HOW TO MAKE THE BABY FRIENDLY PROCESS WORK It is Possible Janet Tolley RNC-OB, BAN, IBCLC, CD(DONA) Lactation and Doula Program facilitator Susan O’Connor RN, BSN, IBCLC,CPST-I Patient and Community Education Objectives • Define the importance of your role in the baby friendly process • Summarize breastfeeding resources available in your facility and community • Discuss beginning steps for hospitals and the barriers associated with them Protecting, Promoting and Supporting Optimal Infant and Young Child Feeding through Health Professional Education Historical Perspective • Inventory of your skills • Not everyone is a crusader • What are your strengths • Who has the power • Failure is not trying • Stagnation is not progress The Power Behind the Change Spoke to CEO Nursing Director Maternity Supervisor Assistant Supervisor Mother-Baby Assistant Supervisor Labor and Delivery Janet Tolley Lactation Program Facilitator Administration • Committee met with Director • Director set up meeting with CEO • He signed the letter of intent • All first line management supported this move Quick vs Slow Implementation • Changes immediate. • Staff meetings. • Short discussion. • Administration support. 1993 • How we started on the road to BF. • We reviewed all policies. • 1993 set out guidelines for all staff. • No longer stocked cribs with formula or water. • No formula gift packs given. Memorandum TO: All MBU Staff FROM: Eileen Lucas Janet Tolley DATE: April 6th, 1993 Subject: Breastfeeding Practices St. John’s hospital administration has joined with the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in support of the global “ Baby Friendly Initiative”. In support of the “Baby Friendly” ten steps for successful breastfeeding, as well as the Wellstart International breastfeeding policies (attached), the following practices will be implemented, effective immediately: A.) B.) C.) We will no longer stock cribs of breastfeeding babies with water or formula. We will no longer put pacifiers in cribs of breastfeeding babies We will not give discharge, formula company, gift packs to breastfeeding mothers. PLEASE NOTE that these practices are being initiated in support of breastfeeding families and our staff is expected to participate in this initiative. At this point, we are NOT asking you to call physicians for orders related to these issues. Start Have all References READY • 1995-1998 Education of Staff, Patients, Community, Physicians Who Cares? • YOU • Your Clients‐ gather support • Your Physicians‐ Champions • Your Hospital Administration (CQI)‐ Audits • The Government‐ Reimbursement on Satisfaction rates Who Needs to DO it? • Every Hospital is mandated to provide: • Best Practice • Maternity Services • Health Initiatives • All managers and staff need to have “BUY IN” What Difference will it Make? • In Illinois all maternal child medical associations support it • Research shows we need it • Improve infant Morbidity and Mortality rates • Improve Breastfeeding Continuation Rates What do you know? • The Joint Commission – supports it • Health Priority by all Health Organizations • It is achievable • MPINC reports • The Surgeon General statement • NOW is the TIME How to Become an Activist • Do you see processes that need change? • What is being done now? • Committee or Single in approach? • Are you willing to care more than anyone else? Baby Friendly Hospital Ten Steps Breastfeeding 1. Written breastfeeding policy 6. No food or drink for infants other than breast milk 2. Training for staff 7. Practice “rooming in” 3. Inform pregnant women 8. Encourage breastfeeding on about breastfeeding demand 4. Initiate breastfeeding within one hour of birth 9. No pacifiers or artificial nipples 5. Show mothers how to 10.Foster the establishment of breastfeed and maintain lactation, even if separated breastfeeding support groups from their infants Bust the Myths • Bust the Myths • What are the Myths‐ • As you grow, your personality changes • All staff are thrilled about Baby Friendly • You will have support from all physicians • Parents will be happy with the changes • Formula representatives will not sabotage your efforts Written Policies • Changed them to Reflect the process of Being a Baby Friendly Hospital • Made them reflect what should be done Education • Classroom • One on One • Support Group • Yearly update on Health Stream Learning. • Career Plan • Evaluation Listen • What is the concern • Does it need to be shared • Who has the concern (what shift) Nurses Fears • Babies will get dehydrated. • Babies need to know how to bottle feed. • Babies are hungry. • Mothers milk isn't in. • I need to make sure the esophagus is patent. Nurse’s Concerns over Rooming in • “Babies will die in the rooms” • “Babies will fall on the floor” • “Mothers will not be able to rest” Skin to Skin • Prenatal classes • Doctor office • Educate on Admission • Healthy Full Term Where is the Baby? Mother Baby Safe Nursing How to Educate and Gain Support of Staff. • Poster in‐services. • Policies changed. • Meet in small groups. • Nurse of the month award. • Send key staff to CLC • course. • • Audit monthly‐post results. • Be available to staff. Reflect acceptance in evaluations. Lead by example. NICU Project Troubleshooting Milk Volume problems in the NICU • Worldwide, mothers of prematures have trouble establishing and keeping a milk supply when they must express milk with a breast pump. • Nurses and Physicians often conclude that premature birth makes it impossible to produce an adequate volume of milk. • This assumption is incorrect. Education of Mothers Kangaroo in the NICU Sam Process change Never ending OBTV Documentation • Audits daily to check for compliance • OBTV Charting Rewards INDICATIONS FOR SUPPLEMENTAL FEEDING IN TERM, HEALTHY INFANTS (SITUATIONS WHERE BREASTFEEDING IS NOT POSSIBLE) 1. Separation 3. Infant who is unable to feed at the breast (e.g., Maternal illness resulting in congenital separation of infant and mother (e.g., shock or malformation, illness) psychosis) 4. Maternal medications Mother not at the same (those contraindicated hospital in breastfeeding) 2. Infant with inborn error of metabolism (e.g., galactosemia) The Academy of Breastfeeding Medicine Treatment of Hypoglycemia Assessment of glucose. 1. Accucheck. 2. If less than 60 an I‐stat is drawn. 3. I‐stat lower than 40. 4. Doctor notified. 5. Baby allowed to breastfeed to bring up glucose. Barriers • Physicians want the babies to have formula if the blood glucose is low. 1. Most common in LGA and SGA babies. 2. Babies of insulin dependent mothers. 3. Less than 36 weeks gestation. 4. Stressed infants. What Pacifier? Pacifier education • Prenatal • On Admission • Scripts • Documentation • Audits • Follow ups • Good/Bad Always Look For the Rainbows Medical Office • Information • Promote Classes- Free • Ethics of giving Formula Bags- samples • Assessment of Breasts Hospitals Should Market Health and Nothing Else This practice is opposed by: • the American Academy of Pediatrics • the American College of Obstetricians and Gynecologists • the CDC • the American Public Health Association • the World Health Organization. Check out the “Free” Prenatal reading your office has Does it promote breastfeeding as the NORMAL feeding method? Support Groups Mothers want the BEST Birth at a Baby‐Friendly Certified Hospital You will make a Difference!