FALL WORKSHOP September 3, 2020 Greetings and Introductions - - PowerPoint PPT Presentation
FALL WORKSHOP September 3, 2020 Greetings and Introductions Welcome! You are at the MBC 2020 Fall Workshop Please take a moment to introduce yourself in the chat section (click on the ICON, type your MESSAGE, hit RETURN) Your Name
September 3, 2020
Greetings and Introductions
Welcome! You are at the MBC 2020 Fall Workshop
yourself in the chat section (click on the ICON, type your MESSAGE, hit RETURN)
question controls may be on the top or bottom of your screen
becomes unstable, we may ask that you turn your cameras
you can control your microphone and camera on the control panel or by clicking on PARTICIPANTS
Agenda
Introductions Breaking Barriers to Exclusive Breastfeeding in Hospitals
Jane Heinig, PhD, IBCLC
Break Racial Disparities in In-Hospital Formula Feeding
Marcia McCoy, MPH, IBCLC Rocio Ancasi and Stacey Welman, WIC Peers
Break Fond du Lac Community Health Family Support
Joe Woehrle, BSN, PHN, CLC
Creating Questions to Inform the Understanding of Breastfeeding Practices and Experiences
Florence Orionzi, MS
Discussion and Closure
OUR PRESENTERS TODAY
J O E W O E H R L E J A N E H E I N I G M A R C I A M c C O Y S TA C E Y W E L M A N R O C I O A N C A S I F L O R E N C E O R I O N Z I
JANE HEINIG, PHD, IBCLC UC DAVIS HUMAN LACTATION CENTER
7
Acknowledgements
Parts of this work has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service. The contents of this publication do not necessarily reflect the view or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or
U.S. Government. I have no competing interests to declare.
8
Questions to Answer
breastfeeding during the hospital stay?
breastfeeding support? 3. How can education about common early breastfeeding experiences improve rates of exclusive breastfeeding?
9
Ma Mater ernal al R Reques est f for Su Supplementation o
Hea ealthy Breastfed N Newb wborns
14 focus groups in English- and Spanish- speaking WIC participants (N=97) Study of maternal request for hospital formula for healthy breastfed infants (Damota, 2012)
10
Mater ernal R l Request for
Supplem lemen entatio ion o
Heal ealthy B y Breas astfed ed Ne Newborns Three Themes:
parenting
11
THE IMAGINED BABY
Stern 1998; Heinig et al. 2006
12
DaMota et al. JHL 2012
“Every time that I tried to breastfeed, he would have a tantrum, become really
‘Why? Why should I make him suffer?’”
13
Newborns expected to SLEEP
DaMota et al. JHL 2012
“I guess she wasn’t getting enough from me… they brought me the milk and after she ate, she slept.”
14
The Golden Hour is followed by deep sleep Parents will think:
sleeping baby!
And then…
Nugent 2007; DaMota et al. JHL 2012
15
Reality sets in! Baby is expected to be quiet and sleeping, but now…SOMETHING IS WRONG! Parents ask for formula and the frantic baby falls asleep
Nugent 2007; DaMota et al. JHL 2012
16
Nugent 2007; DaMota et al. JHL 2012
We started formula on the second day…since he never stopped crying”
17
Parents think there is something wrong with their crying and waking baby
formula
18
ONSET OF MILK PRODUCTION THE PERFECT LATCH
19
Many mothers thought their milk would come in as their babies were born
They would also help show how to position him so that I could breastfeed him but no milk would come out and no milk would come out so then I had to give him formula. My milk didn’t come in for about 3 days…
20
85% of mothers - milk comes in at 24-72 hours pp
hours postpartum
56 hours postpartum
21
Day 1
~50 mL for a 3.6 kg newborn
Day 3
~350 mL for a 3.6 kg newborn
Day 5
~560 mL for a 3.6 kg newborn
Casey et al. Am J Dis Child 1986; 140: 933-936.
100 200 300 400 500 600
1 3 5
22
He didn’t suck well, he rejected it right away. I gave her formula, I would put her close but she would barely latch on. It was if she wanted everything to be easy and for everything to be fast. And I would say ‘I can’t do it either.’
