This document discusses supporting breastfeeding in childcare centers. It identifies hand expression as a way for mothers to provide breastmilk when separated from their babies. It promotes the peer breastfeeding counselor program and the importance of childcare provider support for breastfeeding. Examples of supportive actions for childcare centers include providing private spaces for breastfeeding and milk expression, and caring for expressed breastmilk in a way that encourages breastfeeding.

2. • Identify breastfeeding community supports, pre
and postpartum.
• Understand the Baby-Friendly Hospital
Initiative and its benefits to lactation support.
• Understand Montana Breastfeeding Laws and
resources available to mothers in the
workplace.
Presentation Objectives

4. Breastfeeding is Right!
Ever Breastfed
At 6 months
At 12 months
91%
51%
26%

5. Breastfeeding Rates, 2014
NIS Indicator Montana U.S. HP 2020
Ever breastfed 91.2 79.2 81.9
At 6 months 50.7 49.4 60.6
At 1 year 25.5 26.7 34.1
Exclusively through 3 months 53.4 40.7 42.6
Exclusively through 12 months 19.3 18.8 25.5
Data Source: Centers for Disease Control and Prevention, National Immunization Survey (NIS),
2011 births

6. The State of the State: Breastfeeding
91.2
50.7
25.5
0
10
20
30
40
50
60
70
80
90
100
2011 2012 2013 2014
Percent
Montana Breastfeeding Rates, 2011-2014
Ever (Initiation)
6 month
12 month
HP 2020 Goal
60.6
81.9
34.1
Data source: National
Immunization Survey, 2008-
2011 births

7. The State of the State: Breastfeeding
91.2
53.4
19.3
0
10
20
30
40
50
60
70
80
90
100
2011 2012 2013 2014
Percent
Montana Breastfeeding Rates (exclusive),
2011-2014
Ever (Initiation)
3 month exclusive
6 month exclusive
HP 2020 Goal
46.2
81.9
25.5
Data source: National
Immunization Survey, 2008-
2011 births

8. The State of the State: Breastfeeding
0 10 20 30 40 50 60 70 80 90 100
Discharge support
Limit pacifiers
Teach feeding cues
Rooming-in
Limit supplements
Teach BF techniques
Early initiation
Prenatal BF education
Assess staff competency
Model policy
Prevalence of hospitals with ideal BFHI practices in
Montana, mPINC, 2007 and 2013
2007
2013

9. The State of the State: Breastfeeding
0 10 20 30 40 50 60 70 80 90 100
Discharge support
Limit pacifiers
Teach feeding cues
Rooming-in
Limit supplements
Teach BF techniques
Early initiation
Prenatal BF education
Assess staff competency
Model policy
Prevalence of hospitals with ideal BFHI practices,
mPINC, 2013
MT
U.S.

10. Montana Baby-Friendly
Hospital Initiative
Terry Miller IBCLC, CLC
Senior Breastfeeding Consultant
Montana Nutrition & Physical Activity Program

11. Two-thirds of U.S. mothers who intend to exclusively breastfeed
are not meeting their breastfeeding goals.
(PEDIATRICS Volume 130, Number 1, July 2012)
Goals Not Met
Data Credit: http://pediatrics.aappublications.org/content/early/2012/05/29/peds.2011-3633.full.pdf &
https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx
Photo Credit: http://www.aaroncourter.com/
More likely:
- Married
- More than one child
Less likely:
- Smoke
- Obese
- Longer planned
duration goal
Hospital Predictors:
- No formula or pacifiers
- BF an with 1 hour
- Rooming in & Support

12. Breastfeeding &
Baby-Friendly
Benefits society
Data Credit:http://www.womenshealth.gov/breastfeeding/breastfeeding-and-everyday-life.html
http://www2.aap.org/breastfeeding/files/pdf/Breastfeeding2012ExecSum.pdf
Photo credit: New York City Health Department
Breastfeeding Benefits
Protects your baby
Benefits mom’s health
Check- out the AAP’s Executive
Summary on Breastfeeding for
excellent data on the
benefits of breastfeeding.

