Breastfeeding Friendly

Physician Offices

Jennifer Stewart, R.D., M.B.A., CLS Loving Support Breastfeeding

Program, Riverside County Department of Public Health

Susanna Sibilsky, Regional Breastfeeding Liaison,

Shasta County HHSA - WIC

AAP Recommends The WHO Ten Steps to Successful Breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

2. Train all health care staff in the skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within the first hour of birth.

5. Show mothers how to breastfeed and how to maintain lactation even if they are separated from their infants.

6. Give newborn infants no food or drink other than breast milk, unless medically indicated.

7. Practice rooming-in (allow mothers and infants to remain together) 24 h a day.

8. Encourage breastfeeding on demand.

9. Give no artificial nipples or pacifiers to breastfeeding infants.*

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital.

* The AAP does not support a categorical ban on pacifiers because of their role in SIDS risk reduction and their analgesic benefit during

painful procedures when breastfeeding cannot provide the analgesia

Impact of Physician Encouragement

Lu, et al found ◦ Provider encouragement significantly

increases breast-feeding initiation among American women of all social and ethnic backgrounds.

three-fold among young, low income, and less

educated women

nearly five-fold among black women

nearly eleven-fold among single women

Affordable Care Act

The law requires insurance companies to cover preventive services

without cost sharing requirements including:

Breastfeeding support, supplies, and counseling: Pregnant

and postpartum women will have access to comprehensive

lactation support and counseling from trained providers, as well as

breastfeeding equipment. Breastfeeding is one of the most effective

preventive measures mothers can take to protect their children’s

and their own health. One of the barriers for breastfeeding is the

cost of purchasing or renting breast pumps and nursing related

supplies.

So how can WIC help with

breastfeeding friendly

medical offices? The sky is the limit when we develop

relationships

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Riverside County

Department of Public Health

Breastfeeding Friendly Physician

Program

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History

The Riverside County Department of Public Health Loving Support Breastfeeding Program received funding from First 5 Riverside - Children and Families Commission (Prop 10) in 2001

Funding was for a 24 hour Breastfeeding Helpline and a physician outreach program

We also received a one-time WIC grant to provide

education to physicians. This was the beginning of

the Breastfeeding Friendly Physician Program

Began in 2005 – Physicians could obtain this

designation by achieving the 7 steps

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Goal

The goal of the grant was to provide seamless services for the women of Riverside County. That they would receive the same breastfeeding messages from their OB provider, WIC, the hospital and their Pediatric provider.

To support the AAP recommendation that infants are exclusively breastfed throughout at least their first year of life.

Our Vision, Our Program

Our Vision: “Breastfeeding Representatives” (patterned

after pharmaceutical representatives) “selling” the idea of

breastfeeding to doctors.

Breastfeeding Representatives market breastfeeding to physicians, nurses and other

health professionals so that, in turn, they market breastfeeding as their

expectation of how their patients feed their babies.

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In the beginning

Our staff was trained on how to approach the physician staff – initial contact, getting the agreement signed, setting up the exam room, follow-up contact

Our staff went to re-stock the displays every 2 weeks.

Very important to start a relationship with the offices

Loving Support OB Displays

Formula does not stack up to Breastmilk

Office Visits

Breastfeeding Representatives Visit over 250 offices quarterly

Stock wall displays

• Bring: WIC information, updated breastfeeding research, local

resource lists

-Very important – we were able to offer our 24 hour Breastfeeding Helpline

Information Entered Into Data Bank When pregnant women call our Helpline

we mail them an Infant Feeding Package and enter information into our database for future calls.

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“Doo-dads and Paraphernalia”

Just as pharmaceutical reps have done in the past - we have given the following outreach materials to offices: Lunch boxes, coffee mugs, lanyards, badge holders, pens, notepads, wall clocks(“Time to breastfeed”),clipboards, wall calendars.

All have our bf message and Loving Support information.

