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Breastfeeding

The Georgia Chapter is excited to expand its availability of breastfeeding resources to Georgia’s Pediatricians.  Kathryn McLeod, MD is the Chapter’s Breastfeeding Coordinator and is the Chairman of both the EPIC Breastfeeding Advisory Committee and the Physicians Breastfeeding Committee. Arlene Toole, IBCLC, RLC is the Director of the EPIC Breastfeeding Education Program.  The EPIC Breastfeeding Program curriculum has been developed with the guidance and expertise from the Curriculum Committee that is comprised of physicians and breastfeeding experts. The EPIC Breastfeeding Program is a ground-breaking state funded initiative and was launched in July 2007.  We are confident that the Breastfeeding program will follow in the footsteps of the well established and successful EPIC Immunization Program.  

To request a Breastfeeding program download form and fax to (404) 249-9503
Click Here to download Request forms!

    

AAP Chapter Member Benefits 

As one of the benefits of being a chapter member we have Arlene Toole available to answer your breastfeeding questions.  She is an IBCLC certified lactation consultant with 18 years of experience working with breastfeeding mothers and educating health care providers.  She can answer questions on breastfeeding management, increasing milk supply, pumping and storing breast milk and help you access resources in your community.   She is also our EPIC Breastfeeding Program Director.   If you are a member of the GA. Chapter of the AAP, you may call our office for breastfeeding questions at 404.881.5095 or email her @ atoole@gaaap.org.  

Breastfeeding Updates

Aggressive Breast Cancer Reduced with Breastfeeding

Boston University’s Sloan Epidemiology Center has found one reason that African American women have a higher risk of developing more aggressive breast cancers.  The study was published in Cancer Epidemiology, Biomarkers & Prevention.  The 14 year study found that giving birth to 2 or more children was associated with an increased risk of certain aggressive cancers, but only among women who had not breastfed. There was a 50 % increase of estrogen and progesterone receptor negative (ER-/PR) cancers in these women who did not breastfeed. The conclusion is that breastfeeding can reduce risk of developing the aggressive, difficult-to-treat breast cancers that disproportionally affect African American women.  The study was supported by the National Cancer Institute of the National Institutes of Health.

 

 

CDC’s 2009 Maternity Practices in Infant Nutrition and Care (mPINC) Survey is Out

 

Georgia had a composite score of 59 out of 100%.  Georgia also ranks 43rd in the nation in meeting the CDC’s goals.  This study describes specific opportunities to improve mother-baby care in hospitals in Georgia.

 

This study points out:

Breastfeeding helps protect against childhood obesity and other illnesses, and lowers medical costs.

·         The American Academy of Pediatrics recommends babies be fed nothing but breast milk for about the first 6 months and continue breastfeeding for at least 1 year.

·         Babies who are fed formula and stop breastfeeding early have higher risks of obesity, diabetes, respiratory and ear infections, and sudden infant death syndrome (SIDS), and tend to require more doctor visits, hospitalizations, and prescriptions.

·         Low rates of breastfeeding add $2.2 billion a year to medical costs.

·         Mothers who breastfeed have lower risks of breast and ovarian cancers.

 

Hospitals should do more to help mothers start and continue breastfeeding.

·         Hospitals that wait to start the first breastfeed, or separate babies from mothers, or routinely give formula to breastfeeding babies make it harder for mothers and babies to be able to breastfeed.

·         When hospitals support mothers to feed their babies only breast milk, it helps mothers to continue feeding only breast milk at home.

 

Baby-Friendly hospitals make special efforts to support mothers to breastfeed.

·         The World Health Organization/UNICEF Baby-Friendly Hospital Initiative, endorsed by the American Academy of Pediatrics, recognizes hospitals that follow the Ten Steps to Successful Breastfeeding.

·         When hospitals have more of the Ten Steps to Successful Breastfeeding in place, mothers breastfeed longer.

