Colorado
Breastfeeding Update
Published by the Colorado WIC Program and Colorado Breastfeeding Coalition
ExclusivelyPumpingBreastMilk
By:SueODellRN,MS,CPNP,IBCLC,KaiserPermanentePerinatalHospital&HomeCareServices
Lactationconsultantsandpediatricprovidersarenoticingagrowing
numberofnewmotherswhomakethechoicetoexclusivelypump
breastmilkfortheirbabies(alsoreferredtoasEPing).Anational
surveyin2008foundthataboutfivepercentofallbreastfeeding
motherspumpexclusively.Theirbabiesarefedmothersmilkbybottle,
cuporothermeans,ratherthanatthebreast.Althoughnegative
judgmentsareoftenmadeaboutEPing,itisaviableoptionforsome
mothersandbabies.Healthcareprovidersarecalledupontolearnhow
tosupportmotherswhochosetoprovidetheirbreastmilkwithout
directbreastfeeding.
CommonReasonsMothersChooseExclusivePumping
Prematurityofbaby
Latchproblemsforreasonssuchasbreastrefusal,shallowlatch,
painfullatch,babytoosleepy,anatomicaldifficulty(cleftsorinverted
nipples)
Illnessofmotherorbaby
Separationofmotherandbaby
Maternalchoicedislikeofbreastfeeding,historyofsexualabuse,
abilitytoschedulefeedings,greaterfreedom,andabilitytohave
othershelpfeedbaby
Stress
PositiveFeaturesofExclusivePumping
Valueofprovidingoptimalnutritionforbaby
Costsavingsoverformulapurchase
Feelingsofprideandaccomplishment
Respectofothersformothersdedicationandefforts
Otherscanhelpfeedthebaby
Healthandcognitivebenefitsforbaby
Healthbenefitsformother
PotentialNegativeFeaturesofExclusivePumping
Timecommitment
Sorebreastsandnipples
Commentsfrommisinformedpeopleaboutmothernot
breastfeeding
Resentmentofthepump
Jugglingbabysneedsandrigorouspumpschedule
Overwhelmingdesiretoquitpumping
Lactationconsultantsandmedicalprovidersmaybeconcernedthat
motherswillnotbeabletoestablishafullmilksupplywithEPingor
theywilldiscontinuebreastfeedingsoonerthanthemotherswhonurse
theirbabiesatthebreast.Manymothersareprovingtheseconcerns
areunwarranted.
ManyEPingmothersactuallyproducemoremilkthantheirbaby
needsanddonatetomilkbanks.
Healthy People 2020
Breastfeeding Objectives Released! page 2
A Newsletter for Health Care Professionals
Winter 2011 Vol. 19, No.1
Books,articles,WebsitesandblogsonEPingarefrequentedby
thousandsofmotherstosupporttheirchoicetoexclusivelypumpand
helpthemsucceed.Themanyelectricbreastpumpscurrentlyavailable
forrentalandpurchaseprovideconvincingevidenceofthehuge
marketfortheseproducts.Thenewerhandsfreepumpsandpumping
brasareverypopularwithmotherswhochoseEPing.Healthcare
providersmustprovideaccurateinformationandsupporttohelpthese
mothersestablishandmaintainafullmilksupplyaslongaspossible.
Mothersalsoneedadviceandsupporttoincreasetheirmilksupplyif
theyarestrugglingtoprovideallthemilktheirbabiesneed.
FundamentalstoSharewithMothersaboutExclusivePumping:
Useagoodqualitydoubleelectricbreastpump
Adheretoapumpingschedule.Schedulingandtimingofpumpingis
veryimportant.Pumpatleast120minutesina24hourperiod.
Recommendpumpingevery2hoursandnottoexceed3hours
betweendaytimepumpingsessions.Pumpatleastoncebetween
1:004:00amwhenprolactinlevelsarehighest.
Keeparigorouspumpscheduleforthefirst23months;thenslowly
droppumpingsessionswhilemonitoringmilkvolumes.Donodrop
morethanonepumpingsessionperdaypermonth.
Engageinskintoskincontactwithbabybeforepumping.
Relaxandgetcomfortable.Haveaconsistentplacetopump.
Encouragemothertothinkaboutherbaby.
Suggestwaystodistractmothertooccupyhermindwhilepumping,
suchas,books,television,movies,knitting.
Assistmilkejectionreflex.Applywarmcompresses,takeawarm
shower,andmassagebreastspriortopumping.
Ensurecorrectfitofpumpflanges;usepropersuctionlevels.
Followappropriatenipplecare.
Usehandsfreedevicesifdesired.
Thesameadviceandguidancethatprovidersoffernursingmothers
applytoEPingmothersintermsofmaintainingandincreasingtheir
milksupplies.Babiesandmotherscanreceivetheamazinghealth
benefitsofbreastmilk/breastfeedingwhetheritcomesfromabreast
orabottle.
Pleasesupportandencouragemothers,whatevertheirchoice,and
referthemtothesegreatresources:
Book:ExclusivePumpingBreastMilkbyStephanieCasemore,
@2004,GrayLionPublishing
Websites:www.exclusivepumping.com;www.mother2
mother.com/ExclusivePumping;www.kellymom.com
Blogsites:www.ivillage.com/exclusivelypumpingbreastmilk;
www.thelactivist.blogspot.com/.../exclusivelypumping
Dear Reader:
Your Action Is Required for Future
Newsletters! see page 4
HealthyPeople2020ObjectivesReleased!
BreastfeedingObjectivesDetailSupport!
Thenewpublichealthbreastfeedingobjectives(targets),
releasedinDecember,addressmaternitycareandworkplace
accommodationsfornursingmothers!Furthermore,the
previousHealthyPeople(HP)objectivesrelatedto
breastfeedinginitiation,exclusivity,anddurationratesfor2010
havebeenraised!TheAmericanAcademyofPediatrics
recommendsinfantsbefedonlybreastmilkforthefirst6
monthsoflife,andyetfewerthan1outof4Coloradobabies
meetthisbreastfeedingideal.Thetablebelowdescribesthe
changesandnewobjectives.
Thegoalstargetformulasupplementationofhealthynewborn
infantsduringthematernityhospitalstay.The2010CDC
breastfeedingreportcardforColoradoreportedthat16.5%of
healthybreastfednewbornswerefedformulainthehospital.
Theaimistocutthisrateto15%by2020.Coloradocandothis!
ManyColoradohospitalsarealreadyimplementingpoliciesand
practicestoreducemedicallyunnecessarysupplementationof
healthynewborns.DatafromtheColoradoDepartmentof
PublicHealthandEnvironmentPregnancyRiskAssessment
MonitoringSystem,whichsurveysmothersresponsesabout
theirhospitalexperience,showsthepercentofallbabies
(healthyandatrisk)fedonlybreastmilkinthehospitalhas
increasedoverrecentyears,from43.5%in2002to54.6%in
2008.
Thegoalstargetworkplacesupport,whichfurtherdemonstrates
thatsystemsincommunitiesmustchangetoenablemothersto
achieveoptimalfeedingfortheirinfants.Coloradocanmeet
thisobjectivetoo!ColoradosWorkplaceAccommodationfor
NursingMothersAct,coupledwiththelargenumberof
resourcesavailabletoemployers(suchasontheinternetand
fromlocalorganizations),meansthatnursingemployeesshould
beabletoaccesssupportwhileatwork.
Breastfeedingchampions,healthcareproviders,employers,and
communitygroupsaroundthestatemustjointogetherto
createdialogueandimplementprogramsinordertomeetthe
newtargets!

