mama*cue

We’re starting our breastfeeding peer counselor training TONIGHT, and I’m at Staples printing out all the handouts for our first session. Tonight we will cover the benefits of breastfeeding, anatomy of the breast, breastfeeding disparity, and importance of peer counselors. It’s going to be a PACKED evening!

I’ve been drawing from a lot of sources to create this training, including training materials from La Leche League and WIC. Here’s a sample of what we’ll be talking about tonight:

• Milk production overview
• Dose-dependent benefits of breastfeeding
• More benefits of breastfeeding
• “Foremilk” and “hindmilk”
• What’s in breast milk v. formula

I’m also printing out a ton of data, some articles about the importance of peer counseling, and excerpts from The Womanly Art of Breastfeeding, this fabulous California WIC breastfeeding peer counselor handbook, and from my very favorite resource, Breastfeeding Answers Made Simple.

I don’t know whether we’ll get through all of it, but I’m confident that it’s going to be a lot fun!!

@@Jamie

Photo courtesy of the United States Breastfeeding Committee

If there’s anyone who has the power to influence hospital policies that impact breastfeeding, it’s the Joint Commission. The Joint Commission is an independent nonprofit that provides accreditation and certification to hospitals and other health care organizations. Recognition from the Joint Commission is crucial for hospitals competing for patients. If the Joint Commission says, “Jump,” hospitals say, “How high?”

As of January 1, 2014, hospitals with more than 1,100 births per year will be required to report their exclusive breastfeeding rates to the Joint Commission as one of the Core Measures that will be used to evaluate their performance. And smaller hospitals are not totally off the hook. The Joint Commission warns that it’s likely that more hospitals will be required to report their exclusive breastfeeding data in the future, and encourages smaller hospitals to start tracking exclusive breastfeeding now.

This means that as of January 1, having policies that support breastfeeding will not just be a nice thing to do–it will directly impact how hospital quality is evaluated, particularly the hospitals that are serving the most mamas and babies.

I <3 the Joint Commission.

There are some great free tools available to help hospitals comply with what the Joint Commission wants. The United States Breastfeeding Committee created this toolkit specifically details how hospitals can implement the exclusive breastfeeding Core Measure. Kaiser Permanente also has a new toolkit to help hospitals improve their exclusive breastfeeding rates.

The Joint Commission not only has hospital leadership scurrying around trying to track and improve their exclusive breastfeeding rates, it also has great materials for patients through their Speak Up initiative. The purpose of Speak Up is to empower patients to improve safety by becoming more involved in their care.

The Speak Up breastfeeding brochure encourages parents to speak up about their desire to breastfeed, and includes a lot of questions patients can use before, during, and after birth to help ensure that breastfeeding gets off to the right start. This is a POWER PACKED little brochure with a lot of great information. My favorite part is, “If anyone tells you to stop breastfeeding, ask why and get a second opinion.” What an outstanding suggestion!

There are a few parts of the brochure that may be somewhat misleading though. The brochure encourages the patient to ask the nurse to help them with breastfeeding, which would only be helpful if the nurse were well trained, which may or may not be the case. And it encourages patients to ask about what they should be eating and drinking while breastfeeding, which could easily open the door to some bad advice. (As kellymom.com puts it, “research tells us that the quality of a mother’s diet has little influence on her milk.”) It also mentions pumping if the baby can’t breastfeed, but hand expression is generally more effective than pumping when mama is making colostrum.

The brochure also says that the baby shouldn’t go more than three to four hours between feedings, but it doesn’t give an idea of how often a newborn baby breastfeeds (8-12 times, or even more, in 24 hours). I could easily see a mama misinterpreting this brochure to mean that it would be normal for a baby to take three or four hour breaks between feedings, when it’s more realistic to expect such a long break just once, or maybe twice a day.

Finally, the brochure says to keep baby within hearing range so as not to miss early feeding cues. But most of the early feeding cues are silent (baby sticking out his or her tongue, rooting, squirming from side to side, putting hands in his or her mouth) or very quiet (that little “eh, eh, eh,” sound). By the time the baby gets loud enough to be heard from any kind of distance, the baby has moved on to late feeding cues, which means the feeding has been delayed (which can interfere with establishing milk supply). Waiting for a baby’s louder late cues may leave you with a fussy or crying baby who has a harder time latching on.

