PA-Breastfeeding Coalition Minutes of meeting October 23, 2002 in Harrisburg

Karen Foard PA-MILC (Mid-state ILCA chapter)
Chris Hansson Women & Babies Hospital in Lancaster
Kay Hoover Philadelphia Dept of Public Health
Martha Kautz Lancaster County Breastfeeding Coalition
Cindy Maki PA State WIC Breastfeeding Coordinator
Chris Mulford PRO-LC (Eastern PA ILCA chapter)
Kathy Romberger Pinnacle Health System
Wendy Shore LC, Memorial Hospital, York
Rosa Snyder-Boyd WIC, Allegheny County Breastfeeding Coalition
Ruth Solomon La Leche League
Jeanne Spencer Laurel Highlands Breastfeeding Coalition
Helen Vermilya Susquehanna Health System
Ruth Wilf PA Association of Nurse-Midwives

We scheduled the following meetings for 2003:

Date: Jan 15
Time: 12:00 PM to 2:00 PM
Place: your telephone

How to: Dial 814-863-2330

When you first get connected, say hello.
This call will show up on your phone bill. Keep track of the amount to report for 2003 in-kind donations.

Thanks to Rosa for setting up this telephone bridge call through Penn State.

Date: April 23
Time: 10:00 AM to 2:00 PM
Place: the Ramada at the Somerset exit of the PA Turnpike

This will be our first venture west of State College. Rosa and Jeanne have promised to talk the meeting up among prospective new members from their area of the state. Karen proposed that we plan a good sharing session so new people will especially enjoy the meeting. Chris Mulford proposed that we invite Sue Majoris to tell about her hospital's experience developing a model project with CIMS (Coalition to Improve Maternity Services). CIMS has a ten-step program, and their Step #10 is the BFHI (Baby-Friendly Hospital Initiative).

[We need the name of her hospital and the person responsible for inviting her.]

Date: July 16
Time: 10:00 AM to 2:00 PM
Place: Fredricksen Center, off I-81 near Harrisburg

We all liked this place last July, but some people had trouble finding it. Kathy promises to provide easier directions this time.

Date: October 22
Time: 10:00 AM to 2:00 PM
Place: State College, South Ridge Motor Inn
( 814) 238-0571

The Minutes of the July meeting were accepted as written.

The Treasurer's report was accepted. We have

$990.90 in savings and $462.41 in checking.

We don't have to file an income tax report because the PA-BC doesn't have enough assets. We have sent in the proper form to establish this status.

Nominations/elections
Jeanne Spencer and Karen Foard were elected unanimously as Chairperson and Secretary. The Coalition thanks them for offering to serve. Wendy Shore was appointed to finish out Jeanne's term as Vice-Chair.

Correspondence
Susan Mongel of Uniontown, PA, wrote to us at the website to ask about setting up a nursing station at a fair. She also asked for information about our bylaws. In her area there is a small local group of breastfeeding advocates. Barb Shocker notified Martha, who emailed and then phoned Susan. Rosa will invite Susan to the April meeting.

Website
Webmistress Barb Shocker has asked to be replaced. Karen Foard volunteers to take it on. [Thank you, Karen!] and will contact Barb to make the hand-over.

Karen Foard plans to make a master copy of the brochure available to Coalition members by putting it on the website in a computer PDF file.

She also hopes to post

PA WIC's breastfeeding handouts
a write-up of the two Telephone Conferences which we put on this year by working with PA-AAP and AAFP, plus information on how to get tapes

Karen asked each committee to give her a "wish list" of items for the website. Her email addresses are kfoardlc@Adelphia.net kfoardlc@hotmail.com

Membership
Rosa will send out renewal notices in the next few weeks.

Coalition Display
Wendy reported on setting up and staffing a PA-BC display at the PA-MILC conference in October. She borrowed a display board from Pinnacle, got a family donation of foam-core to make a Velcro-able sign saying "Pennsylvania Breastfeeding Coalition," and laminated a copy of our poster. She also posted the mission statement and descriptions of the coalition committees. She prepared a pink 3-ring notebook with print-outs of all the pages from the website.

We gave a framed poster as a door prize.

Brochure
As a group, we gave a final reading and approval of the coalition brochure. We asked that the date of this version be added. Rationale for saying "protect, support, and promote" instead of following the Innocenti Declaration order is that this is the way we said it in the bylaws.

Teleconference
See report in Cindy Maki's sharing.

After a sharing session, committees met and reported back.

Committee Reports
Public Policy Committee
A. Our task from the July meeting was to draft a letter to the head of the state DOH about the need for breast pumps. However, recalling the discussion in July about not having enough solid research-based information about which brands of pump to recommend for which uses, we thought that first we should write a letter to USDA, suggesting that independent research be conducted. Now that WIC is buying pumps with food dollars, USDA has a vested in getting the right pump for the need. We outlined such a letter.

