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Model Payer Policy for the United States – Steps to Make a Difference

by Cathy Carothers, IBCLC, FILCA, Chair of the United States Breastfeeding Committee

usbcIn the rapidly-changing landscape of insurance coverage requirements rolling out under the U.S. Affordable Care Act (ACA), few have been more confusing than those to cover “breastfeeding support, supplies, and counseling.” The lack of guidelines or recommendations as to who may provide and be paid for lactation care, and what kinds of equipment should be covered for breastfeeding families, has, frankly, created chaos for families, health care professionals, and insurance payers. Inappropriate breast pumps are being issued (ex: manual pumps for mothers pumping for a sick or preterm infant), pumps are often delayed (sometimes for up to 2 weeks) or limited to insurance company durable medical equipment providers, and professional support is often limited strictly to those already in the insurance company’s provider network … who may not necessarily be qualified in lactation support.

In response, the United States Breastfeeding Committee (USBC) has released a new, evidence-based model policy identifying best practices for payers that appropriately meet the requirements of the ACA and ensure adequate delivery of support for breastfeeding. The USBC worked collaboratively with the National Breastfeeding Center (NBfC), an organization with particular expertise in working with insurance companies, the California WIC Association, and other national entities, to develop the Model Policy: Payer Coverage of Breastfeeding Support and Counseling Services, Pumps and Supplies. In addition to support and counseling services and supplies/equipment, coverage of donor human milk is also included.

The process has not been easy! There were many considerations, including the rights of breastfeeding families to optimal care and the complexities of the breastfeeding community and its multiple types of care providers. This landscape was further complicated by the intricate nature of how insurance companies perceive goods and services and process reimbursements. In order to be recognized as a credible and useful resource by payers, the document was designed to offer solutions that would be palatable to them.

We believe this model payer policy is a significant first step in increasing awareness among private insurance companies concerning appropriate coverage for lactation goods, services, and donor milk. Here’s what you as IBCLCs should know about it:

  • Insurance companies have very strict guidelines, and licensure is their primary and historic criteria for “permitted providers” entitled to be paid under a policy. Although IBCLCs are not currently licensed in any state in the U.S., the GOOD news is that some payers DO also consider credentialing through an independent accreditation process (such as that used by the National Commission for Certifying Agencies). Therefore, language was included to demonstrate that IBCLCs are one example of a provider who does meet that standard. Aetna has already taken the step of including IBCLCs among their contract providers whose services are covered, and hopefully many other companies will follow their example.
  • The model payer policy uses the term “approved lactation care providers” as one of the types of recommended permitted providers, with a footnote explaining that term. IBCLCs meet the document’s definition of an “approved lactation care provider” because they “have individual certification awarded by an independently-accredited program that measures assessment of predetermined standards for knowledge, skills, or competencies in a health-related profession…”
  • “Approved lactation care providers” are listed as one of the types of recommended permitted providers for each type of breastfeeding support and counseling services in the chart on page 8. This means that IBCLCs in private practice, as well as those working in other health care settings, are recommended as permitted providers. “Approved lactation care providers” are also listed as one of the types of recommended permitted providers of breastfeeding pumps and supplies in the chart on pages 9-10.
  • Unfortunately, the ACA requirement of coverage of “breastfeeding support, supplies, and counseling” only applies to private health plans. It does not apply to Medicaid; rather, coverage decisions for Medicaid are managed at the state level. In 2012, the Centers for Medicare & Medicaid Services (CMS) published an Issue Brief about “Medicaid Coverage of Lactation Services.” The brief encourages states to go beyond current requirements to include lactation services as separately reimbursed pregnancy-related services, and provides examples of current state practices. We encourage you to work with your state United States Lactation Consultant Association (USLCA) chapter and/or state breastfeeding coalition to advocate for the implementation of the model payer policy’s recommendations in your state Medicaid program. The USBC is also committed to using the model payer policy to advocate for changes in the federal Medicaid statute and regulations.

The coverage details listed in the Model Policy are merely recommendations. The reality is that individual insurance companies may continue to implement the required coverage of “breastfeeding support, supplies, and counseling” however they wish, and some may insist on only using their existing network of providers. This is why continued advocacy will make the difference! The USLCA is your primary mechanism for advocating for the IBCLC in the U.S., so we urge you to get involved!

Navigating the landscape of private and public payers is indeed complex. As clinicians, we have a lot to learn to fully understand their language and policies, as well as to be the levers to influence change. Be watching for a series of webinars from USBC/NBfC soon on how we can do just that.

What’s exciting is that national attention to breastfeeding has never been higher in the U.S. And what happens in the U.S. can have a profound impact on global policies and practices, as well. By working together, we can build on this amazing momentum and make a difference for all new families.

