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LINDSEY DERMID-GRAY, MPH, CLC
CREATING A BREASTFEEDING-FRIENDLY NEVADA
The Lancet Vol. 387 No. 10017
LET’S TALK ABOUT BREASTS
Breastfeeding and the suppression of fertility, Food and Nutrition Bulletin Volume 17, Number 4, 1996
The reproductive cycle includes both pregnancy and breastfeeding
Moms begin making breast milk at 16 weeks gestation
Milk does not “come in”, but rather transitions to different types of milk
All mammals are born with the expectation to breastfeed
BIRTH & BREASTFEEDING CONTINUUM
Besides water, fat and protein, human milk has hundreds of other species-specific bio-active components forming a unique microbiome.
White blood cells in breast milk kill pathogens directly, indirectly.
Not considered a body fluid for which special precautions are required.
BREAST MILK COMPOSITION
Victora CG, Bahl R, Barros AJD, et al, for The Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–90Rollins NC, Bhandari N, Hajeebhoy N, et al, on behalf of The Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387: 491–504.
“If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.”
“Never before in the history of science has so much been known about the complex importance of breastfeeding for both mothers and children.”
IF OPTIMAL BREASTFEEDING WAS UNIVERSAL
IMPACT OF BREASTFEEDING -US
CDC Breastfeeding Report Card, 2014
BREASTFEEDING RATES IN NEVADA
PAID PARENTAL LEAVE
National Compensation Survey, 2014
12 weeks unpaid leave to care for self, family or new child
Only applies to companies who have greater than 50 employeesEmployee must have been working at business for one year to apply
FAMILY MEDICAL LEAVE ACT (1993)
REPORT: 1 IN 4 WOMEN RETURN TO WORK LESS THAN 2 WEEKS
Parents receive portion of normal salary
Funds are derived from employee-paid payroll taxes, not the employer
Administered through respective disability programs
State and Family Leave Laws. National Conference of State Legislatures. http://www.ncsl.org/research/labor -and-employment/state-family-and-medical-leave-laws.aspx
CALIFORNIA NEW JERSEY RHODE ISLAND
STATES WITH FAMILY LEAVE PAY
9/29/2015
Hospital Policies that Support Breastfeeding After Birth
GETTING STARTED
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 one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breast-milk, unless medically indicated.
7. Practice rooming in - allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the
hospital or birth center.
TEN STEPS TO BREASTFEEDING SUCCESS
BABY FRIENDLY HOSPITAL DESIGNATION
Nevada = 18 Maternity Centers●5 rural●3 urban (northern Nevada)● Avg. annual births: 2,000
●10 urban (southern Nevada)● Avg. annual births: 2,300
BABY FRIENDLY IN NEVADA
●Initiate breastfeeding within the first hour after birth. ●Promote 24-hour rooming-in, encouraging the family to recognize and respond to infant’s hunger
cues. ●Avoid giving infants fluids or solids other than breast milk unless medically necessary. ●Do not use a pacifier or artificial nipple with healthy term infants during the hospital stay. ●Give mothers a list of resources to call for help with breastfeeding after discharge, and review this
list with them.
Review evidence behind each step, role-play their application and troubleshoot identified barriers
Hospital training that targets 5 of the10 steps which have been shown to significantly impact duration rates
BABY STEPS TO BREASTFEEDING SUCCESS
Training offered to all 15 non-Baby Friendly hospitals
Hospitals that have received the training so far:●Banner Churchill (Fallon)●Spring Valley (LV)●Centennial Hills (LV)●Summerlin (LV)
In total 330 nurses and 15 MDs have been trained
HOSPITALS TRAINED
A 2014 survey of Nevada Maternity Centers identified physician support as being the biggest need in improving infant feeding practices
NEXT STEPS – PHYSICIAN SUPPORT TOOLKIT
POLICIES IN THE WORK-PLACE
●Employers must provide adequate time and space for expressing breastmilk●NOT a bathroom
●Only covers non-exempt employees (not teachers)●Only covers up to one year post-partum●Breaks do not need to be paid; make-up of work missed at discretion of employer
SECTION 7(r) OF THE FAIR LABOR STANDARDS ACT
BREAK TIME FOR NURSING MOTHERS ACT (2010)
Access to Workplace Accommodations to Support Breastfeeding After the Passage of the Affordable Care Act. Women’s Health Issues 26-1 (2016) 6-13
●Only 40% of mothers had access to both time and space●Mothers with access to adequate time and space were 2.3 times as likely to be exclusively breastfeeding at 6 months and 1.5 times as likely to continue exclusively breastfeeding with each passing month as those women without●Low-income women and single mothers are significantly less likely to have access to either break time
or private space to express breast milk at work, mirroring the socioeconomic patterns of breastfeeding
STUDY FINDINGS:
ACA IN ACTION
Business Case for Breastfeeding: Easy Steps to Supporting Breastfeeding Employees
Lower medical costs and health insurance claims for breastfeeding employees and their infants ●Up to 3 times lower for breastfeeding employees
Reduce turnover rates ●89% of breastfeeding employees return to work after childbirth when a lactation support
program is provided compared to the national average of 59%
Lower absenteeism rates ●Up to half the number of 1 day absences
Improve productivity
Raise employee morale and loyalty to the company.