23
49 22 14 10 20 30 40 50 Day 1 Day 3 Day 7 % of Infants
Dewey et al. Pediatrics 2003; 112: 607-619.
24
25
BREASTFEEDING CAN’T BE FIXED WELL MEANING “HELP”
26
Breastfeeding could not be “fixed”
He wouldn’t stop crying so the nurse gave him a
fine to a bottle so I said ‘okay.’
This Photo by Unknown Author is licensed under CC BY-SA27
My boyfriend, he was worried about me not giving the baby enough, so he wanted me to give formula, so he knew how much he was taking. It depends on your nurse, my nurse gave me a lot in my crib… and that helped, you know, with my c-section recovery.
28
Every study participant had a reason for requesting supplementation
29
When do more than ¾ of babies typically start to latch well?
30
What proportion of women experience the onset of copious milk between 24 and 72 hours?
31
Mater ernal R l Request for
Supplem lemen entatio ion o
Heal ealthy B y Breas astfed ed Ne Newborns
parenting – crying and waking
expected changes in breasts and the perfect latch from the first feed
seemed to “fix” everything
Which of these have you seen in your work?
32
33
34
KNOWLEDGE:
TOOLS for how to teach parent’s about understanding baby behavior and responding effectively
35
36
If people believe there is a solution – Problem Management
If people don’t believe there is a solution – Emotional Regulation
Glanz J Occup Med 1992; 34: 1071-8.
Do you see these behaviors?
37
BELIEVING THERE IS NO SOLUTION IS LIKE LOOKING AT A BRICK WALL
38
THAT’S THE KEY!
39
Infant behavior has been explored and documented for more than 30 years
40
Focused on Healthy Families
Simplified normal infant behavior Baby Behavior does not address clinical lactation issues Works with clinical support services
41
BABIES ARE DRIVEN TO LEARN AND SOCIALIZE. THEY USE CUES TO SIGNAL READINESS.
42
Young infants try to tell caregivers when they want to interact (engagement cues) Young infants try to tell caregivers when they need something to be different (disengagement cues)
Kelly et al. Promoting First Relationships, NCAST Pub 2003
43
Subtle
Obvious
Kelly et al. Promoting First Relationships, NCAST Pub 2003
44
45
Subtle
Obvious
Kelly et al. Promoting First Relationships, NCAST Pub 2003
46
47
Babies are biologically driven to learn! Early cues are limited and confusing When adults respond to cues, babies get better at using them – takes time
48
49
50
Cues are simplistic and NOT specific
detective” to figure out what their babies are trying to tell them For most healthy term babies, feeding cues are
51
52
CRYING IS A VITAL “TALENT” USED BY INFANTS TO INDICATE DISTRESS.
53
Crying results in a sound that affects the nervous system in most adults
Must be loud to rouse sleeping caregivers
reduce crying
Hiscock H. The Crying Baby. Australian Family Physician 2006; 35: 680-4.
54
All babies cry for many reasons Hungry babies use hunger cues Occurs more often when needs are not addressed
55
56
Address the issue – look for cues! Reduce varied stimulation Introduce repetitive, sustained stimulation (repetition to soothe)
57
Bottle = quiet baby
can’t make noise
the sucking reflex
This can be explained to parents
58
Baby Luz is 28 hours old She was fed an hour ago, and now she is being passed around and held by relatives visiting the hospital. She begins to cry. Thinking she is hungry, her mother tries to breastfeed her. But Luz seems to get only more upset, crying, turning her head away and arching her back.
59
Crying doesn’t always mean hunger – look for hunger cues (feed every time they see them) Respond to other cues as best they can Reduce stimulation if possible Use repetition to soothe as needed
60
BABIES DO NOT SLEEP LIKE ADULTS
61
Active sleep (REM) is light sleep
increases to the brain bringing nutrients to active brain cells
development
Peirano et al. J Pediatr 2003; 143: 70-9.
Qui Quiet s sleep eep i is deep deep s sleep eep
brain to rest and recover
Infants “cycle” through active sleep, quiet sleep, and waking.