13. What is Baby-Friendly?
 A global movement, spearheaded by WHO and UNICEF,
that aims to give every baby the best start in life by creating
a health care environment where breastfeeding is the
norm.
Has two main goals:
1) to transform maternity wards and hospital facilities by
implantation of the 10 steps.
2) To end the practice of distribution of free and low-cost
formula to hospitals and birth centers.
Data Credit: http://http://www.unicef.org/nutrition/index_24850.html & http://www.unicef.org/nutrition/files/BFHI_2009_s3.1and2.pdf
Photo Credit: WHO & UNICEF Program

14. Data Credit: Montana NAPA Program & Baby Friendly, USA
Photo Credit: breastfeedingcenterofpittsburgh.com & MT NAPA Program
The 10 Steps to Successful Breastfeeding

15. International Code of
Marketing of Breastmilk
Substitutes
 The primary purpose of the “WHO-
CODE” is to protect mothers and
babies from the highly effective,
aggressive and predatory marketing
of substitutes for breastfeeding (i.e.
infant formula, bottles, artificial
nipples).
 at the most vulnerable period of
their lives, the birth of a new baby.
Data Credit: http://www.unicef.org/nutrition/files/BFHI_2009_s3.1and2.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376885/ &
http://www.statista.com/topics/1218/baby-food-market/
Photo Credit: http://apps.who.int/iris/bitstream/10665/85621/1/9789241505987_eng.pdf?ua=1

16.  To be designated a
Baby-Friendly
birthing facility birthing
centers undertake an
arduous 4-phase
process
implementing best
practices in infant
nutrition & care.
 4 year average
 Baby-Friendly, USA
Baby-Friendly, USA
Photo & Data Credit: https://www.babyfriendlyusa.org/get-started

17. Designation?
- Benefits for families - Benefits for facilities
- Benefits for communities
Data Credit: https://www.babyfriendlyusa.org/faqs & http://pediatrics.aappublications.org/ content/early/2012/05/29/peds.2011-3633.full.pdf
Photo Credit: utahbreastfeeding.wordpress.com

18. Support for “10 Steps”
 Indian Health Service (2014)
 Surgeon General’s Call to Action (2011)
 American Academy of Family Physicians
 Centers for Disease Control and Prevention (CDC)
 National WIC Association
 American Academy of Pediatrics (2009) footnote regarding pacifier use
Data Credit: https://www.babyfriendlyusa.org/about-us/baby-friendly & http://www.aafp.org/afp/2009/0415/p681.
“ The Ten Steps are endorsed and promoted by the
major maternal and child health authorities in the
United States” – Baby-Friendly, USA

19. Is Baby-Friendly Working?
 Mothers who give birth at Baby-Friendly facilities
are more likely to start exclusive breastfeeding &
more often sustain breastfeeding at six months &
one year (i).
 Adherence to the Ten Steps decreases racial,
ethnic, and socio-cultural disparities in
breastfeeding rates in U.S. hospitals (ii).
 In the U.S, new mothers exposed to at least six of
the Ten Steps were 13 times more likely to
continue breastfeeding at 6 weeks (iii).
i. The Ten Steps to Successful Breastfeeding, Protecting, Promoting and Supporting Breast-feeding: The Special Role of Maternity Services. Geneva:
WHO, 1989.
ii. iii. Merewood, A, Mehta, LB, Chamberlain, BL, Phillip, BL, and H Bauchner. 2005. Breastfeeding rates in US Baby-Friendly hospitals: Results of a
national survey. Pediatrics. 116(3): 628 - 634.
iii. ii. DiGirolamo, AM, Grummer-Strawn, LM, and SB Fein. 2008. Effect of maternity-care practices on breastfeeding. Pediatrics. 122 (Suppl 2): S43-
S49.

