199285 In Hospital and Public Health Collaboration to improve exclusive breastfeeding rates: The BEST program

Monday, November 9, 2009: 9:06 AM

Eric G. Walsh, MD, MPH , Family Health Division/Nutrition Services, Health Care Agency, County of Orange, Santa Ana, CA
Gowri Madhavan, MPH , Epidemiologist, Family Health Division, Health Care Agency, County of Orange, Santa Ana, CA
Introduction: Orange County (OC) ranks 48th among the 58 counties in California in exclusive breastfeeding (EBF). Prevalence of EBF is 28.6% at hospital discharge.

BEST (Breastfeeding Education Support Team) is a collaborative between a community hospital and the OC Health Care Agency. BEST offers a coordinated continuum of breastfeeding support using Public health and hospital nurses. BEST works with hospital administration to change policies and procedures to increase EBF.

Objective: Increase EBF rates at discharge from 0% to 30% using the BEST program and in-hospital policy changes. The study will track to 1 month post-partum for EBF (over one year).

Methods: Data will be collected prenatally, at discharge and one month post-partum. In hospital skin to skin and rooming in time will be collected. In-hospital data will be taken from the chart and at one month post partum by participant survey.

Preliminary Results: EBF rate at discharge was 0% until November 2008. At that time maternal intent to EBF prenatally averaged 20%. Follow-up data in 2008 showed one month post partum EBF rate of about 25% on average over 2008. Implementation of BEST increased EBF rates to 15.7% at discharge by January 2009.

Conclusion: It appears mothers intend EBF before delivery. Once discharged mothers went home and exclusively breastfed. This indicates that the challenges to EBF may be due to in-hospital practices. This study evaluates a program that creates seamless support for mothers, while changing in-hospital culture by empowering and investing in labor and delivery and nursery nurses.

Learning Objectives:
At the end of the session, the participants will be able to: 1.Design community, public health and hospital partnerships to improve exclusive breastfeeding rates. 2.Evaluate barriers to exclusive breastfeeding in hospitals. 3.Demonstrate the success of programs like BEST to increase breastfeeding rates.

Keywords: Breast Feeding, Community-Based Public Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have presented at National Meetings before, currently Medical Director of the Family Health Division for the County of Orange, Health Care Agency. I give CME/CEU talks frequently. Published with the Biomyrs/Psiomyrs research group at Loma Linda University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.