10 STEPS

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10 STEPS to support breastfeeding mothers
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QUOTES FROM PROFESSIONALS

• As a neonatologist I have always strongly
  encouraged the mothers of all of my patients to
  provide their breastmilk for their babies.A
  mothers own milk is always the best feeding
  option.
• Susan Sward-Comunelli, MD
• Founder of the Mothers Milk Bank of North
  Texas

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the texas ten step program

• Recognizes hospitals and birth centers that
  provide optimal breastfeeding support to new
  mothers
• Offers trainings and updates
• Supports facilities in reaching the Healthy
  People 2020 goals.

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the healthy people 2020 goals

• Increase Texas breastfeeding initiation rates to
  82
• Increase the percent of Texas infants
  breastfeeding at 6 months to 61
• Increase the percent of Texas infants
  breastfeeding at 12 months to 34
• Increase the percent of Texas infants exclusively
  breastfeeding at 3 months to 44
• Increase the percent of Texas infants exclusively
  breastfeeding at 6 months to 24

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the healthy people 2020 goals

• Reduce the proportion of breastfed newborns who
  receive formula supplementation within the first
  2 days of life to 16
• Increase the proportion of live births that occur
  in facilities that provide recommended care for
  lactating mothers and their babies to 8
• Increase the proportion of employers that have
  worksite lactation support programs to 38

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WHY SHOULD WE BECOMEA TEXAS TEN STEP FACILITY?

• Over 75 of women in the state of Texas are
  choosing to breastfeed their infants
• These women are seeking medical care that will
  support them in this decision
• The Texas Ten Step designation will help you
  advertise as a breastfeeding friendly facility

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QUOTES FROM PROFESSIONALS
Enthusiastic support and involvement of
pediatricians in the promotion and practice of
breastfeeding is essential to the achievement of
optimal infant and child health, growth, and
development. AAP The American College
of Obstetricians and Gynecologists strongly
supports breastfeeding and calls upon its
Fellows, other health professionals caring for
women and their infants, hospitals and employers
to support women in choosing to breastfeed their
infants. All should work to facilitate the
continuation of breastfeeding in the work place
and public facilities. Breastfeeding is the
preferred method of feeding for newborns and
infants. Health professionals have a wide range
of opportunities to serve as a primary resource
to the public and their patients regarding the
benefits of breastfeeding and the knowledge,
skills and support needed for successful
breastfeeding. ACOG
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HOW WILL MY FACILITY BENEFIT FROM RECEIVING THE
DESIGNATION?

• The TTS designation can be used to advertise the
  expert care your facility provides to
  breastfeeding women
• Your facility will be provided with a variety of
  itemsto advertise your commitment to offering
  infants the very best care. The Texas Department
  of State Health Services will provide you a
  unique log-in that will allow you to order
  breastfeeding materials for your patients free of
  charge.

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How do I apply?

• Create policies that protect and promote
  breastfeeding
• Applications are located at www.texastenstep.org
  /apply

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DSHS WILL SUPPORT EFFORTS TO MEET THE TTS
CRITERIA BY PROVIDING

• Free on-site breastfeeding trainings
• Free breastfeeding materials for patient
  education
• Additional training for staff off-site

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STEP 1
Make breastfeeding the preferred method of
infant feeding.
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DEVELOP POLICIES THAT PROMOTE BREASTFEEDING AS
THE PREFERRED METHOD OF INFANT NUTRITION

• All interventions and care plans should protect
  this valuable resource
• Decisions to interrupt breastfeeding or withhold
  human milk should be evidence based
• Policies should be communicated to staff upon
  employment and updated on a regular basis
• Sample Policies can be found at
  http//bfmed.org/ace-files/protocol/mhpolicy_ABM.
  pdf.

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STEP 2

• Employees who care for mothers and infants should
  receive breastfeeding training within six months
  of employment, with updates provided on a regular
  basis.

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Training can be offered in house by the
Department of State Health Services at no charge.
CEs are available for -Breastfeeding
Management -Breastfeeding the Compromised
Infant -Managing Breastfeeding Complications To
schedule a training through DSHS please
contact Hellen Sullivan Hellen.Sullivan_at_dshs.st
ate.tx.us [phone]
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STEP 3

• Breastfeeding is presentedas the feeding choice
  for all mothers, including those that must be
  separated from their infant.