20. .
The Montana Baby-Friendly
Hospital Initiative
Photo Credit: MT NAPA Program
- St. Peters
- Glendive
- Livingston
- Community
Medical Center
- Bozeman-Deaconess
- Barrett
- Central Montana
- Marcus Daly
- North Valley
- St. Vincent's
- Big Horn County
- Birth Center Missoula

21. MT Nutrition & Physical
Activity Program
 Technical Support Offered
- Yearly Breastfeeding Learning Collaborative - Monetary
support - MT BFHI Hospital Partner Collaborative
 Goal: About 12,300 babies are born in the State of Montana each year
& breastfeeding is a highly effective measure for preventing a number
of chronic diseases and obesity in both children and mothers. The NAPA
Program recognizes and supports hospitals during this critical period
for mothers and babies to learn how to breastfeed.
NAPA supporting MT birthing facilities undertaking
Baby-Friendly Designation since 2011

22. Baby-Friendly & Community
Breastfeeding Support
Photo Credit:www.thenewbornbaby.net

23. Contact Information/
Resources
 Terry Miller – TMiller6@mt.gov
 NAPA Baby-Friendly Webpage - https://dphhs.mt.gov/publichealth/NAPA/BFHI
 Baby-Friendly,USA - https://www.babyfriendlyusa.org/about-us
 AAP - http://www2.aap.org/breastfeeding/files/pdf/Breastfeeding2012ExecSum.pdf
 WHO – Baby-Friendly http://www.who
.int/nutrition/topics/bfhi/en/
Photo Credit: http://1funny.com/happy-baby-face/

24. SUPPORTING
BREASTFEEDING IN THE
CHILDCARE CENTER
DAWN GORDON-WILCOX, CLC, CBS

25. HAND EXPRESSION
• MOM/BABY SEPARATION
• FEEDING DIFFICULTIES
• MILK EXPRESSION
• ESTABLISH/BUILD SUPPLY
• BUILD CONFIDENCE

26. HAND EXPRESSION VIDEO
AND DEMONSTRATION
HTTPS://WWW.YOUTUBE.COM/WATCH?T=60&V=K0ZVCWDJZW0

27. WIC PEER BREASTFEEDING
COUNSELOR PROGRAM (PBC)
• NATIONWIDE
• MOTHER TO MOTHER SUPPORT
• BASIC EDUCATION AND CHEERLEADING
• WIC BREASTFEEDING SUPPORT VIDEO

28. MONTANA PBC PROGRAMS
• ALL MAJOR WIC OFFICES
• INDIVIDUALIZED TO THE COMMUNITY
• BREASTFEEDING CLASSES
• HOME VISITING
• SUPPORT GROUPS
• PHONE SUPPORT

29. THE CENTERS FOR DISEASE CONTROL
SAYS YOUR SUPPORT IS CRITICAL
• BREASTFEEDING AT SIX MONTHS IS SIGNIFICANTLY ASSOCIATED WITH
SUPPORT FROM CHILDCARE PROVIDERS TO
• FEED EXPRESSED BREASTMILK TO INFANTS
• ALLOW MOTHERS TO BREASTFEED ON SITE BEFORE OR AFTER WORK OR
DURING LUNCH BREAKS.

30. THE CENTERS FOR DISEASE CONTROL
CALL FOR ACTION FOR CHILDCARE
SETTINGS
• ENCOURAGE, PROVIDE ARRANGEMENTS FOR, AND SUPPORT
BREASTFEEDING
• FACILITY STAFF SHOULD BE THE MOTHER’S CHEERLEADER AND
ENTHUSIASTIC SUPPORTER
• FACILITIES SHOULD HAVE A DESIGNATED PLACE SET ASIDE FOR
BREASTFEEDING, AS WELL AS A PRIVATE AREA FOR PUMPING

31. LET’S THINK ABOUT IT
• BREAK UP INTO GROUPS OF 2
• THINK ABOUT WHERE YOU WORK NOW OR WHERE YOU HAVE IN
THE PAST
• HOW DID YOUR FACILITY SUPPORT BREASTFEEDING FAMILIES
• HOW COULD YOUR FACILITY HAVE DONE A BETTER JOB?

32. IMAGINE THE POSSIBILITIES
• A SEMI-PRIVATE, COMFORTABLE SEAT WITHIN YOUR CENTER OR
CLASSROOM
• A POLICY THAT INFORMS PARENTS THAT THEY HAVE THE RIGHT TO
BREASTFEED OR PROVIDE BREASTMILK FOR THEIR CHILDREN WHILE UNDER
YOUR CARE
• A PARENTING RESOURCE CENTER THAT INCLUDES BREASTFEEDING
INFORMATION
• TOYS AND BOOKS THAT DEMONSTRATE BREASTFEEDING AS THE
PREFERRED AND NORMAL WAY TO FEED INFANTS