Cathy Carothers_2012Cathy Carothers is co-director of EVERY MOTHER, INC., a nonprofit organization providing counseling and lactation training for health professionals across the United States. She is the current Chair of the United States Breastfeeding Committee, and immediate past president of the International Lactation Consultant Association. She was recently named a Fellow of ILCA, and has been an International Board CertifiedLactation Consultant since 1996.

An experienced trainer and speaker, Cathy has provided more than 400 training events in every U.S. State and Territory, and several foreign countries. She is the project director for national breastfeeding programs for the Federal government, including the brand new breastfeeding peer counseling program for the USDA WIC Program, Loving Support Through Peer Counseling: A Journey Together, and the national WIC staff curriculum in breastfeeding, Using Loving Support to Grow and Glow in WIC. She is also author and project director for the national Business Case for Breastfeeding project through the U.S. Department of Health and Human Services and is involved in national level outreach to business organizations and labor unions through the HHS Office on Women’s Health.

A former University public relations director, she served as the State Breastfeeding Coordinator for the Mississippi WIC Program, coordinating the state’s comprehensive peer counseling program and breastfeeding promotion campaign that earned them the

Cathy is married to a United Methodist minister, and is the mother of 5 healthy breastfed children, now ages 20 to 32. She is also the proud grandmother to two beautiful breastfed grandsons, ages 3 and 1.

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IBCLCs Play a Critical Role in the US Best Fed Beginnings Program

By Debi Ferrarello, MSN, MS, IBCLC

The National Initiative for Children’s Healthcare Quality (NICHQ) launched it’s CDC-supported Best Fed Beginnings program with the ambitious goal of preparing 90 US hospitals for Baby-Friendly designation by September, 2014. The 90 hospitals were selected from 235 applicants and represent 29 states with dubious distinction of having the lowest breastfeeding rates and the highest rates of supplementation during the hospital stay. The 90 hospitals were further divided into three geographical cohorts of 30
hospitals each.

IBCLCs gathering at the recent NICHQ Region B conference in Baltimore.

Each hospital has a “core team” that includes a senior administrator, at least one physician, a nurse leader, a bedside nurse, a data manager, a team leader, a senior lactation consultant, and a mother who does not work for the hospital and has given recently given birth at the hospital. This model addresses administrative “buy-in” issues by requiring senior administrator participation. In fact, the senior administrators have their own track tailored especially for their needs. Since creating a community that supports breastfeeding is a goal of Baby-Friendly, involving a mother from the community makes so much sense!

Recently, hospital core teams from “Region B” gathered in Baltimore, MD for a two day learning session (and Baltimore’s famous crabcakes on our own!). National public health leaders such as CDC’s Laurence Grummer-Strawn and Charles Homer, MD, MPH, president of NICHQ and on faculty at Harvard University, kicked off the event and energized the crowd. Over the course of two days, participants learned more about why breastfeeding is so important, how hospital practices make a difference, and what teams can do to transform the culture. We heard specifics about Baby-Friendly designation directly from Trish Mac Enroe and Liz Westwater of Baby Friendly USA. ILCA members Lori Feldman-Winter, MD, MPH, IBCLC and Anne Merewood, PhD, IBCLC provided specific strategies for success. Pediatrician Sahira Long, MD, gave insights into providing culturally appropriate care. We learned Continuous Quality Improvement (CQI) techniques that are essential to measure our baseline, develop strategies for change and chart our progress as we strive to support breastfeeding from the prenatal period, throughout childbirth and the hospital stay, and into the postpartum period. Finally, we heard from hospitals in our region who have already become Baby-Friendly as they shared trials and triumphs that we could all relate to.

Each participating hospital made a “story board” or video about their hospital, their goals, their successes, and challenges. Pennsylvania Hospital Core Team members enjoyed seeing what others have done and were proud to share our history of “rooming-in” dating back to 1765! Debi Ferrarello, Susan Meyers, Brittany Stofko, Kelly Wade, Pam Powers, and Karen Anastasia in front of their hospital story board.

So what do IBCLCs need to know about this initiative? IBCLCs need to know that after years of pushing that boulder up the mountain alone, there is suddenly an army of folks pushing right along with us…And we need to welcome the newcomers to the task. We need to be prepared to graciously play support roles as leaders who may never before have considered breastfeeding suddenly “discover” it. Many of the hospital team leaders are IBCLCs, meaning that we need to quickly become experts in CQI tools that were never part of The Exam and develop the essential skills to effectively lead an interdisciplinary team through a complex and multi-layered transformation. This is challenging work, but then again, IBCLCs have always be up for a challenge!

