EXPANDED HOSPITAL POLICY #2:

INTERVENTION / MANAGEMENT

RATIONALE

RESOURCES

2.1 Pregnant and postpartum women should be provided information prior to birth, following birth, and before discharge regarding the benefits and management of breastfeeding and the risks associated with artificial feeding.

This information should include how to maintain lactation when separated from their infants.

Classes and teaching materials should be selected which consider the woman’s cultural background, education and preferred language.

2.1 Knowledge and support improve the breastfeeding experience. Most women make their decision about breastfeeding prior to delivery. 2,6,7,8,9,10,15,20,21,23

• Sample Antenatal Checklist (PDF)
• Committee Opinion #361, "Breastfeeding: Maternal and Infant Aspects," is published in the February 2007 issue of Obstetrics & Gynecology. More detailed information on breastfeeding can be found in ACOG Clinical Review (Vol. 12, Issue 1 (supplement), Jan-Feb 2007) "Special Report from ACOG, Breastfeeding: Maternal and Infant Aspects" available to Fellows online at www.acog.org and to nonmembers by emailing jbrenner@acog.org. 
• Sources of links to assist mothers in creating their own Birth Plans:
• English: http://www.birthplan.com/
• Spanish: http://plandeparto.com/
• Sample Birth Plan in English and Spanish with check boxes
• English Birth Plan (Word) 
• Spanish Birth Plan (Word)
• Information for Health Worker/Educator (PDF)

2.2 Education should be provided using a combination of techniques such as one-to-one teaching, group classes, pamphlets and/or video taped instruction.

Hospitals should work with prenatal providers to inform and encourage pregnant women and their partners to attend available breastfeeding classes during the prenatal period.

2.2 Consistency of information provides a similar frame of reference. The mother can refer to educational materials during and after her hospital stay to reinforce learning. 12,16,19,24

Sources of educational materials for patients (Word)

Health Literacy:
http://clearhealthcommunication.com/

Sources of free Breastfeeding education materials include:

• US Department of Health and Human Services
• California Breastfeeding Coalitions
• Breastfeeding Task Force of Greater Los Angeles
• San Diego Breastfeeding Task Force
• Educational Handouts (Word)
• Bright Futures Lactation Resource Centre

Sources of information about California Laws related to breastfeeding

2.3    Classes, pamphlets and videos should reflect the cultural background, education, and language of the population being served.

2.3 Understanding the cultural and socioeconomic context of infant feeding practices is necessary to provide clients with relevant education. 5,21

• Example of a list (PDF)of information that is useful for those working with mothers of different cultures. Source: California WIC Breastfeeding Peer Counselor Training Manual’s Handout #7 in the Appendix (see http://www.wicworks.ca.gov/)
• Riordan J& Gill-Hopple K: Breastfeeding Care in Multicultural Populations (Abstract)

2.4 Materials that promote the use of commercial products known to interfere with breastfeeding should not be used to teach breastfeeding.

2.4 All materials used for breastfeeding promotion and education should be produced by companies whose interests are not in conflict with the promotion of breastfeeding. 15,20

• Perform an office assessment by using: Office and Hospital Scavenger Hunt (PDF)

2.5 Teaching methods should be tailored to the age of the client.

2.5 Teens may prefer alternative learning opportunities such as field trips, games and videos when appropriate.4

Helping Adolescent Mothers Breastfeed by Bonnie Tilson, Pennsylvania – La Leche League website:

2.6 Regardless of feeding choice, discharge teaching should include the benefits of keeping the baby in close physical proximity.

As part of the continuum of care, mothers should be provided discharge education on sleeping with their infants.

2.6 When mothers and babies are in close proximity, mothers are able to identify their infants’ hunger cues and readiness to feed. 2,4,15,16,19,20

The American Academy of Pediatrics (AAP) guidelines regarding parents sleeping with their infants should be followed. 3

Example of a flyer that addresses safe sleeping alternatives. (Solano county – Your Baby Matters (PDF))

Sources of patient information that address cue feeding:

• First Day of Breastfeeding (Word)
• Following Your Baby’s Cues (Word)
• or purchase some from http://www.ncast.org/
• video clips from www.breastfeeding.com

2.7 Physicians should be encouraged to support breastfeeding enthusiastically, according to the recommendation of the American Academy of Pediatrics, and should educate patients based on AAP guidelines.