Maternal,InfantandChildHealth Colorado
HP2020 HP2010
BreastfeedingObjectives 2010
Objective21:Increasetheproportionofinfantswhoarebreastfed

(DataSourcetheCDCNationalImmunizationSurvey)
21.1Ever 81.9% 75% 88.7%
21.2At6months 60.5% 50% 57.7%*
21.3At1year 34.1% 25% 29.3%*
21.4Exclusivelythrough3months 44.3% 40% 46.8%
21.5Exclusivelythrough6months 23.7% 17% 22.5%*
Objective22:Increasetheproportionofemployersthathaveworksitelactation
Datanot
supportprograms.(Datasource:EmployeeBenefitsSurvey,SocietyforHuman 38.0%
available
ResourceManagement)
Objective23:Reducetheproportionofbreastfednewbornswhoreceive
formulasupplementationwithinthefirst2daysoflife.(Datasources:National 15.6% 16.5%*
ImmunizationSurvey(NIS),CDC,NCIRD,andNCHS)
Objective24:Increasetheproportionoflivebirthsthatoccurinfacilitiesthat
providerecommendedcareforlactatingmothersandtheirbabies.(Data 8.1% 6.62%*
source:BreastfeedingReportCard,CDC,NCCD)
*AreaswhereColoradoisnotmeetingtheHP2020objectives