33. OTHER WAYS TO BE SUPPORTIVE
• PRAISE MOM FOR PROVIDING THE VERY BEST NUTRITION FOR HER
BABY
• ASK MOMS HOW YOU CAN HELP
• KEEP TRACK OF WET AND SOLID DIAPERS
• KEEP TRACK OF THE AMOUNT OF MILK BABY CONSUMES
• TRY NOT TO OFFER MILK TO BABY CLOSE TO PICK UP TIMES
• TRY TO REMAIN POSITIVE, EVEN WHEN CHALLENGES ARISE

34. •EVERY BABY
DESERVES
THE BEST
NUTRITION
Human Milk

35. Milk Banking55
 First human milk bank was established in 1910 in
Boston, Massachusetts after a physician discovered
that infant morbidity & mortality were related to
artificial feedings
 In the 1980’ s there were 30 milk banks in the US
and 23 in Canada
 Milk banks were severely impacted by the discovery
of HIV and Hepatitis this coupled with economic
factors caused many milk banks to close

36. HMBANA
 In 1985 the Human Milk Banking Association of North
America (HMBANA) was established to establish guidelines
for screening donors and processing milk were to ensure the
safety of donor milk banking
 In 2000 there were five HMBANA banks in North America
 Mothers’ Milk Bank of Montana became the 15th full
functioning milk bank under HMBANA on October 2013
 HMBANA banks circulated 2.18 million ounces in 2011

37. Milk Process- The Donors

38. Milk Process-Who Donates?
• Some mom’s produce more
milk than their infant
needs.
• Our largest donor per day was
feeding her 3 & 1.5 year old 8 oz
of milk per day plus exclusively
feeding her 4 month old and had
32 oz extra per day to give to the
milk bank.
• Another donor, over the course
of 10 months, has donated over
5000 ounces of milk. That’s
equal to almost 40 gallons of
milk.

39. Milk Process- Screening the donor
• 7 levels of screening:
 Phone interview
 14 page health history form
 Signature approval from donors’
medical care provider
 Signature approval from donors’
infant medical provider
 Blood test for HIV, HTLV,
Hepatitis B & C, Syphilis
 Complete chart review by two
medically trained milk bank staff
members
Things that we are looking for
and screening out:
Over the counter medication,
prescription medications, alcohol, and
recreational drugs
Lifestyles/behaviors that are risky or
unhealthy
Always prioritizing donor’s baby
Exposure to communicable diseases
Individuals with chronic infections

40. Milk Process- Pooling
 Because milk changes throughout
the day and over the lifespan of the
infant batches of milk are made
from pooling 1 to 5 donors to get a
good sample mix
 Milk can be classified differently
based on when it was pumped and
the age of the infant. For example:
 mature
 premature
 hospital grade
 preterm
 colostrum
 It can also be classified by the diet of
the donor-dairy free or gluten free

41. Milk Process- Pouring
 Milk is then poured into
individual bottles &
capped.
 Our milk at MMBMT is
available in 20z or 4oz
sizes.
 The glass bottles can be
recycled or reused
 Each batched milk is
given a lot number so it
can be tracked in case of
a recall

42. Milk Process- Testing
 One bottle from each batch is sent
in for testing.
 Only sterile milk will be dispensed
to recipients
 Bacteria found in milk:
– bacillius
– Straphococus
– Gram negative rods
•Despite the self filtering ability milk
has, it is possible during the
collection, storage and pasteurization
process milk can become
contaminated and unsafe for human
consumption

43. 1 in 8 babies are born premature
in the United States (12.5%)

44. Human Milk for Human Babies
•“To be the least interruptive of
development for a premature
infant, nutrients need to be
delivered in as natural,
complete and non-synthetic a
form as possible to that
development can occur as
normally as possible.” ~ Arnold

45. Necrotizing Enterocolitis (NEC)
Infants who are exclusively formula fed
have a 6-10 x greater likelihood of contracting NEC
•#1 killer of premature
infants
•Breast milk is the only
known prevention
against NEC
•Parts of the infants
intestines die causing
bloating, feeding
intolerance, vomiting,
sepsis. Mortality rate for
NEC is between 20-35%.
•Surgery can be used to
remove the necrotic parts
of the intestine however
it will impact the infants
ability to absorb
nutrients for the rest of
the child’s life
•I

