In This Issue:

• EMPower for Breastfeeding 1• IBCLC Reimbursement 2• Letter from the Director 3• Associates’ Corner -

Dr. Greg Randolph 4• Donor Human Milk Resource 4• Alumni Spotlight -

Jessye Brick, MPH 5• Carolina BEBES Update 5• Announcements 6• Publications and Presentations 7

Carolina Global Breastfeeding Institute

Newsletter

Volume 6, Issue 4, December 2014

Breastfeeding Exclusive

Helping Hospitals - EMPower for Breastfeeding

Happy Holiday Season!

The EMPower Project: Enhancing Maternity Practices for Breastfeeding (EMPower) project is designed to support the achievement of Baby-Friendly USA (BFUSA©) designation by 100 hospitals over a 3-year period. The project funding of $6.6 million was awarded by the Centers for Disease Control and Prevention (CDC) to Abt Associates as the prime contractor, and will be collaboratively executed by Abt Associates, the Center for Public Health Quality (CPHQ) and the Carolina Global Breastfeeding Institute (CGBI). Additional organizations involved are the BFUSA© and Lactation Education Resources (LER).

The key organizations approach this work with diverse skill sets and expertise. Abt Associates, based in Cambridge, MS., is a global leader in research and program implementation in many fields, including health. With expert skills in monitoring and evaluation of maternal and child health programs, they are well equipped to manage the data for EMPower and ensure successful completion of the project. Cynthia Klein, PhD serves as the project lead, with support from project manager, Donna Elliston, DrPH, MSPH and project assistant, Danielle Wisotske, MPH.

CPHQ fosters and supports continuous quality improvement in the public health system by collaborating with local, state, and national partners. As such, they are a national resource for quality improvement among public health organizations. Greg Randolph, MD, MPH, Director of CPHQ, and Beth Mainwairing, MPH, Senior Program and Operations Director, will lead a team of quality improvement experts in providing appropriate technical assistance to EMPower project hospitals. Continued on Page 2

Members of EMPower Team at a kick-off meeting in September.

Helping Hospitals - EMPower for BreastfeedingContinued

CGBI will work toward fulfilling its mission to promote increased quality of care and creation of an optimal breastfeeding norm through the EMPower project. The CGBI team will utilize their breastfeeding expertise to provide appropriate evidence-based technical assistance to EMPower project hospitals, working in dyads with CPHQ’s quality improvement experts. Miriam Labbok, MD, MPH, IBCLC, FACPM, FABM, FILCA, Catherine Sullivan, MPH, RD, LDN, IBCLC, and Kathy Parry, MPH, IBCLC will lead CGBI’s team of breastfeeding experts.

BFUSA© designation is US approach to the World Health Organization/UNICEF’s Baby-Friendly Hospital Initiative (BFHI), which supports the implementation of the “Ten Steps to Successful Breastfeeding”. Worldwide, more than 22,000 maternity centers have been designated as “Baby-Friendly.” Trish MacEnroe, Executive Director of BFUSA© will provide technical support regarding the designation process to the EMPower project. LER stands ready to offer training when needed. Headed by Vergie Hughes, RN, MS, IBCLC, FILCA, LER has been teaching lactation courses for over 20 years.

Applications for hospital participation will be announced shortly. For more information, please contact: Cynthia_Klein@abtassoc.com.

Project Update:Building a Case for Medical Reimbursement of IBCLCs using GIS Data

Catherine Sullivan, Ellen Chetwynd, and Katie Houk are compiling resources to support advocacy for reimbursement of IBCLC services by North Carolina Medicaid. While data that could prove helpful in understanding the breastfeeding support landscape exists piecemeal across research institutions, hospital systems, and state agencies, they are currently assembling relevant data into a model toolkit for advocacy that can be replicated by divisions of public health, legislators, and breastfeeding activists across the country. One component of this toolkit is an analysis of data from the Pediatric Nutrition Surveillance System (PEDNSS) that was conducted in collaboration with partners at the NC Nutrition Services Branch. First, PEDNSS breastfeeding data was obtained for 11,338 low-income infants in federally funded maternal and child health programs, and the number of IBCLCs practicing in each NC county was collected from the credentialing organization. The team used logistic regression to estimate the association between geographic proximity to professional lactation support services, represented by the county-level availability of IBCLCs, and any breastfeeding at six weeks among a low-income population at high risk for early breastfeeding cessation. The findings suggest that the availability of IBCLC services is associated with increased breastfeeding prevalence at six weeks, especially in more urban countries where access to these services is likely improved. While the availability of IBCLCs does not guarantee utilization of their services, this analysis can be used to support advocacy for Medicaid reimbursement of IBCLC services to expand access to this important and effective clinical breastfeeding support. Zoom in to view poster or view it online in November newsfeed.

