The Baby Friendly Hospital Initiative IHS Clinical Rounds July 12th, 2012 Host: Susan Karol, MD; IHS Chief Medical Officer Presenter: - Suzan Murphy, MPH, RD, CDE, IBCLC
Objectives for Today’s Rounds • Enumerate the public health concerns addressed by supporting breastfeeding. • Understand breastfeeding support outcomes that the Baby Friendly Hospital Initiative (BFHI) will improve. • Enumerate the ten steps to BFHI certification. • Demonstrate the importance of having at least one resource for breastfeeding support and one for BFHI information.
Accreditation • The Indian Health Service (IHS) Clinical Support Center is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The IHS Clinical Support Center designates this live educational activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. • The Indian Health Service Clinical Support Center is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. • This activity is designated 1.0 contact hours for nurses.
Disclaimer Accreditation applies solely to this educational activity and does not imply approval or endorsement of any commercial product, services or processes by the CSC, IHS, the federal government, or the accrediting bodies.
Guidelines for Receiving Continuing Education Credit • To receive a certificate of continuing education or certificate of attendance, you must attend the educational event in its entirety and successfully complete an on-line evaluation of the seminar within 15 days of the activity. At the end of the evaluation, click on the appropriate line to obtain your certificate, fill in your name and print the certificate. • If you need assistance, please contact Dr. Chris Fore (chris.fore@ ihs.gov) or Mollie Ayala (mollie.ayala@ihs.gov).
Faculty Disclosure Statement • As a provider accredited by ACCME, ANCC, and ACPE, the IHS Clinical Support Center must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Course directors/coordinators, planning committee members, faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty will also disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of this information will be included in course materials so those participating in the activity may formulate their own judgments regarding the presentations. The course directors/coordinators, planning committee members, and faculty for this activity have completed the disclosure process and have indicated that they do not have any significant financial relationships or affiliations with any manufacturers or commercial products to disclose.
Topics for Future Rounds August 9, 2012: “Standards of Care and Clinical Practice Recommendations: Type 2 Diabetes” Ann Bullock, MD; Cherokee Hospital Sept 13, 2012: “Improving Timing Stroke Care: Advances in Tele-Stroke Consultation” Dr. Bart Demaerschalk; Mayo Clinic
Meet the Presenter Suzan Murphy Sue Murphy has been a public health nutritionist since 1976, has served in IHS since 1994. She has worked in breastfeeding support at PIMC since 1999. Ms. Murphy holds a Masters in Public Health from the University of California, Berkeley, is a Registered Dietitian, a Certified Diabetes Educator, and is certified by the International Board of Lactation Consultants.
Supporting Breastfeeding US Department of Health and Human Services Indian Health Service Adobe Connect meeting July 12, 2012
Thank you for joining us today My name is Sue Murphy I am an RD, MPH, CDE, IBCLC Phoenix Indian Medical Center 4212 N 16 th Street Phoenix, AZ 85016 602-263-1200 X 1737 Breastfeeding Helpline – 1-877-868-9473 suzan.murphy@ihs.gov
Learning Objectives Participants will be able to identify: 1. Public health concerns addressed by supporting breastfeeding. 2. Breastfeeding support outcomes that the Baby Friendly Hospital Initiative (BFHI) will improve. 3. The ten steps to BFHI certification. 4. At least one resource for breastfeeding support and one for BFHI information.