Despite these issues, I think that this brochure is an excellent tool when coupled with in-person breastfeeding support.

Allow me to repeat: I <3 the Joint Commission.

@@Jamie

For my next trick, I will make the formula bags REAPPEAR!

If your baby can’t get human milk for whatever reason, then formula is your friend. Next to breast milk, it’s the healthiest and safest option for babies.

But don’t get confused–the formula companies are NOT your friends! They are the enemies of mothers and babies everywhere. Their goal is NOT for you and your baby to be as healthy as possible. Their goal is to sell their brand of formula. And boy, are they sneaky. Don’t believe me? Take a look at these 3 slimy tactics that hospital staff reported at the Pennsylvania MotherBaby Summit last week.

But first, here’s the back story. Many hospitals all over the country are trying to ban formula gift bags–diaper bags that formula companies give hospitals to distribute to mamas that include formula marketing materials (free formula and/or coupons). Some hospitals are also trying to get rid of free formula, and instead, pay market value for the formula they use. Getting rid of the bags and paying for formula are both evidence-based practices that improve breastfeeding rates.

And just to clear up some misconceptions, the question is not whether patients pay for formula, it’s whether the hospital pays for formula. The cost of formula can be included in whatever the hospital ordinarily charges. Does this mean that cost to patients is going to go up? No. Because of the health benefits and inexpense of breastfeeding, paying for formula can actually help a hospital’s maternity expenses go down. And even if a hospital isn’t ready to dive in and pay for the formula, it can still ban the formula bags. Banning the bags DOES NOT mean the hospital has to pay for formula. Hospitals can ban the bags without spending a single penny. (Or, hospitals can make their own bags. Some hospitals just view it as part of their marketing expenses.)

So imagine you’re a hospital. You know that banning the bags and paying for formula are evidenced-based practices that support breastfeeding, and you want to do what’s best for your mamas and babies. You can do it! But be prepared, because your Formula Reps have some tricks up their sleeves.

1. Play with the price. So you want to pay for formula, eh? Well do you know how much that’s going to cost you? The answer is, you probably have no idea. Your Formula Rep throws out a number. It’s a big, scary number. In fact, it’s so scary, that you probably decide that free formula isn’t such a bad idea after all. But maybe you persevere. After all, you know this is the best thing for mamas and babies, and plus, your hospital’s attorney says that accepting free formula violates anti-kickback laws. So you take  a deep breath and tell your Rep that you want to get rid of the free formula. How much is it actually going to cost you? Well, now the Rep is saying they’ll give you the whole bunch for $1. A dollar is money. It’s a great price, and you’ll be “paying” for the formula, *wink, wink.* The problem is, the evidence shows that hospitals paying fair market value for their formula are the ones that improve their breastfeeding rates. So you ask around at a few Baby Friendly hospitals, find out what they pay, and decide to pay that. Low and behold, your formula costs end up MUCH less than what the Formula Rep originally said it was going to cost you. Either these Formula Reps are really bad at math, or their just the sleaziest creatures on the planet.
   
2. Talk to a different department. You’ve decided to ban the bags. There was a lot of resistance from staff members who liked the idea of giving moms bags, but you finally decided to go ahead and set an anti-formula-bag policy, effective February 1st. The transition to a bag-free hospital has been smoother than your staff expected. The patients don’t seem to care nearly as much as you thought, and your exclusive breastfeeding rates are going up. But one day, you turn a corner, and there they are! The bags are back! Who brought back the bleep-ing bags?! Turns out the Formula Rep made some new friends. Can’t get the bags in through Maternity? Get them in through the hospital dietary committee!
3. Send the bags anyway. You’ve cleared things up with the dietary committee, and the bags are gone again. You’re starting to feel like you can put this whole bag issue behind you. But then–oh no!–another stack of bags materializes out of thin air! You do some more detective work, and no one authorized this. The Formula Rep decided to just send the bags anyway, without talking to anybody in authority. The lesson for hospitals? If you’re banning the bags, make sure to let the people working in the stockroom know.