Letter from the DirectorDr. Miriam Labbok

Dear Friends and Colleagues:

This has been a very productive quarter for CGBI. As we head into the new year of 2015, we are happy to be announcing a new significant endowment that will support a second CGBI professor, and new funding for CGBI to serve as the breastfeeding Ten Step technical lead for the new CDC/Abt Associates contract to support 100 hospitals to achieve Baby-friendly designation (see page 01) These new resources will have a significant impact on our ability to respond to the needs for local, national and global breastfeeding protection, promotion and support.

Thanks to the ongoing support from W.K. Kellogg Foundation, John Rex Foundation, CGBI endowments, and continual support from wonderful donors, we have many outcomes to share. A few example are:

• Completion of intervention research on breastfeeding support in DRC• Completion of a draft Care Groups module on responsive feeding for Guatemala• Professional revisions of Ready, Set, Baby Prenatal Counseling Materials• Dozens more Breastfeeding-friendly child care settings across the US• A formative research plan to assess the impact of prenatal and postnatal interventions on

new mothers, with community inputs• Surveys of NCATS and NCABC participants to ensure that needs are being addressed• Continued 100% pass rate on the IBLCE exam by MRT-TI students.• Contributions to materials published by UNICEF, WABA and ABM • A new APHA policy Statement on global need for maternity protection, authored by

Jennifer Yourkavitch• Completed draft book for publication, based on the Breastfeeding and Feminism

Conference, 2013• Stakeholder- supported draft for pilot Breastfeeding-friendly Community designation.• Continued active participation in ABM, ACPM, APHA, BFIC, ILCA, LLLI, NCBC, USBC,

USLCA and WABA • Staff completion of North Carolina Lactation Educator Training Program• Student advising and mentoring, involving 4-5 graduate students in our projects and

publications, and involvement with student group, Carolina BEBES

With more to come in the new year, ... our 10th as CGBI.

With wishes from all of us for a very happyand healthy holiday season,

Miriam and the CGBI TeamFrom Left to Right: Kathleen Anderson, Katie Houk, Kathy Parry, Kristin Tully, Diane Rowley, Catherine Sullivan, Miriam Labbok, and Thea Calhoun-Smith

Associates Corner

Dr. Greg Randolph

Greg Randolph, MD, MPH is the Director of the Center for Public Health Quality and is a Professor of Pediatrics and Adjunct Professor of Public Health at UNC. Dr. Randolph has over 15 years of experience in quality improvement (QI) leadership, implementation, education, and research. He has published extensively on the application of QI in health care and public health. He currently provides QI expertise nationally via the Public Health Accreditation Board Evaluation and Quality

Improvement Committee, the American Board of Pediatrics Maintenance of Certification Committee, the American Academy of Pediatrics (AAP) Quality Improvement Innovation Network’s Steering Committee, and the AAP Chapter Quality Network’s Project Advisory Committee. He has also served on the Institute of Medicine Committee on Quality Measures for the Healthy People Leading Health Indicators, the US Department of Health and Human Services Expert Panel on Public Health Quality, the Executive Committee of the AAP Council on Quality Improvement and Patient Safety, and as Editor of the AAP Quality Connections newsletter.

As the leader of a team of QI professionals at The Center for Public Health Quality (CPHQ), Dr. Randolph is well positioned to collaborate on work aimed at improving maternity care practices in hospitals. “The improved outcomes from optimal breastfeeding practices are numerous and substantial, yet far too few of our children are getting those benefits,” Dr. Randolph said. “We are thrilled to partner with Abt Associates and CGBI to assist hospitals that serve areas with some of the lowest breastfeeding rates in the country in order to improve breastfeeding rates and decrease inequities.”

CGBI is pleased to be offering a new resource in our Tools for Action online: http://breastfeeding.sph.unc.edu/what-we-do/programs-and-initiatives/toolkits/tools-for-action-donor-human-milk-banking/

The Tools for Action – Donor Human Milk Banking site provides:

1) a monograph offering the results of a 3 year exploration of donor milk banking. The document offers a “state of the art” review of donor human milk (DHM) and related issues in the United States,

2) a summary of the next steps for DHM research, policy and practice that emerged from this work, and recommended other actions for advancing best DHM banking practices to support increased access and health equity,

3) sample posters and slide sets that have been developed from this work.

We wish to thank the W. K. Kellogg Foundation for their encouragement and funding for CGBI to conduct this work as a First Food Field Builder.

