New Food Choices Support Breastfeeding

1. New Food ChoicesSupport Breastfeeding No one can make you feel inferior without your consent. Eleanor Roosevelt

2. New Food Choices will bring changes to the way we support breastfeeding moms Today we will: • Learn about the new breastfeeding policies • Identify two key points behind the rationale of not issuing formula in the first month of life • Become familiar with the term “Anticipatory Guidance”

3. New Food Choices will bring changes to the way we support breastfeeding moms • Learn the steps of a Breastfeeding Review • Locate three key breastfeeding resources available to you during a Breastfeeding Review

4. Policy Changes Formula will no longer be routinely issued to breastfeeding babies All breastfeeding moms & babies will receive a full Breastfeeding Review before receiving any formula The Breastfeeding Review shall be documented in the Notes section in the client record

5. Breastfeeding moms with infants over 6 months of age receiving more than ½ the amount of formula in an infant formula food package: Will no longer receive food for themselves Will be counted as participating on the WIC program as breastfeeding women Will be given support and education to continue breastfeeding Policy changes

6. Time for a change • Thinking about how WIC supports breastfeeding, what have you learned about New Food Choices changes that surprises you? Sally Blizzard Yakima Neighborhood Health Services

7. The breasts make milk in response to three factors: Hormones Stimulation Milk being removed from the breast Breastfeeding makes breast milk! Why no infant formula in the first month

8. These common practices can cause moms to lose their confidence and quit breastfeeding early: Formula samples given by medical providers Formula supplementation in the hospital Formula samples and coupons given in discharge bags Formula checks issued at WIC “just in case” Why no infant formula in the first month

9. Provide pregnant moms information on: What to do in the hospital to start nursing off right Normal breastfeeding What to expect as baby grows Breastfeed - right from the start! This is called “Anticipatory Guidance”

10. An overview of the Breastfeeding Review • A Breastfeeding Review is an assessment of how breastfeeding is going • It must be completed anytime a breastfeeding mom is requesting formula, or asks for an increase in the amount of formula she already receives from WIC • The purpose of the review is to address concerns and help find solutions that enable continued breastfeeding, and to minimize/delay the use of formula

11. Who can do a Breastfeeding Review and issue formula checks to breastfeeding infants? • Only Competent Professional Authorities (CPA’s and nutritionists) trained in breastfeeding support may do a Breastfeeding Review .

12. Where a Breastfeeding Review starts

13. A walkthrough of a Breastfeeding Review 1. Establish rapport with the client by introducing yourself“Hello April. My name is Martha.” • Tell the client the reason for the discussion “I understand you have some breastfeeding concerns.”

14. A walkthrough of a Breastfeeding Review • Show respect for the client and engage her in discussion about how she is feeding her baby and what her plans are “Most new mothers have questions about feeding their baby.” • Use open-ended questions and active listening skills to find out why the client is requesting formula “Tell me why you think your baby needs formula today.”

15. A walkthrough of a Breastfeeding Review • Affirm the client’s feelings or concerns and engage the client in the discussion while offering support and encouraging continued breastfeeding “Being a new mom is exhausting. The first few weeks can be challenging. Let’s figure out a plan so you can continue to breastfeed. It’s going to get easier!” • Allow the client to share thoughts and try to avoid dominating the conversation “Tell me more about that.” “What have you tried that seems to makes breastfeeding work better for you and your baby?”

16. A walkthrough of a Breastfeeding Review • Target education to the client’s needs and avoid providing unneeded information “It sounds like you want some help in figuring out how deal with your sore nipples. I have information I can share with you. Would you like to hear more?” • Discuss the information in any handouts provided “On page 35 of this booklet I’ll give you is a list of things we discussed about dealing with sore nipples. I placed a bookmark so you can go back for a quick review.”

17. A walkthrough of a Breastfeeding Review • Ask for the client’s feedback on the usefulness of the information “What information was useful for you?” “What other questions do you have?”

18. What would this scenario look like in our clinic?

19. The Breastfeeding Review: Scenario 1 Maria

20. The Breastfeeding Review: Scenario 2 Lisa

21. The Breastfeeding Review : Scenario 3 Anna

22. CPA shall educate and counsel the mother that adding formula to her baby’s diet will have a negative effect on her breast milk production and may end breastfeeding. When formula is Issued to a breastfeeding baby

23. What if there is no CPA available to do a Breastfeeding Review? • Affirm the mom’s concerns and explain that staff who can determine the food package are not available • Encourage her to keep breastfeeding and inform her that giving formula may decrease her ability to make milk • Offer support within your skill level • Schedule as soon as possible with a CPA who can do a BFR or refer to community resources to do a BFR, if available • Offer to have someone contact her by phone • Suggest resources for formula

24. It’s not just one person’s responsibility to “do breastfeeding” It’s everyone’s responsibility Share your favorite breastfeeding resource with your team Our clinic’s breastfeeding resources The La Clinica Team

25. Attend regional WIC breastfeeding trainings Read books in the clinic The LLL Answer Book, Amy Spangler’s book, “Breastfeeding … Keep it Simple” Other books Read and study the WIC client handouts Visit http://www.doh.wa.gov/cfh/WIC/breastfeeding.htm Review self study materials Complete online courses What you can do to learn more about breastfeeding

26. A Breastfeeding Review is an assessment of how breastfeeding is going. A Breastfeeding Review must be completed before any formula is issued to a breastfeeding baby, or when the amount of formula is increased. It may also happen whenever a breastfeeding mom has questions, whether she is requesting infant formula or not. The purpose of the review is to address concerns and help find solutions that enable her to continue to breastfeed, and to minimize/delay the use of formula. Our goal is to help moms successfully breastfeed! One more look at the Breastfeeding Review

27. Closing

28. DOH 960-113 August 2009 For persons with disabilities this publication is available on request in other formats. To submit a request, please call 1-800-841-1410.