Breastfeeding Grand Rounds 2018 - Originally broadcasted August 2, 2018

Increasing Skin-To-Skin Contact to Improve Perinatal Outcomes and Breastfeeding Success

Speakers:
Nils Bergman, MB ChB, DCH, MPH, MD
Kangaroo Care Movement, Co-Founder
International Network of Kangaroo Mother Care, Steering Committee
Public Health Physician & Professor
University of Cape Town, South Africa

Denise Barbier, OTR/L, MOT
United States Institute of Kangaroo Care, President
Co-Author: “Jumping into Kangaroo Care” Toolkit
Pediatric NICU Occupational Therapist

This webcast gave an “overview of skin-to-skin contact (Kangaroo Care) for newborn infants, including the strong evidence-base that skin-to-skin contact provides health benefits to infants and mothers and leads to breastfeeding success. Successful strategies, including prenatal education by WIC providers to increase early use and longer duration of skin-to-skin contact for all mothers, was discussed. Examples from New York, other states and abroad were highlighted”.

Program Objectives:
After watching this webcast participants will be able to:

Explain the neurobehavioral and physiological basis for mother-infant skin-to-skin contact for all newborns.
List at least three evidence-based health benefits for infants and mothers from skin-to-skin contact.
Describe how early skin-to-skin contact facilitates breastfeeding success.
Identify successful strategies from New York, other states, and/or countries to increase implementation of early and longer duration of skin-to-skin contact.
View this link for the webcast and handouts at no cost.

https://www.albany.edu/sph/cphce/bfgr18.shtml

Continuing education credits are available after completion of the evaluation and post-test.


The Journal of Breastfeeding Medicine published a study in January 2017, titled; “Breastfeeding and Complementary Feeding Patterns Among Women Enrolled in WIC: WIC Infant and Toddler Feeding Practices Study-2.”, “Feeding My Baby”.

This large study conducted over a period of 5 years, across states nationwide looked at infant and toddler feeding practices during late pregnancy and early infancy used by parents and nutrition outcomes of children enrolled in WIC and the effect WIC has on these practices.

The study looked at:

• Attitudes toward breastfeeding
• Infant feeding perceptions of WIC services
• Where participants go for feeding advice
• Knowledge of WIC benefits and food packages

The study showed negative views of breastfeeding have decreased from 1995 to 2013 with 80% of WIC mothers believing breastfed babies are heathier offering them protection from disease and creating a strong bond with baby. From 1995 to 2013 negative views about breastfeeding has decreased.
The good news is, breastfeeding rates have more than doubled since earlier studies.

Main findings:

• The percentage of WIC infants who are exclusively breastfed without supplementation is very small
• Maternal race and ethnicity, immigrant status and maternal education are associated with the choice of feeding methods
• In addition to formula supplementation, substantial breastfed infants also receive some supplemental foods during the first few months
• Half of breastfeeding mothers supplement about the time their infant is 2 months old
• Mothers who have breastfeeding problems are 70% more likely to supplement
• Perceived benefits of breastfeeding are associated with lower likelihood of supplementation
• Knowledge of the WIC breastfeeding food package is associated with lower supplementation
• Half of WIC mothers who initiative breastfeeding wean their infant by 57 days of age
• Early initiation of cow’s milk or other milk appears to be less of a problem for WIC mothers
• 70% of mothers did not reach their breastfeeding goal

To view the reports:

• WIC IFPS- 1 Infant Feeding Practices Study, 1997 -https://www.fns.usda.gov/wic/wic-infant-feeding-practices-study
• WIC ITFPS-2 Infant Report: Intention to Breastfeed, 2015 - https://www.fns.usda.gov/wic/special-supplemental-nutrition-program-women-infants-and-children-wic-infant-and-toddler-feeding
• WIC ITFPS-2 Infant Report: Infant Year Report, 2017 - https://www.fns.usda.gov/wic/wic-infant-and-toddler-feeding-practices-study-2-infant-year-report

Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017

Breastfeeding reduces the risk of Sudden Infant Death Syndrome (SIDS)
We know breastfeeding decreases the risk of SIDS by 50 % or more. A study published in Science Daily, October 30, 2017, looked at breastfeeding duration and exclusively demonstrates breastfeeding for just 2 months cuts the risk in half and the longer baby is breastfed the greater the protection. The important finding in this study where they looked at several studies, mothers do not have to breastfeed exclusively, as previously thought. This is good news for mothers who chose to both breast and formula feed or are unable to exclusively breastfeed. You may wonder how breastfeeding influences SIDS, it is thought that breastfeeding offers protection against illness, has a calming effect on baby and the mother and helps baby organize their sleep/wake cycle.

