PA-Breastfeeding Coalition Minutes of meeting October 24, 2001 in State College

Present:
Tasha Dershem, Cindy Maki, Wendy Shore, Karen Foard, Chris Mulford, Jeanne Spencer, Kay Hoover, Kathy Romberger, Helen Vermilya, Martha Kautz, Linda Shaw and student, Ruth Wilf, Teresa Wirtner

Minutes of the July meeting were approved.

Treasurer's report showing a balance of $1500.24 total from both accounts was approved.

The January meeting via conference call will be arranged by Rosa Snyder-Boyd. The time is Jan 23, 12:00 to 2:00. The number to call is 814-863-2330. See the attached reminder of bridge call 'etiquette.'

July 2002 meeting
The original July meeting date of July 24 conflicts with the ILCA conference, so the date is changed to July 10. Pinnacle has a room we can use on the 10th. Kathy will get directions to Chris for distribution.

Membership Committee report
Rosa Snyder-Boyd (chair) was unable to attend but sent a note to bring us up to date on recording our "in-kind" contributions to PA-BC. She is working out a way to record how much both the individual members and the member agencies are contributing to PA-BC in the form of time, travel, phoning, copying, and postage. Rosa has recorded on the membership list al reports she has received. The list will be passed around at each meeting for people to check for accuracy and add their in-kind contributions since the last meeting (or since their last update).

The group decided that we would like the Membership Chair to make an annual report of in-kind contributions. Agencies that donate to PA-BC may need documentation of what they are donating, and we as a coalition also need to know this for future grant-writing.

If people need this information for their own tax records, they can contact Rosa directly. rosasb@sgi.net or rosasboyd@yahoo.com

A final draft of the membership brochure was distributed for comments.

PA-BC's generic media response letters

These letters are ready. The procedure to follow is this:

1. Member sees an article deserving comment (positive or negative) from PA-BC.

2. Member sends the article to Martha.

3. Martha sends the official PA-BC comment.

Distribution of posters

Almost all of the first printing of the PA-BC poster has been distributed. No second printing was done.

We decided to wait and see whether the planned Continuing Ed program in partnership with PA-AAP will be a reality before we decide to print more posters or design another one.

New business:
The question was raised whether the PA-BC should do anything in response to current interest in anthrax. After discussion of producing an information sheet, the question was referred to the Public Relations Committee. See report below.

Committees met and reported.

Public policy committee

1. Report on project to support Helen's outreach to encourage Williamsport Hospital to support breastfeeding as an employer. Helen has got a lot of excuses from people she has talked with at the hospital. Her focus has shifted to working on the problem of consistent information from prenatal through postpartum follow care. She learned that women get basically NO information about breastfeeding during prenatal care. Doctors are not seeing babies within two days of discharge. The Maternal-Child Cycle Service Committee has discussed the possibility of a postpartum lactation clinic for this reason.

2. Workplace support:

Teresa got complaints from WIC moms who were not allowed to pump in bathroom at work. Teresa sent materials from Washington Business Group on Health. Cindy Maki has written a letter for PA WIC to send employers; this was sent also. The employer has not responded to either letter.

We discussed how to get the message to employers that breastfeeding support saves them the costs in lower productivity and higher absenteeism when employees bottle-feed. Cindy plans to instruct local WIC agency coordinators to send her the names and addresses of problem employers; she will send letter to each one from the state WIC.

We see a need to empower mothers, especially WIC moms. High unemployment rates make it difficult for women to advocate for what they need. Our committee could take on a project of producing a sample local press release, letter to employer from PA-BC, and sample letter for the mom to use. Cindy will email her employer letter to Chris. We should also collect a list of mother-friendly companies in the state.

3. Planned letter to PA chapter of National Organization for Women: Chris will work on this letter with Rosa.

Research
The committee agreed that the publication of the new AAP drug list gives an excuse to mail a letter to hospital pharmacies now, encouraging pharmacists to use the AAP list as a reference. The letter has already been drafted. The mailing will include the Phila Health Department's 'Breastfeeding Times' issue on medications and bf. Karen Foard has the list of hospital addresses and will email it to Kay.

For future plans they discussed

1. contacting the CDC about their survey on breastfeeding to find out what we would need to do to get such a survey done in Pennsylvania.

2. finding out how to go about getting the information about feeding choice on the birth certificate as is done in New Jersey.

3. finding out if we can get feeding method at the time of each immunization added to the immunization record.