IHS and Tribal Health Care (www.ihs.gov)
Healthy children are the goal of every community and the future of each tribe
Prevalence of Overweight and Obesity in IHS Active Clinic Patients (2008) 90% 81% 80% 70% 60% 51% 49% 45% 50% 40% 30% 20% 10% 0% 20-74 yrs 12-19 yrs 6 - 11 yrs 2-5 yrs
Prevalence of Type 2 Diabetes and Pre-Diabetes 35.0% 30% estimate 30.0% 25.0% 20.0% 16.3 % 15.0% 8.7 % 10.0% 5.0% 0.0% AI/AN AI/AN pre-diabetic non-Hispanic white HHS/IHS/Division of Diabetes Treatment and Prevention, Facts at-a-Glance, June 2008
Obesity and Diabetes are Epidemic Obesity Rates in the General Population, CDC 2010 40% 33.8% 35% 30% 25% 20% 17.0% 15% 10% 5% 0% 2-19 yrs adults Obese = >30 BMI
Perinatal and Lifelong Impact Perinatal predictors of future risk for diabetes and over weight: • Gestational diabetes/impaired glucose tolerance. • Macrosomia/newborn hypoglycemia. CDC, 2011 – • New diagnostic criteria for gestational diabetes will increase the proportion of women diagnosed with gestational diabetes. • Using these new diagnostic criteria, an international, multicenter study of gestational diabetes found that 18% of the pregnancies were affected by gestational diabetes.
Type 2 Diabetes at age 40 by Early Feeding Choice (1997) Rate of diabetes (%) Relative weight (%)
More Results (Young et al, 2002) Early Infancy Risk Factors for Diabetes in Native Canadians 1.2 1 1 0.8 odds ratio 0.6 0.4 0.24 0.2 0 Formula Fed Breastfed 12 months or longer
Risk of Early Childhood Overweight for Infants of Gestational Pregnancy (Schaefer-Graf UM et al, 2006) n = 354 40% 33.7% 32.5% 35% 30% 25% 22.0% 20% 15% 10% 5% 0% Not breastfed Breastfed less than 3 Breastfed more than 3 months months
Obesity Risk by Feeding Choice at Nine Months (T Harder et al, 2005)
SIDS SIDS by Feeding Choice at 6 months (M Bartick et al, 2010) 1.2 1 1 0.8 odds ratio 0.64 0.6 0.4 0.2 0 Any Breastfeeding Formula 75% of SIDS occurs between 2 - 6 months of age
And for Mom Less risk of: • Type 2 Diabetes • Ovarian Cancer • Breast Cancer
Health $ Saved in Billions (M Bartick et al 2010) $3.35 $4.00 $2.68 $3.00 Billions $2.00 $1.00 $0.00 90% Breastfeeding rate 80% breastfeeding rate Percentage of new families reaching Healthy People 2010 goals – Exclusive breastfeeding to 6 months, Continued breastfeeding with solids to 1 yr or more.
Socioeconomic Benefits • Breastfed infants usually require fewer sick care visits, prescriptions, and hospitalizations. • Employers benefit: improved absenteeism rates. • Reduced insurance costs.
Lives Saved Annually (M Bartick et al 2010) 1000 911 900 741 800 700 600 500 400 400 300 200 100 0 90% 80% carseats (DOT data) Percentage of new families reaching Healthy People 2010 goals – Exclusive breastfeeding to 6 months, Continued breastfeeding with solids to 1 yr or more.
More Breastfeeding Means • Less illness for babies and their communities. • Less diabetes for baby and mom. • Less obesity or overweight. • Fewer health care dollars used for preventable problems.
Baby Friendly Hospital Initiative (BFHI/USA) • BFHI - part of Let’s Move! in Indian Country (LMIC): • LMIC is the White House initiative to reduce obesity among children. • Reflected in the new IHS Healthy Weight for Life Initiative • BFHI will bring new awareness to the untapped benefits of breastfeeding.
What does Baby Friendly mean? 1. Have a written breastfeeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Help mothers initiate breastfeeding within one half-hour of birth. 5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
What does Baby Friendly mean? (cont) 6. Give newborn infants no food or drink other than breast milk, unless medically indicated. 7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day. 8. Encourage breastfeeding on demand. 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
As of 2007, in the US • 2.9 percent live births occurred in facilities that provide recommended care for lactating mothers and their babies
BFHI Results BFHI (US) No BFHI Initiation 84% 70% Exclusivity 78% 46% Pediatrics, Merewood A, et al, 2005
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