Breast milk is nature’s perfect food: It gives babies the healthiest start to life

Contributors:

  • Julie Ware, MD, MPH, IBLC, Center for Breastfeeding Medicine, Cincinnati Children’s Hospital Medical Center
  • Michelle Allison, MS, RD, LD, CLC, State WIC Breastfeeding Coordinator, Ohio Department of Health
  • Esther S. Gillett, MS, RD, LD, IBCLC, Breastfeeding Coordinator/Peer Supervisor, Franklin County WIC

Mothers’ milk boosts a baby’s immune system, reducing the risk of many illnesses, asthma, ear infections, childhood cancers and sudden infant death syndrome (SIDS). Breastfeeding also helps reduce infant mortality which is a crisis in our community. In fact, it’s estimated that more than 900 infant lives per year could be saved in the U.S. if 90% of mothers exclusively breastfed for 6 months, or an estimated 32 Ohio infant lives saved per year.

The American Academy of Pediatrics (AAP) recommends that infants are breastfed exclusively for the first 6 months and that breastfeeding continues with the addition of complementary foods for at least 12 months, and as long thereafter as both mother and baby desire.

And we are doing better in Ohio!

Breastfeeding rates and the Ohio mPINC (Maternity Practices in Infant Nutrition and Care) Score reached historic highs in Ohio!  On the 2016 CDC Breastfeeding Report Card, 77.7% of mothers initiated breastfeeding in Ohio, nearing the Healthy People 2020 goal of 81.9% initiation, and the mPINC score rose from 67 (out of a possible 100) in 2007 to 80 in 2015 (surpassing the national average score of 79!)  The mPINC scores hospitals on maternity practices including those that align with the Ten Steps of Successful Breastfeeding.

The mPINC survey has been conducted by the CDC since 2007 to monitor maternity care practices across the US.  The scores are aggregated by state and nationally, but each participating hospital receives their own site specific results.  Each mPINC report highlights both improvements in care and areas for improvement.  This year, the Ohio mPINC report suggested that we help hospitals to meet the Joint Commission Perinatal Care Core Measure for exclusive breastfeeding, and that we ensure that hospitals staff are trained in infant feeding care. The most current 2015 Vital Statistics data for exclusive breastfeeding on hospital discharge shows a rate of 52.8% for Ohio, very close to the national average of 53%.

These increases have only been possible because of the many efforts of hospitals, physicians, lactation experts, the WIC program, home visitors, and more! The Women, Infant and Children Program (WIC) is working to promote and encourage exclusive breastfeeding for income-eligible women (pregnant, postpartum and breastfeeding) and infants and children under age 5. The WIC Program provides services in all 88 Ohio counties, including: free prenatal breastfeeding classes; education and support from breastfeeding peers and certified breastfeeding staff; assistance with obtaining a breast pump; Helpline for questions/concerns; referrals to support groups; free baby weight checks; and, more foods for exclusively breastfeeding moms the baby’s first year.

The 106 birthing hospitals around the state have been working hard to improve maternity care practices; 62 of these birthing hospitals are participating in the Ohio First Steps program for recognition of their efforts to improve maternity care practices by implementing practices aligned with The Ten Steps to Successful Breastfeeding developed by UNICEF and WHO.  In addition, 11 hospitals have been designated as Baby Friendly Hospitals in Ohio – a designation achieved when all Ten Steps are in place, and the hospital has passed a full evaluation.  “The Ohio First Steps program has been a priority for the Ohio Department of Health (ODH), and we are pleased to see such positive statewide improvements in breastfeeding support in hospitals as part of statewide initiatives to improve infant health and help prevent infant mortality,” said Sandy Oxley, Chief of Maternal, Child and Family Health at ODH.

“The Ohio Hospital Association is proud to work alongside Ohio hospitals to make significant strides in educating and assisting new moms about the importance of breastfeeding through implementation of supportive best practices, as reflected in the latest mPINC data”, said Ryan Everett, director of population health, OHA. “We are proud to have been a part of the great collaborative effort through the First Steps program which has helped provide valuable resources to hospitals and ultimately patients, and we look forward to continuing to work with our hospitals to support all new families in Ohio.”

Do you know if the hospital(s) where the babies coming to your practice are born are participating in Ohio First Steps, and/or are a Baby Friendly Hospital?  Each hospital working on the Ten Steps needs a pediatric, family practice, and obstetric champion to help them through this process.  Could YOU be that champion?

The Ten Steps to Successful Breastfeeding have many areas where pediatricians play an important role.

  1. Have a written breastfeeding policy that is routinely communicated to all healthcare and staff. (If you are on your hospital’s newborn team or task force, you may asked to participate in creating this policy.  The AAP can help you with this.)
  2. Train all staff in skills necessary to implement the policy. (If you are on staff at a Baby Friendly Hospital, you will be provided with a minimum of 3 hours training on breastfeeding!)
  3. Inform all pregnant women about the benefits and management of breastfeeding. (How many pregnant women visit your office every week?)
  4. Help mothers initiate breastfeeding within one hour of birth by placing babies skin-to-skin. (You can talk about this in prenatal visits to prepare all moms for this important event post-partum, even if she chooses not to breastfeed – colostrum is the First Immunization – AAP Poster available!)
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants. (You can learn how to help mothers breastfeed and how to get pumps if separated, with resources listed below.)
  6. Give newborns no food or drink other than breastmilk unless medically indicated. (You can help guide staff to only give supplementation for medical indications.)
  7. Practice rooming-in – that is, allow mothers and infants to remain together 24 hours per day. (You can round in the rooms to do your exam, and teach the parents about what to expect with breastfeeding.)
  8. Encourage breastfeeding on demand. (You can help teach parents feeding cues, so they know when it is time to feed again [frequently in the early weeks!], not just watching the clock – as well as when to expect growth spurts)
  9. Give no artificial nipples or pacifiers to breastfeeding infants. (You can reinforce this prenatally and postnatally until breastfeeding is well established.)
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital. (You can encourage mothers after hospital discharge to get breastfeeding support through WIC, lactation professionals, La Leche League and support groups to help them reach their breastfeeding goals.)