We all want to increase breastfeeding rates and breastfeeding exclusivity.
Moms at work often depend on breast pumps to maintain lactation.
There's little research about effectiveness of different pumps. Research funded by pump companies is suspect because it is not disinterested.
USDA, through the WIC program, provides pumps for breastfeeding moms˜and needs to have the best information about which pumps to provide.
We suggest that USDA should fund a research project to find out which pumps or pump types are most effective and cost effective for working women in different work settings.

Cindy offered to get us the name of a person at USDA to send the letter to.

B. Continuing on the topic of women who need breast pumps, we returned to the problem to making the current system work for everyone. We understand that the state MA (Medical Assistance) guidelines specify supplying pumps for moms separated from their baby for reasons of work, school, or sickness.

We want to have "chapter and verse" of this policy.
We need to obtain the information about how to get Medicaid HMOs to follow the guidelines.
We want to spread that information throughout our network.
It would also be good to find out how to gather data about whether PA mothers are actually getting this service that they are entitled to.

Rosa and Chris set up a schedule for getting this information. Cindy will work with Rosa to find sources for the information.

Public Relations:
For now the goal is to get the next newsletter out by Nov 5.

Provider Education discussed a simple idea that could have a big effect, which is to make accurate patient education handouts available to providers through an existing data base which already provides handouts for other topics. They will look into getting Jack Newman's handouts into that data base. Also the data base provides full-text access to many medical textbooks; the committee will try to get Hale's book onto that list. [If I had more info about this data base, I could put it in---name, for instance?…]

Research
Kay would like to do the same survey she did in Philadelphia (see Sharing) for all hospitals in the state by using the Coalition's county contacts.

The meeting adjourned at 2:00 PM.

Sharing:

Karen Foard:

She saw two moms within a week with NO lactogenesis. One had full-torso radiation at age 15 for non-Hodgkin's lymphoma. The other had no discernable reason not to make milk. Karen asked whether the first mom might lactate after more pregnancies? How much regeneration capacity does the breast have?
Ruth Wilf commented that good history-taking is an issue for LCs; an LC shouldn't get surprises like this.
The PA-MILC-conference lost $2-3,000, perhaps because of competition with other conferences. Karen sees the need for a clearinghouse of conference dates among planners. ILCA is planning four regional conferences in the USA in 2003.
The "bread-and-butter" participants at the PA-MILC conference are maternity nurses. Not many came, and a common reason is that there was no money in budget to send them. So the ones who did come were paying their own way.
Karen notices that there are new people in the lactation field who don't know the faces or names of the pioneers in the field. She thinks we need to include history lessons in our conferences.
PSNA will now require that all speaker materials have to be sent in ahead of time in order to qualify the program for credits for nurses.
Chris Hansson:

Her hospital did a "Lunch & Learn" for nurses during WBW. They talked about the HP 2010 goals and obstacles to breastfeeding in the hospital; they also played games, such as taking away familiar utensils, urging participants to eat more than they wanted, and timing them.
The goal at Women & Babies Hospital is to nurture a group of "breastfeeding champions" among the nurses, by providing extra education to the ones who want it.
They had a challenging case of a woman who had gone through fertility services for Senal (?) syndrome, caused by an abnormality at the base of pituitary. The mom never went through puberty, had only two periods in her life, both induced. She had no breast development until the pregnancy. The mom did make milk˜the bare minimum for baby's growth˜even with hyperstimulating by pumping. The LC talked to endocrinologist, who "didn't think [her condition] would have anything to do with breastfeeding."

Kay Hoover:

Kay shared a new book by Gro Nylander, Becoming a mother.
At the last meeting, Cindy & Kay discussed a need for a good video with no breast exposure that can be run on a continuous loop in waiting rooms. Kay has asked MD, TX, and MS WIC programs for permission to put their three videos on one loop and edit out breast exposure. Cindy and Kay will continue looking for an editor and funding. (Kay suspects that the moment before a mom puts baby to breast makes people uncomfortable because they THINK they will se a bare breast.)
On cup feeding: a hospital LC wanted to introduce cup-feeding. The hospital administration was not interested in seeing a stack of research articles about it; they only wanted to know what the other hospitals were doing.
Kay has informally surveyed hospitals in the City of Philadelphia. She asked how many births the hospital does, whether the hospital has an LC position, how many hours, whether it has a NICU, and whether the hospital offers out-patient home visits.
Kay suggests that the PA-BC should give some recognition to physicians who are IBCLCs. Also, how can PA-BC be useful to the AAP breastfeeding coordinators˜Deb Bogan, Penny Soppas, and Linda Shaw?
Kay set up and coordinated a skills workshop for participants coming to the American Dietetic Association meeting in Philadelphia. The workshop was not part of the official ADA program, but met the afternoon before the conference. Local mothers and babies came to be models and local LCs donated their time as skills instructors.
Martha Kautz told about two activities at the Lactation Center for WBW. First, the Center gave a certificate to each breastfeeding mom who delivered during the week, plus a raffle for a Medela Pump in Style. Second, they targeted OBs and Peds to receive a card from the Center, saying, "Thank you for your support of breastfeeding families." They got positive feedback from several physicians.

