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?