WIC in Vermont

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10 Steps to Empower Mothers and Nurture Babies

Birth & Beyond: Supporting Mothers and Nurturing Babies
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. Hospital policies, procedures and staff can influence mothers and babies as they begin to breastfeed, and can affect long term and exclusive breastfeeding.


88 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. Our goal is to increase exclusive breastfeeding rates at six months by assisting hospitals to adopt the “10 Steps to Successful Breastfeeding.”

About the 10 Steps Project

Our goal is to increase exclusive breastfeeding rates at six months by assisting hospitals to adopt the “10 Steps to Successful Breastfeeding.” 10 of Vermont’s 12 birthing hospitals are participating in this important project.

To facilitate a quality improvement initiative focused on evidence based maternity care practices, the Vermont Department of Health’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC) partnered with the Vermont Chapter of the American Academy of Pediatrics, the Academy of Family Physicians, and the Vermont Child Health Improvement Program (VCHIP).

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:

  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. Assist with initiation of skin-to-skin and breastfeeding within 1 hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
  7. Practice “rooming in”— allow mothers and infants to remain together 24 hours a day.
  8.  Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10.  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.

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Project Overview

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.

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Birth and Beyond Breastfeeding Training

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. 

BBC’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 was re-envisioned with permission of the California Department of Public Health (CDPH). This curriculum was adapted from the Birth and Beyond California instructional materials developed using Title V funding from CDPH; Maternal, Child and Adolescent Health Division. BBC built upon the original concept developed by the Perinatal Services Network led by Carol Melcher.  

Vermont’s 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 materials were used by the training team in five two-day sessions across Vermont. The training materials 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.

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Project Faculty and Workshop Training Team  

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.

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Training Resources Portal

The Birth and Beyond: Empowering Mothers and Nurturing Babies presentation “platform” uses an innovative design approach that allows trainers to present the training curriculum in a highly-visual, easy-to-navigate format. All components of the platform—photo slides, picture stories, video clips, and resources are linked together through hyperlinks in a single platform.

Select the 10 Steps Training Resources button to get started. To request access to the training materials contact Karen Flynn, WIC Program Administrator at karen.flynn@vermont.gov.

May 2014 - New Version Released

Birth and Beyond: Empowering Mothers and Nurturing Babies presentation platform was revised and version 2 is now available for download.

Revisions include:

  • Speaker notes & hyperlinked bibliography revised.
  • Navigation buttons changed from light to dark to minimize distraction for the audience.
  • Additional photos and graphics added to enhance presentation. (Primarily in Modules 1 & 2.)
  • Citations added to slides showing journal articles.
  • Slide shows with video open faster. (If using platform from a network server, opening embedded video may still cause a slight delay.)
  • Revised "Video List" indicates if video is embedded, linked to website, or will require DVD.
  • New reference document, "Platform site map," includes the name of each slide show in the modules, the number of slides per show, and any activities, discussions and video in the show. Includes length of recommended video segments.

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10 Steps Training Resource Portal