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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!