| Abstracts for ILCA's 2004 Poster
Session |
Project/Program Posters
Outstanding Project Poster
Pumps for Peanuts: A Hospital-Based Initiative to Provide
Breast Pumps for Urban Women
Marcy J. Mcmahon, RN, IBCLC; Anne Merewood, MA, IBCLC; Bobbi
L. Philipp, MD, FABM, IBCLC; Laura Beth Chamberlain, BA; Susan
Davies, BA, CLC Boston Medical Center, Boston, MA, USA
Abstract
Background: Boston Medical Center (BMC), is a Baby-Friendly,
inner-city hospital with 2000 births per year. 40% of the 350
mothers of infants admitted annually to the BMC Neonatal
Intensive Care Unit (NICU) either had no insurance, or
insurance that would not cover an electric breast pump. Other
insurances provided pumps, but only for medical reasons.
Objectives: 1. Guarantee an electric breast pump for all NICU
mothers. 2. Increase access to pumps for BMC mothers and women
in our community. Methods: The Kids Fund, an internal BMC
charity, donated $10,000-$15,000 per year for mothers of NICU
infants who could not obtain pumps. A local breast pump
company provided low cost pumps, and assisted with Medicaid
reimbursement. We worked with Healthy Start, a regional safety
net program for pregnant women, to ensure their clients
obtained electric breast pumps. We then persuaded BMC Health
Net Plan, a local HMO, to cover electric pumps for all
breastfeeding women on their plan. Within months, other
regional insurers followed suit. Results: All mothers with an
infant in BMC NICU are guaranteed an electric breast pump.
From March 2003 to March 2004, we helped mothers obtain 436
electric pumps, from the following sources: 36 (8%) Kids Fund;
19 (4%) standard Medicaid; 216 (50%) BMC HealthNet Plan with
Medicaid; 49 (11%) Neighborhood Health Plan with Medicaid; 86
(20%) Healthy Start; 30 (7%) other insurers. Conclusions:
Urban women need breast pumps. Hospital-based advocacy can
extend beyond acute need to provide pumps for women in the
community at large.
The Creation of a Novel Staff Resource Model: MILC (Mother
Infant Lactation Counselor)
Tracey Grady, BSN, RN, IBCLC
Women Infant Services, Banner Good Samaritan Medical Center,
Phoenix, AZ, USA
Abstract
The five Phoenix metropolitan hospitals welcome nearly 25,000
babies into the world each year. Eighty percent of the mothers
delivering at these hospitals state their intention to
breastfeed their infants. With only five full-time Lactation
Consultants, some mothers were not getting the special
attention required to get breastfeeding off to a good start.
The post-partum nurses are expected to help new mothers with
the basics of breastfeeding, but how to best help those
needing extra time and attention in light of limited Lactation
Consultant availability? Some of these mothers can be helped
by a MILC, a Mother Infant Lactation Counselor, a member of a
team of RN's and PCA's (Patient Care Assistants) who have
received extra training in lactation management. The MILC Team
members work in the post-partum and labor and delivery areas
and cover all shifts, providing quickly accessible help as
problems arise. Lactation Consultants are contacted for thoses
patients whom the MILC has been unable to help. Initial
training includes classroom and clinical hours, and continuing
education is provided formally and informally by the Lactation
Consultants. This new program has been deemed successful by
patients and staff. The MILC Team members themselves are
enthusiastic breastfeeding advocates, and report high
satisfaction in this expanded role.
Best Practices: Herbal Galactagogue Policy for Hospital and
Outpatient Clinic for Low Milk Supply
Cheryl J. Renfree, RN, PhD, IBCLC
Perinatal Services, Kaiser Permanente, Sacramento, CA, USA
Abstract
Background: A collaborative project between a local HMO
physician group and lactation services to establish safe
parameters for mothers enquiring about herbal galactagogues.
