Cindy Galloway

2018 Summit Registration Now Open

The Second Annual Idaho Breastfeeding Summit sponsored by the Idaho Breastfeeding Coalition is planned for June 28-29, 2018 at St. Alphonsus Health System Boise. Summit details and registration are now available, HERE!

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St. Luke’s Nampa Embraces Innovative Peer Breastfeeding Program

St. Luke’s Nampa Embraces Innovative Peer Breastfeeding Program

By Amy Stahl, News and Community

January 4, 2018
Cindi Bennett (at left), a nurse at St. Luke’s Nampa, has helped champion a peer breastfeeding program in partnership with Central District Health. She is pictured here with peer counselor Debra Scott.

In the months before Yule Stimpson gave birth to her son in January 2017, she worried about breastfeeding and the health of her baby. “I felt really confused and overwhelmed sometimes,” said the first-time mom.

During her pregnancy, Stimpson was introduced to a peer breastfeeding counselor through an innovative program at Central District Health Department’s Supplemental Nutrition Program for Women, Infants and Children (WIC).

After the baby’s delivery, they stayed in touch via phone calls, texting and personal visits. The peer breastfeeding counselor provided anticipatory guidance and support at a time when Stimpson was anxious about the baby’s ability to receive adequate nutrition by breastfeeding.

“It’s really nice to have someone who has your back when you are vulnerable,” she said.

Now, more new mothers will benefit from this invaluable service. St. Luke’s Nampa and Southwest District Health Department are expanding the acclaimed mother-to-mother peer breastfeeding program to Canyon County.

According to the U.S. Surgeon General, one of the most effective preventive measures a mother can take to protect the health of her infant and herself is breastfeeding. However, while 75 percent of U.S. mothers start out breastfeeding, only 13 percent of babies are exclusively breastfed at the end of six months.

Cindi Bennett, a nurse at St. Luke’s Nampa, is overjoyed. Bennett, an International Board Certified Lactation Consultant (IBCLC) and a graduate nursing student in population health, helped champion a partnership between St. Luke’s Boise and the Central District Health WIC program in 2016. The goal is to support breastfeeding moms and their babies, particularly late preterm infants born between 34 and 37 weeks.

As a former IBCLC nurse in the Newborn Intensive Care Unit (NICU) at St. Luke’s Boise, Bennett became acutely aware of the needs of the these babies and their moms.

“Working in a NICU opened my eyes to the special care needs of all the NICU population, particularly the late pre-term babies because it takes these infants a long time to transition to full feedings at the breast and they require professional and community lactation support,” Bennett said.

Although late pre-term infants are often treated as full-term babies and discharged within two days, they are more at risk for readmission due to jaundice, rapid weight loss and slow weight gain.

Breastfeeding can help improve health and reduce readmissions, yet new mothers face numerous challenges.

“The number one reason why moms quit breastfeeding is because they don’t know if they are feeding their baby enough milk,” she said.

Peer counselor Brenda Jimenez.

New moms learn from the personal experiences of their peer counselors. All the counselors are recruited from WIC’s target population – low-income mothers. They undergo extensive training, including a hospital orientation, meetings with nursing staff and tours of the NICU and mother/baby units.

St. Luke’s Women’s Service Line Administrator Dixie Weber helped guide the process that enabled the peer mentors to establish contact with new moms in the hospital. By normalizing their presence, the peer mentoring program becomes an “an expected aspect of care.”

“It is a win-win for our patients and our community partners. It provides an innovative approach to providing ongoing breastfeeding support to vulnerable populations and is in alignment with your service line’s desire to establish community partnerships that benefit their patients”.

“The WIC program aligns with St. Luke’s Strategy 2020 by preventing silos along the care continuum and is driving innovation aimed at improving outcomes or decreasing the total cost of care,” she said.

The peer counselors also script their initial phone calls and review resource materials to help them understand the unique needs of mothers who are breastfeeding a late pre-term infant.

The peer counselors learn to listen, encourage and refer situations outside their scope of practice for more advanced medical needs.

“The peer counselors realize they need to get help when the issues are outside their skill sets,” Bennett said.