Online Resource Added: Donor Human Milk Banking

Alumni Spotlight:

Jessye Brick, MPH

Carolina BEBES: Birth and Breastfeeding: Evidence Based Education and Support

UNC BEBES finished off the semester with two great events surrounding birth. On November 12th at the SPH, BEBES, along with the Student Global Health Committee, co-hosted a screening the documentary SISTER (see image below), a film that tells the story of maternal and child health workers from Ethiopia, Cambodia, and Haiti. The audience was joined by the film’s director via Skype after the screening for a rich and enlightening discussion about birth in developing countries. Also, BEBES hosted a local postpartum doula, Victoria Facelli, for an intriguing discussion about the need, importance and role of doulas not only in the birth process but also during the postpartum period. BEBES members learned about the DONA certification process, what it takes to start a small business, and what the schedule of a doula is really like.

We are looking forward to a busy Spring semester with more events and collaborations coming up! We also want to recognize one graduating member of the leadership team, Allie Stevens. Thank you for all you have done for BEBES! You will be missed!

Jessye Brick received her Master’s in Public Health from the UNC Department of Maternal and Child Health in 2013 and was a member of the BEBES leadership team in the 2012-2013 school year. She is currently the Director of Community Investment at Cabarrus Health Alliance in Kannapolis, North Carolina. In her current position, she works with numerous community partners to assess community needs, develop evidence-based and innovative programs, and seek grant funds.

Recently, Jessye led efforts that resulted in Cabarrus County being awarded a $2.5 million Racial and Ethnic Approaches to Community Health grant from the CDC. The three-year project will focus on implementing policy, systems, and environmental approaches to increasing access to physical activity and healthy food. She loves working at an agency that is very supportive of breastfeeding and has three breastfeeding rooms that are available to staff and clients. Her department has several new mommas and she tries to encourage them to breastfeed. One coworker even donated to the WakeMed Milk Bank after Jessye shared research she had done with CGBI on milk banking.

Mary Rose Tully Training InitiativeStudents Maintain a 100% IBLCE Exam Pass Rate!

Dr. Kristin Tully presented her research on “The relationship between infant feeding outcomes and maternal emotional well-being among mothers of late preterm and term infants” at the International Society for Research in Human Milk and Lactation Conference at Kiawah Island, South Carolina on October 25, 2014. Dr. Alison Stuebe also presented t the conference on Lactation, Oxytocin, and Perinatal Depression.

International Society for Research in Human Milk and Lactation Conference

Congratulations and Announcements

Congratulations to students in the 2013-2014 Cohort of the Mary Rose Tully Training Initiative on successful passing the exam administered by the International Board of Lactation Consultant Examiners (IBLCE). Students are now certified as an International Board Certified Lactation Consultant (IBCLC).

Please welcome these new IBCLCs: Leslie Canale, Annie Freeman, Montana Wagner Guillespe, Shelley Hoekstra, Cathy Joyce, Teisha Lightbourne, Annie Oumarou, Abigail Smetana, Zakiyah Williams, and Angela Williamson.

Applications for 2015-2016 Cohort will open on February 1st, 2015.

Registration Now Open for the 10th Annual Breastfeeding and Feminism International Conference

March 19 & 20, 2015:

http://breastfeedingandfeminism.org/

Publications and Presentations

Publications

Chollet-Hinton LS, Stuebe AM, Casbas-Hernandez P, Chetwynd E, Troester MA. Temporal Trends in the Inflammatory Cytokine Profile of Human Breastmilk. Breastfeed Med. 2014 Nov 7. [Epub ahead of print]

Nickel NC, Martens PJ, Chateau D, Brownell MD, Sarkar J, Goh CY, Burland E, Taylor C, Katz A, The PATHS Equity Team. Have we left some behind? Monitoring trends in socioeconomic inequalities in breastfeeding initiation: A population-based epidemiological surveillance study. Canadian Journal of Public Health. 2014;105(5): e362-e368.

Nickel NC, Chateau D, Martens PJ, Brownell M, Katz A, Burland E, Walld R, Hu M, Taylor C, Sarkar J, Goh CY. Data Resource Profile: Pathways to Health and Social Equity for Children (PATHS Equity for Children). International Journal of Epidemiology. E-Pub ahead of Print Sept 11, 2014. doi: 10.1093/ije/dyu190

Martens PJ, Chateau D, Burland E, Finlayson G, Smith M, Taylor C, Brownell M, Nickel NC, Katz A, Bolton JM, and the PATHS Equity Team. The effect of “place” on education and health outcomes for children living in social housing: does neighbourhood socioeconomic status make a difference? American Journal of Public Health. E-Pub ahead of Print Sept 11, 2014.doi: 10.2105/AJPH.2014.302133

Book Chapter

Lawrence RA, Sullivan CS. Encouraging Breastfeeding. Medical Nutrition and Disease: A Case-Based Approach 5th Ed, 2014. Wiley Publishing Oxford, UK

Presentations

Anderson K.L. Supporting breastfeeding in child care. East Coast Migrant Head Start Grantee HSAC Meeting, Raleigh, NC, September, 2014.

