The Journal of the Arkansas Medical Society Issue 10 Vol. 114 | Page 12

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EDITORIAL PANEL
Chad T. Rodgers, MD, FAAP; Elena M. Davis, MD, MPH;
Michael Moody, MD; J. Gary Wheeler, MD, MPS
Keys to Successful Breastfeeding
BY CHAD RODGERS, MD, FAAP;
TINA HEDRICK, BSN, RN,
PCMH CCE, CPHIMS;
and SHANECA SMITH, BSN, RN, CNOR
A
rkansas has one of the lowest
breastfeeding rates in the
nation despite evidence that
breastfeeding is the healthiest and
most economical way to nourish a
newborn. The importance of breast-
feeding to the long-term physical
and emotional health of mothers
and children is well documented. It
promotes children’s optimal cognitive
and physical development.
The decision to breastfeed is usu-
ally made in the prenatal period. To
encourage breastfeeding initiation
immediately after birth, hospitals can
take several evidence-based steps to
increase breastfeeding.
The 10 Steps to Successful
Breastfeeding 1 of the Baby-Friendly
Hospital Initiative, developed by
the World Health Organization and
United Nations Children’s Fund,
promote successful breastfeeding.
Hospitals can earn Baby-Friendly
designation by demonstrating
proficiency in implementing the 10
Steps and the International Code for
Marketing Breast-milk Substitutes.
Major U.S. maternal and child
health authorities have endorsed
and promote these 10 steps:
1. Have a written breastfeeding
policy; routinely communicate it to
health care staff.
2. Train staff in skills necessary to
implement this policy.
3. Inform pregnant women
about benefits and management
of breastfeeding.
4. Help mothers initiate breast-
feeding within one hour of birth.
5. Show mothers how to maintain
lactation if separated from infant.
6. Give infants no food or drink
other than breastmilk, unless medi-
cally indicated.
7. Practice rooming-in to keep
mothers and infants together.
8. Encourage breastfeeding
on demand.
9. Give no pacifiers or artificial
nipples to breastfeeding infants.
10. Foster establishment of
breastfeeding support groups and
refer mothers to them at hospital
discharge.
Four Arkansas hospitals have
enhanced their breastfeeding-friendly
status by earning the Baby-Friendly
USA’s Hospital Initiative designa-
tion — the “gold standard” in maternity
care: Northwest Medical Center Willow
Creek Women’s Hospital; Northwest
Medical Center, Bentonville; North
Arkansas Regional Medical Center,
Harrison; and University Hospital, Little
Rock. Nationwide, 487 hospitals have
earned this designation.
Arkansas’ delivering hospitals can
receive support to promote breast-
feeding by implementing these
essential steps through Baby-Friendly
Arkansas (BFA), the breastfeeding
platform of Healthy Active Arkansas.
Hospital staff can attend a BFA two-
day collaborative summit in May and
a Certified Lactation Counselor (CLC)
course in September.
More than 80 percent of American
mothers initiate breastfeeding, but
only 22 percent are exclusively breast-
feeding at six months, as recom-
mended by the American Academy of
Pediatrics (AAP). These statistics drop
significantly for minority infants.
Breastfeeding support should
continue after hospital discharge. The
next opportunity for formal support
is the child’s physician’s office, which
is essential to increase breastfeeding
rates. Barriers include physicians who
have limited experience supporting
and managing breastfeeding, and lim-
ited staff time to manage complicated
lactation problems.
The AAP has developed a guide
to coding and billing to optimize
breastfeeding support reimburse-
ment at https://www.aap.org/en-us/
Documents/coding_breastfeeding_
lactation_coding.pdf. Some insurers
reimburse for breastfeeding sup-
port; Medicaid does not. Lessen time
constraints by referring complicated
issues to community support person-
nel. Several Arkansas hospitals have
International Board Certified Lacta-
tion consultants (IBCLCs) to assist with
breastfeeding problems.
THE ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. (AFMC) WORKS COLLABORATIVELY WITH PROVIDERS, COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO PROMOTE THE QUALITY
OF CARE IN ARKANSAS THROUGH EDUCATION AND EVALUATION. FOR MORE INFORMATION ABOUT AFMC QUALITY IMPROVEMENT PROJECTS, CALL 1-877-375-5700. • APRIL 2018
228 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 114