ToolKitAvailable:
ImplementingTheJointCommissionPerinatalCare DenverMilkBankNeedsHumanMilk!
CoreMeasureonExclusiveBreastMilkFeeding
TheDenverbasedMothersMilkBankisverylow
ThisSpringTheJointCommissionspreviousPregnancyand onmilk,andthefluandcoldseasonhasarrived.
RelatedConditionscoremeasuresetwasreplacedwiththe
Themilkbankneedsdonorsnowmorethanever!
newPerinatalCarecoremeasureset.EffectiveApril1,2010,
thenewPerinatalCarecoremeasuresetbecameavailablefor
Donorsmustbeingoodhealth,nonsmokers,and
selectionbyhospitals.TheUnitedStatesBreastfeeding nottakingmedicationsorherbs.Refermothersto:
CommitteehasjustrereleaseditsJanuary2010toolkitwith 3038691888ortollfree:8774585503.Formore
additionalinformation.Thenewreleasecontainstwoparts: informationvisit:
Part1GuidelinesforDataCollectionandPart2 http://milkbankcolorado.org/howtodonatemilk/
ImplementingPracticesThatImproveExclusiveBreastMilk
Feeding.Todownloadthetoolkit,gototheHealthCare
Systemlinkat: www.usbreastfeeding.org Page2
 U.S.BreastfeedingCommitteePresents
Breastfeeding:AVisionfortheFuture
Theguidanceofferedinthedocument,Breastfeeding:A
VisionfortheFuture,isaimedtoincreaseawarenessofthe
importanceofbreastfeedingandthesupportneededfromall
sectorsofsocietytoachieve
thesehealthypeoplegoals.The
USBCexplains,TheVision
drawsattentiontothegapsin
U.S.policyandoutlinesnine
crucialobjectivesthatmustbe
mettofullyaddressthebarriers
facedbymothers.
Theseobjectivesinclude:
1. MeetandexceedtheHealthyPeopleobjectivesto
increasetheproportionofmotherswhobreastfeed.
2. Implementmaternitycarepracticesthatfosternormal
birthandbreastfeedingineveryfacilitythatcaresfor
childbearingwomen.
3. Ensurethathealthcareprovidersprovideevidencebased,
culturallycompetentbirthandbreastfeedingcare.
4. Createandfosterworkenvironmentsthatsupport
breastfeedingmothers.
5. Ensurethatallfederal,state,andlocallawsrelatingto
childwelfareandfamilylawrecognizetheimportanceof
breastfeedingandsupportitspractice.
6. Implementcurriculathatteachstudentsofallagesthat
breastfeedingisthenormalandpreferredmethodof
feedinginfantsandyoungchildren.
7. Reducethebarrierstobreastfeedingimposedbythe
marketingofhumanmilksubstitutes.
8. Protectawomansrighttobreastfeedinpublic.
9. Encouragegreatersocialsupportforbreastfeedingasa
vitalpublichealthstrategy
Toviewthedocumentinitsentirety,orsignonandaddyour
support,visitwww.usbreastfeeding.org.
QuarterlyKudos!
TheColoradoSpecialSupplementaryNutrition
ProgramforWomen,Infants,andChildren
(WIC)ishelpingmoremothersthaneverwith
exclusivebreastfeeding!Infactthreeagencies
haveover85%oftheirbreastfeedinginfants
exclusivelybreastfeeding(i.e.,noformulais
receivedfromWIC)fortheirfirstmonthoflife.
KudostotheDenverCountyWICProgram,the
SanJuanBasinHealthDepartmentWIC
ProgramandtheSummitCountyWICProgram!
CDCRecommendsUseofWHOGrowthCharts
forInfantsandChildrenages0to2intheU.S.
Growthchartshavelongbeenusedasakeytooltomonitor
thehealthofindividualchildren.Theyareusedtoassess
nutritionalstatus,screenforadversehealthconditionsand
forreportingpopulationgrowthdataandtrends.Healthcare
providersuseoneoftwodifferentgrowthchartstoguide
theirhealthrecommendationstheCentersforDisease
Control(CDC)growthchartsortheWorldHealthOrganization
(WHO)growthstandards.TheCDCrecommendshealthcare
providersintheUSusetheWHOinternationalgrowth
standardstomonitorgrowthforinfantsandchildren0to2
yearsofage.
ThereareseveralreasonstheCDCmakesthis
recommendation:
TheWHOgrowthstandards,releasedin2006,
establishbreastfeedingasthenorm.Thehealthy
