# Presentation: 515026

## Slide 1

**Notes:**
I thank you for your attention and hope you will remember that WIC  WORKs Wonders for our Families!!

## Elements of a Successful Breastfeeding
Program
San Marcos, California 
760-752-4324

**Program**
- San Marcos, California
- 760-752-4324

## NCHS WIC Agency Profile

- 5 permanent sites and 3 satellite clinics throughout Northern San Diego County.
- 35 Full and Part Time Staff.
- Participation: 10,654 (2/08)
- English 41.5%, Spanish 57.8% and <1% other Languages.
- Number of Infants: 2358 (2/08)
- 1 Part-time IBCLC
- 10 CLE’s and 6 more in training

## Staff Training, Pump Loan and Other Elements

- Extensive Staff Training
- Yearly in-house trainings for all other staff.
- Thorough training for new staff.
- Brought CLE training to our agency.
- Breast Pump Loan Program
- Over 200 electric breast Pumps to lend.
- Breastfeeding Friendly Environment
- Referral Systems
- WIC staff can refer complex BF problems to the CLE or IBCLC.
- NCHS providers refer BF problems back to WIC.
- Breastfeeding promotion is everyone’s job!

## Comprehensive Participant Education and Support

- Two prenatal breastfeeding classes.
- A “Why To BF” and a “How To BF”.
- All prenatal ppts. are made aware of our “No formula in the first month” policy.
- Early post-partum BF support phone calls to ALL new mothers.
- Breastfeeding Warm-Line for ppts to call with questions.
- Breastfeeding support groups.

## No Formula in the First Month

- Set a date 9 months in advance to start policy.
- Begin with extensive staff training, so all are comfortable discussing and supporting breastfeeding.
- Start telling all pregnant women at enrollments, trimester checks and classes that WIC doesn’t routinely give formula to breastfed babies less than one month old.
- Enroll baby then recertify post partum mother the following month, so they receive two contacts of BF support.
- If they want to combo feed, tell them they can after  exclusively breastfeeding for the first month.
- We find after they get through the first month, they often don’t need the formula in the second month.
- Formula is only given in extenuating circumstances  with supervisor approval.

## Early Postpartum Phone Call Study

- Hypothesis: WIC mothers who received an early postpartum phone call to offer BF support will be more likely to _exclusively breastfeed_ and _breastfeed for a longer period of time_ than a control group.
- Babies born to NCHS WIC from 10/03 and 11/03 were in study and FI’s were followed for a year.
- Half received phone calls (intervention) and half did not (control).

## Our Study Population

|  | Intervention N =86 | Control N = 92 |
| --- | --- | --- |
| Ethnicity | Hispanic = 75 (87%) | Hispanic 79(85%) |
| Primary Language | Spanish = 59 (69%) | Spanish = N/A |
| Prior Experience 
Breast Feeding |  42 (49%) | N/A |
| Calls Made Within 
First 14 days | 62 (73%) | N/A |
| Average Age of 
Infant at Second Call | 22 days old
 | N/A |
| Average Age of 
Infant at Enrollment Appointment | 20 days old | 16 days old |

**Notes:**
Who was our study population?
Ended up with 86 people in the intervention group and 92 in the control
The majority of each group were Hispanic women and Both groups had similar ethnicity with 87 and 85percent.  These percentages are slightly higher than the state of California’s Hispanic WIC population which is 75%.

We knew our intervention group’s primary language was Spanish and although we did not collect that info, we expect it was comparable. 
We also knew that 1⁄2 of our Intervention group had prior breastfeeding experience but unfortunately we did not collect this info on the control group.

73% of the Intervention group recd. Our 1st phone call within their first 14 days pp
And that the average age of the baby at the 2nd call was 22 days

And lastly the I group delayed coming into WIC until their babies were 20days old versus the control group.

## We Made a Difference!

| Age at which 25% are still Exclusively Breastfeeding 
(or Excl. BF w/solids)  | 315 days old
(10 1⁄2 months) | 194 days old
(61⁄2 months)  |
| --- | --- | --- |

- Statistically Significant at .05

|  | Intervention | Control |
| --- | --- | --- |
| Breastfeeding Exclusively at 
First month | 72/86 (84%)
 | 68/92 (74%) |
| Breastfeeding Exclusively at 
Second month | 49/86 (58%)
 | 45/92 (42%)
 |

**Notes:**
And here are the results of our study:  Note that the numbers in red are statistically significant.

This slide shows that 
There were more mothers exclusively breastfeeding at their first monthly WIC appointment in the intervention group as compared to those moms who did not receive an early pp call. And that difference was signif different.
 The difference between the 2 groups remained signif through the second month.
This is important because we have a breastfeeding policy in our agency whereby we discourage our breastfeeding mothers from using formula in the first month unless medically indicated. We also know that giving formula to a bf women undermines her confidence to exclusively bf.

This policy is in place because we want to give our breastfeeding mothers adequate time to get her milk supply well established and breastfeeding well established with her new baby. This policy is routinely communicated throughout their pregnancy so when they come into the WIC clinic at month I expect that our staff are going to do a great job of encouraging that mom to exclusively breastfeed- 

So in other words we expected a lot of bfing in month really in both groups and we were very happy to see that even more of our I  group were breastfeeding BUT we were truly excited to see that signif diff stay thru the 2nd month in the I group.

THE SECOND PORTION OF THIS GRAPH SHOWS THAT OUR INTERVENTION GROUP EXCL BF FOR A LONGER DURATION THAN THE CONTROL GROUIP.  In fact 25% OF THE I GROUP WAS STILL EXCL BF AT 10.5 MONTHS VS 25% of the C group was still exclus BF at 6 1⁄2 MONTHS.  
The difference between these 2 numbers was also Signif. Dif. 

## Why it Worked

- Connected with Mothers at _their_ time of need
- The calls were beyond the normal WIC “clinic” services
- They were reached at a “vulnerable” time in breastfeeding.
- Mothers had 100% of our attention,
-  Staff were given time to make call, build rapport with women.
-  The intervention was individual and personal.
- Well-trained staff
- Open ended & closed questions were asked that allowed us to educate, guide and reassure.
- WIC is a trusted resource.

## Conclusion

- Early phone intervention helped the group of mothers have a better breastfeeding experience, and prevented them from _quitting_ _prematurely_.
- Using early postpartum phone intervention calls, we increased breastfeeding exclusivity and duration.
- Early postpartum phone intervention fits within the “scope of WIC services”.
- The calls could be easily replicated in other settings.

## NCHS WIC Program
Policies 
and 
Procedures

- Policies
- and
- Procedures