8/31/2015 Health care Communities systems Michelle Futrell, MS, RD, - - PDF document

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Michelle Futrell, MS, RD, LDN Nutrition Consultant School Health Unit Children & Youth Branch Woman’s and Children’s Health Section NC Division of Public Health Michelle.futrell@dhhs.nc.gov (919) 707‐5669

Families Health care systems Employers Clinicians Communities Leadership

Today’s Learning Objectives

Identify sociocultural, political & community impact on breastfeeding Develop at least one strategy to strengthen breastfeeding support in their agency

AAP Policy Statement

American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2012:129:e827-841.

Human milk is species‐specific, uniquely superior for infant feeding Breastfeeding is a public health issue …not a lifestyle choice Direct breastfeeding is best >>>> but expressed breast milk, fortified when appropriate for premature infants, is next best

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This includes expressed mother’s milk as well as donor human milk, both of which may be fed to the infant by means other than suckling at the breast “A newborn receiving only breast milk and no other liquids or solids except for drops or syrups consisting

• f vitamins, minerals, or medicines”

The Joint Commission defines exclusive breast milk feeding as:

Feldman‐Winter, L., Douglass‐Bright, A., Bartick, M. C., & Matranga, J. (2013). The New Mandate from The Joint Commission on the Perinatal Care Core Measure of Exclusive Breast Milk Feeding Implications for Practice and Implementation in the United States. Journal of Human Lactation, 29(3), 291‐295.

Surgeon General’s Call to Action

“One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed.”

U.S. Surgeon General, Dr. Regina M. Benjamin, 2011

In 2011, the U.S. Surgeon General, Dr. Regina

• M. Benjamin, released The Surgeon General’s

Call to Action to Support Breastfeeding

U.S. Surgeon General’s Six major areas of emphasis

Health care systems Employers Clinicians Communities Leadership Families

US Department of Health and Human Services. (2011). Executive Summary The Surgeon General's Call to Action to Support Breastfeeding. Breastfeeding Medicine, 6(1), 3‐5.

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Healthy People 2020 Objectives

• Increase the proportion of infants who

are breastfed MICH ‐ 21

• Increase the proportion of employers

who provide worksite lactation support MICH ‐ 22

• Reduce the proportion of breastfed

newborns receiving formula supplementation the first 2 days of life

MICH ‐ 23

Healthy People Maternal, Infant, and Child Health 2020 Objectives: http://www.healthypeople.gov/2020/topicsobjectives2020/objectives

Healthy People 2020 Objective

MICH ‐ 21

Increase the proportion of infants who are breastfed

MICH – 21.1 Ever 81.9% MICH – 21.2 At 6 months 60.6% MICH – 21.3 At 1 year 34.1% MICH – 21.4 Exclusively through 3 months 46.2% MICH – 21.5 Exclusively through 6 months 25.5%

Healthy People Maternal, Infant, and Child Health 2020 Objectives: http://www.healthypeople.gov/2020/topicsobjectives2020/objectives

CDC Breastfeeding Report Card

Objective (%) North Carolina 2009 (%) North Carolina 2010 (%) North Carolina 2011 (%) Nation 2012 (%) Healthy People 2020 Ever Breastfed

68.2 73.5 67.3 76.9 81.9%

Breastfed 6 months

38.3 35.9 37.0 47.2 60.6%

Breastfed 12 months

20.8 19.4 19.6 25.5 34.1%

Exclusivity for 3 months

37.6 28.2 28.1 36.0 46.2%

Exclusivity for 6 months

15.3 8.7 8.2 16.3 25.5%

http://www.cdc.gov/breastfeeding

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In North Carolina

Breastfeeding Mothers Percentage Hispanic mothers 77.2% Caucasian mothers 63.3% African American mothers 53%

Hyun, N. (2014) N.C. Makes Gains in Breastfeeding, but disparities persist. North Carolina Health News. Recovered from http://www.northcarolinahealthnews.org/2014/02/13/n‐c‐makes‐gains‐in‐breastfeeding‐ but‐disparities‐persist/

Barriers to breastfeeding among African American women

 Pain  Nursing in public  Sexuality  Work  Drugs & alcohol  Time  Healthcare

Ware, J. L., Webb, L., & Levy, M. (2014). Barriers to breastfeeding in the African American population of Shelby County, Tennessee. Breastfeeding Medicine, 9(8), 385‐392.

Most women would like to breastfeed

Some reasons why these intentions are not achieved include….. Lack of

a)

Knowledge

b) Peri‐partum skilled support c)

Commitment ‐ enhanced by marketing and media

d) Self‐efficacy e)

Access to skilled support once home

f)

Models and community examples

g)

Paid maternity leave

h) A place to turn for help in addressing the realities of

daily life

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Additional reasons include:

1. Need to care for other children 2. Does not like breastfeeding 3. Breast milk alone does not satisfy baby 4. Nipples sore, cracked or bleeding 5. Not producing enough milk

• 6. Going back to work or school

U.S. Department of Health and Human Services. Executive Summary: 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; January 20, 2011.