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PRENATAL CLASSES AND HOSPITALTEACHINGS SHOULD
INCLUDE

• The health risks associated with not
  breastfeeding
• Principles of milk establishment and supply
• Importance of skin-to skin contact
• Maintaining lactation if mother and infant are
  separated

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STEP 4

• Mothers are encouraged to breastfeed their
  newborn within one hour of birth, within 30
  minutes is ideal.

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SKIN-TO-SKIN CONTACT

• Mothers with c-sections or complications should
  be assisted to breastfeed as soon as possible
• Mothers should have the opportunity for early
  skin-to-skin contact regardless of type of
  delivery

Protocols for skin-to-skin after birth and
research supporting this contact can be found
at http//bfmed.org/ace-files/protocol/peripar
tum.pdf
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STEP 5

• Breastfeeding should be assessed within six
  hours after birth and at least once per shift.

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• There should be staff with training beyond the
  basics of breastfeeding to assist with unusual
  management concerns (IBCLC, nurses or physicians
  with additional training).

Additional training could include staff that have
attended Principles of Lactation Management and
Lactation Counseling and Problem Solving
(Trained Breastfeeding Educators) or staff that
have clinical breastfeeding training. Staff can
register for these trainings at
http//www.dshs.state.tx.us/wichd/lactate/courses
.shtm.
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STEP 6

• Newborns should be given artificial human milk
  only if it is medically indicated and ordered
  by the physician or requested by the parent.

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• Policy should state that the parents are advised
  on the impact of introducing formula prior to
  establishing breastfeeding
• If infant needs supplementation staff should
  protect breastfeeding while offering the
  supplement

Protocols on supplementation and methods of
supplementation can be found at
http//bfmed.org/ace-files/protocol/supplementati
on.pdf
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STEP 7

• Mothers and newborns should be encouraged to
  room-in unless separation is medically indicated.

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• Limit time away from mother for medical
  procedures
• Nurses should help families plan for periods of
  rest during their hospital stay.
• If the mother requests newborn be brought to the
  nursery, the infant should be brought to the
  mother when hunger cues are evident.

Additional information on peripartum
breastfeeding management can be found at
http//bfmed.org/ace-files/protocol/peripartum.pdf
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STEP 8

• Mothers should be encouraged to breastfeed their
  newborns without restriction and breastfeeding
  should take priority over non-emergent events.

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• Mothers should be instructed to
• Recognize early hunger cues
• Assess latch and adequate feed
• Monitor wet and soiled diapers
• Recognize normal feeding patterns of a newborn
• Recognize changes in the infants feeding
  patterns as the infant goes through growth
  spurts and starts solids

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STEP 9

• Artificial Nipples should be discouraged for the
  healthy newborn.

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• Alternate feeding methods should be used if
  supplementation is necessary.
• Expressed breastmilk should be the first choice
  if supplementation is necessary.
• Mothers should not be given discharge packs that
  include formula or formula advertisements.

Protocols for supplementing a breastfeeding
infant can be found at the Academy of
Breastfeeding Medicines website
http//bfmed.org/ace-files/protocol/supplementati
on.pdf
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STEP 10

• Breastfeeding mothers should receive support
  following discharge.

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• Follow up should include a list of resources
  including
• - Online resources such as www.breastmilkcounts.c
  om
• - Telephone hotlines
• - Area Mother-to-Mother support meetings
• - IBCLCs in the area
• Hospitals can provide a lactation clinic, in-home
  visitation or follow-up phone calls to support
  breastfeeding moms.

WIC Peer Counselors can be a great resource for
breastfeeding families and hospital staff. For
information on this program please contact
Jewell Stremler Jewell.Stremler_at_dshs.state.t
x.us [phone]
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MOTHER FRIENDLY WORKSITE

• Texas Ten Step facilities must be designated as a
  Mother-Friendly Worksite.
• This designation shows that you support your
  staff in giving their infants the very best.

Information on applying to become a Mother
Friendly Worksite can be found at
http//www.dshs.state.tx.us/wichd/lactate/mother.s
htm