Best Fed Beginnings brings opportunities for IBCLCs. In order to become Baby-Friendly, hospitals need to make sure that all of their nurses have at least 20 hours of breastfeeding education, including five hours of competency-based demonstration. IBCLCs can teach classes and conduct skills labs for the competency education. While hospitals are not required to employ IBCLCs for Baby-Friendly designation, many do hire IBCLCs to care for their patients, as well as to provide education for other staff members. And finally, as hospitals invest resources into breastfeeding support, the visibility of those with expertise in lactation care rises. IBCLCs become far more valuable in the eyes of the hospital and the community. This is all good for IBCLCs, and ultimately for mothers and babies!

Debi Ferrarello, MSN, MS, IBCLC is honored to lead the NICHQ Core Team for the nation’s first hospital—Pennsylvania Hospital in Philadelphia.  Over the years she has worked in private practice, co-founded the nonprofit communty-based Breastfeeding Resource Center with Colette Acker, IBCLC, and led hospital-based lactation programs.  She conducts breastfeeding-related research, writes and speaks about breastfeeding, and is passionate about breastfeeding as public health.  She currently serves on the board of the United States Lactation Consultant Association. 

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Hats Off to Kentucky Educational Television for An Awesome Breastfeeding Panel Discussion!

Kentucky Educational Television (KET) is Kentucky’s educational television network with a mission of “educating, inspiring, informing, and connecting its citizens through the power of public media.” With Kentucky’s breastfeeding rates ranked 48th among states in the US according to the 2012 CDC Breastfeeding Report Card (59.4% ever-breastfed; 9.6% exclusively breastfed at 6 months), there is lots of opportunity to educate, inspire, and inform on this important topic. Check out the following trailer for the segment on YouTube.

KET took up the call for this year’s National Breastfeeding Awareness Month by airing a 28-minute segment on all things breastfeeding: benefits, barriers, laws, workplace considerations, hospital initiatives, cultural challenges, and more. The panel of breastfeeding gurus included Doraine Bailey, MA, IBCLC of the Lexington-Fayette County Health Department (and ILCA’s eGlobe editor), Jan Johnson, RD, IBCLC of the Pike County Health Department, and Cerise Bouchard, President of the Lactation Improvement Network of KY.

You can view the 28 minute segment HERE.

Kudos to KET for covering this important topic!  

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Interview with Trish MacEnroe of Baby Friendly USA

Lactation Matters recently caught up with Trish MacEnroe, Executive Director of Breastfeeding USA.  While the Baby Friendly Hospital Initiative is well established in many areas of the world, the number of facilities pursuing the designation has soared recently in the US.  Trish gives us a glimpse into the current trends.

1.      Can you give us a brief history of the Baby Friendly Hospital Initiative in the US?

The Baby-Friendly Hospital Initiative (BFHI) is an international recognition and quality improvement program that evaluates hospital practices to ensure the successful implementation of the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) Ten Steps to Successful Breastfeeding and International Code of Marketing of Breast Milk Substitutes. In addition, the Baby-Friendly assessment serves as an external verification of the CDC’s mPINC survey and is a key strategy to sell my settlement for meeting Healthy People 2020 Goals for breastfeeding. At its core, this designation process involves significant quality improvement and organizational change that replaces long-standing practices with new evidence-based practices that have been proven to lead to better outcomes.

The Baby Friendly Hospital Initiative was launched globally in 1991.  In 1992, the US Department of Health and Human Services funded an Expert Work Group to consider how to implement the BFHI in the United States. In 1994, with support from the U.S. Committee for UNICEF, Wellstart International Screen Sharing developed the evaluation tools to implement the BFHI assessment process. At the request of the U.S. Committee for UNICEF, in January 1997, the Healthy Children Project, Inc. accepted responsibility for creating the organization to serve as the designating body for the BFHI in the United States. Since August 1997, Baby Friendly USA, Inc, a non-profit 501(c)(3) organization, is the US national authority for this global breastfeeding initiative.

Currently, 145 hospitals and birthing centers in 34 states are designated as Baby-Friendly Facilities in the United States. 23 hospitals were added in 2011 and 22 more have already received the designation in 2012. Another 675 are working towards designation. The Baby Friendly Hospital Initiative is growing rapidly in this country as more and more birthing facilities commit to becoming Baby Friendly.

 2.      How has the Surgeon General’s Call to Action impacted the practice?

The US Surgeon General acknowledged the benefits of the Baby-Friendly Hospital Designation in her Call to Action to Support Breast Feeding. Baby-Friendly USA, Inc. (BFUSA) is committed to advancing effective strategies that assist hospitals, breastfeeding coalitions, public health entities and funders to work collaboratively in implementing Action 7 of the Call to Action and improve outcomes.