breastfedinfantisthestandardagainstwhichall
otherinfantsarecompared.TheWHOstandards
werecreatedusingasampleofapproximately8,500
babiesfromselectedcommunitiesworldwidewho
werebreastfedfor12monthsandpredominantly
breastfedforatleastfourmonths.
TheCDCgrowthcharts,releasedin
2000,arefrequentlyusedas
standardsforhowyoungchildren
shouldgrow.TheCDCcharts
howeverareagrowthreferenceand
describehowcertainchildren,both
breastfedandformulafed,grewina
particulartimeandplace.Thesetypicalgrowth
patternsmaynotbeidealgrowthpatterns.The
WHOgrowthchartsarestandardsanddescribethe
growthofhealthychildreninoptimalconditions.
TheWHOstandardsarebasedonastudydesigned
expresslyforcreatinggrowthcharts.Lengthand
weightweremeasuredatfrequentintervals,unlike
theCDCgrowthcharts,forwhichweightdatawere
notavailablebetweenbirthand3monthsofageand
usedsmallsamplesizesforsexandagegroups
duringthefirstsixmonthsoflife.
TheCDCrecommendshealthcare
providersusetheCDCgrowthcharts
forchildrenaged2yearsandolderin
theUSbecausethechartsextendup
toage20yearsandcanbeused
continuously.TheWHOgrowth
chartsfollowchildrenupto5years
ofage.Themethodsusedtocreate
theCDCgrowthchartsandtheWHO
growthchartsaresimilarforchildren
25years.
Formoreinformationandcopiesofthegrowthcharts,goto
www.cdc.gov/growthcharts/who_charts.htmorviewthe
MorbidityandMortalityWeeklyReport(Sept.10,2010/Vol.
Page3 59)atwww.cdc.gov/mmwr.
Upcoming Events
Colorado Breastfeeding Coalition: 2011 meetings, 9:00 11:00 a.m.,
January 18, March 15, May 17, July 19, September 20, November 15.
Locations to be determined. Call 303-869-1888 or for more information
visit www.coloradobreastfeeding.org.
Lactation Journal Club: Meets the second Wed. of the month: First
meeting in 2011 on February 9. Held from 2:30-5:00 p.m. at P/SL
Medical Center, 1719 E. 19th Ave., Denver. Registration fee: $30. To
receive regular Journal Club updates, register at the Nourish Family
Center Web site (www.nourishfamilycenter.com) by entering your email
address at the Join Our Mailing List button on right side of Home Page.
Reframing Birth and Breastfeeding: Moving Forward. March 11-12,
Chapel Hill, N.C. For information go to: www.motherfriendly.org
Breastfeeding: A Continuing Education Program for Health Care
Providers. April 6, Oklahoma City. Information at
www.risingstareducation.net.
Breastfeeding Resources
General Information and Support:
Colorado Breastfeeding Coalition
www.coloradobreastfeeding.org or 303-869-1888
La Leche League www.llli.org or 303-779-6722
WIC Program www.cdphe.state.co.us/ps/wic/wichom.asp or
303-692-2400
Family Healthline 800-688-7777
International Lactation Consultant Association
www.ilca.org
National Breastfeeding Helpline
www.womenshealth.gov or 800-994-9662
Colorado Breastfeeding Essentials
http://www.cdphe.state.co.us/ps/bf/
Special Breastfeeding Problems:
Mothers Milk Bank 303-869-1888 or 877-458-5503
Breastfeeding Management Clinic 720-777-2740
Breastfeeding Products for Purchase/Rent:
Ameda 800-323-8750
Medela, Inc. 800-TELL-YOU (800-835-5968)
Information about medications and breast milk:
University of Rochester, Lactation Study Line 585-275-0088
(handles inquiries from health professionals)
Thomas Hales Breastfeeding and Medication Forum (for
health care professionals) http://neonatal.ama.ttuhsc.edu/lact/
Drugs and Medication Database
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Infant Risk Center www.infantrisk.org or by phone 806-352-
2519, Monday-Friday 8am-5pm central time)

