Colorado helps babies by helping mothers breastfeed

Colorado helps babies by helping mothers breastfeed

Joanne Widner

When it comes to encouraging new mothers to breastfeed–and to continue breastfeeding until their babies are at least 6 months old–Colorado has reason to brag.

The state is a leader in promoting and supporting breastfeeding as the healthiest choice for babies, and the state’s breastfeeding rates–both of mothers initiating breastfeeding at birth and continuing several months–are among the highest in the country.

It’s no accident. The state has developed a number of successful breastfeeding promotion and education activities, many of them sparked by the work of an active interdisciplinary task force.

Brings together many groups

One of the reasons for the group’s success is its diversity. Task force members include:

* state and local health department staff, including those who operate USDA’s Special Supplemental Food Program for Women, Infants, and Children, commonly known as WIC, and the Child and Adult Care Food Program (CACFP);

* doctors nurses, and representatives from hospitals and health maintenance organizations;

* lactation consultants and representatives from groups like La Leche League and Nursing Mothers Counsel, Inc. (a telephone support group for breastfeeding women).

Also on the task force are people who bring other helpful perspectives and skills–a day care provider, a journalist, and an attorney.

Representatives from the medical community come from a variety of specialties. Among the doctors, for example, are perdiatricians and family practice physicians as well as an obstetrician. In addition to obstetrical nurses who deal with prenatal and well-child clinics. There is also a hospital dietitian.

A number of these people are involved in education as well as delivery of health services and are, therefore, in a good positiion to help shape young professionals’ attitudes and knowledge. Two of the task force pediatricians, in fact, have already added a breastfeeding component to the curiculum for pediatric residents at the University of Colorado’s medical center.

The task force is co-chaired by Patricia Daniluk, chief WIC nutritionist for the state department of health, and Cathy McCool, the department’s breastfeeding project manager. Vee Ann Miller of the Food and Nutrition Service’s Mountain Plains staff os FNS’ liaison to the task force.

an important step

One of the task force’s goals is to draw upon many community resources in reaching out to and teaching women. Often working in smaller subgroups, members address a variety of issues ranging from hospital practices and policy Development, to using the media, providing training, and dealing with employers.

As Daniluk points out, even though Colorado is a national leader in breastfeeding promotion, the group has much work to do.

While the state enjoys a high overall rate of breastfeeding initiation–72.6 percent of new mothers were breastfeeding when their babies were born in 1991, compared to the national rate of 53.4 percent–that rate is lower among low-income groups, including WIC participants, teenage mothers, and minority women.

“In addition,” says Daniluk, “It’s a big problem keeping women from ‘dropping out’ before they reach their personal breastfeeding goals.” Although Colorado’s 6-mouth duration rate (of mothers still breastfeeding after 6 months) was 31.1 percent in 1991, compared to the national rate of 18.2 percent, it is still far from the goal of 50 percent.

There are many reasons for this.

As hospital stays become shorter, there is less time for women to learn to breastfeed. Without postpartum support , many give up at first sign of problems. Shortly maternity leaves from work (often less than 3 months) and the complicated logistics of work and day care may also make it difficult for mothers to continue nursing.

In addition, mothers may not have more than one affordable day care alternative avaialable to them, and that one provider may not be supportive of breastfeeding. If the mother has a non-office job, lunch and rest breaks may be short and a private area for pumping milk may not be available. Even in an office setting, making these arrangements may not be easy.

Group looks for creative solutions

The Colorado task force is exploring these barriers as well as ways to encourage women who have not yet made up their minds to breastfeed.

According to task force members might possible incentives for mothers might include sliding-scale fees for trained lactation consultants. Medicaid reimbursement for lactation counseling, and availability of pumps for women with a short-term need who cannot afford to purchase them.

Another task force concern is making sure there are enough trained location consultants available to help mothers who choose to breastfeed.

Local health agencies are in special position to reach low-income women through the WIC program. In fact, encouraging participating mothers to breastfeed is one of the WIC program’s national goals. To enable local WIC staff to help mothers breastfeed successfully, the Colorado Department of Health is encouraging special training in this area.

As a result, even though money isn’t available to hire additional lactation specialists, state managers say, at least a basic capability will exist as WIC staff increase the amount of breastfeeding support they provide to participants.

