Marylands Commitment to Breastfeeding Begin with an end in mind
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Disclosure I have no real or apparent conflict of interest that
have direct bearing on the subject matter being presented. 2
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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. 3
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Breastfeeding: A Public Health Issue Optimal infant nutrition
Prevention of acute and chronic disease 4
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Breastfeeding: A Health Disparities Issue Health disparities
are associated with - Poverty - Education - Race/Ethnicity 5
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Breastfeeding is a great equalizer Exclusive and extensive
breastfeeding reduces the risk for many diseases. 6
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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 7
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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 8
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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 9
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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 10
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Maternal Health Outcomes Decreased postpartum blood loss. More
rapid involution of the uterus. Breastfeeding and the Use of Human
Milk, Pediatrics 2012 11
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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 12
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Maternal Health Outcomes 21% reduction in ovarian cancer 12%
reduction in diabetes mellitus Ip, Agency for Healthcare Research
and Quality, 2007 13
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Identifies barriers to breastfeeding Recommends actions for
Mothers and families Communities Health care providers and
facilities Employers Public health leadership Researchers 14
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Affordable Care Act Preventive Services Womens 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 15
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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 16
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A Snapshot of Breastfeeding in Maryland 17
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Marylands Breastfeeding Report Card 2013
http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf
http://www.usbreastfeeding.org Categories of Infant Feeding Healthy
People 2020 Breastfeeding Objectives 2013 CDC Breastfeeding Report
Card Maryland Rates Ever Breastfed81.9%69.4% Breastfed at 6
months60.6%52.0% Breastfed at 1 year34.1%24.2% Exclusively
breastfed at 3 months46.2%29.3% Exclusively breastfed at 6
months25.5%15.1% Reduced percent of breastfed newborns receiving
formula supplementation in first two days of life (goal) 14.2%22.9%
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Maryland PRAMS Report 2011 Births 19
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21 Nearly all births in the United States occur in hospital
settings
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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 22
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Marylands Goal All Maryland Birthing Hospitals will obtain or
initiate Baby-Friendly certification or adhere to the Maryland
Hospital Breastfeeding Policy Recommendations 23
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On the Path to Continuous Quality Improvement 24
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The Ten Recommendations for Improved Breastfeeding Support
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A policy helps to: o ensure consistent, effective care for
mothers and babies o provide a standard of practice that can be
measured o support actions # 1: Have a written policy that is
routinely communicated to all health care staff
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Train on all of the Ten Recommendations Training assists staff
to implement these steps # 2: Train all health care staff in skills
necessary to implement the policy
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Discuss the importance of breastfeeding with pregnant women and
highlight practices that support the initiation of breastfeeding
#3: Inform all pregnant women about the benefits and management of
breastfeeding
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Facilitate skin-to-skin contact and early initiation of
breastfeeding #4: Help breastfeeding mothers initiate breastfeeding
within 1 hour of birth
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Teach parents to identify early feeding cues Teach parents
expected normal newborn behaviors related to feeding #5: Encourage
breastfeeding on demand
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#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
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Minimize separation of mothers and infants for routine care
Teach parents that both mother and infant will be healthier and
happier if kept together #7: Practice rooming in encourage
breastfeeding mothers and infants to remain together 24 hours a
day
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Support successful breastfeeding Providing anything other than
breast milk at this time interferes with the establishment of
successful breastfeeding #8: Give breastfed infants no food or
drink, other than breast milk, unless medically indicated
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Pacifiers and artificial nipples can interfere with the
establishment of breastfeeding Determine medical need when using
pacifiers #9: Give no pacifiers or artificial nipples to
breastfeeding infants in the hospital, unless medically
indicated
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Discuss with a mother how to find support for breastfeeding
after she returns home #10: Foster the establishment of
breastfeeding support groups and refer breastfeeding mothers to
them on discharge from the hospital or clinic
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Referrals for Breastfeeding Support 36 Lactation Consultants
Hospital Support Groups WIC La Leche League International Lactation
Consultant Association (ILCA) Maryland Breastfeeding Coalition
(MBC)
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Letters of Commitment 37 23 hospitals signed letters of
commitment to meet Maryland Best Practices. 9 hospitals have
expressed their intent to be certified as Baby-Friendly.
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38 Thank you for supporting breastfeeding in Maryland
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Questions 39
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Works Cited 40 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 Generals 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.