 

Percentage of US hospitals with recommended policies and practices to support breastfeeding, 2007 and 2009


 

SOURCE: CDC National Survey of Maternity Practices in Infant Nutrition and Care (mPINC)

 
For more information about mPINC and to see how you can improve your hospital’s score go to http://www.cdc.gov/VitalSigns/Breastfeeding/

U.S. Surgeon General’s Call to Action:
Increase Support for Breastfeeding Families

On January 20, 2011 the Surgeon General Regina M. Benjamin issued a “Call to Action to Support Breastfeeding.”  She challenged the entire nation to work toward removing obstacles that can make it difficult for women to achieve their breastfeeding goals.  The “Call to Action” identified ways that families, communities, employers and health care professionals can improve breastfeeding rates and increase support for breastfeeding:

·        Communities should expand and improve programs that provide mother-to-mother support and peer counseling. 

·        Health care systems should ensure that maternity care practices provide education and counseling on breastfeeding.  Hospitals should become more “baby-friendly,” by taking steps like those recommended by the UNICEF/WHO’s Baby-Friendly Hospital Initiative.

·        Clinicians should ensure that they are trained to properly care for breastfeeding mothers and babies.  They should promote breastfeeding to their pregnant patients and make sure that mothers receive the best advice on how to breastfeed.

·        Employers should work toward establishing paid maternity leave and high-quality lactation support programs.  Employers should expand the use of programs that allow nursing mothers to have their babies close by so they can feed them during the day.  They should also provide women with break-time and private space to express breast milk.

·        Families should give mothers the support and encouragement they need to breastfeed.

According to the “Call to Action” breastfeeding protects babies from infections and illness.  Moms benefit by having a reduced risk of breast and ovarian cancer.  A study in the Pediatrics journal last year estimated that the US could save $13 billion per year in health care and other costs if 90% of all babies were breastfed for just 6 months.

For a printed copy of the Surgeon Generals “Call to Action to Support Breastfeeding” you can send an email to cdcinfo@cdc.gov and reference the publication title.
 

Healthy People 2020

The U.S. Department of Health and Human Service (HHS) has updated its Healthy People program by providing new objectives for 2020. The new objectives for breastfeeding include several new goals for providing support for breastfeeding families.    Among the new targets for breastfeeding are the following goals in the Maternal, Infant, and Child Health category:

 

MICH-22:  Increase the proportion of employers that have worksite lactation support programs from 25% baseline to 38%.

MICH-23:  Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life from 15.6% to 10%.

MICH-24:  Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies from 2.9% baseline to 8.1%.

 

In addition to these breastfeeding support goals, Healthy People 2020 raised the targets for breastfeeding initiation, duration, and exclusivity.  They are:

 

MICH-21-1:  Ever breastfed from 73.9% to 81.9%.

MICH 21-2:  Breastfed at 6 months from 43.4% baseline to 60.5%.

MICH 21.3:  Breastfed at 1 year from 22.7% baseline to 34.1%.

MICH 21.4:  Breastfed exclusively through 3 months from 33.1% baseline to 44.3%.

MICH 21.5:  Breastfed exclusively through 6 months from 13.6% baseline to 23.7%.

 

These numbers reflect the importance of continued support for breastfeeding from hospitals, physicians, health care workers, WIC and families across the US.  There is more focus on exclusive breastfeeding and supporting breastfeeding mothers when they return to work.  We hope to see breastfeeding rates continue to increase in Georgia.  You can learn more about how to assist our breastfeeding families by hosting an EPIC Breastfeeding Program in your office, hospital or health department. Please call Arlene Toole at the chapter’s office if you would like to schedule a program.

      CDC Report on Breastfeeding Initiation and Duration

  
The CDC has a new report out on racial and ethnic differences in breastfeeding initiation and duration by state and nation.  The report is an analysis of children born between 2004 and 2006.  This data is from the National Immunization Survey (NIS).  The report found that non-Hispanic blacks had a lower prevalence of breastfeeding initiation than non-Hispanic whites in all US states but two.  These differences were more predominate in southern states.  Most states were not meeting the Healthy People 2010 target for initiation of breastfeeding, breastfeeding to 6 months and breastfeeding to age 12 months that are 75%, 50%, and 25% respectively.  For more information go to:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5911a2.htm.

Table below shows the prevalence of breastfeeding initiation and duration to 6 and 12 months for Georgia.  This is from the National Immunization Survey, US 2004-2008. 

