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Hospital Practices Influence
Breastfeeding Rates:
The Data Tell the Story
Birth & Beyond California:
Breastfeeding Training& QI Project
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Objectives
• Name the source of in-hospital breastfeeding data for California
• Describe the trends in California for ‘any’ and ‘exclusive’ in-hospital breastfeeding from 1992- 2007
• Identify three hospital practices that can discourage breastfeeding
• List three hospital practices that increase breastfeeding duration
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In-Hospital Breastfeeding Data Source:
Newborn Screening Program• Administered by the Genetic Disease
Screening Program (GDSP)• Primary purpose is to collect infant blood
samples to screen for genetic diseases• Staff complete the forms following the
instructions provided by GDSP• Summary data is sent to the Epidemiology
staff of the Maternal, Child and Adolescent Health Program and made available yearly on-line
California Department of Public HealthMaternal, Child, and Adolescent Health Division
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Breastfeeding Categories
• Exclusive breastfeeding– Infants fed only human milk– Recommended by American Academy of
Pediatrics, American College of Obstetricians and Gynecologists, Academy of Family Physicians, American Dietetic Association
• Any breastfeeding– Includes infants fed only human milk and
infants fed a combination of human milk and formula
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California Any and Exclusive In-Hospital Breastfeeding: 1994-2007
43%43%44% 44% 43% 44% 44% 44% 43% 43% 43% 42% 42% 42%
87%87%86%86%86%85%84%84%83%82%80%79%77%77%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Exclusive Breastfeeding Any Breastfeeding
Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)
The “GAP” is Growing
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Percent Any/Exclusive In Hospital Breastfeeding: 2007
81%86%
83%87%
43%
24%30%
35%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
California Average LA County Average Orange County Average Central Valley Average
Any BF Exclusive BF
Gap
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2007 California’s BestAny/Exclusive Breastfeeding
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Any BF Exclusive BF
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Best LA HospitalsExclusive Breastfeeding 2007
94%91%89%
95%92%92%
53%
61%
69%
51%
66%
55%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Cedars Holy Cross* St Johns San Dimas Santa Monica UCLA
Any BF Exclusive BF
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Percent Any/Exclusive In Hospital Breastfeeding: 2007
Closing the Gap92% 92% 95%
61%
85% 87%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Holy Cross SAN FRANCISCO GENERAL* Alta Bates
Any BF Exclusive BF
Closed the Gap
Closed the Gap
Closing
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HOSPITALAny/Exclusive Breastfeeding Rates 2004-2007
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Hospital Practices that Influence Breastfeeding
• Strongly encouraging• Encouraging• Discouraging• Strongly discouraging
HHS, Blueprint for Action on Breastfeeding, 2000
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Practices that Discourage Exclusive Breastfeeding
• No written policy to keep healthy mothers and infants from being separated
• Lack of staff training• Routine formula supplementation• Delay of first feeding• Breastfeeding assessments not recorded• Mothers told to limit time breastfeeding
Heinig, UC Davis, 2006
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0 25 50 75 100
Baby breastfed in 1st hour after birth
Baby fed only breastmilk in hospital
Baby stayed in same room with mother
Baby did not use pacifier in hospital
Hospital gave mother phone number to call forbreastfeeding help
Percent
No
Yes
Hospital practices are associated with breastfeeding continuation at 8 weeks
Murray, Birth, 2007
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• Providing Breastfeeding Support: Model Hospital Policy Recommendations
• Model Hospital Policy Recommendations Toolkit
www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Pages/MainPageofBreastfeedingToolkit.aspx
….or link to these by entering the url:
http://cdph.ca.gov/Breastfeeding
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The Ten Steps To Successful Breastfeeding
Baby Friendly Hospital Initiative
• More than 19,000 hospitals worldwide• 79 in United States• 23 in California
As of March 2009www.babyfriendlyusa.org
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Policy and Practice Changes
• What barriers to changes in policy & practices do you see?
• What do you think should be done to address those barriers?
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Birth & Beyond California
• Training– 2 hour Decision Maker – 16 hour Learner Workshop– 16 hour Train the Trainer
• Quality Improvement– Participation in your QI team for 3 months– Policy revision technical assistance– Technical assistance, and tools for data
collection and analysis tailored to your hospital• BBC Regional QI Network meetings
– Monthly through June 2011
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The Physiologic Norm is Easier
• Skin to skin triggers – Infant competence – Appropriate maternal responses
• Exclusive breastfeeding in the early days promotes a cascade of breastfeeding successes
• Mother/baby togetherness in the early days enhances parental competence
Moore, Cochrane Review, 2007
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Day One Conclusions
• Mother/baby attachment – Is supported by skin–to–skin contact
• Risks of not breastfeeding – A public health concern
• Nurses can teach parents – To recognize predictable newborn
patterns
• Breastfeeding rates– Reflect maternity care policies & practices
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Assignment Prior to the Next Class
Clinical Experiences• Observe a newborn placed skin-to-skin
with mother for 20 minutes
• Observe an infant breastfeeding and listen for suck and swallow sounds
• Observe the cluster feeding pattern of the breastfeeding newborn
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Thank you
• Complete evaluation
• Bring your syllabus next time
• See you then!