BENEFITS OF LACTATION SUPPORT PROGRAMS
▪ A door that locks from the inside / coded keypad
▪ A comfortable chair, made of a material that is easy to clean (not cloth covered), that provides sufficient back support and sized so that an average woman's feet can touch the floor.
▪ An electrical outlet for plugging in a breast pump.
▪ A table, on which to rest a breast pump and other supplies, in front of the chair.
▪ A sink located in the room or in close proximity to the room, along with soap and paper towels.
▪ Small refrigerator for storing breast milk.
▪ Supplies of cleaning wipes and hand sanitizer.
▪ Soft light, pictures, and decorations that encourage relaxation.
SETTING UP A LACTATION ROOM
Nevada Department of Health and Human Services
Babies can remain with their primary caregiver until mobile
Employees with positions which do not regularly require interaction with public are eligible
INFANT IN THE WORKPLACE POLICY
COMMUNITY
BREASTFEEDING IN PUBLIC
BREASTFEEDING WELCOMED HERE CAMPAIGN
ROLE OF WIC
DISPARITIES IN BREASTFEEDING RATES
Wants to be cuddled
Overstimulated
Tired
Wet / Dirty Diaper
Gassy Tummy
Hot / Cold
Reasons Baby Might Be Crying
BABY BEHAVIOR CAMPAIGN
BABY BEHAVIORS CAMPAIGN
PEER COUNSELING PROGRAM
Recipients of the 2015 FNS Breastfeeding Bonus Award●Greatest improvements in exclusive breastfeeding
NATIONAL RECOGNITION
Each of us can play a role in ensuring mom’s success in meeting her goals.- In the beginning
Hospital staff: Encourage our hospital to receive the Baby Steps to Breastfeeding Success TrainingParents: Communicate desire for skin-to-skin, rooming in and breastfeeding immediately after birth
- In the workplaceParents: Establish pumping arrangements in advance of deliveryParents / Coworkers: Ensure your employer is aware of the Break Time for Nursing Mothers Act – I can help!
- In the communityEveryone: Encourage businesses to sign our Breastfeeding Welcomed Here campaign and post our sticker in their window
Everyone: Support mothers who are breastfeeding in publicMothers: Nurse your baby in public in whichever way you suits yours and your baby’s preferences
IN CONCLUSION
QUESTIONS?
Workplace Support●Easy Steps to Supporting Breastfeeding Employees●http://www.womenshealth.gov/breastfeeding/government-in-action/business-case-for-
breastfeeding/easy-steps-to-supporting-breastfeeding-employees.pdf●Break Time for Nursing Mothers Act●http://www.dol.gov/whd/nursingmothers/●To file a complaint in Nevada: Nevada Wage and Hour Division 702.388.6001
Nevada Breastfeeds●NevadaBreastfeeds.org
Breastfeeding Welcomed Here – Nevada●NevadaBreastfeeds.org/breastfeeding-welcomed-here/ ●www.facebook.com/BreasfeedingWelcomedHereNV/?fref=ts
Women, Infants and Children (WIC) – Nevada●1.800.8.NEV.WIC nevadawic.org
RESOURCES
