Anne Merewood PhD MPH IBCLC

Director, the Breastfeeding Center, Boston Medical Center

Assoc. Prof. of Pediatrics, Boston University School of Medicine

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Out with the old…..

Who to teach

What to teach

How to teach

Who will teach

How to pass!

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The Pathway to Baby-Friendly Designation

Hospital Breastfeeding

Policy

Readiness Interview

Implement QI Plan

Collect Data

Train Staff

Data Collection

Plan

Prenatal/Postpartum Teaching Plans

Staff Training Plan

On-Site Assessment

Start

Discovery

Development

Dissemination Designation

BF Committee Or Task Force

BFHI Work Plan

Register with Baby-Friendly USA

Obtain CEO Support Letter

Complete Self Appraisal Tool

Baby-Friendly Designation

Bridge to Development Phase-

Registry of Intent Award

Bridge to Designation Phase

Dissemination Certificate of Completion

Bridge to Dissemination

Phase- Development- Certificate of

Completion

© 2012 Baby-Friendly USA, Inc..

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Inform all pregnant women about the benefits and management of breastfeeding

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Obviously, all prenatal settings shouldoffer breastfeeding anticipatoryguidance

What sort of breastfeeding ed dowomen get?

When do they get it; who delivers it?

What about high risk clients?

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Are you going to breastor bottle feed? “Bottle feed” – ends discussion

Mom annoyed if brought upover and over

Breastfeeding class 1-time event – who attends?

1 session of childbirth ed

Or…no-one really bringsit up at all….

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‘Discuss’ breastfeeding/infant feeding

Health benefits of breastfeeding

Give out a ton of printed info

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Handouts

Breastfeeding management

Positioning

Latch

Frequency of feeds

“Every 3 hours for 10 mins on each side…”

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For BF compliance:

You are only responsible for clinician ed amongclinicians who see patients between admit inlabor to discharge with baby

Any clinician on the unit on assessment daycould be interviewed

Mind the gap!

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You are only responsible for prenatal ed forpatients from hospital-owned settings

When BF USA comes, they will onlyinterview YOUR pregnant women aboutprenatal care in any depth

No prenatal care – no expectation reinterviews

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Well educated clinicians who can educatewell

A plan for when prenatal ed will be taughtin your clinic/setting

Outreach to prenatal settings that send youmothers

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Women prepared for skin to skin when theyarrive in labor

Women know about rooming in (howdescribed??)

Helps to put pressure/”encourage” your hospitaldelivery service

Helps women to advocate for optimal MCH care

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Baby-Friendly USAGuidelines and Criteria

http://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria

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Skin to skin at birth (all moms)

Rooming in in hospital (all moms)

Frequency of feeds: “feeding on cue andrecognizing cues”; “8-12 x in 24 hours”

Exclusive breastfeeding

Specifically – not supplementing

Formula prep 1 on 1 postpartum (not ingroup setting; not prenatal)

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Class

Waiting room

Peer counselors

Appointmenttime

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Usually taught by ‘specialist’ (notintegrated, unless Centering Pregnancystyle class)

Advantage – lot of control over content

Disadvantage – not all women come,women who don’t may be ones you mostwant to reach

Class fine but not optimal; cannot standalone

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Advantages:

Pictures!

No provider needed if youuse video loop

Captive audience

Disadvantages

Impersonal/no questions

No way to assess whosaw/understood what

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Peer counselors sit with moms (Moms did notapproach IBCLCs at a table)

Moms pick a poster and get a raffle ticket

Poster winners announced and moms drawn for aprize

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Handouts OKbut thinkpictures!

If handouts,discuss

Make sure up todate

Health literacyand languageconcerns

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Use photos of your patients

Use catchy words and pictures (think – advertising!!)

Be creative! Apps? Computer games? Etc.

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Integrate into prenatal care visits

Research shows, women more likely toremember if info is repeated

Create a system where provider presentsinfo in ‘bundled’ form

Regular and comprehensive

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Info broken down fore.g. at 2nd, 4th, 6th visit(by trimester?*)

*Needs to be“complete” by 3rd

trimester

Premature birth plus BFUSA!

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Regular prenatal provider should dothis

Any other system open to problems

How can IBCLC/childbirth ed/RDpossibly see all patients (unless v. smallfacility)

What if that person moves or is away?

Not good practice to have regularproviders reliant on a “special” person

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MDs may need >3 hours

Prompts – index cards, notes in chart,handouts “equipment” – dolls, breastsetc

Prompts in EMR/chart

“But I don’t have time”

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Documented staffeducation

Patient responses

Can momsanswer questionsin the Step 3 audittool?

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We are not doing it

We are not doing it in any systematic way

We give them all the info on their 1st

prenatal visit

We are not documenting it

Patients are getting handouts but not theteaching to go with them

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Over to you…….

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