 

Georgia

No. of respondents

Initiation

6 Months

12 Months

Hispanic

318

76.5

42.9

21.7

White, non-Hispanic

  

1,231                           

 

71.6

 

38.1

 

17.2

Black, non-Hispanic

 

498

 

53.2

 

27.3

 

11.8

   

CDC National Survey of Maternity Care Practices

in Infant Nutrition and Care (mPINC)

 The CDC collects data on maternity care practices and policies related to infant feeding.  They provide this information to help hospitals and birthing facilities improve their policies and practices of maternal and child health.

The CDC has issued the second national Maternal Practices in Infant Nutrition and Care (mPINC) survey.  The first survey was sent out in 2007. All hospitals and birthing centers in the US were surveyed.  The report expresses the importance of evidence based maternity care practices and establishes a baseline measure of these practices and documents how these practices differ by state and region.  Maternity practices influence breastfeeding success during a critical time when the establishment of lactation is most important.  Some of the things that were evaluated were:  labor and delivery care, breastfeeding assistance, separation of mother and baby, staff training and discharge care.

80% of the 87 eligible hospitals and birth centers in Georgia responded to the 2007 CDC mPINC survey.   Georgia had a composite score of 56.  Our rank was 46.  For more information about the mPINC survey, scoring methods and more details on Georgia’s score please go to www.cdc.gov/mpinc.  

Breast Milk Collection and Storage

 

As more and more mothers choose to breastfeed their children there are many mothers returning to work still breastfeeding.  Those working mothers usually have questions about how to store their milk and how long can it keep. The Academy of Breastfeeding Medicine has come out with a protocol for collection and storage of breast milk that is helpful.  To summarize:

 

  1. Moms need to wash their hands with soap and water before beginning to pump.
  2. Mothers can use a pump or hand express to attain their milk.
  3. Most moms choose plastic bags for milk storage.  These should be sturdy and be able to seal well.  Moms should avoid using containers with bisphenol A.
  4. Containers do not need to be sterilized.
  5. Breasts or nipples do not need to be washed before expressing nor does the mom need to discard the first drops of breast milk collected.
  6. Containers should not be filled to the top to account for expansion during the freezing process.  (Usually 2-4 ounces is ideal.)
  7. All milk should be labeled with the date of milk expression and the name of the child if the milk is used in a day care setting.
  8. Moms should avoid adding warm milk to already cooled or frozen milk.
  9. Sometimes the freezing process changes the smell and taste of the milk.  This is due to the activity of lipase that breaks down into fatty acids. The milk is not spoiled and can be fed to the infant but some infants do not like the taste.
  10. You may defrost frozen milk in the refrigerator overnight or thaw by placing under warm water or in a pan with warm tap water.  Microwaving breast milk is not recommended. (nor do we recommend microwaving formula)
  11. Moms should always choose fresh milk first if available.

Expressed milk does not require “universal precautions” like other bodily fluids such as blood. Breast milk can be stored in a workplace refrigerator where other workers store their food.  However, some moms prefer to store their milk in a personal lunch bag with a freezer pack.

 Milk Storage Guidelines

 

Location of storage                   Temperature                    Maximum recommended

___________________________________________________storage duration

                                                                                               

Room Temperature                   16-29°C (60-85° F)           3-4 hours optimal

                                                                                 6-8 hours acceptable under very clean conditons 

                                                                                 

Refrigerator                                =4°C (39°F)                  72 hours optimal

                                                                                 5-7 days under very clean conditions

                                                                                      

Freezer                                     <-4°C (24°F)                 6 months optimal

                                                                                 12 months acceptable

 

For more information on the collection and storage of breast milk you can go to http://www.bfmed.org/Resources/Protocols.aspx.