To view the study:
https://www.sciencedaily.com/releases/2017/10/171030123401.htm

Loving Support Award of Excellence
USDA has announced the Loving Support Award of Excellence application period from October 10 to December 17, 2017. This award was developed to recognize and celebrate WIC Local agencies that provide exemplary breastfeeding programs and support services.

Local WIC agencies that have operated a peer counseling program for at least one year, which meets all the required core components of the FNS Loving Support© Model for a successful peer counseling program, are eligible to apply. The award is available at three levels of performance: Gold, Gold Premiere, and Gold Elite. This approach recognizes three groups of agencies that include those that are demonstrating model practices, as well as those who are at varying stages of implementing exemplary breastfeeding promotion and support practices. The Loving Support awards are valid for a 4 year period; however an LA may apply for an award of higher achievement each year.

The latest application, instructions, and frequently asked questions documents can be found here.

Resources that are being provided to assist in the application process include the important attachments as well as these helpful links:
FY 2016 WIC Breastfeeding Data Local Agency Report 
Loving Support Award of Excellence Application Page 
Loving Support Award FAQs 
Past award winners 

Northeast Region Loving Support Awards
The United States Department of Agriculture (USDA) has developed an internal Northeast Regional Office (NERO) Newsletter, 'At The Table'. This newsletter showcases the wonderful work that USDA's nutrition assistance programs are doing in our region, and the strong community partnerships that they have established. 
We are delighted to announce that this year’s USDA Loving Support Awardees from the Northeast region are featured in the newsletter. The newsletter includes great pictures of our USDA representatives personally awarding our local agencies with their awards! The Northeast Region, comprised of 7 states, awarded 12 WIC local agencies in the NERO region with Loving Support Awards. New York local agencies received 8 of the 12 awards. They are as follows:

• Whitney Young Health Center
• Opportunities for Otsego, Inc.
• Clinton County Health Department
• Bedford Stuyvesant Family Health Center
• St. Barnabas Health System
• Urban Health Plan
• Catholic Charities of Buffalo
• The Stony Brook WIC Program

New Morbidity and Mortality Weekly Report (MMWR) released

The Centers for Disease Control and Prevention have released a new Morbidity and Mortality Weekly Report (MMWR) entitled, "Trends in Breastfeeding Among Infants Enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children — New York, 2002–2015." To assess breastfeeding trends among New York State WIC infants, indicators for measuring breastfeeding practices reported by the New York State WIC Pediatric Nutrition Surveillance System (PedNSS) during 2002–2015 were examined. Despite improvements in breastfeeding initiation, increasing the duration of breastfeeding and of exclusive breastfeeding among infants enrolled in the New York State WIC program remains challenging. Identifying targeted strategies to support continued and exclusive breastfeeding should remain priorities for the New York State WIC program.

A Community Partnership to Support Breastfeeding Mothers of Late Preterm Infants

Late preterm infants are those born between 34 and 36 weeks’ gestation. These babies present challenges to mothers who want to exclusively breastfeed. These infants often adapt well to life outside the womb and may have difficulties with suck, have more sleepiness, low breast milk intake putting them at risk for readmission to the hospital for jaundice, weight loss or slow weight gain. In a recent article "A Community Partnership to Support Breastfeeding Mothers of Late Preterm Infants", published in Nursing for Women’s Health, August/September 2017 the article shows the importance of support for the late pre-term mother.
A partnership was formed between WIC and the hospital to ensure seamless continuity of care for mothers faced with unique challenges.
A tertiary hospital in the Mountain West region of the U.S. and a WIC peer counselor program formed a partnership to improve breastfeeding outcomes for the late preterm infant. The peer counselors received training to understand the challenges mothers faced and were encouraged to listen, encourage the mother and refer situations that were outside their scope of practice. The hospital NICU RN, Lactation Consultant would notify the WIC peer counselor and the PC would meet the mother in the hospital. This project was expanded beyond the NICU to the hospital mother/baby unit where all WIC mother/baby dyads were connected with a PC.

To review the entire article, visit: https://doi.org/10.1016/j.jneb.2017.05.364

In a recent Webinar Dr. Marianne Neifert discussed how to support the mother of the late preterm infant: Preemie Series: “Just a Few Weeks Early, Breastfeeding Management for the Late Preterm Infant”. The achieved webinar can be viewed here.

Upcoming Breastfeeding Conferences:


Understanding Health Care Reform & Breastfeeding
Wondering how health care reform might impact breastfeeding promotion? The U.S. Breastfeeding Committee recently published a summary of the breastfeeding provisions in the Affordable Care Act. They also summarized potential impacts to breastfeeding from the proposed American Health Care Act. Read their analysis here.


Academy of Breastfeeding Medicine Releases Revised Supplementary Feedings Protocol
The Academy of Breastfeeding Medicine (ABM) recently updated their protocol for supplementary feedings of breastfed newborns. The revised protocol highlights ways to reduce the need for supplementary feedings, and clarifies how providers can determine whether supplementation is truly required. The revised protocol can be found here.