46. Cost of using donor milk in the NICU
 Due to reduction of days in the hospital, nosocomial
infection, NEC, RSV, it is estimated savings of $11 for every $1
spent on donor milk - Wight 2001
 We need to shift our view to the long term outcome of the
use of donor milk.
– decrease obesity
– better bone growth, brain growth
– protection against heart disease and other chronic
illnesses

47. Impact of use of donor milk in the NICU
• As a tool to impress mothers of the importance of
their own milk
 A bottle of donor milk is a symbol of other preterm infant
mothers banding together to help her infant until her milk
comes in
 Symbol of success, that there are mothers in the same position
that are able to overcome the lactation barriers
 Identifies the importance of her milk from the health
professional’s perspective

48. Processing Fee for Banked Milk
 The cost of milk is set by each HMBANA bank based on its operation
costs
 Its current price varies $4-8 ounces per ounce
 MMBMT sells its milk to hospitals & individuals for $4.00 per ounce
 Banked donor milk is not currently covered by Montana insurance
companies- in certain situations in other states it has been covered
 When supplementing a mothers’ own supply for a short duration of
time is affordable for most
 Exclusive feeding of banked milk can cost a family 100s to 1000s of
dollars per month
 Often families look at donor milk as medicine for their baby knowing
that every ounce the baby receives life long health benefits

50. Working for Wellness
http://dphhs.mt.gov/publichealth/napa
http://dphhs.mt.gov/publichealth/Cancer/RegionalPrograms.aspx
http://montanaworksitewellness.org/

51. Breastfeeding Policies in the
Workplace
• Community Transformation Grant
– September 2011 – September 2014
• 26 worksites implemented breastfeeding policies
• Montana Cancer Control Program Contractors
– June 2014 – March 2015
• 7 worksites implemented breastfeeding policies

52. Terry Miller IBCLC, CLC
Senior Breastfeeding Consultant
Montana Nutrition & Physical Activity Program

53. Who We are…
Photo Credit: Montana State Breastfeeding Coalition

54. Goal 1 - Legislation & Advocacy
Support legislation which supports breastfeeding
Photo Credit:
http://www.nwlc.org/sites/default/files/pdfs/final_nwlc_preventiveservicest
License to Breastfeed
MT Breastfeeding Laws Fact Sheet
Understanding the ACA toolkit

55. Goal 2 Lactation Education Promotion
Support activities which provide education and training
for professionals and paraprofessionals on
breastfeeding.
 IBCLC scholarship/mentorship program
 Yearly CLC scholarships
 Statewide lactation education trainings
Goals 3 & 4 - Networking & Sustainability
• Plan at least one breastfeeding related activity per year
• Secure financial support to secure a viable coalition status

56. Successes
 Increased support of statewide lactation education
training opportunities
 Increased support & networking of grassroots
coalitions & partnerships
Montana is # 4 in the US in
Breastfeeding initiation rates!
• Outreach to community breastfeeding supporters in our
geographically large region
• Increase breastfeeding rates at 3, 6 and 12 months
• Work to develop an effective worksite breastfeeding support
program
Challenges

57. 2015 Goals & Outreach
 Spring 2015 Lead Action
Team
 2015 Breastfeeding Learning
Collaborative
 Winter 2015 Awarding of 2
IBCLC
scholarship/mentorships
 Awarding of 2015 Kick-starter
Award
 Summer 2015 awarding of
CLC scholarships
 Supporting expansion of
current coverage to include
Medicaid coverage of
outpatient lactation services
Photo Credit: Terry Miller

58. Join the MSBC!
MSBC Website
MSBC Twitter
MSBC Newsletter
MSBC FacebookPhoto Credits: Montana State Breastfeeding Coalition

59. Resources
 http://www.cdc.gov/breastfeeding/pdf/Strategy6-
Support-Breastfeeding-Early-Care.pdf
 http://www.cdc.gov/breastfeeding/index.htm
 Montana Nutrition & Physical Activity Program
 Montana State Breastfeeding Coalition Law Fact Sheet
 National Women’s Law Center Toolkit
 ACA Breastfeeding Fact Sheet

60. Thank you!
Any questions?