospitals had 43% exclusive

breastfeeding rates at 3 months

did it make a difference to population health
Did it make a difference to population health?
  • >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
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
Why it matters
  • Patient-Centered Care
  • Population health
    • (babies and likely mothers)
other resources
Other resources
  • Resource page
  • Link to videos on

MassBreastfeeding Coalition

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