62
Newborns start sleep in Active Sleep (AS) (dreaming for 20-30 mins) and move to Quiet Sleep (QS). Wake frequently
63
64
Dreaming/light sleep are good for baby’s development and safety Newborn may wake when laid down while dreaming As they get older, babies sleep longer and more at night
65
66
67
Newborn Behavior and Breastfeeding
Disengagement cues are confusing Crying on day 2 is often misinterpreted Waking frequently is misinterpreted
68
The Breastfeeding Transition
Latch takes time
frequently
Expect quick improvement Can be a roller coaster at first Learning to BF is a “journey, not a moment…”
69
70
71
On day 2, baby will wake and demand feeds Babies use cues – get better with response Latching takes practice – expect quick improvement Moms feel changes in breasts after discharge
72
Supporting Lactation
Prepare for strong emotions
knowledge to reassure
Explain and demonstrate how to obtain best level of alertness for feeding
Demonstrate steps for latch attempts
breast
Explain feeding reflex not volume drives satisfaction with feeds – can’t rush process
73
74
75
The Cornerstones
1.Engage the caregiver by explaining baby behaviors parents see and hear (use the baby’s name) 2.Share information. Stay with the basics related to caregiver questions/needs 3.Empower parents to help them fix or cope with the issue
Simplification of NBO and NCAST interventions
76
Show caregivers that you understand their baby (use the baby’s name) “I can see that Lila is upset. Before I came in, did she……? And then did she …..”
77
“Lila may cry for many reasons.” “Latching does take practice.” “It’s hard but crying more on day 2 shows us Erin is doing well.” “When her face twitches, Keisha is dreaming and sleeping lightly.”
78
“Once you and Lila know each other better, you’ll be able to understand her cues better than anyone.” “Keisha will fall asleep in light sleep first and she’ll be easy to wake. You could hold her in the same position until she stops twitching or you could have someone else hold her until she falls into a deeper
79
80
A mother calls you shortly after her 6 morning visitors leave. Baby Luz is 28-hours-old, quietly fussy and arching away from her mother who says “she hates breastfeeding, she’s rejecting the breast. We need a bottle.”
What might you say first?
head away when you tried to feed her?
81
Baby Lilly is 36 hours old. Her mother, Monica, is eagerly anticipating a consultation with the lactation consultant. She tells you, “I’ll be so relieved once they fix her latch problem and I can be sure she’s getting what she needs.”
What might you say first?
slowing you guys down as you get closer to a consistent latch. It always takes a few days.
consistently.
82
Simplify
Parents get overwhelmed if you make baby behavior too complicated Identify cues/signs that the baby is already exhibiting or that parents are most likely to see and use the baby’s name Promote and support interaction rather than focus
Consistent messaging is important
83
84
85
UC Davis Human Lactation Center lactation.ucdavis.edu
SEPTEMBER 3, 2020
INCREASING EXCLUSIVITY WITH PRENATAL EDUCATION ON BREASTFEEDING GOALS
Marcia Burton McCoy, MPH, IBCLC
marcia.mccoy@state.mn.us Stacey.Welman@hennepin.us
Stacey Welman, WIC peer counselor Rocio Ancasi, WIC peer counselor
Rocio.Ancasi@hennepin.us
Even brief exposure to formula carries risks
Even brief exposure to formula alters the infant microbiome. Among infants who were exclusively breastfed post-discharge but received formula as neonates, this brief supplementation was detectable at 3 to 4 months of age, with lower abundance of Bifidobacteriaceae and higher abundance of Enterobacteriaceae. (Forbes) Avoiding cow’s milk formula for at least the first three days of life was protective against allergy at 2 years of age. (Urashima) Formula supplementation in the hospital often leads to continued supplementation after discharge. (Pérez-Escamilla; Wilde)
Exclusively breastfed infants had lower rates of respiratory and gastrointestinal tract infections compared to partially breastfed infants. (Duijts 2010) Exclusive breastfeeding minimizes the risk of sudden infant death (SIDS), compared to partial and full formula feeding (Hauck 2011)
The risk of early weaning was significantly greater for breastfed infants when they were given formula in the hospital (Hazard ratio for weaning 2.5 to 6.1 times greater for supplemented babies across the first year).
