Meeting Challenges, Managing Change California Leads the Nation
A Policy Update on California Breastfeeding and Hospital Performance Produced by California WIC Association and the UC Davis Human Lactation Center Los Angeles County: 2014 Data
Exclusive Breastfeeding Provides Hospitals Must Meet Ongoing Lifelong Health Advantages Challenges to Support New Breastfeeding is a crucial first step in protecting the Mothers health of mothers and infants, nourishing infants and Improved hospital policies and practices have led building a foundation for a healthy immune system.1 to increased breastfeeding among all California Hospital practices have an enormous impact on mothers. However, the lowest exclusive rates still 2-4 are found in hospitals serving low-income women infant-feeding success. Mothers who receive in- 7 hospital support to breastfeed exclusively often of color. continue to do so after discharge. The number of credentialed staff to support Hospitals that have instituted Baby-Friendly policies new mothers continues to increase, but access to have high rates of breastfeeding, no matter where they skilled support remains limited during off-hours 5,6 are located or what populations they serve.5-6 As more and for women who don’t speak English. California hospitals have adopted these evidence- Mothers are inundated with conflicting and based reforms, in-hospital exclusive breastfeeding has inaccurate information about breastfeeding. When increased since 2010 from 56.6% to 66.6%.7 mothers are unprepared or confused, they may give up on their breastfeeding goals too soon. 8 Continued on page 4 The UC Davis Human Lactation Center used data reported by the California Department of Public Health Maternal, Child and Adolescent Health Program to create the following charts showing in-hospital breastfeeding rates.9 Los Angeles County In-Hospital Breastfeeding Rates, 2014
ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING 96.5 91.6 100 89.5 85.9 89.0 82.1 77.4 80 70.6 74.2 57.3 60 37.4 40 25.1 23.2 20 14.4
percentage 0 ANTELOPE BEVERLY CALIFORNIA CEDARS-SINAI CENTINELA CITRUS VALLEY- COLLEGE VALLEY HOSPITAL HOSPITAL HOSPITAL MEDICAL CENTER HOSPITAL QUEEN OF THE MEDICAL CENTER MEDICAL CENTER VALLEY hospital (continued) 1 Los Angeles County In-Hospital Breastfeeding Rates, 2014
ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING
100 97.0 91.3 95.9 93.5 93.1 96.8 74.2 80 63.0 60 48.8 51.6 48.5 49.4
40 23.0 20 <6 percentage 0 EAST LOS ANGELES FOOTHILL GARFIELD GLENDALE GLENDALE GLENDORA GOOD DOCTORS PRESBYTERIAN MEDICAL CENTER ADVENTIST MEMORIAL COMMUNITY SAMARITAN HOSPITAL MEDICAL CENTER HOSPITAL AND HOSPITAL HOSPITAL HEALTH CENTER hospital
93.7 95.0 96.9 95.6 96.8 94.6 100 86.3 76.1 80.2 80 72.4 64.0 62.5 60 44.7 47.2 40 20 0 percentage GREATER EL HARBOR-UCLA HENRY MAYO HOLLYWOOD HUNTINGTON KAISER BALDWIN KAISER DOWNEY MONTE HOSPITAL MEDICAL CENTER NEWHALL PRESBYTERIAN HOSPITAL PARK MEMORIAL MEDICAL CENTER hospital
100 97.0 96.9 95.6 94.9 95.2 87.8 97.6 78.3 80 74.2 71.6 73.0 71.5 60 50.3 40 20 <12 0 KAISER LOS KAISER PANORAMA KAISER SOUTH BAY KAISER WEST LOS KAISER WOODLAND LAC+USC MEDICAL LOS ANGELES
percentage ANGELES CITY ANGELES HILLS CENTER COMMUNITY HOSPITAL hospital
100 91.9 94.0 91.7 87.2 96.7 93.4 92.5 80 65.8 63.5 61.8 54.0 60 43.9 41.4 40 21.2 20 0
percentage MEMORIAL METHODIST MILLER MONTEREY PARK NORTHRIDGE OLIVE VIEW-UCLA PACIFIC ALLIANCE
percentage HOSPITAL OF HOSPITAL OF CHILDREN'S & HOSPITAL HOSPITAL MEDICAL CENTER MEDICAL CENTER, GARDENA SOUTHERN WOMEN'S MEDICAL CENTER INC CALIFORNIA HOSPITAL LONG BEACH hospital
(continued)
2 Los Angeles County In-Hospital Breastfeeding Rates, 2014
ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING
94.2 91.3 91.3 94.7 96.7 100 85.1 90.5 77.0 80 56.9 56.7 60 46.2 50.7 40 24.7 20 7.1 0
percentage PACIFICA PIH HEALTH POMONA VALLEY PRESBYTERIAN PROVIDENCE HOLY PROVIDENCE PROVIDENCE HOSPITAL OF THE HOSPITAL INTERCOMMUNITY CROSS MEDICAL LITTLE COMPANY LITTLE COMPANY VALLEY MEDICAL CENTER HOSPITAL CENTER OF MARY SAN OF MARY PEDRO TORRANCE hospital
97.6 96.9 94.1 98.1 96.2 96.7 100 85.9 89.1 74.4 74.1 80 65.2 58.8 60 45.7 49.7 40 20 0 percentage PROVIDENCE PROVIDENCE PROVIDENCE RONALD REAGAN- SAN DIMAS SAN GABRIEL SANTA MONICA- SAINT JOHN'S SAINT JOSEPH TARZANA UCLA MEDICAL COMMUNITY VALLEY MEDICAL UCLA MEDICAL HEALTH CENTER MEDICAL CENTER MEDICAL CENTER CENTER HOSPITAL CENTER CENTER
hospital
100 87.3 92.2 95.8 94.3 95.3 94.9 96.4 92.1 80 68.3 67.0 60.6 65.2 55.6 53.9 60 42.2 40 31.7 20 percentage 0 ST. FRANCIS ST. MARY TORRANCE VALLEY VERDUGO HILLS WEST HILLS WHITE WHITTIER HOSPITAL MEDICAL MEMORIAL PRESBYTERIAN HOSPITAL HOSPITAL AND MEMORIAL HOSPITAL LYNWOOD CENTER HOSPITAL HOSPITAL MEDICAL MEDICAL CENTER CENTER hospital
Los Angeles County Baby-Friendly Hospitals
Twenty-seven Baby-Friendly hospitals: Antelope Valley Hospital, East Los Angeles Doctors, Glendale Memorial Hospital and Health Center, Greater El Monte Hospital, Harbor-UCLA Medical Center, Henry Mayo Newhall Hospital, Hollywood Presbyterian Medical Center, Kaiser Baldwin Park, Kaiser Downey, Kaiser Los Angeles, Kaiser Panorama City, Kaiser South Bay, Kaiser West Los Angeles, Kaiser Woodland Hills, LAC+USC Medical Center, Olive View-UCLA Medical Center, Pacific Alliance Medical Center, Pomona Valley Hospital Medical Center, Providence Holy Cross Medical Center, Providence Little Company of Mary San Pedro, Providence Little Company of Mary Torrance, Providence St. Joseph Medical Center, San Gabriel Valley Medical Center, St. Francis Hospital, St. Mary Medical Center, Valley Presbyterian Hospital, White Memorial Medical Center
(continued)
3 California Steps Up: Managing Targeted efforts are needed to maintain Change on Many Levels momentum toward improving the quality Changes in California hospitals have been part of a long-term, statewide mission to support of perinatal care in California hospitals. breastfeeding on many levels, from the passage of new laws to increased access to training for medical Community advocates have worked with local and 9 providers and public health staff. Targeted efforts statewide coalitions to advocate for laws, cooperation, are needed to maintain this momentum toward and media coverage, changing public perceptions of improving the quality of perinatal care in hospitals. breastfeeding and its importance in public health.10 By funding strategic planning, sharing hospital Medical organizations and hospitals have worked infant-feeding data, establishing education and together to improve hospital practices and overcome support interventions within state and local barriers to Baby-Friendly status. 11 programs, creating regulations, and passing laws to support breastfeeding, public health officials and State and academic institutions have enhanced local advocacy groups have initiated and managed training opportunities in an effort to expand both change to drive breastfeeding rates upward. the number and diversity of skilled professionals supporting women in areas of greatest need.12
Los Angeles County Breastfeeding and Hospital Performance
County average breastfeeding rates: Any – 93.5% Exclusive – 57.4% County ranked 42nd in the state for exclusive breastfeeding Seven hospitals among the 15 lowest-scoring in the state: Monterey Park Hospital, Garfield Medical Center, PIH Health, Whittier Hospital, California Hospital Medical Center, Methodist Hospital of Southern California, Memorial Hospital of Gardena Highest performing hospital in county: Ronald Reagan-UCLA Medical Center