Public relations

1. In response to terrorist attacks in the U.S. on 9/11, the committee decided to develop and send out an information sheet on bf in emergency situations. The main points would be

a) immunizations are safe to take while bfing

b) how to get information on the safety of medications for nursing mothers

2. The 2002 newsletter so far has 5 pages. It includes contact information for the coalition, sample feedback letters for local advocates to use in media response, information on WBfW, an article on bf & wt gain in full-term well baby by Linda Shaw, a table tent, and an information sheet about anesthesia and bf.

3. It was noted that the PR mailing list needs updating.

Provider Ed
The provider ed committee did not meet at the 10/25 meeting. See minutes for report on Cindy Maki's application for funding through WIC for the CE telephone conference.

The meeting was adjourned at 2:00 PM.

Next meetings:
January 23.................Bridge call, 12:00 to 2:00, 814-863-2330.
April 24.....................State College, South Ridge Motor Lodge, 10:00 to 2:00
July 10.......................Harrisburg, place TBA, 10:00 to 2:00
October 23................State College, South Ridge Motor Lodge, 10:00 to 2:00

Respectfully submitted,
Chris Mulford, Secretary

Sharing:

Tasha Dershem:
Tasha pointed out that dietitians have struggled to win reimbursement for medical nutrition therapy. PA Dietetic Association now offers workshops on billing, which we might use as a model.

Tasha is the program planner dietetic CE for Central PA.

Karen Foard:
PA-MILC is planning a 2002 conference, either Oct 11-12 or Oct 12 at the Penn Stater.

A possible theme is 'A systems approach to bf benefits.' Karen asked us for possible speakers who could address topics like bf and immune function, bf and nervous system development, or bf and/ and GI development. She also asked us to mull: should they do a session on "encouraging the lay volunteer"?

PA-BC could co-sponsor a session on reimbursement on the second day.

A practice note: Karen likes the new personal fit flange sizes. You can buy in bulk from Medela, a bag of 36 of any one size. 24mm, 27mm, 30mm. Karen says we need information on how to recommend the size, an in-service on how to fit flanges. How about a device to help fit them? Ruth Wilf compared this to the diaphragm fitting rings used by midwives/OBs.

Judy Heald:
Judy did not attend the meeting but sent some internet materials on bf and obesity

Kay Hoover:
The Philadelphia 'Pink Book' is available on-line. Go to www.phila.gov/health/decywh and click on "special programs/projects."

Martha Kautz:
A letter from NANN&emdash;the National Association of Neonatal Nurses&emdash;has arrived which totally changed the whole NICU policy in their area. No alternative feeding methods are allowed except bottle.

The letter says there is not sufficient evidence for cup feeding, finger feeding, etc. Now mothers and dads of NICU babies are writing to hospital saying "we requested no bottles and you are violating our rights."

We discussed why NANN may have done this.

a) insufficient data on the safety and efficacy of alternative methods?

b) afraid of lawsuits?

c) Did NANN members ask for this?

d) Are they afraid of change?

Ruth Wilf volunteered to discuss this letter with neonatologist Vinnie Butani in Philadelphia.

Our job as bf advocates/experts is to collect the studies that provide an evidence base for non-bottle alternatives and bring them into the discussion.

The group suggested making a comparison between two hospitals in Martha's area&emdash;one NICU uses no bottles; the other uses only bottles&emdash;but that one has smaller, sicker babies. The neonatology service is the same for both hospitals.

Hospital is cutting again&emdash;MK says her program will survive. Sister hospital uses their LC services but supplements ALL babies and feeds in nursery at night.

Martha says her program is getting better reimbursement from HMOS in the last year; Medical Assistance is one of the most consistent payers.

We identified a need to know how hospitals do get reimbursed for lactation services. It was suggested that Martha use what she has learned over many years of experience to help the Coalition develop a kit with the necessary information on how to set up billing for lactation. It should include sample bills, current ICD-9 and HCVA standards for coding, and info on chart documentation for reimbursement: what elements of the history and physical exam, what kind of counseling was done and how long it took. The kit would help an LC prepare a presentation to her hospital's financial people, including hints on how to overcome their barriers. People in charge of finances for a hospital need teaching about what LCs do. We need to introduce them to key concepts, like "breast" and "baby's food."

Cindy Maki:
Cindy has been working on a plan to educate physicians about breastfeeding through WIC. She made curricula for OB and Peds offices, designed in a Jeopardy game format, gearing the questions to WIC-specific problems. These are available for use with residents and students. Practicing physicians proved too difficult to bring into the project for education, so Cindy instead has worked on finding funding for the PA-BC and PA-AAP's telephone conference by applying to USDA.

