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Promoting the Best

Promoting the Best

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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