Proposed CDC Strategies

Strategy 1: Maternity Care Practices Strategy 2: Professional Education Strategy 3: Access to Professional Support Strategy 4: Peer Support Programs Strategy 5: Support for Breastfeeding in the Workplace

McGuire, S. (2014). Centers for Disease Control and Prevention. 2013. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta, GA: US Department of Health and Human Services, 2013. Advances in Nutrition: An International Review Journal, 5(3), 291‐292.

Proposed CDC Strategies

Strategy 6: Support Breastfeeding in Early Care & Education Strategy 7: Access to Breastfeeding Education and Information Strategy 8: Social Marketing Strategy 9: Addressing the Marketing of Infant Formula

McGuire, S. (2014). Centers for Disease Control and Prevention. 2013. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta, GA: US Department of Health and Human Services, 2013. Advances in Nutrition: An International Review Journal, 5(3), 291‐292.

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Marketing

Infant formula marketing, including TV ads, free samples, coupons, and even some government programs, have been implicated in undermining breastfeeding “Create an Office Setting that Promotes and Supports Breastfeeding”… EK Chung Mothers often identify support received from health care providers as the most important intervention the health care system could have offered to help them breastfeed All health care providers, whether providing general or specialty care, play a very important role in a family’s decision to initiate and continue breastfeeding

Slide provided by CDC

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Professional Support of Breastfeeding

Professional support has:  A significant impact on exclusive breastfeeding in the first few months after an infant was born  A beneficial effect on breastfeeding duration

Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database of Syst Rev. 2007(1):CD001141.

Opportunities to Promote Breastfeeding

 Give mothers the support they need to breastfeed their babies  Develop programs to educate fathers and grandmothers about breastfeeding

U.S. Department of Health and Human Services. Executive Summary: 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; January 20, 2011.

Preconception Prenatal visits Early pregnancy Peripartum/postpartum

The Breastfeeding Friendly Healthcare Office

 Give encouragement rather than instructions  Encourage women/staff to breastfeed in the office  Display pictures of breastfeeding infants  Avoid distributing infant formula or coupons  Emphasize there is no one shoe fits all approach  Display confidence that breastfeeding will work  Reassure mom that her baby’s actions are normal

Meek, J. Y. (2012, October). Section on Breastfeeding Platform Presentation. In 2012 AAP National Conference and Exhibition. American Academy of Pediatrics.

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At Any Visit:

 Verify success, anticipate challenges and support prolonged breastfeeding  Refer the mother to a lactation specialist and/or support group whenever needed  Keep referral information in each exam room  Discuss return‐to‐work plans and breast pump options  Always use commercial‐free breastfeeding materials in your office

Be sure to initiate a conversation with the patient Suggested conversation starters include:

 How is feeding going?  Do you have any concerns about your breasts or how breastfeeding is going?  How often is your baby breastfeeding?  How is the milk flowing?  Is your baby latching well?

Patient Protection & Affordable Care Act

 Employers must provide reasonable break times and a private, non‐bathroom place to express milk  Applies to non‐exempt (hourly) wage earners

American Academy of Pediatrics. Pickering LK (ed). Red Book: Report of the Committee on Infectious Diseases, 28th ed., 2009.

How Long to Breastfeed?

• Exclusively for the first 6 months of life
• Continuing for at least the first year of life, with

addition of solids

• Thereafter, for as long as mutually desired by mother and

child

AAP Pediatrics 2012;129;e827‐41

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Returning to the Workplace or School

 Continued breastfeeding is feasible and desirable for mother and infant  Prepare ahead by discussing with the employer or school personnel  Breaks for feeding/expressing  Private, clean place to pump  Refrigerator or cooler with ice packs to store and transport milk

Adolescents and Breastfeeding

 Highly recommended for adolescent mothers  Prenatal education and postpartum support are essential  Arrange with school personnel to express milk at school or use on‐site child care program, if available  Maintain healthy diet with adequate calories, 1,300 mg calcium per day, 15 mg iron, and a daily multivitamin

Benefits of Breastfeeding

 Customized ‐ Species specific  Norm for infant feeding  Optimal development outcomes  Promotes appropriate growth pattern  Promotes mother‐infant attachment  Immune Benefits

Meek, J. Y. (2012, October). Section on Breastfeeding Platform Presentation. In 2012 AAP National Conference and Exhibition. American Academy of Pediatrics.

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Dose Dependent Benefits

Acute otitis media 50% less with EBF > 3‐6 months Atopic dermatitis 42% less with EBF > 3 months Gastroenteritis 64% less any BF

• vs. none

Lower respiratory tract disease and hospitalization 72% less with EBF > 4 months Asthma 40% less with BF > 3 months Type 1 DM 30% less with BF > 3 months Type 2 DM 40% less with any BF

• vs. None

SIDS 36% less with any BF > 1 month

Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality, 2007. http: / / www.ahrq.gov/ clinic/ tp/ brfouttp.htm

Child Health Benefits

Decreased rates of:

• Celiac disease
• Inflammatory bowel disease
• Hypertension
• Hypercholesterolemia

 Reduces the risk of obesity by 4% for each month of breastfeeding  Reduces the risk of obesity by 6% for each month of exclusive breastfeeding

Li, R., Magadia, J., Fein, S. B., & Grummer‐Strawn, L. M. (2012). Risk of bottle‐feeding for rapid weight gain during the first year of life. Archives of pediatrics & adolescent medicine, 166(5), 431‐436.