NOTES: • All nonmilitary hospitals providing maternity services are required to complete the Newborn Screening Test Form [Version NBS-I(D) (12/08)]. • Infant-feeding data presented in this report include all feedings since birth to time of specimen collection, usually 24 to 48 hours since birth. Upon completing the form, staff must select from the following three categories to describe ‘all feeding since birth’: (1) Only Human Milk; (2) Only Formula; (3) Human Milk & Formula. • The numerator for “Exclusive Breastfeeding” includes records marked “Only Human Milk.” The numerator for “Any Breastfeeding” includes records marked “Only Human Milk” or “Human Milk & Formula.” The denominator excludes cases with unknown method of feeding and those receiving TPN at time of specimen collection. Statewide, approximately 1.8% of cases have missing feeding information and/or are on TPN at time of specimen collection. • Excludes data for infants who were in an Neonatal Intensive Care Unit (NICU) nursery at the time of specimen collection. • Excludes cases that were not collected by facilities listed as “Kaiser” and/or “Regular” maternity hospitals in the newborn screening database. • Data for counties include information for all births occurring in a ‘Regular’ or ‘Kaiser’ facility providing maternity services in that county. Counties and facilities with fewer than 50 births with known type of feeding are not shown. REFERENCES: 1. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011. (http://www.surgeongeneral.gov) 2. Perrine CG, et al. Baby-friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics. 2012 Jul; 130(1):54-60. 3. Grummer-Strawn LM, et al. Maternity care practices that support breastfeeding: CDC efforts to encourage quality improvement. J Womens Health (Larchmt). 2013 Feb;22:107-12. 4. Cramton R, Zain-Ul-Abideen M, Whalen, B. Optimizing successful breastfeeding in the newborn. Curr Opin Pediatr 2009;21:386-396. 5. Bartick M, et al. Closing the quality gap: promoting evidence-based breastfeeding care in the hospital. Pediatrics 2009;124:e793-e802. 6. Ahluwalia IB, et al. Maternity care practices and breastfeeding experiences of women in different racial and ethnic groups: pregnancy risk assessment and monitoring system (PRAMS). Matern Child Health J. 2012 Nov;16(8):1672-8. 7. California Department of Public Health, Center for Family Health, Genetic Disease Screening Program, Newborn Screening Data, 2014. http://www.cdph.ca.gov/data/statistics/ Pages/InHospitalBreastfeedingInitiationData.aspx 8. Dietrich, et al. “Be positive as well as realistic”: a qualitative description analysis of information gaps experienced by breastfeeding mothers. Int Breastfeed J. 2015 Mar 7;10:10. 9. Breastfeeding: Investing in California’s Future.http://www.cdph.ca.gov/programs/breastfeeding/Documents/MO-BreastfeedingFullDocument.pdf 10. California Breastfeeding Coalition. http://californiabreastfeeding.org/ 11. Semenic, et al. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review. J Hum Lact. 2012 Aug;28(3):317-34. 12. Birth and Beyond California: Hospital Breastfeeding Quality Improvement and Staff Training Demonstration Project Report. http://www.cdph.ca.gov/HealthInfo/healthyliving/ childfamily/Documents/BBCP_FinalReport2.17.2012.pdf. December 2015 This project was supported by Kaiser Foundation Hospitals
Photograph Sources: www.Istockphoto.com, United States Breastfeeding Coalition
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Two outer hearts: C=55 M=24 Y=0 K=11
Middle heart: C=100 M=58 Y=0 K=21
Type outside hearts : C=100 M=57 Y=0 K=40