 

Breastfeeding Benefits

Breastfeeding, Maternal & Infant Health Outcomes in Developed Countries – AHRQ Review Summary April 2007

•         Comprehensive, systematic review of studies conducted in developed countries

–        Screened >9,000 abstracts

–        43 primary studies on infant health outcomes

–        43 primary studies on maternal health outcomes

–        29 systematic reviews or meta-analyses covering approx. 400 individual studies

Breastfeeding, Maternal & Infant Health Outcomes in Developed Countries – AHRQ Review Summary April 2007

Infant Outcomes

•         Breastfeeding is associated with a reduced risk of:

–        Sudden infant death syndrome (SIDS)

–        Obesity

–        Type 1 and 2 diabetes

–        Childhood leukemia

–        Asthma

–        Acute otitis media

–        Non-specific gastroenteritis

–        Severe lower respiratory tract infections

–        Atopic dermatitis

–        Necrotizing entercolitis (NEC)

Maternal Outcomes

•         Breastfeeding is associated with a reduced risk of:

–        Type 2 diabetes

–        Breast cancer

–        Ovarian cancer

–        Early cessation/not breastfeeding is associated with an increased risk of:

–        Postpartum depression 

Barriers to Breastfeeding

  • Special attention should be given to barriers to breastfeeding for all women especially African American and other minority women.  Below are several barriers to breastfeeding that where identified in focus group findings.

    • Embarrassment
    • Lack of social support
    • Worried about not enough milk
    • Lack of support at work or school
    • Worried about having to eat well
    • Lack of information

    Studies show that mothers who receive advice, information and encouragement from their physicians to breastfeed are more likely to breastfeed than those who do not receive such advice. The American Academy of Pediatrics Policy Statement outlines physicians’ roles in the promotion and protection of breastfeeding. View it on the web by accessing http://www.aap.org/policy/re9729.html

    Maternity Care Practices Survey done by the CDC conveys that a mother’s ability to successfully breastfeed her baby is strongly affected by the practices and policies of the hospital that she delivers her baby.  Previous CDC research shows that women who are subjected to the best possible in hospital breastfeeding practices are eight times as likely to continue breastfeeding for at least six weeks compared to women who have a less favorable in-hospital experience.  Postponing the initial breastfeeding experience beyond the first hour of life, giving supplementary feedings in addition to breastfeeding and feeding the baby on a specific schedule all appear to strongly interfere with the successful initiation of breastfeeding. DeGirolamo AM, Grummer-Strawn LM, Fein S. Maternity Care Practices:  Implications for Breastfeeding.  Birth. 2001, 28: 94-100.

               

Studies show that returning to work after having a baby is a major barrier to mothers who want to breastfeed. Moms worry that their employer may not be supportive and provide break time that they would need to pump. They usually have questions about how to pump, how to store milk and how their co-workers will react when they need to take break time to pump.

There is now a well-researched program distributed by the Department of Health and Human Services and the Maternal Child Health Bureau to help these mothers make an informed decision.  The program is called “The Business Case for Breastfeeding”. Georgia was one of 10 states that received funding through the Georgia Breastfeeding Coalition to help implement this program. This funding was to train trainers to offer technical assistance to businesses wanting to start a lactation program.

The Business Case for Breastfeeding includes comprehensive resource kits that target breastfeeding mothers, employers, human resource personnel and others.  The kits or booklets help support a mother’s decision to continue breastfeeding after returning to work.  The program was developed in a train-the-trainer format to assist breastfeeding educators and breastfeeding coalition members to provide information and support to local business and their employers.  The goal is to increase awareness of the economic benefits of breastfeeding, increase the number of employers that provide a worksite breastfeeding support program and provide models for implementing a worksite breastfeeding support program. The information provided focuses on a company’s return on investment (ROI) in employee retention, productivity, decrease in absenteeism and job loyalty.

These resource kits are available free of charge from the US Department of Health and Human Services but it is recommended that employers receive information through those that have been trained to provide technical assistance in their implementation.  For more information you may contact Mary Nicholson-Jackson, the president of the Georgia Breastfeeding Coalition @ mnj03@comcast.net. You may also contact www.ask.hrsa.gov or http://cdc.gov/hwi for a free copy of the brochures. 

Georgia Breastfeeding Rates 2006

 

Help the Georgia Chapter AAP make Georgia a healthier state by scheduling an EPIC Breastfeeding Program.  Let’s increase our states breastfeeding rates together. 

 

 


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