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Promoting the Best

Promoting the Best. Julie Pham, DO. Objective. Share Goals for My Community Medicine Project to Promote Breastfeeding Identify Points of Influence to Promote Breastfeeding Review Barriers to Initiate and Continue Breastfeeding

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Promoting the Best

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  1. Promoting the Best Julie Pham, DO

  2. Objective • Share Goals for My Community Medicine Project to Promote Breastfeeding • Identify Points of Influence to Promote Breastfeeding • Review Barriers to Initiate and Continue Breastfeeding • Discuss Clinical Experiences on Perceived Obstacles and Ways to Promote Breastfeeding

  3. Community Medicine Project • Breast is Best • 3 part series • Data Collection • Literature Review • Confirm with Medical Professionals and Mothers • Analysis and Development • Implementation

  4. Breastfeeding Healthy People 2010 Goal: • Initiation – 75% • At 6 months – 50% • At 12 months – 25% American Academy of Pediatrics Recommendation: • Exclusively breastfeeding for 6 months • Continue with appropriate food through first year

  5. Definition • Exclusive • WHO: breast milk from the mother or a wet nurse, or expressed breat milk and no other liquids or solids • Initiated immediately after birth • Until 6 mos of life and continue up to 2 yrs • Partial • Supplement breast milk with formula

  6. Benefits of Breastfeeding • For Infant • Decrease risk of infectious disease • Complete nutrition for growth and hydration • Developmental and psychosocial benefits • Reduce chronic disease • Decrease SIDS and tooth decay • For Mother • Reduce risk of chronic disease • Help with recovery after birth • Psychosocial benefits

  7. Benefits of Breastfeeding • For Families • Healthier infant •  less health care expense •  less time off work • Lower food cost • For Society • Saved $ for •  formula •  health care

  8. Epidemiology • Before 20th century – nearly 100% • 1930’s – rise in popularity of artificial milk • By Early 1970’s – 25% initiated; 5% at 6 months • Starting 1970’s – increase rate and duration • Less medically intrusive • More natural birth • 1998 – All time high of 64.3%

  9. EpidemiologyBF among women in the Maternal and Infant Health Assessment (2005-2006)

  10. Epidemiology

  11. Social Barriers • Not Social Norm • “It’s hard to BF in public with people watching.” • “…I don’t want to see [women feeding her baby]…something you do in private…it shocked me because I’ve never seen that, no in public” • Lack Support • “At the hospital…I didn’t really know whether I wanted to BF or not, so they just went ahead and right away gave him the bottle.”

  12. Social Barriers • Lacking Role Model • “I didn’t know what was going on with my breast and milk and things like that. I really didn’t know too much so I just stopped. I asked my mother-in-law but she didn’t know. “ • Lack Supportive Working Environment • “I work, so I can’t BF. I don’t have time. • “You have to stay home, you can’t go anywhere or do anything else.”

  13. Personal Barriers • Painful, Sore nipples • Perceived inadequate milk supply • Maternal fatigue • Anxiety • Depression • Prior breastfeeding experience • Confidence • Negative attitude

  14. Cultural Barriers • Acculturation • Recent immigrants vs US born/Years in US • Traditions • Food • Practices • Timing • Role of personal support system

  15. NOT a barrier • Awareness/Knowledge • “BF is healthier for the baby…babies get less sick” • “[Babies] grow faster and fatter.” • “I felt [my baby] close to me… I bonded a lot better with her.” • “”It makes babies healthier less cranky, and they get fewer earaches.” • Contained more “vitamins” than formula; babies are smarter • BF “because I could lose weight faster” • “Your uterus shrinks up faster when BF

  16. Points of Influence

  17. Points of Influence:Preconception/Interconception • Knowledge development and planning • Birth control • Pregnancy • Parenting Strategies • Annual visits • Opportunity to provide benefits, address misconceptions or concerns/questions

  18. Point of Influence:Antenatal • Period of high interest • Frequent clinic visits • Making behavior and health decisions • Counseling on EBF correlates with higher rate of EBF • Help define intention to EBF • Address counterforce: misconceptions, formula advertisements, etc

  19. Point of Influence:Perinatal (Birth) • Period when birthing process can affect initiation, duration and exclusivity of BF • Babies born in Baby-Friendly Hospitals are 28% more likely to EBF and 2x the rate of duration from 6-12wks. • Some studies show SVD babies are 1.5x more likely to initiate EBF vs. C/S • Report states receiving epidurals have significance in earlier cessation of EBF

  20. Point of Influence:Perinatal (Birth) Baby Friendly Hospitals: Ten Steps to Successful Breastfeeding • Maintain a written BF policy that is routinely communicated to all staff • Train all staff skills necessary to implement policy • Inform all pregnant mom about benefits and management of BF • Help moms initiate BF w/in 1 hr of birth • Show moms how to BF and maintain lactation, even if mom/baby are separted. • Give babies no food or drink other than breastmilk, unless medically indicated • Practice “rooming-in” for 24hrs a day • Encourage unrestricted BF • Give no pacifiers or artificial nipples to BF babies • Foster the establishment of BF support groups and refer moms on D/C.

  21. Point of Influence:Immediate Postpartum • This period is highly associated with initation and duration of BF • Creating relationship with mother and infant • Overcome factors that can interrupt immediate BF: immediate BF, skin-to-skin contact • Supplemental formula without indication  unsuccessful EBF • Avoid use of pacifier • BF counseling  greater effect on EBF

  22. Point of Influence:Days 3-12 • Milk “comes in” • Adaptation after discharge • Establishing routines • Mother-Infant bonding • Family/Friends support • Decrease contact with medical professionals • Questions, concerns • Adequate wt gain, Milk insufficiency, BF problems

  23. Point of Influence:Day 12 – Week 6 • Rate of EBF drops significantly during this time period • Establish mother/baby interaction • Sufficiency of milk production • Subject to societal norms • Planning to return to work

  24. Point of Influence:Weeks 6 – 12 • Maintenance of sufficient milk production • Misconception of supplemental food by 3 months of age • Misperception that formula = breast milk • Lactational Amenorrhea Method • Conception will not occur in 1st 6 wks • Frequent infant suckling  suppression of ovulation  delay the return of menses in postpartum period • 99.5% effective with perfect use; 98% with typical use during 1st 6 wks • Returning to work

  25. Point of Influence:Months 4 - 6 • Critical period in continuation of EBF • Drop-off in rates of EBF • Misperception of infants’ nutritional needs • Adaptation to social influences and health worker inputs • Return to work - 80% return to work • Day care

  26. Share Your Experience • What are the points of influence you’ve used to promote BF? • What are the barriers from your experience?

  27. Have a great day! Thank you

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