@@Jamie

*Okay, the link to the report should work now. Only wordpress has eliminated many of my paragraph breaks for no apparent reason. Grumble, grumble, grumble….*

Holy PA breastfeeding data, Batman! Hot off the press, it’s the PA Department of Health’s new breastfeeding report. For a 37-page report, it really is an engaging read (if you’re nerdy and you like that kind of thing). It’s brimming with fabulous breastfeeding data and a six-part plan for improving rates in Pennsylvania. Click here to read the report.

The report is also a ringing endorsement of what we’re doing with our breastfeeding peer counselor program for young mamas in North Philadelphia. Probably every other page says something like, “Hey, you know what would really be great? If we trained young mamas of color to do breastfeeding support.” Exactly.

Here are some highlights from the report:

(1) Breastfeeding rates for young mamas in PA! I have never seen this data, and it is so helpful. Here it is, folks! This data tells a very sad story about how much breastfeeding support the youngest mamas get in our state. Under 15 and over 45 are the only age-groups in which breastfeeding rates have not improved. This data has nothing to do with whether the youngest mamas are able to breastfeed. It’s a story about us, and how we’re failing our youngest sisters.

(2) PA breastfeeding rates by race. I don’t think I’ve seen these data before either. Here they are: This might be the first time I’ve seen breastfeeding rates for Asian Americans. Who knew those rates would be the highest? It makes me wonder about the Asian population in PA. What’s the predominant country of origin for Asians in PA, and what are the breastfeeding practices there? Or have most Asians in PA been here for several generations? What’s the median income and education attained for Asians in this state? I have no idea, but this sure makes me curious.

The other rates look pretty similar to what we see in the national data, and beg the question, what are the barriers preventing black mamas from breastfeeding?

(3) PA breastfeeding rates by county. I saw this map in a presentation by Kay Hoover at the La Leche League conference I attended last fall. To me, this map tells a story about money. Wealthy Pennsylvanians are more likely to see mamas in their community enjoy and succeed in breastfeeding because of greater access to breastfeeding resources ($ or insurance to pay for IBCLCs, more La Leche League Leaders in the area), more flexible work places (or a partner who makes enough money for mama to be able to stay at home), and so forth. Southeastern PA, a wealthy part of the state, is doing pretty well, with one major exception: Philadelphia, the ONLY county in Southeastern PA in the 50-63% initiation rate range. The bottom line for us? We’re doing the right thing by focusing on Philly!

(4) Focus on peer counseling, breastfeeding disparity, and community partnerships. Recommendations for creating and expanding peer counselor and mother-to-mother support programs were ALL OVER the report (and not surprisingly, since according to the research, that’s what works!). At least 2 of the 6 “Strategies for Pennsylvania stakeholders and supporters of breastfeeding” are directly addressed by our program: Strategy 2: addressing disparities and Strategy 6: building community partnerships.

The “address disparities” section was really the only part of the report that I found to be somewhat disappointing. On the one hand, this part of the report literally recommended that we do exactly what we have been doing: “Recruit minority women, teens and others to become breastfeeding peer counselors.” Done!

On the other hand, looking at this recommendation in the context of the rest of the recommendations in this section left something to be desired. For instance, ”Recruit minority women, teens and others to become breastfeeding peer counselors” was followed by “Encourage healthcare professionals serving disparate areas to obtain advance (sic) breastfeeding education or become lactation consultants.” This made me wonder–why not say, “Encourage minority women, teens and others to obtain advanced breastfeeding education or become lactation consultants”? Why shouldn’t our goal be for the mamas we most want to reach to achieve the highest levels in breastfeeding training and leadership?