To help in this effort, Cathy McCool and Colorado WIC breastfeeding promotion coordinator Sarah Scully worked together on developing a WIC breastfeeding handbook for clinic staff.

The handbook includes material adapted from a Tennessee WIC manual. It details ways to provide support to prenatal as well as postnatal clients, and offers suggestions for first and second visits.

Approaches are tailored for women who know in advance they will breastfeed, those who know they won’t, and those who are undecided prior to delivery. The manual is a handy resource and tool.

Colorado also uses the best materials it can “borrow” from other states. The “Best Start” materials originally developed in the Food and Nutrition Service’s Southeast region are a prime example.

This series of 10 pamphlets addresses such areas of concern to new mothers as handling embarrassment and gaining dad’s cooperation. Posters supplement the brochures, and continuously repeating videotapes reinforce the message in some WIC clinic waiting rooms. A motivational tape produced by the Texas WIC program is also often used.

Many interesting efforts underway

While WIC agencies have a key role in encouraging and helping low-income mothers, Daniluk stresses that breastfeeding education and support is a community responsibility that needs to be shared. “After all,” she says, “WIC can’t do it all.”

That’s one of the reasons Daniluk and other task force members are excited about the group’s accomplishments and future plans.

During its first year, the task force provided training for hospital personnel and public health nurses, doctors, and nutrittionists. As a result , several local task forces have mobilized to promote breastfeeding within their own specific populations.

One such program has been put into place by Denver Health and Hospitals in the Denver metro area. Originally stimulated by WIC’s mandate to promote breastfeeding, this coalition also surveyed hospital policies and practices, developed educational materials, and directed efforts toward raising the public’s awareness about the benefits of breastfeeding.

Results of the survey were released in conjunction with World Breastfeeding Week, August 1-7, 1992.

Tasj force efforts have also included working with family day care home sponsors, day care center directors, and community colleges that train day care directors. The goal is to train 5,000 day care home providers and 300 day care center directors by September 1993, using conferences, workshops, newsletters, and handouts to providers and parents.

In addition, they’ll target employers, beginning with large ones such as the

state government and perhaps the telephone company and local firms such as Coors and Manville. They have developed promotional materials that stress the potential benefits to employers–particularly the reduced frequency of a mother’s absence to care for a sick child.

(Because of natural immunities in their mother’s milk, babies who are breastfed are less likely to experience early-childhood health problems. Medical experts point out, for example, that babies breastfed for at least 3 months have fewer ear respiratory infections and less gastrointestinal distress.)

To get the word out to the general public, the task force’s media work group tied breastfeeding interviews into a series of local “Baby Your Baby” Television spots.

They also worked with local newspapers to get articles published, providing among other things dramatic photos of stack of baby bottles and formula cans to illustrate the environmental benefits of breastfeeding. Task force members also staffed information booths at fairs focusing on child health.

Task force efforts have also included working for changes in legislation and hospital practices. One goal is to have legislation mandate breastfeeding support as part of postnatal care under home health care laws. Another is to find ways to increase a mother’s chances of breastfeeding sucessfully despite very short hospital stays.

One result of task force efforts in these areas is the addition of language to proposed legislation specifying postnatal home health care visits for Medicaid clients (many of whom are also WIC participants). Several task force members have worked to make such support routinely available in their own hospitals.

In addition, as a result of contacts made during a hospital survey project, several hospitals have begun to issue “breastfeeding discharge packs,” replacing or supplementing standard “formula packs” issued to postpartum women.

State recognized for its success

The renowned Dr. Marianne Neifert, known nationally as “Dr. Mom,” is a member of the task force. “It’s time,” she says, “that we recognized Colorado is a leader in this area of mother/baby health care.”

As the task force steams ahead full speed to advance that goal, the work of the interdisciplinary group is winning support and recognition from high levels. For each of the past 3 years, for example, Colorado Governor Roy Romer has proclaimed the week of Mother’s Day as “Breastfeeding Awareness Week.”

And nationally, the U.S. Department of Health and Human Services selected the Colorado Department of Health to receive one of Four SPRANS (Special Projects of Regional and National Significance) grants for breastfeeding promotion.

Following Colorado’s lead, maybe more states will use an interdisciplinary approach to spread the good news about breastfeeding.

COPYRIGHT 1993 U.S. Government Printing Office

COPYRIGHT 2004 Gale Group