Cindy Maki:

The telephone conference was a successful collaboration of the Coalition with WIC, PA-AAP, PA AFP and other professional organizations. The first one had an audience of 198 pediatricians, 39 nurse practitioners, 246 nurses, 15 office managers, and 130 others (students, etc.)
The ACOG teleconference was smaller, but still had 42 lines and reached 118 people. Pamela Berens was the speaker; Jeanne found her via the ABM listserve. She emphasized the prenatal promotion aspect. People feel good about the OB conference˜this is a hard audience to reach. WIC sent a follow-up letter thanking those who participated. Best Start sent posters.
Cindy's on-going challenge: trying to get local WIC staff to promote breastfeeding.
PA WIC now has "Quik-WIC," the new computer system that rolled out in March.
Cindy has developed 25 promotional fliers and breastfeeding support fliers. All are available as Word documents and all have been translated into Spanish. (It's these that Karen Foard wants to put onto the website.)
South-West PA has a Loving Support grant for breastfeeding promotion; the project will cover all counties in the area except Allegheny. A team from Best Start will kick the project off on Nov 12-13.
Cindy has developed a letter for employers about workplace breastfeeding issues. The letter has the State Department of Health logo on it. Cindy will send it to any employer along with a cover letter from WIC and a glossy brochure that tells how employers benefit from having employees who breastfeed.
Chris Mulford reported that PRO-LC continues to provide varied and challenging CERP sessions at meetings, a friendly/networking/educational journal club/pot-luck twice a year, and a yearly outstanding physician award. 2002 saw a WBW display contest in hospitals throughout the region.

Chris also traveled to Tanzania in September, where she participated in the second WABA Global Forum and assisted with running a track of workshops about workplace issues. The WABA Women and Work Task Force is part of a coalition producing an action kit with materials and ideas for how to press for better maternity protection laws, collaborate with trade unionists, and act at the workplace level. This kit will be available early in 2003 through the ILCA office and will be useful to groups working at the state or local level as well as the national level.

Kathy Romburger is starting to provide home visits.

Wendy Shore took and passed the IBLCE exam!

Rosa Snyder-Boyd:

Rosa's group again set up a booth for breastfeeding at the fair. They had planned a bigger booth but didn't get it together. Moms were lined up out the door, waiting in line to nurse.
Allegheney Cty will bring out an educational piece under the county health dept logo, which will address the topic of safe co-sleeping.
Ruth Solomon reported on LLL's World walk for breastfeeding and the LLL-EPA conf. Next year's dates are Nov 14-15, 2003, in Lancaster.

Jeanne Spencer

The Laurel Highlands Coalition did their placemat project again for WBW, distributing 6900 placemats at a total cost of $400. Funding came from the two local hospitals, which as sponsors each paid $200 for an ad on the placemat.
The billboard project was also done, and 182 people were surveyed at OB offices. 114 saw the billboard. 156 thought that an ad for breastfeeding could influence a woman's decision on infant feeding. Asked about the most important personal influence, 74 people chose "nurse," 52 "midwife," 24 "mother," and 30 "friend."
Jeanne has been serving as program director of a residency program.

Helen Vermilya:

During WBW, the LCs presented a mini-conference for nurses and in the process learned about using Powerpoint!
Helen is writing a quarterly newsletter for docs and nurses and is introducing LC services to residents etc.
Helen worked with an adopting mother who had researched a protocol that puts a woman on birth control pills and Domperidone for a 6 or 9 month period, then the woman suddenly stops the BCP and begins pumping. There is no report about the efficacy of this regimen. One problem was getting the Domperidone, as it is not FDA-approved. Kay says that with a prescription you can get from a US pharmacy; the prescription should say "off-label use." Martha has worked with a doctor who prescribed Domperidone, which had to be obtained from a "compounding pharmacy." Insurance will pay only if policy covers "compounded medicines." Medicap Pharmacy in Williamsport will compound. In Kay's Breastfeeding Atlas is a website that lists compounding pharmacies. See also Jack Newman's site and Cindy Curtis's site.
The mother had done the research and chosen to follow the protocol. The LCs saw their role as to try to educate local physicians about this protocol.
Helen also had a drugs question. If a woman is on a non compatible med and she pumps and stores the milk, can she use the milk after it has sat for awhile? No one had an answer. [I suspect not, although it would depend on the kinetics of the drug. Where's the drug gonna go? CAM]
In prepping a mother who needs to discuss medications with her provider, suggest she say, "Weaning is not an option. What's your next suggestion?" Another idea: "I've talked to somebody [an LC, or a breastfeeding-friendly physician] who would be glad to talk with you about medications."
Ruth Wilf reported that the LCs at Pennsylvania Hospital are very busy. One of their interns passed the IBLCE exam. Ruth put together a talk for LaCTo (South Jersey ILCA Chapter) on what LCs need to know about postpartum. She sees a need for continuing education on this subject.