Did you know that 60% of mothers do not reach their own breastfeeding goals?

How You Can Help:  Mom’s listen to YOU!

Encourage moms to exclusively breastfeed for 6 months as recommended by the AAP,  continue for at least one year of life with the addition of complementary foods, and continue breastfeeding as long thereafter as mutually desired by both mom and infant.

  • Provide early support to mothers to overcome breastfeeding challenges – breastfeeding concerns during the first 3-7 days are associated with early cessation of breastfeeding. You are key in identifying these issues and making referrals to lactation experts as needed (see below).
  • Connect moms to resources to obtain a breast pump if needed to maintain milk supply while breastfeeding problems are addressed, and encourage her to provide breast milk over formula whenever possible until she can return to exclusive breastfeeding. (KEEP MOMS EMPTYING THE BREASTS!)
  • Check available resources on medications while breastfeeding when moms have questions (LactMed – Free Phone app or go to https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm or Dr. Thomas Hale’s Medications and Mother’s Milk.
  • Encourage moms to avoid bottles and pacifiers unless there is a medical reason or until breastfeeding is well established, as it can cause a baby to reject the breast, and may result in soreness and decreased milk supply.
  • Reassure mothers that they are making plenty of milk as long as the baby is having adequate wet/dirty diapers and is gaining weight.
  • Provide ongoing support to mothers to overcome later breastfeeding challenges especially at 3-4 weeks of age (growth spurts) and 2-3 months (when mother may be returning to work and 2nd growth spurt occurs)
  • Avoid formula company displays or offering samples as this has been documented to reduce the duration of breastfeeding. (Want breastfeeding posters for your office? We can get them for you from AAP, WIC, and Ohio First Steps!)

Do you want to learn more about how to help the mothers and babies in your practice to reach their breastfeeding goals?  Several online learning modules are available to you, some with CME, and even MOC 2 and 4.

Brand New! – Maryland  (FREE with CME)  Physician Webinar Series http://phpa.dhmh.maryland.gov/mch/Pages/Hospital_Breastfeeding_Resources.aspx.

Virginia Breastfeeding Friendly Consortium

https://bfconsortium.org/pages/13  – $$ for those outside Virginia, (CME and MOC 2 and 4)

Alabama 3 hour FREE CME Maximizing Breastfeeding Outcomes in the Outpatient Setting Online Training   https://www.alaap.org/maximizing-breastfeeding-module

Massachussetts (FREE) Expanding Clinicians Role in Breastfeeding Support http://www.northeastern.edu/breastfeedingcme/

Wellstart International (FREE no CME) http://www.wellstart.org/Self-Study-Module.pdf

AAP Pedialink $$ (CME)  Breastfeeding Matters:  The Pediatrician’s Role  http://shop.aap.org/breastfeeding-matters-the-pediatricians-role/

ACOG Breastfeeding Toolkit

http://www.acog.org/breastfeedingtoolkit

AAP Breastfeeding Curriculum https://www2.aap.org/breastfeeding/curriculum/index.html.

Need help with any breastfeeding issues for your practice?  Contact one of your 3 AAP Chapter Breastfeeding Coordinators across the state and we will do all we can to help you!

Lydia Furman, Rainbow Babies and Children, Cleveland  Lydia.Furman@UHhospitals.org

Tara Williams, Cleveland Clinic Children’s Hospital, williat4@ccf.org

Julie Ware, Cincinnati Children’s Hospital Medical Center, julie.ware@cchmc.org

For more information on WIC visit http://www.odh.ohio.gov/odhprograms/ns/wicn/wic1.aspx

Ohio State WIC Breastfeeding Coordinator, Michelle Allison, MS, RD, LD, CLC (michelle.allison@odh.ohio.gov)

For More information on Ohio First Steps, visit www.odh.ohio.gov/Ohio First Steps             (the “Resources” section is the best compilation of breastfeeding resources you will find anywhere!

Ryan Everett, MPH, Director of Population Health, Ohio Hospital Association (ryan.everett@ohiohospitals.org)

Bre Haviland, MS, RD, LD, CLC, Ohio Department of Health, Bureau of Maternal, Child and Family Health (Breanne.Haviland@odh.ohio.gov) 

For Breastfeeding Resources near you, visit Ohio Breastfeeding Alliance Resource Database:  http://www.ohiobreastfeedingalliance.org/database.html

YOU MAKE A DIFFERENCE IN THE LIVES OF YOUR FAMILIES!  These improvements in Ohio would not be possible without your efforts.  Thanks so much for all you do!