Given concerns regarding the increasing use of herbs among
breastfeeding women and frequent maternal request for
information on herbal galactagogues to assist low milk supply,
Kaiser Permanente became the first HMO to adopt a
physician-approved policy and protocol for the safe use of an
herbal galactagogue. The project sought to look at the
standard of practice on the use of herbal galactagogues in
local and national health care communities, as well as
evidenced based botanical medicine information for the
development of safe standards. Aim: To provide safe parameters
for the use of herbal galactagogues for inpatient and
outpatient lactation services. This poster session showcases
the local effort between physician and lactation consultants
to develop patient teaching handouts, hospital policy and
outpatient protocols for the safe use of an herbal
galactagogue in a medical setting. Participants will learn how
to develop and implement a collaborative process between
physician/provider groups and lactation consultants to
establish hospital based policies and protocols on the use of
herbal galactagogues for low milk supply management. The
poster includes details of the highly successful
implementation of physician and patient education on the use
of herbal galactagogue use for low milk supply management, in
use since 1999. Partners in this effort are a diverse group
including pediatricians, pediatric nurse practitioners,
hospital based lactation consultants, and outpatient based
lactation educators and consultants. This poster session
showcases the process for implementation of a
reproducible/replicable inpatient and outpatient policy and
protocol for the use of fenugreek, an herbal galactagogue..
Samples of hospital and outpatient policy, protocol, physician
and patient teaching handouts will be available.
Las Dos Cosas: Encouraging Exclusivity in Hispanic Women
Aixa Gonzales, RN, IBCLC; Laura Beth Chamberlain, BA; Luz
Lopez; Barbara L. Philipp, MD, FABM, IBCLC; Anne Merewood, MA,
IBCLC
Boston Medical Center, Boston, MA, USA
Abstract
Background: Cultural factors may influence exclusivity of
breastfeeding. Approximately 23% of the 2000 women who give
birth at inner-city Boston Medical Center (BMC) annually are
Hispanic. A perception exists among maternity providers that
more Hispanic women "do both": offer both breast milk and
infant formula to their babies. The introduction of formula
jeopardizes the benefits of exclusive breastfeeding. Aim: To
examine the perception that Hispanic women "do both" and
suggest strategies to increase exclusivity among Hispanics.
Methods: We examined national and BMC breastfeeding data to
determine levels of supplementation among Hispanics. We
suggest strategies from the academic literature and the
cultural expertise of a Puerto Rican lactation consultant and
a Mexican peer counselor. Results: Hispanics have a larger
percentage of women who offer supplements in hospital compared
to other cultures. In 2002, at BMC, 70% of Hispanics offered
breast milk and formula in the hospital compared to 62.5% of
"all women" and 63.7% of blacks; nationally, 37% of Hispanics
offered supplements, compared to 26% of blacks and 19% of
whites. Strategies: To increase Hispanic exclusivity at BMC,
we are implementing the following strategies: 1. Use
Spanish-speaking peer counselors and IBCLC and offer classes
in Spanish, which explain benefits of exclusivity and risks of
small amounts of formula; 2. Teach all women that they make
only 3 tablespoons of milk on day 1, and that we expect their
babies to lose weight; 3.Include the significant other and/or
family in breastfeeding counseling; 4.Establish early
lactation follow-up, utilizing either a Spanish-speaking
lactation consultant or referring to a bilingual telephone
support line. Conclusion: At BMC we relate breastfeeding back
to the Hispanic culture by targeting family and friends for
both education and support, and by teaching in Spanish, during
both the antenatal and postpartum periods.
California First 5 Grant Used to Promote Breastfeeding at a
County WIC Agency
Anne M. Garrett, RN, MS, IBCLC
Department of Public Health-WIC Program, San Mateo County
Health Services Agency, San Mateo, CA, USA
Abstract
A woman's ability to optimally breastfeed her infant depends
on the support she receives from those around her. The
Breastfeeding Care Center's overriding philosophy is to
educate and to support mothers so breastfeeding as easy as
possible for the mother rather than to discourage her from
breastfeeding, whether intentionally or unintentionally. San
Mateo County Health Services Agency WIC Program received a
three-year grant from First 5 San Mateo County that started
July 2001. We received $738, 120 for the three year period.