McCoy, M. B., & Heggie, P. (2020). In- hospital formula feeding and breastfeeding duration. Pediatrics, 146 (1) e20192946; DOI: https://doi.org/10.1542/peds.2019-2946 Commentary: In-Hospital Formula Feeding and Breastfeeding Duration Lori Feldman-Winter and Ann Kellams Pediatrics July 2020, 146 (1) e20201221; DOI: https://doi.org/10.1542/peds.2020-1221
Rates of In-Hospital Formula Feeding (IHFF) and median days breastfed for breastfed infants born in 2016 and enrolled in the Minnesota WIC program, by cultural identity infants in
percentage IHFF median days breastfed Interquartile range American Indian 273 41.8 73 19-254 Hmong 714 82.4 53 8-143 non-Hmong Asian 600 58.3 174 52-381 U.S.-born Black 1284 52.5 61 15-174 foreign-born Black 1899 72.6 271 147-382 White 2295 32.6 119 31-313 Hispanic (all races) 1658 44.3 191 51-381
McCoy, M. B., & Heggie, P. (2020). In-hospital formula feeding and breastfeeding duration. Pediatrics, 146 (1) e20192946; DOI: https://doi.org/10.1542/peds.2019-2946
Implementation of Baby-Friendly Hospital Initiative (BFHI) 10 Steps Culturally appropriate prenatal education Peer counseling Staff and physician education Giving supplementation only when medically indicated Early skin-to-skin contact. Team -based care including lactation specialists integrated into routine patient care helps to reduce IHFF and supports the infant feeding goals
When do you see families?
Lack of confidence/nervousness/pressure ‘permission’ to give formula
Mom needs to rest It’s o.k. if you need to supplement
No permission asked before giving formula
Just to be safe Doing the mom a favor
Onus is on the care provider, not the family Provider endorsement very influential Racial/cultural gap in prenatal education
I want to initiate breastfeeding/chestfeeding within the first
attach, and I do not want the baby forced into the first feeding. I would like all newborn procedures delayed until after the first feeding with my baby lying on me or held by me. I want my baby to stay in my room with me, and I want to hold my baby skin to skin as much as possible during our stay.
I would like help in establishing a comfortable and effective latch and learn different positions for nursing my baby. I would also like assistance in learning hand expression, how to recognize my baby is swallowing, and what to expect in the days following discharge from the hospital. If I encounter any breastfeeding problems, I would like help from an International Board Certified Lactation Consultant or
I do not want any water, glucose water, formula, bottles, or pacifiers given to my baby. If there is a medical need for supplements, I would like the opportunity to discuss it with my pediatrician and lactation consultant first, including the
If I am separated from my baby for any reason and unable to establish breast or chestfeeding, I would like to learn how to use a breast pump to establish my milk supply.
I do not want to be given or shown any promotional material on formula, including diaper bags, crib cards, or the formula itself. I would like to receive information on breastfeeding support resources in my community. I would like help from the hospital staff to manage my visitors so I have private time to feed my baby.
Adapted with permission from Student Health Services, University of South Carolina’s “Breastfeeding Worksheets.”
Marcia McCoy marcia.mccoy@state.mn.us
References
cessation among first-time mothers intending to exclusively breastfeed. The Journal of pediatrics. 2014; 164(6):1339-1345.
gut microbiota and risk of overweight in the first year of life. JAMA Pediatr. 2018. 172(7):e181161-e181161.
meta-analysis. Pediatrics. 2011; 128(1):103-110.
https://doi.org/10.1542/peds.2019-2946
months? Adv Nutr. 2019.
130:54–60.
meta-analysis. Acta Paediatr. 2015; 104:3-13.
and food allergy by avoiding supplementation with cow’s milk formula at birth: a randomized clinical trial. JAMA Pediatr. 2019; 173(12):1137-1145.