Colorado Breastfeeding Update is published quarterly by the Colorado Colorado Breastfeeding Coalition
Department of Public Health & Environment Nutrition Services WIC Program and the
P.O. Box 201445
Colorado Breastfeeding Coalition. Editor: Jennifer Dellaport, RD, MPH. Editorial
Board: Donna Brown, RN, IBCLC, Kimberly Hammett; Nancy Krebs, MD;
Denver, CO 80220
Marianne Neifert, MD; Lorry Watkins, BSN, IBCLC; Heidi Williams, RD, MPH,
Geri Davis, BSN, IBCLC, Mary Ann Kerwin, J.D. Layout: Katie Roby Breast Milk Food From the Heart

Dear Reader:

Your Action Is Required for Future Newsletters!

The Colorado Breastfeeding Update will be converting to an

The Colorado electronic newsletter! Beginning with the spring issue, the newsletter
Breastfeeding Coalition is a will be sent by email to those recipients we have email addresses for.
volunteer organization If you would like to be added to that list, or confirm your listing, please
whose mission is to ensure email Katie Roby with the request at katie.roby@state.co.us.
optimal infant health and
development of mother- If you must continue receiving the newsletter, as a black and white
infant bonding by increasing print copy, you will need to contact Katie by email or mail to provide
Colorado breastfeeding your current mailing address.
rates, particularly among
Colorado Dept of Public Health and Environment
underserved populations. WIC Program
4300 Cherry Creek Drive South
Denver, CO 80246

WICThe Special Supplemental Nutrition Program for Women, Infants, and Children provides nutrition
education; breastfeeding promotion, education, and support; supplemental foods; and encourages
regular health care. If you have patients who may qualify to receive WIC services, we appreciate your
referral. Please check your directory or the WIC website www.cdphe.state.co.us/ps/wic/wichom.asp
for the WIC Program in your community or call 303-692-2400 or 1-800-688-7777.

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