WIC in Vermont
Preventing childhood obesity and promoting lifelong health begins with breastfeeding. Breastfeeding for at least six months decreases a baby’s odds of becoming overweight by more than 30 percent, according to the Centers for Disease Control & Prevention. Hospital policies, procedures and staff can influence mothers and babies as they begin to breastfeed, and can affect long term and exclusive breastfeeding.
Eighty-eight percent of Vermont mothers start to breastfeed in the hospital. The hospital stay is a critical period for establishing maternal confidence in breastfeeding and laying the physiological foundation for breastfeeding success. By six months, only one in four mothers are still exclusively breastfeeding their babies. Many mothers stop breastfeeding before they are ready, citing reasons related to their experiences in the hospital.
The Vermont Department of Health’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC) partnered with the American Academy of Pediatrics, Vermont Chapter, the Academy of Family Physicians, and the Vermont Child Health Improvement Program (VCHIP) to facilitate a quality improvement initiative focused on evidence based maternity care practices. The goal is to increase exclusive breastfeeding rates at six months by assisting hospitals to adopt the “10 Steps to Successful Breastfeeding”. Ten of Vermont’s 12 birthing hospitals are participating.Implementing hospital practices proven to better support mothers and babies can improve breastfeeding rates. The ’10 Steps for Successful Breastfeeding’ (endorsed by the national American Academy of Pediatrics) include:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Assist with initiation of skin-to-skin and breastfeeding within 1 hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
- Give newborn infants no food or drink other than breast milk, unless medically indicated.
- Practice “rooming in”— allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
Hospitals that follow the 10 Steps recognize the benefits of breastfeeding and are committed to helping every mother achieve her goal. Hospitals that fully implement the “10 Steps to Successful Breastfeeding” can gain international recognition from the WHO (World Health Organization) as a Baby-Friendly Hospital.
In 2012, the Vermont WIC Program, in partnership with VCHIP, VTAAP and VTAFM, initiated a QI project using CDC's Maternity Practices in Infant Nutrition and Care (mPINC) survey data to improve maternity care practices. Key outcome measures include: 100% of participating hospitals will have administrative support for participation; 90% of maternity care RN staff at participating hospitals will complete a 16 hour breastfeeding training; 100% of participating hospitals will have an updated or draft breastfeeding policy for all mother/baby units; and, 100% of participating hospitals will demonstrate appropriate use of infant feeding supplementation.
Ten hospitals joined the project to address prioritized individual and collective goals (or outcome measures).
Vermont updated the Birth and Beyond California (BBC) curriculum, provided training for staff from participating hospitals and supporting birthing hospitals to deliver future trainings to their staff. Birth and Beyond California’s training provided an opportunity to teach best practices to support early maternal-infant bonding through skin-to-skin contact for all mothers and babies, and delivered new knowledge and skills to promote, protect and support a mother’s decision to breastfeed. The 16 hour BBC training curriculum, originally developed in collaboration with The Regional Perinatal Programs of California and Breastfeeding Taskforce of Greater Los Angeles, was re-envisioned with permission. Vermont’s adaptation, Birth and Beyond: Empowering Mothers and Nurturing Babies builds on the BBC training with a focus on “The Ten Steps to Successful Breastfeeding” and adds new content to fulfill training objectives for the “Baby-Friendly Hospital Initiative”. The training materials were used by the training team in five – 2 day sessions across Vermont in the fall of 2012. After final revisions, they are now being made available to other states to further hospital focused trainings for maternity care staff. Training resources can be used to train new or existing staff, in groups or as self-study modules.
Audrey Naylor, MD, DrPH, FAAP, FABM, Laura Murphy, MD, Anya Koutras, MD, IBCLC, Rebecca Goodman, MD, IBCLC, Dawn Kersula, MA, RN, IBCLC, FACCE, Tricia Cassi, BSS, IBCLC, Molly Rideout, MD, Jennifer Ustianov, BSN, RN, Kirsten Berggren, PhD, FNP, IBCLC, Patricia Berry MPH, Karen Flynn and Elizabeth Hunt, MD, IBCLC.