The Journal of the Arkansas Medical Society Issue 10 Vol. 114 | Page 13

A
C L O S E R
Clinics interested in promoting a
breastfeeding-friendly practice can
implement these evidence-based
recommendations. 2
1. Establish a written breastfeed-
ing-friendly office policy and include
all staff in its implementation. Estab-
lish a lactation room for employees
and mothers.
2. Train staff in breastfeeding
support skills, including knowledge
of community resources. Identify
lactation support staff to serve
as breastfeeding champions.
Breastfeeding peer counselors are
in several local county health u nits
and can assist with breastfeeding
positioning, plans to return to work/
school and provide support.
3. Become knowledgeable about
rare breastfeeding contraindications
including maternal HIV, tuberculo-
sis, illicit drug use, chemotherapy or
radiation; or infant galactosemia.
4. Discuss breastfeeding at pre-
natal visits and regularly throughout
the first year. Encourage parents or
partners to attend; include family
decision-makers.
5. Encourage breastfeeding moth-
ers to feed newborns only human
milk and avoid water, formula, supple-
ments or other liquids, unless medi-
cally indicated.
6. Work with the local birthing
hospital to implement breastfeeding-
friendly care and encourage them
to pursue Baby-Friendly USA des-
ignation. During rounds, support
breastfeeding and evaluate a feed-
ing or review chart for adequacy of
feeding. Encourage mothers to attend
breastfeeding classes and schedule a
lactation consultant for mothers with
recurrent problems.
7. Schedule a newborn visit by the
third to fifth day of life. Reinforce the
importance of exclusive breastfeeding
NUMBER 10
L O O K
AT
Q U A L I T Y
A CLOSER LOOK AT QUALITY
for six months and up to one year, as
mutually desired by mother and in-
fant. Provide guidance about weight-
gain expectations.
8. Educate mothers about Special
Supplemental Nutrition Program for
Women Infants and Children (WIC).
9. Provide guidance about re-
turning to work, and the expression
and storage of breast milk. Arkansas
statutes (Acts 680 and 621 of 2007)
support breastfeeding families.
Arkansas Breastfeeding in Public
permits women to breastfeed in
public and provides protection from
prosecution. Arkansas Breastfeeding
in the Workplace says employers shall
provide reasonable unpaid break time
to express breastmilk, and reasonable
effort to provide a private, secure, and
sanitary room, near their work area.
10. Have front-office staff advise
the family that the physician or
lactation support staff may need
to observe a feeding. Ask the
family to indicate when the infant
is ready to feed while waiting for
their appointment. At subsequent
appointments, observe feeding if the
mother identifies a problem or weight
gain is inadequate.
11. Provide culturally sensitive and
literacy-appropriate educational re-
sources for parents about the benefits
of breastfeeding, duration, peer sup-
port and community resources. Avoid
literature provided by infant formula
manufacturers. AFMC has free, bilin-
gual, consumer breastfeeding materi-
als available to order or download at
https://afmc.org/product-category/
practices/breastfeeding-_outpa-
tientphysicianoffice/. UAMS’ Learn on
Demand patient breastfeeding educa-
tion is at https://patientslearn.org/.
12. Encourage breastfeeding in
waiting and exam rooms with posters
and pamphlets.
13. Do not distribute to parents
free formula or infant items from
formula manufacturers.
14. Train staff to follow phone
triage protocols for breastfeeding
concerns, including when to refer to
an IBCLC. Expressly for You provides
telehealth breastfeeding consults at
501-202-7378. Breastfeeding promo-
tion timeline and nurse triage check-
list available at https://afmc.org/
product-category/practices/breast-
feeding-_outpatientphysicianoffice/
15. Regularly update your com-
munity resources list and preferred
referral procedures. Get to know
community support groups. Trained
lactation consultants are available at
Arkansas’ Breastfeeding 24/7 Helpline,
sponsored by the Arkansas Depart-
ment of Health and Baptist Health at
800-445-6175 or 844-344-0408.
16. Ensure the effectiveness of
breastfeeding latch and refer for fre-
notomy when appropriate.
17. Collaborate with the obstetric
community to develop breastfeeding
support programs because breast-
feeding decisions are often made
before pregnancy.
18. Provide support and educa-
tion to local child care centers on the
importance of breastfeeding and
handling, storage and feeding of
expressed milk.
19. Monitor breastfeeding initiation
and duration rates in the practice. s
Dr. Rodgers is AFMC’s Chief Medical
Officer; Ms. Hedrick and Ms. Smith are RN
quality outreach specialists with AFMC.
REFERENCES
1. Ten Steps to Successful Breastfeeding.
Baby-Friendly USA www.babyfriend-
lyusa.org/about-us/1--steps-and-interna-
tional-code
2. Meek J, Hatcher A. The Breastfeeding-
Friendly Pediatric Office Practice. Pediat-
rics, Amer Acad of Pediatrics May 2017
APRIL 2018 • 229