Baby Friendly USA!&

The ‘REAL’ World of Lactation

Breast Feeding Conference 2010

The Baby Friendly Hospital Initiative (BFHI) is a global program sponsored by

the World Health Organization (WHO) and the United Nations Children’s Fund

(UNICEF).

BFHI promotes, protects and supports breastfeeding through

‘The Ten Steps to Successful Breastfeeding for Hospitals’.

Working through the process…

All 10 SIMPLE STEPS!

EDUCATION• ALL DOCTORS AND

NURSES IN MATERNAL/CHILD AREAS ARE REQUIRED TO TAKE A BREASTFEEDING COURSE

• ALL CORPSMAN IN L&D ATTEND A BREASTFEEDING CLASS

Breastfeeding Education Options• http://www.breastfeedingtraining.org• Excellent option for Providers – offered free and

CME’s are included

• “The Curriculum in Support of the Ten Steps to Successful Breastfeeding” - offered by Healthy Children’s Project, Inc. - MOST COST EFFICIENT OPTION FOR RN STAFF

• www.healthychildren.cc

• “Ten Steps to Successful Breastfeeding” – available through Jones and Bartlett Publishing

• $$ COSTLY BUT EXCELLENT CURRICULUM

BREASTFEEDING POLICY

FOLLOWING THE 10 STEPS FOR SUCCESSFUL BREASTFEEDING

Many Sample policies that meet the Baby-Friendly

requirements are available online

12- HOUR BREASTFEEDING DECISION TREE

Feeding Recommendations for (Sleepy/ Difficult to Arouse) Baby: To be used for infant who has not nursed within 12 hrs of bir th

If suckles well but LESS than 10 min, nurse again in 1 hr

If does NOT suckle, give 15 cc expressed breastmilk if available or formula

Start again in 2 hrs.

If does NOT suckle, wake again to nurse in 1 hour

Continue hourly feedings until suckling well for at least 10 min q feed

If suckles well at least 10 minutes, nurse

again in 2 hrs.

Wake baby & put to breast

Nurse q 2 hrs during the day and q 3 hrs at night. (Wake as necessary until

arousing well by self)

PATIENT EDUCATION• BEGIN BREASTFEEDING

EDUCATION EARLY IN PREGNANCY

• PUT BABY TO BREAST AS SOON AS POSSIBLE AFTER DELIVERY

• KEEP BABY SKIN-TO-SKIN FOR FIRST HOUR OF LIFE

• PROVIDE POST-PARTUM SUPPORT

BABY FRIENDLY ON-SITE SURVEY

• The Baby Friendly USA team visited our hospital for two full days focusing on:• Interviewing staff and

patients• Reviewing policies

and statistics• Auditing charts• Reviewing educational

literature

Obstacles Encountered• Staff education: constant staff turn-

over makes education a continuous process; now included in initial orientation to the unit.

• Patient Education: There is a big difference between education offered and pt’s perception of education related to breastfeeding.

• Supplementation: Only when medically indicated, education of staff, providers and patients is essential.

Benefits of MTF’s• Early follow-up appointments by

RN/Lactation consultant.• Orders can be given and must be

carried out.• Younger mind-set of providers• Constantly in learning mode• Most cost effective way to achieve

healthier population• Networking – why reinvent the

wheel!

Support System• Many mom’s are away from family, husband’s

deployed, feel alone, breastfeeding is not her family’s norm.

• MOM CONNECTION: weekly breastfeeding support group *** so important to long term success with breastfeeding.***

• Access to Lactation Consultant• Establish an environment where breastfeeding

is seen as the norm, prenatally, ante-partum, and post-partum, and in the clinics

Robert E. Bush Naval Hospital

• Recognized the long term health benefits of promoting

breastfeeding • Invested in an optimal level of care

to encourage breastfeeding• Strive to provide the best possible

care to our smallest patients

Robert E Bush Naval Hospital

The first and only Naval Hospital worldwide that has achieved

accreditation as a

Baby-Friendly Facility

New Changes For Baby-Friendly Re-Certification

All Baby-Friendly Facilities are now required to do two

Performance Improvement projects every year to maintain certification.

Joint Comission and Orxy

•‘Exclusive Breast Milk Feeding’• Only maternal medical conditions are

acceptable: HIV,substance abuse,TB, Chemo or radiation, active vericella, HSV with breast lesions.

