Abstract
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BFUSA, Baby-Friendly United States of America.
Each Baby-Friendly hospital has a breastfeeding policy that is unique for each facility. Each facility has a Baby-Friendly leadership group involving nursing, providers, and hospital leadership that evaluates the breastfeeding policy based on evidence-based practices and updates the policy on evidence-based practices. Beginning in orientation to the facility at time of hire, Baby-Friendly education begins and the extent of Baby-Friendly/breastfeeding education is determined by job role. Many facilities have a general orientation using the HealthStream education program, skills fairs, and one-to-one mentoring and education. Facility Baby-Friendly information is reported on an IHS Baby-Friendly data mart, through Baby-Friendly reports to local and area leadership. Regular Baby-Friendly meetings using Adobe Connect technology with all Baby-Friendly facilities to share ideas, concerns, and areas needing improvement to provide quality breastfeeding education.
Currently, IHS is tracking statistics through the IHS Baby-Friendly data, including start of exclusive breastfeeding, ongoing exclusive breastfeeding through electronic health record (EHR), Government Performance and Results Act (GPRA) requires performance data to be sent to Congress, and childhood obesity through BMI. EHR templates are being created for documentation of Baby-Friendly education for continuity of care and prenatal and obstetrics (OB) templates will be standardized throughout IHS to improve quality of care, including education.
Many areas of the IHS are considered to be rural or frontier–with many people driving >100 miles round trip to receive healthcare. Frequently weather conditions can affect ability to keep appointments for significant periods of time. Many of the families served live at or below the poverty level resulting in limited resources for transportation, food, clothing, and housing, which creates difficulty in meeting with breastfeeding professionals for breastfeeding education and assistance. Historical trauma has a huge impact on breastfeeding because many families do not often have a recent history of exposure to breastfeeding due to many of the elder population growing up at boarding schools which prevented a sharing of breastfeeding knowledge. Owing to poverty issues, some families fear children being taken away at healthcare visits and leads to a frequent general distrust of healthcare due to child protective issues.
Currently, staffing issues are a big concern at many rural IHS facilities. If adequate care coverage is not available, many small facilities have to resort to diversion of OB services to surrounding facilities with families traveling for many miles for OB care. In many western states, the IHS facilities are the hospitals that are Baby-Friendly designated and the referring facilities that patients are being sent for delivery care do not have Baby-Friendly designation. Owing to the rural areas, often OB volume is low and it can be difficult for staff to maintain competency providing care or have a desire to stay in a location with small volume of OB care. Many healthcare issues compete with each other for high-priority status in many facilities for funds for training and program supplies.
The IHS Division of Nursing has provided startup funds for training of Centering/Group Prenatal Care at the following sites: Northern Navajo Medical Center at Shiprock, Crownpoint, Claremore, Phoenix-PIMC Pine Ridge, and Rosebud. The facilities received centering training and are developing programs based on staffing levels for program development. South Dakota Urban at Sioux Falls, South Dakota, uses a group prenatal care program involving the whole family. Standing Rock Service Unit in North and South Dakota partnered with the tribe for an off IHS campus building with the expectant women and fathers to be and or other family support members to be able to attend the classes. The public health nurses (PHNs) assist with locating prospective participants for the group and home visits throughout pregnancy. The State of Montana has passed legislation that any form of group prenatal care will be reimbursed by the state Medicaid program. In 2016, the March of Dimes sponsored a Promising Pregnancy care conference in northeastern Montana specifically for tribes and their healthcare facilities to learn about the group prenatal care concept and incorporate breastfeeding education into the curriculum.
The Baby-Friendly leads and OB/PHN staff provide one-to-one education for staff at each facility at orientation, skills fairs, and on a yearly as-needed basis. In 2015, Division of Nursing provided funds to Baby-Friendly facilities for online lactation educator training through Arizona State University for OB inpatient and clinic staff along with funding for public health nursing. Both Baby-Friendly designated facilities and nondelivering facilities are making lactation education a priority for staff and providing funding for professional education, leading to the International Board Certified Lactation Consultant (IBCLC) or Certified Lactation Consultant (CLC).
The Division of Public Health Nursing is the heart of the IHS. Beginning in the 1920s at Rosebud and Pine Ridge, Elinor Gregg PHN leads the charge for the maternal child health. She saw the immense need for quality nursing care and education. She developed the nursing program in IHS. Currently, PHNs are vital for providing education and care for women and children prenatally and postpartum on breastfeeding education and newborn and childcare. At many service units, where hospitals are not available or are not delivering hospitals eligible for Baby-Friendly designation, PHNs are developing MCH leaders who are in charge of MCH programming for educating all PHNs on Baby-Friendly concepts/education for breastfeeding, so all Native American women and families can have quality breastfeeding education and support as those service units that have delivering hospitals and are Baby-Friendly designated. Many of the PHNs are attending additional professional education and becoming IBCLC or CLCs.
Through funding by Division of Nursing, ACOG and perform periodic reviews of each Area's Maternal Child Health Programs. ACOG visits all the IHS delivering hospitals and reviews Baby-Friendly concepts and breastfeeding education. ACOG provides recommendations for care and helps develop mentoring relationships with other facilities. ACOG also cosponsors with IHS updates in women's health, including breastfeeding education and support with the 2017 conference in Salt Lake City, August 10–13.
The Committee on Native American Child Health (CONACH) develops policies and programs that improve the health of Native American and Alaska Native children. The CONACH members are committed to increasing awareness of the major health problems facing Native American children, and monitoring legislation affecting AI/AN child health. The CONACH also conducts pediatric consultation visits to IHS and tribal health facilities, and works to strengthen ties with tribes throughout the United States. All CONACH members are appointed by the AAP Board of Directors. Most of all, CONACH is interested in helping to deliver high-quality healthcare to AI/AN children that includes breastfeeding support.
Many Area Tribal Health Boards and local tribal health boards are seeking ways to promote maternal child health. One of the ways is through the promotion and support of breastfeeding. Some areas have comprehensive breastfeeding task forces with many educational and supportive activities in the community and Facebook or websites. A couple of examples is the task force in the State of Washington and the Navajo Nation.
In June 2015, The Breastfeeding Center at Boston Medical Center received a 3-year grant from the W.K. Kellogg Foundation for its American Indian and Alaska Native Communities and Hospitals Advancing Maternity Practices (AI/AN CHAMPS) project! AI/AN CHAMPS is a breastfeeding-focused initiative geared toward improving maternal and child health outcomes through the promotion of Baby-Friendly practices in tribal and Alaska Native hospitals and the communities that surround them. The main goal of AI/AN CHAMPS is to ensure that all five tribal operated birthing hospitals in the lower 48 states and 4 of the 7 Alaska Native hospitals become Baby-Friendly designated. This work will build on The Breastfeeding Center's previous Kellogg-funded projects in Native American communities.
The Indian Health Service continuing to actively partner with families and tribal communities is critical for the ongoing work of establishing breastfeeding as the first feeding choice for Native American children. Breastfeeding is a priority for good health and a positive foundation for the next generation. Breastfeeding training and education for Indian Health Service staff is considered to be a standard of care and is given a high priority for funding in the Indian Health Service. Breastfeeding promotion is an excellent example of a prevention not intervention activity that is happening in tribal communities across the United States with the Indian Health Service, tribes and families working together to establish a healthy future for the next generation.