EPIC Breastfeeding Program Breastfeeding Education EPIC Educating Physicians

EPIC Breastfeeding Program ® Breastfeeding Education

EPIC ® Educating Physicians and Practices In Their Community n Began in 2007 n Peer-to-Peer Physician Breastfeeding Education n Patterned after the EPIC Immunization Program n EPIC Breastfeeding Program hopes to mirror it’s success n

EPIC Breastfeeding Program Partners Georgia Department of Public Health n Georgia Chapter –American Academy of Pediatrics n Georgia Ob/Gyn Society n Georgia Academy of Family Physicians n Centers for Disease Control and Prevention n

Goals of EPIC Breastfeeding Program n n n Educate physicians & their office staff on breastfeeding Give reasons why physicians play a critical role Teach evidence - based standards on how to encourage, promote and support breastfeeding How to access lactation and support services in the community How to access patient education resources Inform physicians of WIC services for breastfeeding mothers

CDC Breastfeeding Report Card Georgia 2007 2009 2010 2012 2013 2014 Breastfeeding Initiation 68. 2% 62. 5% 62. 8% 70. 9% 68. 2% 70. 3% Breastfeeding @ 6 months 38% 36. 4% 33. 5% 40. 8% 31. 8% 40. 1% Breastfeeding @ 12 months 16. 8% 18. 1% 17. 9% 17. 6% 12. 9% 20. 7% Exclusive Breastfeeding @ 6 months 11% 14. 8% 9. 7% 12. 9% 6. 2% 14. 5% Baby Friendly Hospitals 0 0 0 3

Why is educating physicians on breastfeeding important? n “[women] typically receive minimal advice about breastfeeding from a physician. ” Freed et al n “Physicians lack the necessary clinical skills to provide lactation management” Taveras et al. n “Pediatricians are ideally situated to

Challenges for Physicians Not aware of benefits/management n Lack of time n Concerns about reimbursement n Not comfortable examining breasts n No knowledge of community resources n

Breastfeeding Advisory Group n Eight members Meet quarterly n Develop the curriculum n Annual updates to curriculum n Develop additional programs as needed n Provide expert resource n

EPIC Trainers n Physicians, Nurses, Dieticians & Lactation Consultants n n n Physicians and a lactation specialist are a team and are paired to deliver the program Trainers meet twice a year with the EPIC director n n n Must be skilled with breastfeeding management Complete a train the trainer education module Can be done with group or individual Covers curriculum, set-up, maintenance of equipment and other logistics Trainers receive feedback and evaluations of their performance Discuss any updates and offer suggestions for curriculum changes Trainers are given modest stipend and travel

EPIC Program n n n One hour EPIC Breastfeeding Program Delivered through Power. Point Presentation with script Presented in n n Doctors office Hospitals Residencies Health Departments/WIC n Goal is 6 programs a month n Resource materials are left behind for the office to encourage, promote & support breastfeeding

Resources Each office or program receives breastfeeding resources n Books n Handouts n Coding information n WIC information n List of community resources n

Target Counties n n n Bibb Laurens Richmond Clayton De. Kalb Fulton Cobb Thomas Gwinnett Muscogee Chatham

Marketing our Program n n n n GA AAP Board meetings Blastfaxes Exhibiting at conferences Send out mailings to previous program recipients to take a different program Trainers and Advisory members encourage programs Close ties with the WIC and Health Departments Word of Mouth

Evaluation n Pre-program survey n n Program survey n n n Assessing physician knowledge and practices Participant evaluation form Evaluate curriculum Evaluate trainer effectiveness Seek areas of interest Post- program survey (60 day F/U) n n n Access program quality and content Access knowledge gained Changes in practice behavior

EPIC Breastfeeding ® Programs “Breastfeeding Fundamentals” “Supporting Breastfeeding in the Hospital Setting” “Advanced Breastfeeding Support”

Breastfeeding Fundamentals n Challenges for Physicians Realistic expectations n Racial disparities n Benefits of breastfeeding n Latch n Positioning n Milk transfer n

Fundamentals n Breastfeeding at delivery Prenatal visit (emphasis on the OB’s role) n Postpartum routine n n Most common problems Sore nipples n Mastitis n Maternal emotions n Medications n

Fundamentals n Hot Topics Co-sleeping n Milk sharing n Pacifiers n Supplementing n Contraception n Starting solids n n Questions

Supporting Breastfeeding in the Hospital n Benefits of breastfeeding n n Baby Friendly n n Obstacles to breastfeeding 10 steps Policy Joint commission and m. PINC scores After delivery n n n Skin to skin Exclusive breastfeeding Documentation

Hospital Program n Separation of mom and baby n n n Barriers n n n Discharge bags Follow-up and support WIC n n n Pumping/hand expression Kangaroo Care/NICU Food packages Services for breastfeeding mothers Community Resources

n Advanced Breastfeeding Support How do you know if a mother is producing enough milk? n n n How can a mother increase her milk supply? n n Breast changes Urine and stool output Evaluating a feeding Pumping/hand expression Galactogues/medications What can mothers do to prevent or treat sore nipples? n n LATCH Engorgement

Advanced Program n When supplements are indicated, how does a mother supplement without interfering with breastfeeding? n n n Maternal issues Infant factors When to supplement n n When How Methods How does the pre-term infant differ in their ability to breastfeed? n Define pre-term infant

Results 548 programs n 1, 590 physicians trained n 24. 3% are physicians n 6, 889 total trained n 29% held in focus counties n 99. 3% of practices would recommend the training to other physicians n

Future ideas of EPIC® Three hour hospital curriculum n NICU curriculum n Infant feeding curriculum n More emphasis on OB’s and breastfeeding support/WIC referrals n Need more physician data on breastfeeding rates n Working with businesses to set up lactation rooms n

Questions?