2.7 Physicians can influence their patients’ health behavior choices during the perinatal period. 22,23

Many professional organizations actively encourage breastfeeding including the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, American College of Nurse-Midwives, the American Hospital Association, the Association of Women’s Health, Obstetric and Neonatal Nurses and the American Dietetic Association.

• AAP’s Breastfeeding Initiatives Website
• Academy of Breastfeeding Medicine
• American Academy of Pediatrics
• American Academy of Family Practitioners
• American Dietetic Association
• Association of Women’s Health, Obstetric and Neonatal Nurses
• International Lactation Consultant Association (PDF)
• National Association of Pediatric Nurse Associates and Practitioners

Additional information on normal breastfeeding issues can be found in:

•  http://www.lalecheleague.org/
• http://www.linkagesproject.org/

Additional Professional information:
Ten Steps to Support Parents’ Choice to Breastfeed Their Baby: (PDF)

2.8 Mothers should be instructed in a method of hand expression of breastmilk. Instruction should be offered to all mothers regardless of feeding choice, prior to hospital discharge.

2.8 Breastfeeding women may have unexpected separations from their newborns. Hand expression is the easiest way to empower new mothers to manage normal breastfeeding emergencies. Hand expression may produce more milk due to the breast massage and skin contact. 17

Non breastfeeding mothers may require relief from engorgement.

Marmet method of hand expression, or see more in the Womanly Art of Breastfeeding, http://www.lalecheleague.org/

Videos to purchase that demonstrate hand expression:

• Hand Expression – English and Spanish - Kittie Frantz
• Breast is Best – (English or Spanish) –Bright Futures Lactation Resource Center

2.9 The breastfeeding mother should be instructed in the correct use of a hospital grade electric breast pump by an experienced perinatal caregiver when the infant consistently demonstrates inadequate suckling or when prolonged separation of the mother and infant is expected because of prematurity or illness. The mother should be given the opportunity to pump as soon after birth as medically feasible.

2.9 Feeding the infant expressed milk validates the mother’s efforts and provides health benefits to the baby. 11,13,15

2.9.1 The electric pumping system is time-saving for the mother. Piston electric pumps attempt to imitate the suckling cycle of the infant.11,13,15,18

2. 9.2 Breast stimulation and breast emptying are necessary to initiate and maintain lactation. 9

2.9.3 Following a protocol for pumping helps maintain consistency of technique and information between care providers.

Information on each particular brand is available in their websites.

A useful website for mothers, http://www.pumpingmoms.org/, links to many other websites.

When dealing with premature infants, go to the California Perinatal Quality Care Collaborative: http://www.cpqcc.org

For information on transitioning a premature infant to breastfeeding, see the protocols from the Academy of Breastfeeding Medicine: (PDF)
Go to Protocols - #12
Transitioning the breastfeeding/ breastmilk–fed premature infant from the neonatal intensive care unit to home

2.10 Discharge planning for breastfeeding mothers who are likely to be separated from their infants should include methods of expressing breastmilk including hand expression and/or pumping. A support person should be included in the teaching process.

2.10 Emphasize the importance of regular breast expression in maintaining lactation. Pumping frequency and length guidelines are based on the method of expression, taking into account baby’s age and mother’s ability to maintain enough volume to support her infant’s needs. If her supply begins to decrease, increased frequency and duration of pumping may increase production. Mother’s who have support are likely to sustain pumping for a longer period of time. 14,17,18,20

When dealing with sick or premature infants, go to the California Perinatal Quality Care Collaborative: http://www.cpqcc.org/ and see the policies for the nutritional support of the VLBW Infant, Part I and II.

The Human Milk Banking Association of North America has released their newest, 2005, Best Practice for Expressing, Storing, and Handling Human Milk in Hospitals, Homes and Child Care Settings.