A CONSTELLATION OF STRATEGIES TO IMPROVE BREASTFEEDING M. JANE HEINIG, PHD, IBCLC UNIVERSITY OF CALIFORNIA, DAVIS HUMAN LACTATION CENTER CALIFORNIA BREASTFEEDING RATES 1
SETTING OUR COURSE 2
IN HOSPITAL BREASTFEEDING DATA 3
Percent 2/9/16 1 9 7 5 4 3 1 93.5 93.5 94.8 88.5 66.6 64.6 54.9 57.4 California Kern Los Angeles Orange Any Exclusive More than a decade of strategies 4
EXCLUSIVE BREASTFEEDING 1 56.6% 14 66.6% CDPH Genetic Disease Screening Data 1 1 9 7 5 4 3 1 92.7 93.4 9.5 91 73.8 56.8 48.3 66.5 87.2 86.9 84.8.3 White Asian Hispanic Multiple American Indian Any Excl 55.9 Other 49.8 Pacific Islander 46.1 African American CDPH Genetic Disease Screening Data 5
14 1 9 7 5 4 3 1 95 94.8 93.4 93.3.1 61.7 74.4 89.3 88.7 88.2 69.5 White Asian Hispanic Multiple American Indian Any Excl 61.9 59.8 Other Pacific Islander 85.1 56.3 African American CDPH Genetic Disease Screening Data Exclusive Breastfeeding (1 14) 1 9 7 5 4 3 1 74 57 62 48 74 67 7 White Asian Hispanic Multiple American Indian Any Excl 62 56 5 Other Pacific Islander 56 46 African American CDPH Genetic Disease Screening Data 6
Percent 2/9/16 Closing the Gap 1 9 7 5 4 3 1 9.8 91.7 92.2 92.9 93.5 56.6.4 62.4 64.6 66.6 1 11 12 13 14 Year Any Excl Highest County Rates Plumas Marin Santa Cruz Nevada Shasta Lowest County Rates Change since 1 Kings +16.4% Sutter + 3.9% San Benito +11.2% Colusa +31.% Imperial + 9.2% 7
Percent 2/9/16 Exclusive Breastfeeding by County (1 14) 7 5 4 47.2 56.1 54.9 35.9 36 51.9 43.3.2 3 1 Fresno Kern Tulare San Joaquin 1 14 CDPH Genetic Disease Screening Data LOS ANGELES COUNTY Almost 1, births! More than 1/4 of CA births 8
Number Percent 2/9/16 3 25 Baby Friendly Hospitals Los Angeles County 15 1 27 5 1 1 14 7 5 4 In-Hospital Exclusive Breastfeeding Los Angeles County 3 57.4 39.3 1 1 14 9
Percent Percent 2/9/16 The Good List (14) 1 9 7 5 4 3 1 1 2 3 4 5 6 7 8 9 1 Any Excl CDPH Genetic Disease Screening Data The Bad List (14) 1 9 7 5 4 3 1 1 2 3 4 5 6 7 8 9 1 Any CDPH Genetic Disease Screening Data Excl 1
Percent 2/9/16 Closing the Gap: Bad List Hospitals 1 9 7 5 4 3 1 83 86.5 84 87.1 87.2 32.4 24.8 27.2 16.4 1 11 12 13 14 Year Any Excl NATIONAL COMPARISONS 11
Number 2/9/16 1 9 7 5 4 3 1 Highest in the US 88.3 65.9 51.4 56 43.2 43.3 29.2 32.5 21.9 Ever BF Any at 6 mo Any at 12 mo Excl at 3 mo Excl at 6 mo California U.S. National Source: CDC.gov/breastfeeding (12 births) BABY FRIENDLY HOSPITALS 7 5 More than % of all US Baby Friendly Hospitals are in CA 4 3 1 < 2 4 6 8 1 12 14 16 Year 12
Percent 2/9/16 3 25 BF Babies Receiving Supplements in First 2 Days 15 1 5 12.7 11.9 25.6 16.7 1.5 US Avg. California Alaska Connecticut Maine New Hampshire Source: CDC Nutrition, Physical, Obesity: Data, trends, maps (11 births) 13 mpinc SURVEY 7 th in the nation behind: New Hampshire, Vermont, Rhode Island, Delaware, Oregon, Massachusetts 13
FUEL FOR STRATEGIES Exclusive Breastfeeding (1 14) 85 75 7 65 55 5 45 4 74 57 48 62 White Asian Hispanic Multiple American Indian 67 74 7 56 62 Other 5 Pacific Islander 46 56 African American Any Excl CDPH Genetic Disease Screening Data 14
15 counties have breastfeeding rates below the state average Most in the Central Valley or Southern California Only 3% of hospitals are Baby Friendly 31 counties with no Baby Friendly Hospitals 15
13 mpinc Challenges In-room procedures Discharge planning and support New and current staff education Policy covers all 1 steps * Less than 5% have ideal response (7 hospitals responding) So many more challenges 16
All things are possible until they are proved impossible, and even the impossible may only be so, as of now. -Pearl S. Buck 17
Allied staff training Parent education and support efforts Nursing training Physician training Needed resources, materials, equipment Increasing breast milk feeding in the NICU Environmental changes Policy changes Actionable Questions Why? Why? Why? What if.? How? Source: A More Beautiful Question: The Power of Inquiry to Spark Breakthrough Ideas by Warren Berger 18
Why? Why are exclusive BF rates flat? Policies are not in place to support EBF. Why? Why aren t policies in place? Administrators don t think they are worth the cost. Why? Why don t administrators think they are worth the cost? Because hospital rates are not available to the public. What if? What if we let the public know how low their rates are? How? How can the data be made available to the public? Why? Why do some women request formula in the hospital? They don t think they have enough milk. Why? Why don t they think they have enough milk? Their babies are waking and crying more than they expect. Why? Why don t they expect their babies to wake and cry? They have not been provided with information about babies. What if? What if mothers could learn more about their babies behavior? How? How can we create a curriculum to help mothers understand babies? 19
Meanwhile in a local hospital Why? Why aren t community resources shared at discharge. The current list is out of date. Why? Why is the current list out of date? We have not contacted the local coalition for updates. Why? Why haven t we contacted the local coalition? The staff member working with the coalition left. What if? What if we assign another staff member to coordinate with the coalition? How? How can we provide resources for a staff member to coordinate with the local coalition? Beware of black hole questions
Who else is responsible? Don t night nurses supplement all the babies? 21
Isn t breastfeeding support useless without prenatal education? The population we serve doesn t breastfeed. What can we be expected to do about it? 22
Busting myths and black hole questions 1 Hospitals with >85% Medi-Cal 4 Contra Costa Regional San Joaquin General Highland Hospital Watsonville Commmunity San Francisco General Any Excl 23
1 Hospitals with >75% Births to Hispanic Women 4 Salinas Valley Memorial Sharp Chula Vista Ventura County Medical Center Kaiser- Downey Saint Louise Regional Any Excl 1 Hospitals with >45 births 4 Miller Childrens Antelope Valley Cedars-Sinai Hoag Memorial Alta Bates Any Excl 24
We can learn a lot from each other LET S FIRE THE BOOSTERS! 25
Your Turn Why? Why? Why? What if? How? It s too late now. We can t be taken off course 26
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TIME FOR HYPERDRIVE! 28