Maryland’s Commitment to Breastfeeding

1. Maryland’s Commitment to Breastfeeding Begin with an end in mind…

2. Disclosure I have no real or apparent conflict of interest that have direct bearing on the subject matter being presented.

3. Learning Objectives • Identify the benefits of breastfeeding related to patient safety and health outcomes. • Explain how Maryland hospitals are moving towards being more supportive of breastfeeding.

4. Breastfeeding: A Public Health Issue • Optimal infant nutrition • Prevention of acute and chronic disease

5. Breastfeeding: A Health Disparities Issue • Health disparities are associated with - Poverty - Education - Race/Ethnicity

6. Breastfeeding is a great equalizer • Exclusive and extensive breastfeeding reduces the risk for many diseases.

7. Infant Health Outcomes • Risk of hospitalization for lower respiratory tract infections in the first year is reduced 72% if infants are breastfed exclusively for more than 4 months. • Exclusive breastfeeding for more than 3 months reduces the risk of otitis media by 50%. Breastfeeding and the Use of Human Milk, Pediatrics 2012

8. Infant Health Outcomes • Feeding preterm infants human milk is associated with a 58% reduction in the incidence of necrotizing enterocolitis (NEC). • Breastfeeding is associated with a 36% reduced risk of SIDs. Breastfeeding and the Use of Human Milk, Pediatrics 2012

9. Infant Health Outcomes • There is a 52% reduction in the risk of developing celiac disease in infants who were breastfed at the time of gluten exposure. • Breastfeeding is associated with a 31% reduction in the risk of childhood inflammatory bowel disease. Breastfeeding and the Use of Human Milk, Pediatrics 2012

10. Infant Health Outcomes • There is a 15% to 30% reduction in adolescent and adult obesity rates if any breastfeeding occurred in infancy compared with no breastfeeding. • There is up to a 30% reduction in the incidence of type 1 diabetes mellitus for infants who exclusively breastfed for at least 3 months, thus avoiding exposure to cow milk protein. Breastfeeding and the Use of Human Milk, Pediatrics 2012

11. Maternal Health Outcomes • Decreased postpartum blood loss. • More rapid involution of the uterus. Breastfeeding and the Use of Human Milk, Pediatrics 2012

12. Maternal Health Outcomes • Each year of breastfeeding has been calculated to result in a 4.3% reduction in breast cancer. Breastfeeding and the Use of Human Milk, Pediatrics 2012

13. Maternal Health Outcomes • 21% reduction in ovarian cancer • 12% reduction in diabetes mellitus Ip, Agency for Healthcare Research and Quality, 2007

14. Identifies barriers to breastfeeding • Recommends actions for • Mothers and families • Communities • Health care providers and facilities • Employers • Public health leadership • Researchers

15. Affordable Care Act Preventive Services – Women’s Health • Well-woman visits • Gestational diabetes screening • Domestic violence screening • FDA-approved contraceptive methods • Breastfeeding support, supplies and counseling • HPV DNA testing • Sexually transmitted infections counseling • HIV screening and counseling

16. The Joint Commission • Perinatal Care Core Measure Set • Elective delivery • Cesarean section • Use of antenatal steroids • Healthcare-associated bloodstream infections in newborns • Exclusive breast milk feeding

17. A Snapshot of Breastfeeding in Maryland

18. Maryland’s Breastfeeding Report Card 2013 http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf http://www.usbreastfeeding.org

19. Maryland PRAMS Report2011 Births

21. Nearly all births in the United States occur in hospital settings…

22. Breastfeeding Support in Maryland Facilities “Many opportunities exist to protect, promote, and support breastfeeding mothers and infants in Maryland.” Maternity Practices in Infant Nutrition and Care In Maryland —2009 mPINC Survey

23. All Maryland Birthing Hospitals will obtain or initiate Baby-Friendly certification or adhere to the Maryland Hospital Breastfeeding Policy Recommendations Maryland’s Goal

24. On the Path to Continuous Quality Improvement

25. The Ten Recommendations for Improved Breastfeeding Support

26. # 1: Have a written policy that is routinely communicated to all health care staff • A policy helps to: • ensure consistent, effective care for mothers and babies • provide a standard of practice that can be measured • support actions

27. # 2: Train all health care staff in skills necessary to implement the policy • Train on all of the Ten Recommendations • Training assists staffto implement these steps

28. #3:Inform all pregnant women about the benefits and management of breastfeeding • Discuss the importance of breastfeeding with pregnant women and highlight practices that support the initiation of breastfeeding

29. #4:Help breastfeeding mothers initiate breastfeeding within 1 hour of birth • Facilitate skin-to-skin contact and early initiation of breastfeeding

30. #5:Encourage breastfeeding on demand • Teach parents to identify early feeding cues • Teach parents expected normal newborn behaviors related to feeding

31. #6: Show breastfeeding mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants • Assist a mother to learn the skills of positioning and attaching her baby, as well as the skill of hand expression • Help a mother to maintain breastfeeding when separated from the baby

32. #7: Practice “rooming in” – encourage breastfeeding mothers and infants to remain together 24 hours a day • Minimize separation of mothers and infants for routine care • Teach parents that both mother and infant will be healthier and happier if kept together

33. #8: Give breastfed infants no food or drink, other than breast milk, unless medically indicated • Support successful breastfeeding • Providing anything other than breast milk at this time interferes with the establishment of successful breastfeeding

34. #9:Give no pacifiers or artificial nipples to breastfeeding infants in the hospital, unless medically indicated • Pacifiers and artificial nipples can interfere with the establishment of breastfeeding • Determine medical need when using pacifiers

35. #10: Foster the establishment of breastfeeding support groups and refer breastfeeding mothers to them on discharge from the hospital or clinic • Discuss with a mother how to find support for breastfeeding after she returns home

36. Referrals for Breastfeeding Support • Lactation Consultants • Hospital Support Groups • WIC • La Leche League • International Lactation Consultant Association (ILCA) • Maryland Breastfeeding Coalition (MBC)

37. Letters of Commitment 23 hospitals signed letters of commitment to meet Maryland Best Practices. 9 hospitals have expressed their intent to be certified as Baby-Friendly.

38. Thank you for supporting breastfeeding in Maryland

39. Questions

40. Works Cited • American Academy of Pediatrics Policy Statement (2012). Breastfeeding and the Use of Human Milk, Pediatrics, 129(4): e827-e841. • Ip S, Tufts-New England Medical Center. Evidence-based Practice Center., United States. Agency for Healthcare Research and Quality. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality; 2007. • U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. http://surgeongeneral.gov • United States Breastfeeding Committee (USBC). Implementing the Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding. Revised. Washington, DC: United States Breastfeeding Committee, 2010.