Presented by: Joe Woehrle BSN, PHN, CLC
Joe Woehrle BSN, PHN, CLC
certified lactation counselor for the Fond du Lac Band of Lake Superior
role as a member of FDL’s Community Health Services Department’s nurse home visiting team; which is primarily focused on Maternal/Child/Caretaker health and wellbeing. One of Joe’s proudest undertakings is being the emcee for Fond du Lac’s annual Breastfeeding Honoring Dinner.
and sail.
Focus: Prenatal and Postpartum Breastfeeding Support
Prenatal Services: Telehealth, informative handouts, screening tools, referrals for services, invitations to outreach events. Postpartum: Telehealth, weight checks, informative handouts, screening tools, breastfeeding supplies/gifts, referrals to services (WIC, doula etc.), invitations to outreach events.
FDL CHS Nurse Home Visiting Team
to doula and breastfeeding support services.
the breast feeding process (ex: storage bags, breast pads, planning for hospital and the return home, information sheets etc.).
education, breastfeeding honoring dinner etc.)
Prenatal Honoring Gifts:
in 5 prenatal visits.
Postpartum Honoring Gifts:
2020 Breastfeeding Honoring Dinner
Resources:
https://worldbreastfeedingtrends.org/
Prevention (US); Office on Women's Health (US). The Surgeon General's Call to Action to Support Breastfeeding. Rockville (MD): Office of the Surgeon General (US); 2011. The Importance of Breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK52687/
Gifts [Brochure]. Author.
Moccassins [Brochure]. Author.
LICENSED PARENT EDUCATOR
BREASTFEEDING……: , CREATING QUESTIONS TO INFORM THE UNDERSTANDING OF BREASTFEEDING PRACTICES AND EXPERIENCES. MOTHERS TO BE, SERVICE PROVIDERS, POLICY MAKERS AND COMMUNITY.
OBJECTIVES
might have implications for policies that support practice and experiences with breastfeeding
WHAT KIDS NEED (DR. TERI ROSE)
Secure Attachment Relationship
get along better with friends and have fewer emotional problems
ATTACHMENT BEHAVIORS
Vocalizing.
caregivers
children.
REVIEW OF LITERATURE
T ermination of Breastfeeding
birth of a baby but only 13% continue to exclusively breastfeed at 6 months. The rate of continued breastfeeding varies with different races, Hispanics and Whites having the highest rate compared to African- Americans (Harley et al., 2007; Lind, 2011; Lowe, 2011; Lally, 2013).
feeding does not start right away. (Lally, 2013) notes this critical period to be within 3 hours after birth.
WHAT WAS THE FOCUS?
Barriers (include health, environment) Family and community support for breastfeeding Support system here in St. Cloud and in country of origin Practices such as clothing, how babies are carried, co-sleeping
OBSERVATIONS/TAKE AWAYS
professional support and encouragement
babies may have missed secure attachment and the experience was not joyful.
Practices (changed) and attitudes (no change)
RESEARCH QUESTIONS
RESULTS
Breastfeeding practices (Growing up, Parent choices) Attitudes about breastfeeding (beliefs, benefits, length of time) Changes in practices/attitudes from country of origin Support for breastfeeding (sources, desired, support in home country)
duration of breastfeeding varied from 1 -2 years, some didn’t know.
exclusively breastfed for one and half years, stopped after realizing that she was pregnant, otherwise she would have continued until the baby didn’t want to nurse anymore
agrees with the previous study which showed poverty and employment as barriers (Lowe, 2011) to breastfeeding duration.
months, 4 months, 6 months) because of insufficient breast milk production, with doctor’s advice.
Family and community support for breastfeeding How a child and mother are clothed How babies are carried, Co-sleeping
DISCUSSION
DISCUSSION (CONTINUED)
Practices (changed) and attitudes (no change) Factors that influenced choices
OTHER SECTIONS
they represent
Health care providers Parent educators
Thank you, Planning Team!
PA M G . L I N D A K . C A R R I E K . H I M A L I P. M A R C I A M . J E A N N E F. L A U R E N & O L I V E R E .