Helping Up State NY Moms Breastfeed Longer

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Helping Up State NY Moms Breastfeed Longer

• Cynthia R Howard, MD, MPH
• University of Rochester School of Medicine and
  Dentistry
• Rochester General Hospital

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Objectives

• Provide background information about
  breastfeeding duration nationally and locally
• Identify interventions that might be implemented
  locally to help encourage women to choose
  breastfeeding and prolong its duration

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Healthy Children Goals

• 2010 Goals
• Initiation
• 75
• Duration
• 5-6 months 50
• 12 months 25
• 2002 Rates
• Initiation
• 69.5
• Duration to
• 6 mos 32.5
• 12 mos 16

46.2 Exclusive.
17.2
1998
Months
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Healthy Children Goals

• 2010 Goals
• Initiation
• 75 EBF
• Duration
• 5-6 months 50 EBF
• 12 months 25
• 2002 Rates
• EBF at Birth
• 46
• EBF at 6 months
• 17
• 12 mos 16

Months
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Breastfeeding in the US
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Breastfeeding in the US
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Local Breastfeeding Duration and Intensity

C. R. Howard, Pediatrics 111 (3)511-518, 2003.
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Women Employed Outside the Home

C. R. Howard, Pediatrics 111 (3)511-518, 2003.
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Objectives

• Provide background information about
  breastfeeding duration nationally and locally
• Identify interventions that might be implemented
  locally to help encourage women to choose
  breastfeeding and prolong its duration

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The BFHI is a Global Initiative to Increase
Breastfeeding
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Why Was Baby Friendly Necessary?

• By the 1970s the lack of breastfeeding was a
  significant factor in the deaths of at least 1
  million infants every year

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What Preceded Baby Friendly?

• 1981 International Code of Marketing of
  Breastmilk Substitutes adopted by the World
  Health Assembly
• The Convention on the Rights of the Child
• Innocenti Declaration
• World Summit for Children
• World Declaration and Plan of Action
• 1991 meeting in The Hague

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The Baby Friendly Hospital Initiative

• Created in response to these landmark
  declarations issued to address child nutrition
  and the need for improved breastfeeding practices

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The Baby Friendly Hospital Initiative

• UNICEF/WHO
• Targets hospitals and maternity units
• Based on Ten Steps

1991
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What Are The Ten Steps?

• Recommended practices to support breastfeeding
• Based on empiric evidence or (when this is
  lacking) expert opinion
• Encompasses all aspects of perinatal care of
  moms/babies

UNICEF WHO
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The Ten Steps
Administrative Support

• Maintain a written breastfeeding policy that is
  routinely communicated to all health care staff
• Train all health care staff in skills necessary
  to implement this policy
• Inform all women about the benefits and
  management of breastfeeding
• Help mothers initiate breastfeeding within a
  half-hour of birth
• Show mothers how to breastfeed, and how to
  maintain lactation even if they are separated
  from their infants

Prenatal Care
Peripartum Care
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The Ten Steps
Peripartum Care

• Give breastfeeding infants no food or drink other
  than breast milk, unless medically indicated
• Encourage rooming-in -- mothers and infants
  should remain together twenty-four hours a day
  whenever feasible
• Encourage unrestricted breastfeeding - when baby
  exhibits hunger cues or signals or on the request
  of the mother
• Give no artificial nipples or pacifiers to
  breastfeeding infants
• Refer mothers to established breastfeeding and/or
  mothers support groups and services and foster
  the establishment of those services when they are
  not available

Postpartum Care
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Consistent Message
Prenatal Care
Peripartum Care
Postpartum Care
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Baby Friendly Process in the US
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The Baby Friendly Initiative

• 17,000 hospitals worldwide
• 34 in the US
• Large tertiary care small birth centers
• Private public
• Several teaching hospitals
• 45 more hospitals have active certificates of
  intent

OK Fine. But Does it Work???
2003
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Boston City Hospital

• Breastfeeding before after BFHI
• Teaching hospital providing care to poor,
  minority and immigrant population of mothers and
  infants
• 30 non English speaking, 50
• Review of 200 randomly selected newborn charts
  from 1995 (before), 1998 (intent), 1999
  (designation)

Philipp et al. Pediatrics 108 (3)677-681, 2001.
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Boston City Before and After Baby Friendly
Philipp et al. Pediatrics 108 (3)677-681, 2001.

Breastfeeding
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Promotion of Breastfeeding Intervention Trial

• Cluster RCT 6/96 to 12/97 with 1 year f/u
• To assess the effects of breastfeeding promotion
  on
• breastfeeding duration and exclusivity
• Infant health outcomes
• 31 maternity hospitals and polyclinics in the
  Republic of Belarus
• 16 hospitals BFHI, 15 control (usual care)

JAMA 2001, 285 (4) 24-31.
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Promotion of Breastfeeding Intervention Trial

• 17,046 healthy mothers and term infants
• 16,491 (96.7) f/u to 12 months
• Outcomes
• Duration of any breastfeeding
• Prevalence of predominant and exclusive
  breastfeeding at 3 6 months
• 1 episodes of GI infection
• 2 episodes of respiratory tract infection
• atopic eczema in the first year of life

JAMA 2001, 285 (4) 24-31.
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PROBIT Results

• Any Breastfeeding at 12 month
• 19.7 vs 11.4 OR 0.47 (0.32-0.69)
• Exclusive Breastfeeding at 3 months
• 43.3 vs 6.4 (p
• Exclusive Breastfeeding at 6 months
• 7.9 vs 0.6 (p.01)

JAMA 2001, 285 (4) 24-31.
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PROBIT Results

• Gastrointestinal Tract Infection
• 9.1 vs 13.2 OR 0.60 (0.40-0.91)
• Atopic Eczema
• 3.3 vs 6.3 OR 0.54 (0.31-0.95)
• Respiratory Tract Infection
• 39.2 vs 39.4 OR 0.87 (0.59-1.28)

JAMA 2001, 285 (4) 24-31.
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Breastfeeding

• What is the baby friendly initiative?
• Does it work?
• Next steps

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? Could Our Region Become Baby Friendly?

• Long history of breastfeeding support and
  research at University of Rochester
• Rochester General 1992 certificate of intent,
  Designation in 3/2000 (26th US hospital)
• Strong Memorial Hospital and viaHealth Wayne have
  1998 certificates of intent, assessment plans (?)
• NY State Department of Health supports baby
  friendly practices and has also developed other
  breastfeeding initiatives (K-12 curriculum)

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How to Avoid Reinventing the Wheel
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(No Transcript)
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National WIC Breastfeeding Promotion Project

• National WIC Breastfeeding Promotion Project
  repositioned the traditional health benefits of
  breastfeeding to emphasize a new product benefit
  - familiar bonding from birth
• The emotional price of breastfeeding was
  identified as embarrassment and conflicts with
  active lifestyles
• To reduce these prices, a counseling program was
  developed to help mothers work through individual
  constraints
• The place strategy targeted hospital environments
  as well as homes. It focussed on key
  intermediaries such as professional associations
• Media as well as grassroots advocacy comprised
  the bulk of the promotion strategy with media
  stressing a congratulatory tone and communicated
  through family spokespersons.

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Resources

• NY State DOH
• Hospital Assessment
• Baby Friendly USA
• info_at_babyfriendlyusa.org
• Academy of Breastfeeding Medicine
• www.bfmed.org
• Hospital protocols (on line access)
• Six available to date
• Best Start Social Marketing

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Questions?