Since the Surgeon General’s Call to Action, the number of local departments of health, breastfeeding coalitions and other community organizations (auto glass replacement houston shops) assisting hospitals in working to become Baby-Friendly designated has risen dramatically. While there is no direct evidence that it is specifically attributable, since the Call to Action was released 512 hospitals have officially begun work on the BFHI in the US.  My opinion is that the surge in hospital interest is the result of a combination of factors: a call to action from the highest levels of the US government, as well as some new funding opportunities to help hospitals change practices.

3. There has been news lately of the Latch On NYC  initiative to “lock up” formula in the hospital?  What is Baby Friendly USA’s stance on such practices?

Mayor Bloomberg and the NYC Department of Health and Mental Hygiene are to be commended for being proactive on a very important consumer protection issue.

Human milk fed through the mother’s own breast is the normal way for a human infant to be nourished.  Breastfeeding is the biological conclusion to pregnancy and an important mechanism for the continued normal development of the infant.  Naturally, things that occur outside the norm have side effects, including health consequences.  The “Latch-On NYC” campaign, which is voluntary for the facilities, asks that mothers be educated about the benefits of breastfeeding, which naturally includes the possible consequences of formula.  Some mothers will weigh the benefits and risks and compare them to other factors in their lives and decide that formula feeding is the best option for their circumstances.  When that occurs, their wishes should be respected.  This is very much in keeping with the tenants of the Baby-Friendly Hospital Initiative.

Another very important point that has been lost in the media frenzy around the Latch-On NYC campaign is that hospitals have standard policies that either limit access to (which is what Latch-On NYC calls for) or “lock up”  most of the products they use.  This is done for patient safety reasons as well as inventory control.  What we really should be asking is why is this not standard operating procedure for infant formula in all facilities throughout the US, and why has the suggestion of it stirred up such a controversy? It just makes good sense.

4.  What is your hope for BFUSA as we move forward in the US?

I can’t wait for the day that the last hospital in the US receives the Baby-Friendly designation.  My hope is that we effectively fulfill our vision of creating an American culture than values the enduring benefits of breastfeeding and human milk for mothers, babies, and society.

Trish MacEnroe is Executive Director of Baby-Friendly USA, treasurer of the NYS Breastfeeding Coalition, and former chair of the WIC Association of NYS. At Baby-Friendly USA, Trish has reorganized the Baby-Friendly designation process and created
tools to assist facilities pursuing designation. Previously, Trish worked for the WIC program, most recently as Director of the NYS WIC Training Center, and oversaw development of training programs for all aspects of WIC including the development of their Breastfeeding Peer Counselor website and curriculum. Trish received her Bachelor of Science degree in Food Science and Nutrition from the University of Rhode Island.

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World Breastfeeding Week: Massachusetts, USA Hospitals Go Bag Free

By Marsha Walker, RN, IBCLC

Massachusetts is now the second state in the US, behind Rhode Island, to have had all of its maternity hospitals eliminate the practice of distributing formula company discharge bags. Ban the Bags is a campaign that began in 2006 to rid hospitals of the practice of distributing formula company discharge bags or other discharge gifts to mothers when leaving the hospital. It was started after efforts in Massachusetts failed to insert regulations regarding such a ban into our hospital perinatal regulations. Ban the Bags, the Massachusetts Breastfeeding Coalition, and the MotherBaby Summit have all encouraged hospitals to eliminate this practice through letter writing, education of hospital management at summits designed just for them, and downright shamed them into doing it in order to get off the list of hospitals we kept who continued engaging in this practice. The list of hospitals who continued to give out these bags was displayed on the MotherBaby Summit website and was placed on a large poster board and displayed annually at the Massachusetts Breastfeeding Coalition’s yearly conference. Ban the Bags answered many e-mails with suggestions, references, and approaches to help individuals get the bags removed from their hospital.

Ban the Bags found that many hospitals did not really care about the effect of formula bags on breastfeeding but responded when told that it was a breech of medical ethics, was in opposition to the hospital’s own mission and vision, and was no different than unethical arrangements with pharmaceutical companies. We encouraged people to contact their hospital Ethics Committee for an opinion on a practice that promoted the use of a potentially hazardous product and how this related to the ethical principles of “first do no harm” and the obligation of health care providers to act in the best interest of their patient. We counseled people to contact the hospital’s Corporate Compliance Department to report how these bags were a conflict of interest, especially since HIPAA defines them as a form of marketing. We recommended that people contact the hospital’s Risk Management Department to inform them that because the hospital had no stock control there was no method to contact patients who had received the bags if there was a recall of the formula. Such a recall occurred in 2006 when one company’s bags were recalled due to the defective packaging of formula inside which resulted in a vitamin C deficiency. Also, the powdered version of formula is not sterile and the hospital could be handing out and liable for a product contaminated with Chronobacter sakazakii. Mothers were never instructed by the hospital in how to safely prepare the powdered formula that they were essentially marketing for formula manufacturers. Eliminating the bags was a fairly easy way to increase the hospital’s score on the mPINC survey.