Anderson K.L. Supporting breastfeeding families. WIC Regional Meeting,Winston-Salem, NC, September, 2014.

Anderson K.L. Improve the health of mothers and babies through breastfeeding. 2014 Faith and Health Summit, Winston-Salem, NC, October, 2014.

Anderson K., Sullivan C., Labbok M., Taylor E. Breastfeeding-friendly activities in hospitals and child care programs: Making it happen. American Public Health Association Annual Meeting, New Orleans, LA, November, 2014.

Anderson K., Labbok M., Parry K. Carolina Ten Steps to Breastfeeding-Friendly Child Care: Replication and scale-up. American Public Health Association Annual Meeting, New Orleans, LA, November, 2014.

Houk K., Sullivan C., Chetwynd E. Professional Lactation Services and Breastfeeding Rates in North Carolina: A GIS Case for Medicaid Reimbursement of IBCLCs. Poster. American Public Health Association Annual Meeting, New Orleans, LA, November, 2014.

Labbok M. Global Breastfeeding Support: Looking back, looking forward. American Public Health Association 142st Annual Meeting, Abstract and Oral Presentation, New Orleans, LA, November, 2014.

We welcome your feedback. Please send your comments

or suggestions regarding Breastfeeding Exclusive

to the editor at kathyparry@unc.edu

Be In Touch!

Carolina Global Breastfeeding InstituteDepartment of Maternal and Child Health

Gillings School of Global Public Health422 Rosenau Hall, CB# 7445

University of North Carlina at Chapel HillChapel Hill, NC 27599-7445

Email: cgbi@unc.eduPhone: (919) 966-3774 | Fax: (919) 966-0458

http://breastfeeding.unc.edu

Publications and PresentationsPublications and Presentations

Continued

Taylor EC, Labbok M. In-Depth Review of Donor Milk Use: Findings and Recommendations for Action. American Public Health Association 142st Annual Meeting, Abstract and Oral Presentation, New Orleans, LA, November, 2014.

Labbok M. Cost-benefit Analysis (CBA) of the use of donor milk for prematures in the US, Academy of Breastfeeding Medicine Annual Meeting, Cleveland, OH, Abstract and Oral Presentation, November 2014.

Labbok M. Breastfeeding-Friendly Communities: Beyond Healthcare. Academy of Breastfeeding Medicine Annual Meeting, Cleveland, OH, Abstract and Poster, November 2014.

Labbok M, Taylor EC. Human Milk Use: Survey of ABM Members. Academy of Breastfeeding Medicine Annual Meeting, Cleveland, OH, Abstract and Poster, November 2014.

Parry K. Paternal Involvement via Infant Massage: Improved Health and Breastfeeding Outcomes for Mothers and Infants. American Public Health Association 142st Annual Meeting, Abstract and Poster, New Orleans, LA, November, 2014.

Stuebe AM. Lactation, Oxytocin, and Perinatal Depression. International Society for Research in Human Milk and Lactation, Kiawah, SC, October, 2014

Stuebe AM. Talking First Foods for World Food Day. 1000 Days Panel Discussion, National Press Club, Washington, DC, October, 2014

Stuebe AM. Lactation 201: It’s so much than just the Latch. Art of Breastfeeding Pre-Conference Workshop, Chapel Hill, NC, October, 2014

Stuebe AM. Mood, Mother and Infant: Infant Feeding and Postpartum Depression. Building a Breastfeeding Culture, Bronx Breastfeeding Coalition Annual Meeting, Bronx, NY, September, 2014

Stuebe AM. Creating Sustainable Change Using the Six Sources of Influence. Perinatal Quality Collaborative of North Carolina, Raleigh, NC, September, 2014

Stuebe AM. How obstetric providers can enable women to achieve their breastfeeding goals. University of Texas – Medical Branch Ob/Gyn Grand Rounds, Galveston, TX, September, 2014

Sullivan C. Impact of Bariatric Surgery on Breastfeeding, 24th Annual Art of Breastfeeding Conference, Chapel Hill, NC, October, 2014.

Sullivan C. Breastfeeding Update. Perinatal Health Committee of the NC Child Fatality Task Force, Raleigh, NC, September, 2014.