The funding for this grant has been generated from an
increased tax on cigarette sales that was passed several years
ago in California (Prop 10). The Breastfeeding Care Center
(BCC) works within the Women, Infants, and Children's Program
(WIC) in San Mateo County. Our activities include (1) Prenatal
Breastfeeding Classes and Support (2) Toll Free Telephone
Helpline; (3) Electric Breast Pump loans; and (4) Community
Outreach and Education. Since July 2003, we have served 4420
pregnant or postpartum participants within WIC. We have
reapplied for another three years of funding on a
non-competitive grant process. This will allow us to continue
the work started until June 2004.
Partnering for Breastfeeding Education: A Model for Clinical
and Academic Collaboration
Patricia M. Rice, BA, IBCLC, LCCE, FACCE; Patricia Howard, MS,
RN; Jane M. Lamp, MS, RN, BC
Lactation Department, Riverside Methodist Hospital, Columbus,
OH; College of Nursing, Ohio State University, Columbus, OH;
Employee Education Services, OhioHealth, Columbus, OH, USA
Abstract
This poster presentation exhibits a collaborative effort
between the lactation department staff of a major metropolitan
hospital and faculty from The Ohio State University College of
Nursing to improve health outcomes for families through the
provision of evidence-based breastfeeding management. The
process is one that is adaptable to a variety of settings.
Riverside Methodist Hospital in Columbus, Ohio, has
approximately 7,000 births per year with more than 72% of
families initiating breastfeeding. The hospital's maternity
units provide a clinical affiliation for The Ohio State
University's College of Nursing, the largest producer of
baccalaureate nursing students in the state of Ohio. This
collaborative effort- involving hands on patient/student
breastfeeding experiences during the student's breastfeeding
education- helps meet goals of families, students, and the
hospital. The provision of consistent, evidence-based clinical
practice by students for patients improves breastfeeding
outcomes and enhances patient satisfaction. Additionally, the
program strengthens the student's educational experiences and
the hospital-college affiliation, resulting in the potential
recruitment of knowledgeable maternity nurses who are prepared
to be role-models and advocates for the practice of
evidence-based breastfeeding management. The program further
seeks to affect the student personally as future healthcare
decisions are made regarding infant feeding. Finally,
consistent with infant feeding position statements, the
partnership seeks to collaboratively prepare postpartum women
with education in the recommended method of infant feeding and
to help them meet their goals in the successful initiation and
maintenance of breastfeeding. Poster attendees will receive a
brochure that includes lactation education content for the
student class and a description of the challenges and
processes involved in the successful initiation of the
program.
Using a Journal Club to Enhance Professional Practice for
Lactation Consultants
JO Watson MacDonell, RN, MScN, IBCLC, PNC ©; Beth Nolson, RN,
IBCLC
Perinatal Program, Sunnybrook and Women's College Health
Sciences Centre, Toronto, ON, Canada
Abstract
Commitment to continuous learning is a challenge for Lactation
Consultants. Practice settings can be either isolated or so
busy that there is little opportunity for professional sharing
and learning. One approach to continuous learning, used by a
breastfeeding clinic in a perinatal centre, was to develop a
Journal Club. The goals are to provide a forum to share
information, discuss practice issues, and develop resources
for the clinic. The Journal Club supports ILCA's clinical
competency to "utilize current research findings to provide a
strong evidence base for clincal practice and obtain
continuing education to enhance skills". Lactation Consultants
have an opportunity through the Journal Club to identify
practice issues that would benefit from a review of best
practices or best evicence. Once a topic is selected, related
reources and references are identified. All staff prepare to
discuss the clinical issue. This forum creates an opportunity
for academic debate and sharing of strategies which has led to
the creation of evidence based protocols and standards of
care. Staff have particpated in an evaluation of their
experience participating in Journal Club. Their perceptions
and outcomes from previous club meetings will be included in
the poster presentation.
