To: All
Re: Healthy People 2000 comments, case management and the 10 steps.

I share your dismay at the breastfeeding rates, although climbing.  Its just
another push in the right direction for the WHO Code and Ten Steps.  I would
also like to comment on the dialogue about case management.  To me, the ten
steps are the heart of case management for quality care of breastfeeding
mothers.  These should be incorporated into every critical path.  Deviations
from it are deviations from quality and indicators that "something is wrong
with the system".  In regards to looking at cost savings, at our hospital,
after a lactation program for breastfeeding was established, the DRG for
Failure to Thrive for breastfeeding babies admitted dropped to non existent.
The doctors in the clinics told us that - "surprisingly- they just don't see
that much if it anymore".  We also used postpartum feedback and surveys as
quality improvement.  Patient satisfaction increased.  We generated revenues
through establishing a breastpump rental station in the hospital - as
employment and "not enough milk" were the major reasons for BF
discontinuation.  The pump rental activity documented a community need, with
mothers telling us that they were able to breastfeed far longer than they
thought they could, happy campers for the most part!  This process also gave
us areas to focus on for education and development of improved quality.
Work with your local WIC department and obtain their statistics on
breastfeeding for your community (the CDC Pediatric Nutrition Surveillance
System).  Find out about the patterns of breastfeeding in your own
community, why women quit and when, then target those quality issues.  After
a few years, as breastfeeding duration rates climb, you should see a
decrease in postneonatal infant mortality, which says to me that all birth
certificates should document the method of feeding at birth, for purposes of
infant mortality epidemiology and research.   - Okay, so I'm off of my soap
box, just to say "carry on!" - Janet Thurston SNM, IBCLC.