After the moms and babies are discharged, the peer counselors stay in touch via phone calls, text and-in person visits to answer questions about latching, sore nipples, engorgement and milk supply. Sometimes they share videos to help educate frantic moms needing support in the middle of the night.

The program serves as a “baby friendly step in the transition between the hospital and home,” said Cindy Galloway, a Central District Health-registered dietitian and IBCLC.

Southwest District Health has hired three peer counselors, including one who is bilingual.

“We are very excited about getting into the hospitals and helping make a difference,” said Mary Schwartz, a registered dietitian and breastfeeding peer counselor coordinator. “At WIC, our goal is for babies and moms to be healthy. Breastfeeding is a major component since it will get a child off to a good start in health.”

The peer breastfeeding program has earned recognition from the International Board of Lactation Consultant Examiners and the International Lactation Consultant Association. In April, Bennett and Galloway will give a presentation about the program at the National WIC Association Annual Education and Training Conference in Chicago.

While Bennett is grateful that the program is gaining visibility around the country, she is most excited to help the moms and babies in her adopted hometown. The peer breastfeeding counselor program is just the start to improving the health of moms and babies in the community.

“We need to bring everybody together,” Bennett said. “Population health is where you find resources and bring them in. We are going to find those grandmas, neighbors, businesses, other community partners and other resources to help.”

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Even Partial Breast-Feeding for First Few Months Lowers SIDS Risk

Even Partial Breast-Feeding for First Few Months Lowers SIDS Risk

New research confirms that breast-feeding for two to four months of a newborn’s life can significantly reduce the risk of sudden infant death syndrome (SIDS).It’s still unclear how breast-feeding might offer protective effects against SIDS, but there are several theories, the study authors said. Some research has indicated that breast-fed infants are more easily aroused from sleep than formula-fed infants, which might help them to wake if they’re having trouble breathing. Differences have also been found in a mother’s response to her infant’s behavioral cues, depending on feeding mode, which may also affect the baby’s sleep and arousal patterns. Additionally, research has shown that breast-feeding provides immune benefits that help prevent viral infections. Such infections are associated with an increased risk of SIDS, the study authors said. Whatever the reason, “this (study) provides very strong evidence of the benefits of breast-feeding in relation to the protective effects with SIDS,” the author noted.

 

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Education for WIC Peer Counselors About Breastfeeding the Late Preterm Infant

Education for WIC Peer Counselors About Breastfeeding the Late Preterm Infant

Cindi Faith Bennett, MN, RN, IBCLC, St Lukes Health System,  Cynthia Galloway, RDN, LD, IBCLC,

Idaho Central District Breastfeeding WIC Program, and Jane S. Grassley, PhD, RN, IBCLC,

Boise State University collaborated on a project to report on providing breastfeeding education for peer counselors.

Mothers of late preterm infants need ongoing support because they often find establishing breastfeeding (BF)

to be complex and difficult.  Special Supplemental Nutriont Program for Women, Infants and Children peer counselors

provide BF information and emotional support to new mothers in many communities.However, their

current training does not include education about BF for the late preterm infant. The purpose of this report is

to present important information about BF and the late preterm infant that can enhance peer counselors’ ability

to offer appropriate support. The effect of this education on outcomes such as BF rates, maternal selfefficacy,

infant hospital readmissions, and peer counselors’ self-efficacy needs to be investigated.

 

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A Community Partnership to Support Breastfeeding Mothers of Late Preterm Infants

A Community Partnership to Support Breastfeeding Mothers of Late Preterm Infants

Cindi Faith Bennett, MN, RN, IBCLC, a lactation consultant in the NICU at St. Luke’s Health System in Boise, ID

and Jane S. Grassley, PhD, RN, IBCLC, a professor and the Jody DeMeyer Endowed Chair in the School of Nursing

at Boise State University in Boise, ID coauthored a manuscript that was published in the AWHONN

Nursing for Women’s Health Journal.  They presented their research at he AWHONN conference in New Orleans in July.others of late preterm infants need timely breastfeeding support after hospital discharge. Breastfeeding peer counselors with the Special