New York State Family Leave
In 2016, Governor Cuomo signed into law the nation’s strongest and most comprehensive Paid Family Leave policy. Starting January 1, 2018, New York will have the strongest paid family leave plan in the nation to ensure that no one will have to choose between losing a job and missing the birth of a child or being able to spend time with a loved one in their final days. 
The Family Leave Program will provide New Yorkers job-protected, paid leave to bond with a new child, care for a loved one with a serious health condition or to help relieve family pressures when someone is called to active military service. Read more.

Dr. Howard Zucker’s Breastfeeding Call to Action
The 2016 Breastfeeding Grand Rounds featured a video roll-in of New York State Department of Health Commissioner Dr. Howard A. Zucker, MD, JD, who spoke on the importance of exclusive breastfeeding as a public health priority. Dr. Zucker acknowledged the progress made in NYS to strengthen breastfeeding practices, and highlighted the revised Perinatal Regulations and the new Paid Family Leave Act. 
Dr. Zucker’s important message has been adapted into a Dear Colleague letter that has been sent to over 78,000 email addresses of physicians and hospital leaders across the state. This letter builds upon his Call to Action and encourages the development of supportive, enabling environments across the continuum for all women who want to breastfeed, including the importance of working with moms prenatally and early postpartum, and referral to WIC for breastfeeding education and support. The release of this letter provides an excellent opportunity to strengthen collaborations with community providers and to promote WIC as the breastfeeding experts in the community.
Use it as a conversation starter to begin a discussion with providers and community partners on how to establish breastfeeding as a social norm. We all share a responsibility in improving support for women and their families, and invite you to be an agent for change.  

UN Supports and Promotes Breastfeeding

A joint statement was issued by United Nation experts telling countries they need to do more to protect, promote, and support breastfeeding as a human right, including ending the inappropriate marketing of breast-milk substitutes and other foods intended for infants and young children.
UN experts emphasized the importance and many benefits of breastfeeding for both the mother and child. Concern was expressed about the lack of progress made in improving breastfeeding rates globally and in providing women and their children with the support and protection they are entitled to.
The experts voiced particular concern about the continued misleading marketing of breast milk substitutes and other foods intended for infants and young children. They pointed out that there is little corporate accountability for the adverse consequences of such marketing practices which, the experts said, continue to undermine efforts to improve early and exclusive breastfeeding rates.
The experts called upon governments to take all necessary measures to promote and protect breastfeeding and welcomed renewed global efforts to reduce the inappropriate marketing of commercially prepared foods for infants and young children.

National WIC Association Statement on Infant Formula Manufacturers

The National WIC Association (NWA) announced during the NWA’s 2016 Nutrition and Education Conference they are ending their relationship with infant formula manufacturers.  Effective immediately NWA will no longer invite infant formula companies to be members, exhibitors at conferences, advertisers or sponsors of events and activities. This move furthers NWAs goal of supporting WIC as the nation’s Go-to Breastfeeding Program.  For more information, please click here.

New York State Celebrates World Breastfeeding Week 2016

Breastfeeding mothers and families, elected officials and advocates from all over New York City gathered on the steps of City Hall for a rally to celebrate World Breastfeeding Week.  Following the rally many participated in the NYC Breastfeeding Leadership Council’s annual Breastfeeding Subway Caravan.  The caravan traveled on the “A” train to Bedford-Stuyvesant’s Restoration Plaza for the Annual World Breastfeeding Week Fair sponsored by the Brooklyn Alliance for Breastfeeding Empowerment (B.A.B.E.).

At the Rally, the New York City Breastfeeding Leadership Council presented their annual Breastfeeding Champion Award to Council Member Kevin Cornegy for his leadership in promoting breastfeeding as an option for working mothers and co-sponsoring the Lactation Room Bill (Intro 1063) which will require lactation rooms in certain public buildings in New York City.

New York City Helps Their Youngest Get a Healthy Start

On August 11, 2016, New York City’s Mayor Bill de Blasio signed a law which requires lactation rooms in public buildings that serve members of the public. This legislation reinforces a woman’s right to breastfeed in public while creating safe, hygienic, and private spaces where women can breastfeed or lactate comfortably.  New York City leads the way as one of the first cities in the nation to provide this type of service to visitors of city facilities.

New York State Hospitals Support Breastfeeding

Women giving birth in New York State hospitals receive additional support and encouragement for breastfeeding.  In October amended regulations were added that require hospitals to place newborns skin to skin with their mothers following birth (unless medically contraindicated), discuss the risks of early pacifier use and prohibit hospitals from giving out gift bags that contain formula marketing materials or free samples.  Hospitals will provide formula to infants whose parents have chosen formula feeding with additional education on formula preparation and feeding techniques.

View the press release.


View the policy.