Ban the Bags advocates toss bag into the original location of the Boston Tea Party!

Hospitals were concerned that they would have to pay for formula, as the formula companies fought hard to prevent the disappearance of this lucrative and inexpensive marketing tactic. We have found that this was not actually true, as manufacturers did not remove their product from the hospital which represented essentially a captive audience. Companies know that well over 95% of mothers continue to use the brand of formula given to their infant in the hospital. Why would a formula company give up this potent marketing advantage? We heard how terrible it would be for poor mothers who could not receive this “gift.” Of course there is only enough formula in the bag for about a week or so worth of feedings, just enough to reduce a mother’s milk supply and accustom the infant to the bottle. Detractors complained that we were “forcing” mothers to breastfeed or removing their choice of infant feeding methods. Mothers decide how they wish to feed their infants well before entering the hospital. Bags have no effect on feeding decisions, they have only one purpose, which is to cause a breastfeeding mother to use formula and create a customer/market where none existed before. We have found that when hospitals remove the bags, they show up in community pediatric and obstetric offices, clinics, and even in ultrasound departments. Make sure to ask that all of these entities cease distributing formula company materials, as this works directly to counteract your efforts in the hospital.

Ban the Bags at www.Banthebags.org has many helpful recommendations on approaching the elimination of this practice. I am happy to help and you can email me at Marshalact@gmail.com.

Marsha Walker is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently a member of the board of directors of the Massachusetts Breastfeeding Coalition, Baby Friendly USA, Best for Babes Foundation, and the US Lactation Consultant Association (USLCA). She is a past president of the International Lactation Consultant Association (ILCA).

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Can a Change in Pediatric Office Policy Begin to Change the Culture of Infant Feeding?

Written by Jennie Bever Babendure, PhD, IBCLC

In the February issue of Breastfeeding Medicine, Ann M. Witt and her colleagues analyze the impact of integrating lactation consultants into a pediatric practice1.  Although providing referral to or in-office lactation services if requested is not a new idea, what makes this study unique is the systematic change made to schedule ALL breastfeeding newborns with a lactation consultant for their first pediatric office visit.

How did this work?  At the time of the study, the American Academy of Pediatrics (AAP) policy dictated that all healthy term breastfeeding infants be seen at the pediatric office within 3-5 days of hospital discharge2.  In 2009, the study practice changed their policy to routinely schedule these visits with an in-office IBCLC precepted by a physician.  IBCLC’s spent 45-60 minutes with the patient, then discussed the history and breastfeeding evaluation with an available physician who spent about 5 minutes in the room evaluating the patient and deciding on a treatment plan.   Follow up phone calls and in-person visits were scheduled, as well as a routine visit with the primary physician at 2 weeks of age.  More than 45% of patients had multiple visits with a practice IBCLC, and a limited survey indicated high maternal satisfaction with the new policy.  IBCLC’s were employed 4 hours a day 5 days a week in the practice to meet the need for these visits and follow up.  As the physician evaluated the patient at the 3-5 day visit, it was reimbursed as a general medical visit, which sufficiently covered IBCLC salaries.

How did this impact breastfeeding?  In 2007, all infants were seen in the office by 2 weeks of age unless jaundice or weight gain problems were identified in the hospital.  The practice employed an RN, IBCLC 3 days a week to provide phone support for breastfeeding problems as well as in-person consultations.   When researchers compared infant feeding method  in retrospective chart review between 2007 and 2009 patients, they found that non-formula feeding (breastfeeding) went up by 10-15% at all time points from 2-9 months, demonstrating a significant increase in breastfeeding intensity following the intervention.

When I first read this study, I was struck by the brilliant simplicity of this idea.  By integrating lactation consultants into the existing medical structure, mothers and babies got automatic breastfeeding help and follow-up, and physicians could follow AAP policy and monitor jaundice and weight gain as well have a large influence on the on-going health of their patients with minimal input of time or cost and no additional formal training.  As I continued to think about this study, I realized that this policy has a much broader impact.  By making this systematic change to their office policy, they have changed the culture of infant feeding in their practice.  Routinely scheduling the first office visit with an IBCLC sends a strong message to patients.  It says:  “Your physicians know you want to breastfeed, and feel breastfeeding is so important to your child’s health that we will do everything we can to help you through the challenges.”

I can’t help but imagine the impact if all pediatric practices were to adopt this model.  Would these actions speak louder than our words?  Would they whisper or shout: Breastfeeding is a public health issue3, we’re here to help you make it happen.

1.  Witt AM SS, Mason MJ, Flocke SA., Source1 Department of Family Medicine CWRU, Cleveland, Ohio. Integrating routine lactation consultant support into a pediatric practice. Breastfeeding Medicine 2012;7(1):38-42.