Furthermore, the section on breastfeeding disparity focused on understanding cultural barriers to breastfeeding without explicitly acknowledging the large number of practical barriers that exist for low-breastfeeding populations. Putting culture aside for a moment, how are black women’s lives different from white women’s lives in Pennsylvania, and why? How are their jobs different? Their child care options? What resources are available in their neighborhoods? How much can they spare on breastfeeding resources–including very basic things like the time plus the money for transportation to a La Leche League meeting?

Writing in such detail about the challenges that different populations of Pennsylvanians face was obviously beyond the scope of this report. And focusing on culture isn’t a bad thing–culture is important. But by specifically naming “cultural beliefs” and “cultural barriers” and failing to specifically name other barriers, the report made it seem as though the primary factor preventing black, young, low income, and rural mamas from breastfeeding is their own cultural idiosyncrasies, rather than the many powerful structural and social forces that work to constrain mamas’ options or even totally undermine breastfeeding.

(5) Other gems. There was a lot of other really interesting information included in the report. For example, I didn’t realize that first time mamas in PA actually breastfeed at HIGHER rates than mamas with more than one child. I wonder whether this is a national trend. It makes me think–what happened to them the first time around to turn them off? 

Is all this attention on breastfeeding initiation preventing us from asking what may be a more important question: is mama’s breastfeeding experience a positive one? If she’s totally miserable, it’s a big problem. First, she’s not breastfeeding her other kids, and second, she’s now spreading horror stories about breastfeeding to all of her friends and family. I’m sure there are many other ways of interpreting that data, but those are my initial thoughts.

Also, it’s saddening to see that late preterm and premature babies breastfeed at the lowest rates, when they can benefit from breast milk the most. The report explicitly recognizes this irony. There is no reason that this must be so. For example, Children’s Hospital of Philadelphia only provides labor and delivery for high risk pregnancies yet has a breastfeeding rate of 98% (or is it 99%?). They get a lot of preemies who get a lot of breast milk. To find out how they do it, read this.

There was a lot more fascinating information included in the report. I especially encourage you to check out how our hospitals did on the CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) Survey (especially the summary at the bottom of p. 14) and the DYNAMITE list of evidenced-based practices to improve breastfeeding rates at the bottom of p. 27.

@@Jamie

Our Power of Mothers’ Day campaign is officially over. We did not meet our goal of $4000, but it’s impossible for me to be disappointed when so many of you supported our program with such generosity and enthusiasm. We ended up raising $870. I haven’t crunched all the numbers yet, but this should go a long way toward meeting our program expenses for a long time.

I also learned A LOT from this campaign. I now know the locations of all the post offices with late closing times within 45 minutes of my house, I’ve realized that using a dry erase marker to write addresses on plastic envelopes is not a good idea, and I have plenty of ideas for how to improve on what we did this time around.

On top of all that, I just submitted my final project for school this semester, bringing a crazy, but thrilling three weeks of finals and fundraising to an end. I think it’s appropriate that the confetti in the picture above is on the floor, because I plan to celebrate by sleeping!

Anna Marie Jarvis originally established Mothers’ Day to celebrate mothers joining together to support one another and their communities. You all did Anna Marie proud over these past few weeks by rallying to support young pregnant and breastfeeding mamas in North Philadelphia.

The breastfeeding peer counselor training starts this Thursday. I’m very excited to be getting started, and can’t wait to tell you all about it!

HAPPY MOTHERS’ DAY!

@@Jamie

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These photos were taken a few meetings ago (the same meeting when we took some of these shots–only this new batch of photos was taken with a better camera!).

I hope that these photos and the videos give you a feel for what our meetings are like. You can’t hear the kids running around (or how much some of them talk! my goodness!), you can’t taste the food, you can’t laugh with us, or watch my son’s perpetual indecision about whether to run off with the big kids or stay on mama’s lap, but I think the photos at least communicate the informal, fun, family-like tone of the meetings to you.

Please consider supporting us and sharing our program with your friends as we wrap up our campaign and move forward with our training next week!

@@Jamie

Meet more peer counselors here. This is the LAST WEEK of our Power of Mothers Day campaign! We have a long way to go to reach our goal of raising $4000, so please help us spread the word with this link: http://mamacue.me/the-power-of-mothers-day/.

@@Jamie