Mothers of late preterm infants need timely breastfeeding support after hospital discharge. Breastfeeding peer counselors with the Special

Supplemental Nutrition Program for Women, Infants, and Children (WIC) can provide this support, but communication with hospitals is needed

to facilitate early contact with women. We aimed to develop and implement a sustainable organizational process that would expedite support by

providing WIC peer counselors access to mothers of late preterm infants before hospital discharge. Key strategies included creating a workable process;

addressing barriers and stakeholder concerns; planning a pilot program to test the process; and inviting the WIC breastfeeding peer counselors

to tour the hospital, meet nursing staff, and practice scripting their initial encounter with mothers. The organizational pathway currently is being

implemented throughout the health system.

 

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WIC program sponsors 1st-ever Idaho Breastfeeding Summit to continue support for mothers and babies

Mimi Fetzer

By Mimi Fetzer, RDN, LD Breastfeeding Coordinator for the Idaho WIC

Program of IDHW’s Division of Public Health

In the summer of 2016, the Idaho Women, Infants, Children (WIC) program’s breastfeeding accomplishments helped it receive a Breastfeeding Bonus Award of $103,882 from the U.S. Department of Agriculture.

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The Idaho Breastfeeding Summit drew 160 participants Aug. 1-3 in Boise.

Many of the WIC-designated breastfeeding experts also participate in the Idaho Breastfeeding Coalition to help supplement their knowledge and community outreach efforts. It was proposed that a large portion of the Idaho Breastfeeding Bonus Award go toward funding a first-ever Idaho Breastfeeding Summit, a conference that would strengthen breastfeeding efforts currently benefiting the state of Idaho.

 

 

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Dr. Marianne Neifert speaks at the Idaho Breastfeeding Summit in Boise about long-term health benefits from breastfeeding.

 

Many national breastfeeding organizations claim the key to lengthening exclusive breastfeeding duration rates is taking a community approach toward ensuring mothers and babies are supported in multiple areas of their breastfeeding experience. This is difficult in rural Idaho where miles can separate important stakeholders.

Long-term health benefits of breastfeeding for the child include a reduced incidence of childhood obesity, cancers, allergies, and asthma. For the mother, breastfeeding increases the bonding with the baby and also reduces the risk of some cancers. Idaho has the  second-highest breast feeding rate in the nation, according to the Centers for Disease Control.

 

 

 

 

The Idaho Breastfeeding Coalition spread the news of the summit to physicians, dietitians, nurses, WIC staff, and other community members, resulting in the attendance of 160 people over the summit’s three days from Aug. 1-3, 2017.

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(Left to right) Andy Bourne, Ivie Smart, Kristin Mckie Bergeson, Mimi Fetzer participate in one of the panel discussions during the 2017 summit.

 

After consideration of all input, speakers Jane Morton, Marianne Neifert, Thomas Hale, and Marsha Walker were engaged to lend their expertise on topics such as hand expression and pumping, the late-preterm infant, and medications for breastfeeding mothers. The summit concluded with coalition-building, sharing, and taking action. The summit was an great time to recognize the breastfeeding accomplishments of local Idaho community members, such as hospitals who have taken the steps to “Ban the Bag” and eliminate formula sample distribution in their discharge bags.

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Loving Support Award: (from left to right) Western Region Breastfeeding Coordinator Jen Post, Panhandle Breastfeeding/Peer Counseling Coordinator Mary Monroe, Panhandle WIC Coordinator Kim Young, Idaho State Breastfeeding Coordinator Mimi Fetzer

The Panhandle Health District was recognized for being the first in the nation to receive the USDA’s Loving Support Gold Elite award for its Peer Counseling Program. The Idaho Division of Public Health’s own Elke Shaw-Tulloch, Andy Bourne, Ivie Smart, Kristin McKie Bergeson, and Mimi Fetzer spoke about the ways their programs promote breastfeeding.

The summit resulted in newly formed connections, an abundance of breastfeeding promotion resources, and an invigorated desire to promote the most optimal form of support for mothers and babies in Idaho.