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Breastfeeding Friendly Physician

Designation

We also received a one-time WIC grant to provide education to physicians. This was the beginning of the Breastfeeding Friendly Physician Program

Began in 2005 – Physicians could obtain this designation by achieving the 7 steps

Lunch and Learn Topics

Breastfeeding Facts Revealed--formula does not “stack up” to

breastmilk

Staying on Track - Do you know the stations for help? (train theme)

3 step counseling- what to say to Moms

Are you Making the Grade?-Achieving Breastfeeding Friendly

Just One Bottle

WIC Regional Breastfeeding

Liaison Program

In 2010, our First 5 funding for our BF Friendly Physician Program ended.

In October 2010, we received a grant from WIC Regional Breastfeeding Liaison grant to continue our Breastfeeding Friendly Physician Program.

Regional Breastfeeding Liaison

Beginning 2011, WIC Nutritionists based regionally are making quarterly visits to physician offices to:

Promote the “new” WIC breastfeeding program,

Provide WIC outreach materials, Share Loving Support information Provide breastfeeding education and

research updates Assess for Breastfeeding Friendly status

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Important points about our program

We have been around for so many years that offices trust we won’t disappear

They have had good feedback about our services

Our staff remain constant – so a rapport can be developed

Staff gave their business cards so an office could contact them if they had questions

We brought food

Several of the years we offered 1 CME for attending the L and L.

We have a 24 hour Breastfeeding Helpline

What’s going on in Shasta County

2004 Breastfeeding Support Center

◦ First 5 Shasta Funding

◦ Provided a small amount of Peer Counseling

2007 Breastfeeding Support Center came under auspice of WIC

◦ Continued support for all women in Shasta County

2009 First 5 Shasta funding to support Peer Counseling

2010 CA WIC Grant to significantly expand Peer Counseling and

Fall 2010 CA WIC funding for the Regional Breastfeeding Liaison Project

◦ Initial goals:

Re-form regional coalition with the addition of social media networking opportunity

Connect with healthcare provider community

Connecting with

Healthcare Providers Provider input on Toolkit

◦ Private practice and clinic providers

◦ OB/GYNs, Peds, Family Practice, Residents

Offer trainings during staff meetings and lunch breaks

◦ Using Your Toolkit

◦ Changes to WIC – We are not the formula people

◦ How to Teach Breastfeeding Messages

◦ Common Problems…Simple Solutions

◦ Understanding Baby Behaviors

Looking at providing CEUs

What We Learned from

the Focus Group

Preferred clinician to healthcare provider

Want the facts

◦ Status of breastfeeding duration in the county

◦ Bulleted information

◦ How to refer for breastfeeding support

Residents need the basics

◦ Suggested having a breastfeeding mom come

to a training as a show-n-tell

Some of the Facts

90%

43%

38%

31% 28%

25%

35%

45%

55%

65%

75%

85%

95%

WIC Prenatal

Intention to BF

WIC Exclusive BF 1

month

WIC Exclusive BF 2

months

WIC Exclusive BF 4

months

WIC Exclusive BF 6

months

■ 86.3% Mercy Medical Center BF Initiation

■ 84.6% Meyers Memorial Hospital BF Initiation

In Support of Breastfeeding

Clinician Toolkit Features Highlights Peer Counselors

Highlights breastfeeding duration rates

Maximizing Revenues

Clinician Education and Resources

◦ Updated with 2012 AAP Policy Statement and WHO

Growth Charts

Breastfeeding Referral Forms

WIC Program Services

Patient Education and Resources

Before you leave the office…

Ask: ◦ What step can you make today to be a more

breastfeeding friendly office?

And let them know how WIC can help

Toolkit Training Comments

This training increased my awareness and

handy materials for the moms

I will encourage our WIC patients to get a

peer counselor

Talk more with patients about breastfeeding in

public or when they go back to work

Knowing there are breastfeeding resources I

can tell patients about

Asking for more breastfeeding trainings

Additional Training Topics

Breastfeeding 101

Common Problems…Simple Solutions

How to Teach Breastfeeding Messages

Baby-Led Latch

Breastfeeding Myths and Misconceptions

Understanding Baby Cues

Questions?

Contact information:

Jennifer Stewart, R.D., M.B.A., CLS

Riverside County Department of Public Health

Lactation Services

jvstewart@rivcocha.org

Susanna Sibilsky

Regional Breastfeeding Liaison

Shasta County HHSA – WIC

ssibilsky@co.shasta.ca.us