2.  BREASTFEEDING SO. Breastfeeding and the Use of Human Milk. Pediatrics 2005;115(2):496-506.

3.  BREASTFEEDING SO. Breastfeeding and the Use of Human Milk. Pediatrics 2012;129(3):e827-e841.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.

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Why Beyonce Nursing in Public is So Significant

Written by Robin Kaplan, M.Ed., IBCLC, Owner of San Diego Breastfeeding Center and Co-Editor of Lactation Matters

Last week I came across an extremely well-written article by Kimberly Seals Allers of MochaManual.com, called Dear White Women: Beyonce is OUR Breastfeeding Moment. Please Step Aside.  In her article, Kimberly discussed her disappointment with the media coverage of Beyonce, one of the most iconic and popular African American women at this current time, nursing in public.  While this was a wonderful moment for all breastfeeding advocates, it truly was a significant event for African American women, who have statistically had low breastfeeding initiation and duration rates.  Here is my interview with Kimberly Sears Allers.

Kimberly Seals Allers and her children

Robin: Why is Beyonce breastfeeding in public so significant for the African American community?

Kimberly: Beyonce breastfeeding in public is particularly significant for our community because we just haven’t had as many high profile African American celebrities come out and support breastfeeding. Like it or not, role models matter. Celebrities can help create a lifestyle cache and trendiness, particularly among young women, that helps broaden our ideas about who breastfeeds in the black community. When you look at the high infant mortality rate among African American infants, and we know how critical breastfeeding is to saving these babies lives and reducing their risks of respiratory infections and childhood obesity, the possibly the power of one highly-visible black celebrity breastfeeding could potentially save one more infant, and help one more baby become a healthier child is significant beyond words for me.

Robin: In your opinion, how could this media event been covered more appropriately?

Kimberly: For years I have been writing that black mothers are absent from the mainstream “mommy” conversation in this country and it seems our invisibility has carried over with this instance. The media was, for the most part, negligent by not connecting the dots between Beyonce as a black woman breastfeeding an African American child–both of whom are statistically less likely to breastfeed or be breastfed, and highlighting the particular significance for black women who have had historically low breastfeeding rates for over 40 years. This was also a rare, and unfortunately missed, opportunity for those who speak for the breastfeeding movement to connect those dots for them and millions of others. When we have the opportunity for a national microphone, I believe we have to hold our own leaders and the media accountable for thinking about all the issues and looking at these news events from all angles.

Robin: How can lactation consultants better support African American breastfeeding women in our communities?

Kimberly: The most important thing is to understand the cultural nuances of breastfeeding for an African American woman. Breastfeeding is not about simplistic messaging that breast is best; we know that and want that. But many of us are first generation breastfeeders with little or no multi-generational support. Help us with the how. Studies show that our male partners, grandmas, aunties and extended family members have a greater influence on our decision and breastfeeding duration than other women… so target the whole family. Understand the power of media stereotypes, our own internal stereotypes about who breastfeeds in our community, the residual effects of our breastfeeding experiences during slavery, and the role of aggressive infant formula marketing. Educate us so that when our mother or grandmother question if the baby is getting enough, we have an educated answer. Empower us to have more confidence in our bodies and our ability to “do this” even if, and especially if, we don’t have much social support. Having a broader understanding of what this woman is dealing with, beyond the latch issue, a lactation consultant may actually be there to assist, which can mean so much in terms of true support.

Robin: Now, please tell us all about your new project, Black Breastfeeding 360°.

Kimberly: I’m so excited about this! For years, I’ve been frustrated by the superficial news coverage of breastfeeding issues in our community. There is always reporting of the low statistics, with little or no insight into the complexities I previously mentioned or the lack of role models or the lack of social support. So I created Black Breastfeeding 360° as an online content library for media professionals to get everything they need to know on the full spectrum of the black breastfeeding experience. And I created BB360° as a place for women, mothers, and fathers to learn, share and hear the breastfeeding experiences of others. BB360° features articles and commentaries that any media outlet can use for research or download for free use in their publication.  It features audio and video clips of real mothers, fathers and grandparents talking about their true thoughts and feelings about breastfeeding, and it features practical tips and resources specifically written for any black woman nursing her child or even thinking about it. I was supported to create BB360° through my Food & Community Fellowship with the Institute of Agriculture and Trade Policy, funded by the Kellogg Foundation, and I’m so grateful. It’s my baby and I’m breastfeeding it, so I know it will be healthy and robust.

Kimberly Seals Allers is a leading voice on African American motherhood,  author of The Mocha Manual™ series of books and founder of www.MochaManual.com, a parenting and lifestyle destination and blog for African American moms and moms-to-be. An award-winning journalist, Kimberly is also a popular public speaker and consultant on the mom of color market, and fiercely committed to reducing the high infant and maternal mortality rates and increasing the low breastfeeding rates in the African American community.