Cognitive Benefits

Human milk fat

 Provides essential fatty acids to enhance neural and

retinal development

 Enables child to reach full developmental potential

Meek, J. Y. (2012, October). Section on Breastfeeding Platform Presentation. In 2012 AAP National Conference and Exhibition. American Academy of Pediatrics.

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Breastfeeding for Premature Infants

Lower rates of

 Sepsis  Necrotizing enterocolitis  Retinopathy of prematurity  Metabolic syndrome  Blood pressure  Low‐density lipoprotein levels

Improved

 Leptin and insulin metabolism

Meek, J. Y. (2012, October). Section on Breastfeeding Platform Presentation. In 2012 AAP National Conference and Exhibition. American Academy of Pediatrics.

Maternal Health Benefits

 Decreased postpartum bleeding  More rapid uterine involution  Decreased menstrual blood loss  Increased child spacing Reduced rates of  Type 2 diabetes mellitus  Pre‐menopausal breast cancer  Ovarian  Postpartum depression

Meek, J. Y. (2012, October). Section on Breastfeeding Platform Presentation. In 2012 AAP National Conference and Exhibition. American Academy of Pediatrics.

The Burden of Suboptimal Breastfeeding Rates in the U.S.

 If 90% of US families could comply with recommendations to breastfeed exclusively for 6 months, the U.S. would save $13 billion per year  Conclusion: Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths

Bartick M, Reinhold A. The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost

• Analysis. Pediatrics. 2010;125:e1048.

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Community Benefits

Breastfeeding is convenient, saves money, and is “green”

• Reduces health care costs
• Convenient and cost effective
• Environmentally friendly
• Decreased energy demands for production and

transport of infant formula

Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality, 2007. http: / / www.ahrq.gov/ clinic/ tp/ brfouttp.htm

 You can lead the way to improve the health

• f millions of

mothers and babies nationwide  Make a commitment to ensure that breastfeeding support is consistently available at your agency, for every mom and baby Families Health care systems Employers Clinicians Communities Leadership

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Where Can Women Find Help?

Lactation Specific

 IBCLC (International Board Certified Lactation Consultants)  CLC (Certified Lactation Counselor)  LE (Lactation Educators)  (NC) Health Care Professionals who have attended the NCLETP*  WIC peer counselors (limited scope)

General Health Care

 Dietitians  Family Physicians  Midwives  Nurses  Nurse Practitioners  Obstetricians  Pediatricians  Physician’s Assistants

*NCLETP (North Carolina Lactation Educator Training Program)

WIC Breastfeeding Promotion and Support

 Direct/Core Services  Mandated policies  Peer Counseling  Food Package  Training  Grant funded projects

NC Blueprint for Action

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Resources

Community Support  Knowledgeable practitioners  International Board Certified Lactation Consultants (IBCLC)  Hospital support groups  La Leche League International  WIC programs Ensure access for all women to culturally competent, balanced information about breastfeeding!

Resources

CDC Guide to Breastfeeding Interventions

 www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf

U.S. Department of Health and Human Services Publications

1. Your Guide to Breastfeeding 2. Lactanicia

 These guides can be ordered or downloaded from:

http://www.womenshealth.gov/pub/bf.cfm

Breastfeeding Resource Guide for Health Professionals

 http://www2.aap.org/breastfeeding/index.html

Resources

NIH U.S. National Library of Medicine Toxicology Data Network (LactMed Database)  http://toxnet.nlm.nih.gov/ Center for Disease Control And Prevention  http://www.cdc.gov/breastfeeding American Academy of Pediatrics  http://www2.aap.org/breastfeeding/index.html American College of Nurse‐Midwives  http://ourmomentoftruth.midwife.org/

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Resources

U.S. Department of Health and Human Services  http://www.womenshealth.gov/breastfeeding/ International Lactation Consultant Association  http://www.ilca.org National Breastfeeding Helpline:  1‐800‐994‐9662 Academy of Breastfeeding Medicine  http://www.bfmed.org/ World Alliance for Breastfeeding Action  http://www.waba.org.

• N. C. State Breastfeeding Coordinator

Grisel M. Rivera, MPH, RD, LND, IBCLC

N.C. Department of Health and Human Services State Breastfeeding Coordinator, Nutrition Services Branch‐Division of Public Health 5601 Six Forks Road Raleigh, NC 27609 (Office) 919‐707‐5781 (Fax) 919‐870‐4898 grisel.rivera@dhhs.nc.gov www.ncdhhs.gov/dph

Thank You!