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Save the Date August 2017

First ever Idaho Breastfeeding Summit sponsored by the Idaho Breastfeeding Coalition and State of Idaho WIC Program
August 1, 2, 3 2017
St Alphonsus Health System Boise
Contact Cindy Galloway 208-327-8565

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Breastfeeding Medicine US Public Health guidelines should reflect evidence, not anecdote

Breastfeeding Medicine US Public Health Guidelines Should Reflect Evidence, not anecdoteUS Public Health guildelines should reflect evidence, not anecdote

In 2008, the United States Preventive Services Task Force issued the following recommendation with Grade B Evidence: “The USPSTF recommends interventions during pregnancy and after birth to promote and support breastfeeding.” Since that time, breastfeeding initiation, continuation, and exclusivity rates have continued to rise, and the number of hospitals designated as Baby Friendly has increased by almost 5-fold.  The ABM Position on Breastfeeding–Revised 2015 indicates that “breastfeeding is, and should be considered, normative infant and young child feeding” and “a human rights issue for both mother and child.”  ABM further states that “children have the right to the highest attainable standard of health,” and “as breastfeeding is both a woman’s and a child’s right, it is therefore the responsibility of the healthcare system . . . to inspire, prepare, and empower as well as support and enable each woman to fulfill her breastfeeding goals and to eliminate obstacles and constraints to initiating and sustaining optimal breastfeeding practices.” ABM calls for an improvement in breastfeeding promotion, protection and support and states that medical professionals have a responsibility to promote, protect, and support breastfeeding as a basic ethical principle.

The American Academy of Pediatrics, in its 2012 Policy Statement on Breastfeeding and the Use of Human Milk concludes that, “research and practice in the 5 years since publication of the last AAP policy statement have reinforced the conclusion that breastfeeding and the use of human milk confer unique nutritional and nonnutritional benefits to the infant and the mother and, in turn, optimize infant, child, and adult health as well as child growth and development. Recently, published evidence-based studies have confirmed and quantitated the risks of not breastfeeding. Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue. As such, the pediatrician’s role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal.”

Recently, the USPSTF proposed a new recommendation: “The USPSTF recommends providing interventions during pregnancy and after birth to support breastfeeding.”  Note that this statement does not state “promote and support,” but just “support.” The task force made a deliberate decision to delete the “promote” from the previous “promote and support.” The evidence review, however, does not support the proposed change. In explanations about this change, a member of the Task Force, Dr. Alex Kemper, as quoted in MedPage Today, stated that “the reason the Task Force made this slight word change is to recognize the importance of a mother doing what she feels is best for her and her baby and not wanting to, for example, make mothers feel guilty or bad if they decide not to breastfeed,” he said. “It’s really a personal choice that needs to be made based on her own personal situation.”

In the 2016 USPSTF evidence report, the following statement is made:  “We systematically reviewed the literature for a variety of potential adverse events associated with breastfeeding interventions, including mothers reporting feeling criticized by the interventionist, guilt related to not breastfeeding, increased anxiety about breastfeeding, and increased postpartum depression. Only two of our included studies reported adverse events that mothers experienced related to the intervention and included reports of increased anxiety, feelings of inadequacy, and concerns regarding their family’s confidentiality. Although the goals of these interventions focused on initiating and continuing breastfeeding and empowering women to do so, it is important that interventionists respect family’s individual decisions.” The discussion further describes those two Canadian trials of “fair” quality, and goes on to note that: “Dennis and colleagues (CMAJ. 2002 Jan 8;166(1):21-8) compared a peer support intervention with usual care and reported that a few mothers in the intervention group expressed feelings of anxiety, decreased confidence, or concerns about confidentiality. For example, one mother requested to discontinue her participation in the intervention, stating that the peer volunteer frightened her about the potential hazards of not breastfeeding and diminished her feelings of confidence, despite the fact that breastfeeding was going well for her.”  The authors of the quoted study report that: “Of the 130 mothers who evaluated the peer support intervention, 81.6% were satisfied with their peer volunteer experience and 100% felt that all new breast-feeding mothers should be offered this peer support intervention.”  Therefore, it appears that one mother’s complaint about a peer counselor is enough to change a U.S. public health recommendation.  Is this change based on evidence or on personal opinion?