In 2011, Kimberly was named an IATP Food and Community Fellow, funded by the Kellogg Foundation, with a mandate to increase awareness and reducing the barriers to access to “the first food”—breast milk, in vulnerable communities.

In addition to her popular blog on MochaManual.com, Kimberly blogs about the African American parenting experience for Babycenter’s Momformation.com and is a regular commentator for Essence.com and LiftetimeMoms.com.

Her first book, The Mocha Manual to a Fabulous Pregnancy (Amistad/HarperCollins) a hip, funny and informative pregnancy guidebook for women of color, put her on the map as a pregnancy and parenting expert with real-deal insights. The book was nominated for an NAACP Image Award and later turned into The Mocha Manual to a Fabulous Pregnancy DVD, available at Walmart.com. Her book series also includes The Mocha Manual to Turning Your Passion into Profit, and The Mocha Manual to Military Life—A Savvy Guide for Girlfriends, Wives and Female Service Members.

A graduate of New York University and Columbia University Graduate School of Journalism, Kimberly is a divorced mom of two who lives in Queens, New York.

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Web Resources for IBCLCs Working on Baby Friendly Initiatives

Written by Wendy Wright, MBA, IBCLC

The emphasis on becoming Baby Friendly in the United States is growing.  In fact, in late 2011, the Centers for Disease Control and Prevention awarded nearly $6 million over three years to the National Initiative for Children’s Healthcare Quality to help hospitals nationwide make quality improvements to maternity care to better support mothers and babies to be able to breastfeed.   Click here for information on getting involved in the NICHQ’s Best Fed Beginnings program.

Where is your institution on the Baby Friendly Spectrum? 

Whether you are considering applying, just initiating the process, or in the depth of completion for certification – here are some web resources that may be useful toward your efforts.

Initially, make sure you have investigated all of the great information directly from Baby Friendly USA.  This site is filled with details, schedules, suggestions, and resources.  It’s a great place to begin your path toward baby friendly.

The breastfeeding coalitions have stepped up and offer some great video resources for those of us in the trenches of the Baby Friendly effort.  Here is a catchy, simple video from breastfeedLA.org.  IBCLCs could utilize this to introduce the 10 steps, congratulate staff for accomplishing several of the steps, or to motivate staff to progress through the Ten Steps – take a look!

Another coalition, this time in Massachusetts, is pulling together a baby friendly hospital rap video to emphasize that breastfeeding costs nothing and has no downside.  The video is currently in its teaser stage – take a look and contribute if the effort inspires you.

The California Department of Health recently published a new training toolkit on its website.  This toolkit is designed for both administrators and the interdisciplinary team that will develop and implement the new policies to support and promote breastfeeding.  The reference list alone is worth visiting the site!

Lastly, as a previous marketing executive, I just have to share some motivational and promotional YouTube contributions from some Baby Friendly hospitals.  These videos would be great to produce once you reach Baby Friendly status, however, they can also be utilized to demonstrate to administration the potential marketing advantages the Baby Friendly Designation can provide.   “Wouldn’t it be great if our hospital had this type of press coverage?”

Texas Health Celebrates “Baby-Friendly” designation for three hospitals.

Mission Hospital becomes the first Baby Friendly hospital in North Carolina.

Harlem Hospital becomes the first hospital in New York City to gain Baby Friendly recognition.

As stated by William H. Dietz, MD, PH.D, director of the United States Center of Disease Control’s Division of Nutrition, Physical Activity and Obesity. “We know that breastfeeding rates are higher in Baby-Friendly hospitals, yet only 5 percent of babies in this country are born in these facilities. We need to help hospitals improve their maternity care to better support breastfeeding.”  I’m hoping these web resources assist with your important efforts.

Please add additional web resources to the comments section below so we can all benefits from the wealth of information available via the Internet.

Wendy Wright, MBA, IBCLC Co-Owner Lactation Navigation – Workplace Lactation Consultants, LLC

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The Trend Towards Becoming a “Breastfeeding Friendly” University

Written by: Amber McCann, IBCLC, Owner of Nourish Breastfeeding Support

For many of us here in the United States, autumn is about a cool crispness in the air, pumpkin muffins and FOOTBALL! And by football, I mean crazy fans – yell at the TV – wear your jerseys kind of football. I know that in many other parts of the world you understand this fervor, rather in support of another kind of football (i.e., soccer!)
Where I grew up in Ohio, there was one team and one team only. THE Ohio State Buckeyes. The affection and community support runs deep…very, very deep. To cheer for our chief rival, Michigan, could get you booed right out of town. At several hospitals in the area, babies are given Ohio State onsies (infant-size shirts that snap over a diaper) at birth…the indoctrination into the fandom begins early!


