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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

Thank you to ummmc mass breastfeeding coalition mass dph our faculty and staff

Thank you to:UMMMCMass. Breastfeeding CoalitionMass. DPHOur faculty and staff



    • 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

    Password: Skin2Skin