Breastfeeding Best Practices in a WIC Agency
Anne M. Garrett, RN, MS, IBCLC
Department of Public Heatlh-WIC Program, San Mateo County
Health Services Agency, San Mateo, CA, USA
Abstract
San Mateo County WIC Breastfeeding Care Center applied for a
California State Best Practices grant in January 2003. We were
awarded $105,000. The Breastfeeding Promotion and Support
Project focused on three areas of Best Practice. These areas
are 1) Breastfeeding Friendly WIC Site; 2) Staff Training; and
3) Breastfeeding Promotional Efforts. Gliders were purchased
for four WIC sites to provide a comfortable area for
breastfeeding mothers and to use when doing one-on-one
counseling for breastfeeding. Six WIC staff members were sent
for lactation educator training during the year. The San Mateo
County WIC Program cooperated with the County California
Nutrition Network Program in providing "Mom's Spa" programs
for participants who have breastfed beyond two months. These
half-day events included tips for healthy snacks for families,
facials, hand massages and nutrition information. Participants
are recognized for their success at breastfeeding and support
is given to mothers having challenges. In conducting this
Breastfeeding Promotion and Support Project, the participants
have more opportunities to feel successful with breastfeeding,
and there will be more of a community wide promotion of
breastfeeding. We established at each WIC site a prominent
display of "VIP" moms and babies in the waiting area. This
area is a popular place for participants and their families to
congregate. We added a "Gold Ribbon Campaign" as an additional
way to showcase the breastfeeding mothers in the community.
Material developed for the "Did You Know" bulletin boards and
the "Gold Ribbon Campaign" can be utilized by any region or
agency that wishes to replicate the work.
An Integrated Community Effort to Promote Breastfeeding on the
US - Mexico Border
Lizabeth J. Berkeley, MPH, CHES, IBCLC; Christine M. Pillado,
CLC
Southwest Area Breastfeeding Advocates, El Paso, TX, USA
Abstract
Southwest Area Breastfeeding Advocates is a grassroots,
community-wide breastfeeding advocates group founded in 2000,
consisting of representatives from community hospitals, WIC
clinics, area prenatal care providers, La Leche League leaders
and consumers in El Paso, Texas / Ciudad Juarez, Chihuahua,
Mexico. Goal: To increase community awareness of breastfeeding
and to improve the low breastfeeding rates on the border.
Objectives: Four sub groups were formed through overall group
discussion and consensus. The four groups are:
1) Promotoras / peer counselors
a) There is a "promotoras" degree track at the El Paso
Community College within which students may choose a nutrition
emphasis.
b) The members of SWABA have volunteered to do the training on
breastfeeding theory and practice.
2) Baby Friendly Pediatric and OB Offices
a) SWABA members developed a matrix of all classes offered
city-wide. This matrix was made into a poster and mailed to
all pediatricians, obstetricians, midwives and family practice
doctors in the El Paso region.
b) In addition, SWABA members sit on the task force of an
ongoing project at the local medical school modeled on the
Baby Friendly Hospital Initiative. 3) Billboards / murals
a) The county hospital, Thomason General Hospital, donated a
wall on which to paint a mural depicting breastfeeding women.
b) A sketch was donated by a local artist, Job Corps art
students have volunteered to create it, and funds were raised
for paint and supplies through SWABA.
c) This mural will be finished in the summer of 2004.
4) Breastfeeding education for teens
a) Many SWABA members have donated their time and expertise to
teaching local teens.
b) SWABA has developed a tracking list of these activities at
schools and other establishments.
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