So, when I recently saw a press release that said that my beloved Ohio State had won an award for becoming a “breastfeeding friendly” place, my inner Buckeye jumped up and down. They have established rooms in which breastfeeding mothers can feed their children or pump all over campus with “a mini-fridge for storage, a hospital-grade breast pump, a comfortable chair with reading materials and low-light settings for a calm, quiet experience.”

I quickly tweeted my excitement over this development and was met with some healthy “trash talking” from my colleague, Liz Brooks. Liz quickly mentioned that her daughter’s school, Indiana University, a fellow school in Ohio State’s Big 10 Athletic Conference, also had lactation rooms, provided by the Office of Women’s Affairs. With both of our schools in the WIN column, Liz was quick to find out that all 12 of the schools in the conference (a group of universities that all compete together), have established lactation programs!

*The fact that there are 12 teams in conference called the Big 10 is not lost on us! 🙂

Click on the name of the school to find out more about their lactation programs!

University of Illinois

Indiana University

University of Iowa

University of Michigan

Michigan State University

University of Minnesota

University of Nebraska

Northwestern University

Ohio State University

Penn State

Purdue University

University of Wisconsin

What an awesome testament to the importance of Lactation Rooms for mothers! If you have not taken the opportunity to familiarize yourself with The Business Case for Breastfeeding, supported by the United States Department of Health and Human Services, I encourage you to do so. The reports contained within states,
“There is ample evidence that a supportive worksite environment with a private place to express milk and access to a quality breastpump helps women feel more confident in continuing to breastfeed after returning to work (Galtry 1997; Frank 1998) and that lack of accommodations contributes to lower breastfeeding duration (Cobett-Dick & Bezek 1997).”

WAY TO GO to the BIG 10 schools for forging the way for great breastfeeding support in the workplace!

Action Step: Does you alma mater provide lactation rooms and breastfeeding support for their students and employees? If not, as an alumni, communicate with them your desire that they provide this service and link them to The Business Case for Breastfeeding!

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A BFHI Update – ‘Call to Action for Breastfeeding Support from the Surgeon General ‘

How do you see the Call to Action impacting Baby Friendly in the United States? (Maybe even internationally?)

The United States now has a strong, evidence based national policy on infant and young child feeding that specifically calls for expanding implementation of the Baby-Friendly Hospital Initiative (BFHI). This is an extremely important turn of events and status change.  BFHI is also specifically mentioned in the White House Obesity Report, and possibly even more importantly, in The Joint Commission’s recent Speak Out campaign. Internationally, Baby Friendly USA (BFUSA) has always been a strong collaborator with other nations’ BFHI Authorities and I would expect this collaboration to increase.

What changes are you hoping to see?

The Director of Health of my state met with our state Lactation Consultant chapter in early August, and within two weeks convened a high-level meeting of organizations to begin discussions on moving BFHI ahead. That’s amazing progress! Several states have conducted in-depth surveys of maternity facilities (in addition to encouraging hospitals to respond to the Center for Disease Control’s mPINC surveys), developed interim goals and local incentive programs, held Hospital Summits, and more.  Maternity Practices in Infant Nutrition and Care (mPINC) is a national survey of maternity care practices and policies that is conducted by the CDC every 2 years beginning in 2007. The survey is mailed to all facilities with registered maternity beds in the United States and Territories.  I expect the Call to Action will resonate with and inspire the entire public health professional community, at every level.

Why is this Call to Action coming at a critical time?

I’m tempted to say “It’s about TIME!” The momentum for breastfeeding has escalated in the past ten years in the US, partly due to the collaborative work of the US Breastfeeding Committee. The economic conditions are encouraging everyone (individuals and companies) to re-think spending patterns; health decision-making is becoming more transparent; and virtually everyone is calling for better health outcomes. Over 40,000 IBCLCs around the world are working with other health care providers to provide the up-close one-to-one clinical support for mothers and babies. Without this rich network of support, mothers would face far more avoidable problems.

How will the Call to Action impact not only hospital-based lactation consultants, but lactation consultants in private practice, as well?

There’s something in the Call to Action for everyone. As an lactation consultant in private practice myself, I was thrilled to see a call for appropriate reimbursement for my services as an LC, regardless of other credentials or licenses. I’m currently in graduate school and was very excited to see a call for more research on breastfeeding. The Call to Action’s recognition of lactation consultants as important players on the health care team was extremely gratifying.

Linda J. Smith, BSE, FACCE, IBCLC, FILCA
Bright Future Lactation Resource Centre Ltd.
6540 Cedarview Ct., Dayton OH 45459-1214
Phone (937) 438-9458   Fax (937)-438-3229
www.BFLRC.com

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