Breastfeeding and Environmental Change:
A Focus on Maternity Care Practices
The Massachusetts Experience
Rachel Colchamiro, MPH, RD, LDN, CLCState Breastfeeding Coordinator
Massachusetts Department of Public HealthNutrition Division
Breastfeeding in Massachusetts (2005 data)
79% breastfeeding initiation rate
45% breastfeeding at 6 months; 25% breastfeeding at 12 months
43% exclusively breastfeeding at 3 months; 17% exclusive at 6 months
Why Focus on Maternity Care?
Time-sensitive nature of breastfeeding success
Evidence of positive impact of “breastfeeding-friendly” hospital practices
Significant impact of supplementation on later breastfeeding duration and exclusivity
Perinatal Hospital Licensure Regulations
Purpose:
Improve quality of care for all women giving birth in Massachusetts and their newborn infants
Improve perinatal outcomes – maternal and infant
Better serve Massachusetts families
More efficiently provide services to mothers and newborns in Massachusetts
Need for Revision
Regulations initially promulgated in mid 1970’s and revised in the late 1980’s
Part of a multi-faceted strategy to reduce mortality
Health care delivery changes and technology have changed environment resulting in need to update existing regulations
Research informs best practices to promote positive health outcomes
Massachusetts Breastfeeding Coalition
Rejuvenated in 2000 by a consumer/physician
Made up of advocates, health professionals, hospitals and health departments, community organizations, consumers and parents
Includes many prominent individuals in breastfeeding arena
Membership eager and willing to work for change
Excellent website and history of social marketing campaigns
Our Hopes and Dreams
Increase breastfeeding duration and exclusivity
Mandate a level of lactation support in the maternity setting
Improve initiation of breastfeeding by keeping dyad together
Regulate documentation related to feeding
Improve staff knowledge and ability
Eliminate marketing practices that negatively affect breastfeeding
Process - Revision to Regulations
Began January, 2004
Joint process between two bureaus – Center for Quality Assurance and Control and Center for Community Health
Development of Advisory Committee and Sub-Committees--Massachusetts Breastfeeding Coalition leaders active on committees
Lengthy review and approval process including:
Public Health Council
Public comment hearings
Department of Public Health review of comments and revisions
Review by governor and his cabinet
Our Successes:
Key Changes to Regulations
Promoting Breastfeeding
Availability of a Lactation Consultant
Strengthening of patient care policies related to lactation
Documentation of infant feeding care & progress
Discharge planning
Staff education/training in lactation
Significant Sections Related to Breastfeeding
Each hospital, at a minimum, must provide each mother advanced lactation support with consultation from an International Board Certified Lactation Consultant (IBCLC) or an individual with equivalent training and experience
Patient care policies must include:
• Encouragement of breastfeeding as soon after birth as baby is interested
• Encouragement of skin-to-skin care• Safe storage and handling of infant
feedings (labeling and identification)
Significant Sections Related to Breastfeeding
Maternal/newborn record includes infant feeding method, plan of care/progress and documentation of lactation care/services provided
Newborn record must include documentation of at least 2 successful feedings and discharge instruction sheet related to feeding plan, referrals an follow-up care signed by infant’s practitioner
Significant Sections Related to Breastfeeding
Each hospital must provide provision of resources to assist mother/family after discharge including community-based lactation resources and availability of breast pumps
All nursing staff shall receive orientation and periodic in-service education related to initiation and support of lactation
Significant Sections Related to Breastfeeding
What about the bags?
Original languageSample formula and/or formula equipment distributed to breastfeeding mothers only when an individual physician order is written or on the request of the mother
Coalition Tactics
Press
Online petition
Looking at the issue from another angle
Ad placement
Demonstration at State House
Buy-in from major teaching hospital
The Loss…and the Wins
Language regarding sample formula in regulations unchanged
Successes…14 birthing hospitals in Massachusetts no longer distribute bags
Creation of Ban the Bags campaign
Impact nationwide
Challenges of Making Change with Perinatal Regulations
Trickle-down of knowledge
Staffing and funding for reviews
Regulations vs. guidelines
Issues with evaluation