•Must be documented clearly in the chart.

PER JOINT COMMISSION QUALITY CORE MEASURES

• The ‘ONLY’ acceptable reason for a baby to NOT be exclusively breastfed, per Joint Commission and Oryx, are maternal medical indications.... a mother’s choice not to breastfeed is NOT an acceptable reason for the baby to get anything other than breastmilk

WHAT CAN WE DO??• STRESS IMPORTANCE OF

EXCLUSIVE BREASTFEEDING TO PARENTS

• DOCUMENT EDUCATION IN CHART• DOCUMENT REASONS FOR

SUPPLEMENTATION IF NEEDED

NATIONAL AVERAGE• BASED ON THE NEW

STRINGENT GUIDELINES-

THE NATIONAL AVERAGE IS NOW CONSIDERED 30%

EXCLUSIVE BREASTFEEDING

RATE

Lactation Consults• Perceived vs actual low milk supply. • Usually it is a perceived problem, education and

thorough assessment are key. • Many mom’s returning to the workplace that

rely on pumping to maintain their supply may encounter a decreased milk volume. Reglan works quite well in most cases to increase production.• Reglan 10mg: 1 tab on day one; 1 tab BID day two;

days 3-10, 1 tab TID; days 11 & 12, 1 tab BID, days 13 & 14, 1 tab daily. Total: 33 tabs

• Some working mom stay on 1 tab per day throughout duration of breastfeeding

Cont….• Necessary to have access to hospital grade pump

and allowed time and space to pump at work. • There are OPNAV, BUMED, MCO/ instructions

protecting active duty breastfeeding mothers• Tri-care does cover hospital grade pumps for

mothers of premature infants (code E0604)• Some hospitals have electric pump loaner programs

or can refer pt to rental station

Thrush• La Leche League International

quotes research stating the increased use of antibiotics in the OB setting has increased the cases of ductal yeast.

• Tx of GBS+ moms• Routine antibiotic use with C-

sections

Symptoms and Tx• If mom is symptomatic

• burning • itching• deep radiating pain in nipples or breast • traces of white fungus in the folds of nipple • shiny, blistery, cracked, red appearing nipples • mom has vaginal yeast infection• R/O OTHER POSSIBILITIES, ie: latch/positioning

Tx cont…• Treat mom with Diflucan

• “Medications and Mothers’ Milk” Thomas Hale, PhD. Recommended therapy:

• Diflucan 200-400mg loading dose then 100-200mg per day times 14 days

• Encourage natural treatment in conjunction with medication; acidophilus bifidus and grapefruit seed extract

Tx cont…• Jack Newman’s All Purpose Nipple

Cream:• Mupirocin 2% (15g)• Betamethasone 0.1% (15g)• Miconazole powder (brining the final

concentration to 2% miconazole)• Apply sparingly to nipples/areolae

after each feeding, do not wash or wipe it off before feeding.

BREASTFEEDING COUPLET – BOTH PARTNERS, MOM AND BABY, HAVE

TO BE TREATED• Many times the baby is

asymptomatic.• Symptoms include:

• White patches in the mouth• Diaper rash• Whitish sheen to inside of lips/saliva• Baby not nursing well because mouth

is sore.

Thrush Tx cont…• Nystatin:

• Most effective Tx is to treat after every feeding

• One dropper full, half in each cheek• Treat for 2 weeks• Instruct mom to sterilize pacifier,

bottle nipples, anything that baby puts in the mouth

Nipple Shields• Nipple shields are an awesome tool

when used appropriately• Rarely should they be introduced during

the first 24 hours of life• Lactation Consultant should be notified

if use of a shield is initiated• This “quick fix” can create

weeks/months of issues for the nursing couplet

Indications for Nipple Shields

• Premature baby that is not fully effective at the breast

• Latch problems after 24 hours of life

• Neurologic problems, weak suck, tongue thrusting or retracting

• Mother with truly inverted nipples

Inappropriate use of Nipple Shield

• Sore nipples; rather than mask the issue, identify the problem and correct the latch.

• Sleepy baby in the first 24 hours; allow baby time to adjust to extra-uterine like

• Poor latch; contact lactation consultant to assess couplet

Questions?