Linda said that her dream is to use the teleconference as a kick-off for doing local presentations at pediatric offices by a physician paired with a WIC person. The head of PA-AAP is interested.

Cindy's goal for WIC for the year has been for WIC staff to do more prenatal promotion of bf. CM practiced using her protocol herself&emdash;it takes about 20 minutes for a mom. Currently the average WIC certification process takes 20 minutes, and 60 seconds are budgeted for bf promotion. CM is working to set up an extra prenatal appointment to do bf promotion. She can track this on the WIC statewide data and will be able to see whether the women who had the extra lesson actually bf (initiate) more.

Karen Foard asked whether there a role for a community volunteer at the WIC office. She hears from lots of people who want to be LCs, who would like to get practice hours as volunteer bf promoters at WIC.

Chris Mulford:
Chris passed around a report about health plans that support breastfeeding, written jointly by American Association of Health Plans (AAHP) and Office of Women's Health at DHHS. You can read it online at

http://www.4woman.gov/owh/pub/breastfeeding/

or download a PDF version (90 pages) at

http://www.aahp.org/

or read a press release at

http://www.aahp.org/template.cfm?template=/Search/SearchDisplay.cfm

Kathy Romberger:
Kathy reported that a front page article in the newspaper's health and science section was written by a bf educator at local hosp, a PA-MILC member.

Linda Shaw:
At the hospital where Linda practices, she is working with the LC Maureen Mitchell to develop a protocol for the non-latching baby. They are collecting data on the problem. Some babies go 2-3 days before they really latch on, and this contributes to a lot of unnecessary bf failure.

National AAP is revising its protocol for jaundice. The AAP is still trying to get docs to see bf babies by two days post-discharge.

Wendy Shore:
Wendy is at Memorial Hosp in York, where in two years their pump rental station grew from 3 to 12 pumps. All rentals are private pay; the hospital won't let them bill insurance companies.

Memorial has just began a bf committee. Wendy has volunteers who are the core of her monthly mother support group. She works 20 hr/wk as LC and home care, and the volunteers make rounds on her days off.

Jeanne Spencer:
Jeanne has been traveling to recruit residents, and she uses this as an opportunity to promote bf. She lectured on bf to 47 med students at Hershey.

The Laurel Highlands Coalition made table tents for WBfW. They sold "Sheetz tickets" as a fundraiser for their billboard project, which will cost $1000 for three billboards, 1 x 3 months and 2 x 2 months. There also will be a survey of pg women to see if they saw the billboard. Because of the research component, her boss told her they could have funded the project from hospital research funds.

In a project to hang a banner on the hospital for WBW, they got the design, got funding, and then one hour before it was to be printed, the architect said he 'doesn't like banners' and the project was vetoed.

Helen Vermilya:
Helen is working on better coordination between her hospital, WIC, and home health.

She is an MA provider; the benefit is $40 for rental pump and $25 for set-up.

Teresa Wirtner:
At Erie County WIC, bf incidence is the highest (40+%) it's ever been, but duration has dropped from 14 weeks to 10.

Hospitals and family physicians are still a problem, and so is the lack of lactation services for WIC clients. Teresa did a grant with hospitals to fund lactation services.

150 people have participated in a pump program. Moms prefer using Isis manual prefer it to Medela.

Teresa also did a pump program in the city schools, providing 5 reconditioned Lactina pumps for the school nurse offices, which was a great opportunity to do outreach to the nurses.

Kay says that TX WIC does pay $30 an hour for moms to have LC visits.

Guidelines for PA-BC Bridge call scheduled for Jan 23, 2002

Noon to 2:00 P.M.

** This call will constitute our January PA-BC meeting.

** The cost of call will be responsibility of the coalition member. It will be billed to your phone at whatever you pay for other long distance calls. You may use a speaker phone if you want and put several people on the call to help reduce costs.

** The line will open at 12 noon. Call 814-863-2330 any time after noon and listen. When there is a pause, say hello and identify yourself.

** Whenever you make a comment, please identify yourself first.

** If you need to leave, say goodbye, so others on the call will know when you hang up.

** If you are eating lunch during the call watch out for "crunchies" like carrot sticks and potato chips. The noise makes it difficult for others to hear the call. Avoid shuffling papers for the same reason.