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If breastfeeding is truly a public health issue with benefits that have been widely documented for both women and children, then health care providers should be promoting breastfeeding to empower women to make an informed decision about their infant feeding choice.  Physicians who have been taught counselling skills can provide such information without inducing guilt. We don’t seem to worry so much about guilt when counseling patients about smoking cessation, weight reduction, or need to increase exercise.  If we are advocating for each child and mother to achieve the highest attainable state of health, we must both promote and support breastfeeding, protecting each mother and child’s right to do so, and supporting each family in their infant feeding decision.  These are not mutually exclusive outcomes.

The DRAFT Recommendation Statement will be open for public comments until May 23, 2016 at 8:00 PM Eastern.

Joan Meek, MD, MS, FAAP, FABM, IBCLC is a Associate Dean for Graduate Medical Education and Professor of Clinical Sciences Florida State University College of Medicine. She has served as president of the Academy of Breastfeeding Medicine, Chair of the American Academy of Pediatrics Section on Breastfeeding, and Chair of the United States Breastfeeding Commitee. You can follow her on twitter @joanymeek 

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Breastfeeding: achieving the new normal

Breastfeeding: achieving the new normal

Breastmilk makes the world healthier, smarter, and more equal: these are the conclusions of a new Lancet Series on breastfeeding. The deaths of 823 000 children and 20 000 mothers each year could be averted through universal breastfeeding, along with economic savings of US$300 billion. The Series confirms the benefits of breastfeeding in fewer infections, increased intelligence, probable protection against overweight and diabetes, and cancer prevention for mothers. The Series represents the most in-depth analysis done so far into the health and economic benefits that breastfeeding can produce.

However, although the Series is comprehensive, the message is not new. In 2013, a Lancet Series on maternal and child nutrition established that 800 000 child deaths could be prevented through breastfeeding, and called for further support. Despite consolidation of evidence for breastfeeding’s benefits in recent years, in particular the economic gains to be reaped, global action has stalled. Why has so little progress been made?

Rates of breastfeeding vary wildly; it is one of the few health-positive behaviours more common in poor countries than rich ones. In low-income countries, most infants are still breastfed at 1 year, compared with less than 20% in many high-income countries and less than 1% in the UK. The reasons why women avoid or stop breastfeeding range from the medical, cultural, and psychological, to physical discomfort and inconvenience. These matters are not trivial, and many mothers without support turn to a bottle of formula. Multiplied across populations and involving multinational commercial interests, this situation has catastrophic consequences on breastfeeding rates and the health of subsequent generations.

There are glimmers of hope. Despite—or perhaps, because of—the execrable provision for paid maternity leave in the USA, the Affordable Care Act provides protected nursing breaks and insurance cover for breast pumps. Such allowances, the Series predicts, could increase breastfeeding by 25%. But, more importantly, genuine and urgent commitment is needed from governments and health authorities to establish a new normal: where every support she needs to do so.

Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect

The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years and 20 000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.

Why invest, and what it will take to improve breastfeeding practices?http://www.thelancet.com/series/breastfeeding

Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women’s work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry’s large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.

Breastfeeding: a smart investment in people and in economies

If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics. For while “breast is best” for lifelong health, it is also excellent economics. Breastfeeding is a child’s first inoculation against death, disease, and poverty, but also their most enduring investment in physical, cognitive, and social capacity.

Spotlight on infant formula: coordinated global action needed

Breastfeeding has often been described as cost free.1 It is not free. Breastfeeding requires investment to overcome the sociopolitical barriers that exist in many countries2,3 through the effective approaches and practices described in the second paper of the Lancet Breastfeeding Series.4 As shown in the first Series paper, infants, children, and mothers who do not breastfeed experience an increased risk of mortality and morbidity.5 Breastfeeding is nutritionally, immunologically, neurologically, endocrinologically, economically and ecologically superior to breastmilk substitutes (BMS), and does not require quality control of manufacture, transport, storage, and feeding mechanisms.

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