Breastfeeding and the Built Environment

1. Let’s Start at the Very Beginning… Breastfeeding and the Built Environment

3. The information and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC.

4. DNPAO six principal target areas • Increase physical activity • Increase the consumption of fruits and vegetables • Decrease the consumption of sugar sweetened beverages • Increase breastfeeding initiation, duration, and exclusivity • Reduce the consumption of high energy dense foods • Decrease television viewing

5. Once upon a time…

6. Breastfeeding is beyond the realm of public health.

7. Infant feeding is a personal choice.

9. But...

10. Lack of breastfeeding substantially increases health risks to infants. Never breastfed versus ever breastfed Breastfeeding = Control Grp Source: AHRQ, 2007

11. Inadequate breastfeeding substantially increases health risks to infants. Never breastfed versus breastfed at least 3 months* Breastfeeding = Control Grp *Includes studies of never v. bf ≥4 mo and bf ≥6 mo Source: AHRQ, 2007

12. Mixed feeding substantially increases health risks to infants. Exclusive formula feeding versus exclusive breastfeeding* Breastfeeding = Control Grp *Exclusive bf of at least 3 months Source: AHRQ, 2007

13. Then what’s going on?

14. Moms just don’t understand how important it is to breastfeed. Moms just don’t understand what they need to do to breastfeed.

15. Not quite…

17. Problem:The way maternity care is delivered can make it very hard to start and continue breastfeeding.

18. Problem:Medical care processes, policies, and practices, as well as routine practices, traditions, habits, and even design, systems, and expectations are not always conducive to healthy infant care.

19. Problem:Medical care processes, policies, and practices, as well as routine practices, traditions, habits, and even design, systems, and expectations are not always conducive to healthy infant care.

20. Problem:Medical care processes, policies, and practices, as well as routine practices, traditions, habits, and even design, systems, and expectations are not always conducive to healthy infant care.

21. Problem:Medical care processes, policies, and practices, as well as routine practices, traditions, habits, and even design, systems, and expectations are not always conducive to healthy infant care.

22. In-hospital supplemental feeds reduce breastfeeding opportunities. (Nylander, et al. 1991)

23. Breastfeeding at 8 weeks Percent of mothers (interviewed at 8 wks postpartum about hospital experiences) (Murray et al., 2007) Approx mean diff = 12%

24. small scale – signage Breastfeeding and the Built Environment

26. small scale – linen service Breastfeeding and the Built Environment

28. large scale – care systems Breastfeeding and the Built Environment

33. Assessing the maternity care built environment: The CDC survey of maternity Practices in Infant Nutrition and Care

34. Earlyskin-to-skin contact

35. Almost all facilities unnecessarily separate mothers and infants within the first 30 minutes of life. Are mother and baby usually skin-to-skin while staff are completing routine newborn procedures? NB: Routine newborn procedures include Apgar, foot printing, ID banding, etc.

36. Problem:Medical care processes, policies, and practices, as well as routine practices, traditions, habits, and even design, systems, and expectations are not always conducive to healthy infant care. Solution?

37. Standard healthy infant nutrition and care assures all mothers and babies receive care that utilizes best practices and is free of policies, practices, and environmental influences that undermine maternal and child health and wellbeing. Solution:

38. Standard healthy infant nutrition and careassures all mothers and babies receive care that utilizes best practices and is free of policies, practices, and environmental influences that undermine maternal and child health and wellbeing. Solution:

39. Standard healthy infant nutrition and careassures all mothers and babies receive care that utilizes best practices and is free of policies, practices, and environmental influences that undermine maternal and child health and wellbeing. Solution:

40. large scale – maternity care Breastfeeding and the Built Environment

41. Programs Projects Policies The Baby-Friendly Hospital InitiativeTen Steps to Successful Breastfeeding Breastfeeding and the Built Environment

42. Program – Inform (step 3) Help (step 4) Show (step 5) Encourage (step 8) Foster support(10) Breastfeeding and the Built Environment

43. Project – Train staff (step 2) Practice BF (step 6) Room-in (step 9) No pacifiers (step 9) Breastfeeding and the Built Environment

44. Policy – written policy that is routinely communicated to all health care staff (step 1) Breastfeeding and the Built Environment

45. The number of Baby Friendly steps in place predicts risk of breastfeeding cessation. (DiGirolamo et al., 2008) Steps measured: • Early bf initiation • Exclusive breastfeeding • Rooming-in • On-demand feedings • No pacifiers • Information provided

47. Programs Projects Policies The WIC ProgramBreastfeeding Promotion and Support Breastfeeding and the Built Environment