Public Health Breastfeeding Public Health Breastfeeding Policy InitiativePolicy Initiative

Hospital Policy Matters Hospital Policy Matters April 7, 2010April 7, 2010

Silvia Prieto, MD, MPHArea Health Officer

East and South Bay Service Planning Areas

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Hospital Policy & PracticesImpact Breastfeeding Duration

• Breastfeeding at 6 months was associated with – Exclusive breastfeeding in

hospital– Not receiving a gift pack with

formula at hospital discharge

Dabritz, J Hum Lact, 2009

Service Planning Area Map

4Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

In-hospital Exclusive Breastfeeding , 2007Service Planning Area 1 (Antelope Valley)

5Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

In-hospital Exclusive Breastfeeding , 2007Service Planning Area 2 (San Fernando)

6Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

In-hospital Exclusive Breastfeeding , 2007Service Planning Area 3 (San Gabriel)

7Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

In-hospital Exclusive Breastfeeding , 2007Service Planning Area 4 (Metro)

8Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

In-hospital Exclusive Breastfeeding , 2007Service Planning Area 5 (West)

9Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

In-hospital Exclusive Breastfeeding , 2007Service Planning Area 6 (South)

10Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

In-hospital Exclusive Breastfeeding , 2007Service Planning Area 7 (East)

11Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)

In-hospital Exclusive Breastfeeding , 2007Service Planning Area 8 (South Bay)

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Hospital Policy is Key• Administrative prioritization of breastfeeding support

drives the hospital practices that lead to improved breastfeeding

• Hospitals with written policy have better breastfeeding outcomes at 2 weeks

• Monitor improvements in breastfeeding support over time to track policy implementation

Rosenberg, Breastfeeding Medicine, 2008

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Hospital Policy & Practices:Associated with breastfeeding duration

• Breastfed within first hour of birth• Baby did not use pacifier• Stayed in same room with mother• Exclusive breastfeeding in hospital• Hospital gave mother a phone number

to call

Murray , Birth, 2007

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Hospital Policy & Practices: Affect all ethnicities & income levels

• Breastfeeding rates in US Baby-Friendly Hospitals exceed state and regional rates across all ethnicities and income levels

• Breastfeeding rates are high in these hospitals even among populations who do not traditionally breastfeed

Merewood, Pediatrics, 2005

30.0%26.9%

21.5%

13.7%

6.2%3.2%

15.5%

0 1 2 3 4 5 6Number of Baby-Friendly steps mothers reported

experiencing

% o

f mot

hers

, bre

astfe

d <

6 we

eks

Hospital Policies:Increased number of “Baby-Friendly” Hospital practices

in place decreases risk of breastfeeding cessationSteps measured:

Early bf initiationExclusive breastfeedingRooming-inOn-demand feedingsNo pacifiersInformation provided

DiGirolamo, Pediatrics, 2008

Quality Improvement is Essential

• Evaluate current practices• Adopt new policies and practices • Monitor improvements over time

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Hospital Practices decreases BF cessation at 6wks.pptx

The road ahead…

• This is a lengthy journey• Strive for incremental

changes• We’re here to help!

Works Cited• California Department of Public Health, Maternal, Child and Adolescent Health Program.

“California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database, 1994-2007.” Available at: http://www.cdph.ca.gov/DATA/STATISTICS/Pages/BreastfeedingStatistics.aspx

• Dabritz HA, Hinton BG, Babb J. Evaluation of lactation support in the workplace or school environment on 6-month breastfeeding outcomes in Yolo County, California. J Hum Lact 2009;25(2):182-93.

• DiGirolamo AM, Grummer-Strawn LM, Fein SB. Effect of maternity-care practices on breastfeeding. Pediatrics 2008;122 Suppl 2:S43-9.

• Merewood A, Mehta SD, Chamberlain LB, Philipp BL, Bauchner H. Breastfeeding rates in US Baby-Friendly hospitals: results of a national survey. Pediatrics 2005;116(3):628-34.

• Murray EK, Ricketts S, Dellaport J. Hospital practices that increase breastfeeding duration: results from a population-based study. Birth 2007;34(3):202-11.

• Rosenberg KD, Stull JD, Adler MR, Kasehagen LJ, Crivelli-Kovach A. Impact of hospital policies on breastfeeding outcomes. Breastfeed Med 2008;3(2):110-6.