Nutrition
Breastfeeding Support
Each public health district in Georgia has a designated Breastfeeding Coordinator. Contact your
local health department for information regarding the breastfeeding coordinator, as well as to see if there is a Peer Counselor program in your area.
Evidence-based Breastfeeding Interventions which Support Breastfeeding
Evidence based interventions have all been formally evaluated and determined to have a positive effect on direct breastfeeding outcomes include:
- Maternity Care Practices
Maternity care practices related to breastfeeding take place during the intrapartum hospital stay and include practices related to immediate prenatal care, care during labor and birthing, and postpartum care.
Some examples of maternity care practices of interest are:
- Develop a written policy on breastfeeding
- Provide all staff with education and training
- Encourage early initiation of breastfeeding
- Encourage cue-based feeding
- Restrict supplements and pacifiers for breastfed infants
- Provide for post discharge follow-up
- Workplace Support
The reality in the US is that most mothers of young children work outside the home. 70% of employed mothers of young children work full time. One third of them work within 3 months of giving birth, and two-thirds are employed by the time the child is 6 months old.
Low-income women, among whom African American and Hispanic women are over-represented, are more likely than their higher-income counterparts to return to work earlier and to be engaged in jobs that make it challenging to continue breastfeeding (in GA – service jobs, carpet factories, chicken processing plants)
Further, working outside the home is associated with lower rates of breastfeeding initiation and shorter breastfeeding durations. Positive evidence for workplace support of breastfeeding can be found in two arenas – direct breastfeeding outcomes, and employment outcomes. Workplace lactation support increases breastfeeding duration, staff productivity and loyalty, and the public image of employers. Concurrently, it decreases absenteeism, employer health care costs, and employee turnover.
Support for breastfeeding in the workplace includes benefits and services that support continued lactation while mothers are employed. Many local health departments in Georgia as well as other worksites have designated lactation rooms. Recommendations for a lactation room are:
- A private room, or section thereof, for either expressing milk or nursing a baby
- A comfortable chair
- Electrical outlet and small table for breast pump
- Access to a sink to wash hands and equipment
- Small, secure refrigerator for milk storage
- Protected breaks every 3 hours for pumping (may be in place of other breaks)
- Non-harassment policy for breastfeeding mothers
Breastfeeding mothers who work or have official business at Georgia Department of Public Health, Two Peachtree Street offices in Atlanta can now use a special lactation room on the 11th floor to express breast milk. In addition to providing a pleasant private space, the room also offers electric breast pumps, plus videos and reading material about breastfeeding. The facility is part of DHR’s Health Matters employee wellness program. “Breastfeeding is good for both babies and mothers,” says Beth Holloway, former state breastfeeding coordinator for the Division of Public Health. “It increases the baby’s resistance to illness and infections, it promotes bonding between mothers and their babies, and it decreases the time mothers need to take off from work to take care of sick babies.” Anyone wanting to use the lactation room can contact the Division of Public Health, Office of Maternal and Child Health at 404-657-4676 and schedule an orientation.
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The goal of peer support is to encourage and support pregnant women and breastfeeding mothers. It is provided by other mothers who are breastfeeding or have done so in the past and who have training in breastfeeding counseling.
In addition, peer support is a cost-effective, individually tailored approach and culturally competent way to promote and support breastfeeding for women of varying socioeconomic backgrounds, especially where professional breastfeeding support is not widely available.
Women’s social networks have major impact on their health related decisions. Further, perceived social support has been found to be a predictor of breastfeeding duration. Two of the best-known types of peer support are those that are part of La Leche League International mother-to-mother support groups and their peer counseling programs, and the United States Department of Agriculture (USDA) WIC initiative institutionalizing peer support as a core service of the WIC program. The framework used by WIC is widely known as “Loving Support Makes Breastfeeding Work.”
Peer support programs are proven to be effective on their on at increasing both initiation and duration of breastfeeding. It is important to remember that peer support can be provided in a mother-to-mother group setting as well as an individual, one-to-one setting.
A variety of studies have shown peer support to be a promising strategy to protect, promote, and support breastfeeding among at least:
- Middle-income women
- Low-income Latinos
- Low-income African American women
- Women with uncertain breastfeeding goals
- Women intending to breastfeed
The Georgia WIC Program was a pioneer in implementing peer counseling in the WIC program as early as 1985. Several health districts have active breastfeeding peer counselor programs offered through the WIC program. In 2004 Georgia was awarded a USDA Breastfeeding Peer Counselor Grant to implement a breastfeeding peer counselor pilot program. Eight health districts were awarded funds to hire breastfeeding peer counselors. The districts awarded the grant were: Northwest (1-1), Cobb/Douglas (3-1), Fulton (3-2), East Metro (3-4), North DeKalb (3-5), South Central (5-1), East Central (6) and Northeast (10). In 2006, Chatham County (9-1) joined the pilot program. Northwest (1-1) and Fulton (3-2) currently are not participating but have plans in the future to re-establish their program. Beginning January 1, 2010 the following eight districts will be funded: North (1-2), Northeast (2), Clayton (3-3), LaGrange (4), West Central (7), Southeast (9-2), Southside Medical (11-0) and Grady Health Systems (12-0). With these additions, the Loving Support Through Peer Counseling Program will have a total of 103 Peer Counselors!
- Maternal Education
A 2003 review found that maternal education is the most effective single intervention for increasing breastfeeding initiation and short-term duration. In the United States, most new mothers have a general understanding of the benefits of breastfeeding. However, they may have no direct, personal knowledge of breastfeeding. Many new mothers lack concrete information on how to breastfeed.
The key here is to teach about how to breastfeed – not just hand out materials. Some ways to accomplish this might be to:
- Train health educators from local health departments in breastfeeding education
- Incorporate maternal breastfeeding education into Early Intervention, Early Head Start, family planning, teen pregnancy, and women’s health clinic programs
- Encourage childbirth educators to routinely incorporate breastfeeding into curricula
- Encourage health plans to routinely offer prenatal classes on breastfeeding to all their members
- Professional Support
Lack of professional support has been identified as a major barrier to breastfeeding, especially among African American women. Mothers consistently identify support from health professionals as something they expect when getting started with breastfeeding,
A review found that professional support:
- Increases initiation from 6% to 21% vs. education alone
- Increases short-term duration from 11% to 37% vs. education alone
- Increases duration 11% for short-term breastfeeding
- Increases duration 8% for long-term breastfeeding
Support for women by health professionals includes counseling and behavioral interventions to improve breastfeeding outcomes. Other ideas include:
- Hospital based or other walk-in breastfeeding clinics ensure professional support and follow up for breastfeeding dyads
- Collaborate with state Medicaid and insurance commissioners to ensure lactation support is included in reimbursable services
- Develop and disseminate a resource directory of local lactation support services – a step many states and local communities have done
Integrate lactation support services with home visitation programs
- Media and Social Marketing
Media includes promotions and advertising to support breastfeeding.
Social marketing goes beyond media campaigns. Social marketing campaigns are comprehensive, multifaceted approaches providing targeted, coordinated interventions to a variety of audiences; including consumers, their support systems, health care providers, the community, and the general public.
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