New Safe Sleep BPG Posted on Nov 1, 2012
Keep your eyes out for the new RNAO Safe Sleep BPG going out for stakeholder review soon!
New Recommendations for Health Professionals on Infant Nutrition Posted on Nov 1, 2012
Highlights from the NEW revised Health Canada Infant Feeding Guidelines (2012): Nancy Watters E RN,BScN, MScN
The document now includes co-authors the Breastfeeding Committee for Canada Health Canada, the Public Health Agency of Canada, CPS and Dietitians of Canada.
Breastfeeding is acknowledged as "the normal and unequalled method of feeding infants". The guideline recommends exclusive breastfeeding for the first 6 months and continued breastfeeding with complementary foods, for two years and beyond.
The Baby-Friendly Initiative (BFI) including all of the BCC's Integrated 10 Steps for Hospital and Community Services and the WHO Code are endorsed and recommended.
Pasteurized human donor milk is recommended as the best option when exclusive breastfeeding or mothers own expressed breast milk is not an option.
Guidelines for informed decision making related to the use of breast milk substitutes are consistent with the BFI as well the WHO code for Marketing of Breast Milk Substitutes.
First complimentary foods should be iron rich meat and meat alternatives as well as iron fortified infant cereal.
The WHO growth Charts for Canada should be used for growth monitoring
Gestational Weight Gain Report Posted on Nov 1, 2012
Lori Webel-Edgar RN,BScN, MN
In their 2009 report, Weight Gain During Pregnancy: Re-examining the Guidelines, the Institute of Medicine (IOM) identified associations between excess gestational weight gain (GWG) and adverse birth and maternal outcomes.1;2 The report includes guidelines for appropriate gestational weight gain ranges and rates, based on pre-pregnancy Body Mass Index (BMI). These guidelines were adopted by Health Canada3. In order to develop a comprehensive health promotion plan related to healthy weight gain in pregnancy, the Simcoe Muskoka District Health Unit (SMDHU) implemented the Food and Exercise in Pregnancy Survey. Eligible participants were at least 18 years of age, 14 or more weeks' gestation could read English and were receiving antenatal care from a health care provider (HCP) who practiced within the SMDHU catchment area. A total of 457 surveys were analyzed.
Body Mass Index (BMI) and Gestational Weight Gain
Approximately 54% of our sample entered pregnancy at a BMI which fell within the normal weight category; 42% entered pregnancy at a BMI which fell within either the overweight category or the obese category. Only 5% of the pregnant women surveyed had a pre-pregnancy BMI defined as underweight. Fifty-eight per cent (58%) of the sample were exceeding their recommended GWG rate at the time of the survey; 23% had already exceeded the upper limit of their recommended GWG range.
Nutrition Behaviour
Thirty-six percent reported consuming fewer than the recommended 7-9 servings of Vegetables and Fruit; 34% reported consuming more than 9 servings. Although women consumed an average of eight servings of Vegetables & Fruit, two of these servings were from fruit juice. Forty percent of pregnant women consumed the recommended 2-3 servings of products from the Milk and Alternatives food group. Forty-seven percent of pregnant women over-consumed Milk & Alternatives. The average number of Milk & Alternatives servings consumed was 3.5, with 43% of these servings being any type of cheese. Cheese and fruit juice may contribute to excess calorie intake. Pregnant women were more likely to exceed their recommended GWG rate if they reported consuming fast food more frequently than "rarely or never".
Physical Activity
Thirty-two per cent of women surveyed reported engaging in moderate exercise for at least 15-30 minutes 3-4 times per week, as recommended in the Joint Society of Obstetricians and Gynecologists of Canada (SOGC)/Canadian Society for Exercise Physiology (CSEP) Clinical Practice Guideline: Exercise in Pregnancy and the Postpartum Period. Twenty-eight per cent reported rarely or never engaging in moderate exercise. Over half of our sample (57%) reported they engaged in less moderate physical activity since pregnancy began. Barriers to Healthy Eating and Exercise Just over half (52%) of women reported they were told by their health care provider to exercise. A similar proportion was told to follow Canada's Food Guide5 (55%) during their pregnancy. A smaller proportion of women were given specific advice.
Prenatal Health Information
The top three preferred sources of prenatal health information were: one-to-one discussion with Health Care Providers (HCPs) (77%), websites and books written by health experts (41%) and in-person prenatal classes (40%).
Conclusions
Since a large proportion of pregnant women in Simcoe Muskoka are exceeding their recommended GWG rate, it is clear many women need guidance and support to achieve healthy weight gain during pregnancy. Eating according to Canada's Food Guide, including the recommended number/size of servings for pregnant women and following the recommendations for physical activity outlined in the joint SOGC/CSEP Guideline6 will contribute to their success. Discussing strategies to decrease fast food consumption may support the achievement of recommended weight gain rates and ranges.
Working collaboratively to support pregnant women to achieve healthy weight gain during pregnancy is a critical component of a comprehensive health promotion plan. In order to optimize maternal and child health outcomes related to gestational weight gain, health care providers must have the tools and resources required to address healthy lifestyle recommendations for pregnant women, calculate pre-pregnancy BMI, communicate individual GWG range and rate, plot GWG throughout pregnancy and make appropriate referrals to registered dietitians and other community supports.
For more info visit http://www.simcoemuskokahealth.org/JFY/HealthProfessionals/ PrimaryHealthCare/MaternalChildHealth/PracticeGuidelines/GestationalWeightGain.aspx
Exciting Policy Changes at the Provincial and National Levels Improve Support for Breastfeeding Nancy E. Watters RN, BScN, MScN Posted on Nov 1, 2012
These are exciting and rewarding times for the many maternal-child nurses and other professionals who have been working for years to improve health outcomes for infants, children, mothers and families through better breastfeeding outcomes.
I have had the privilege, over the past few years, of working on several provincial and federal committees which have made significant policy changes in Ontario and Canada which will improve the promotion, protection and support for breastfeeding. These changes have created significant momentum and consistent messaging for the implementation of the evidenced based policies and practices of the WHO/UNICEF and Breastfeeding Committee for Canada's Baby Friendly Initiative (BFI).
These include:
- The revised Ontario Public Health Standards (2008) which set a public health objective of increased rates of exclusive and sustained breastfeeding for all children to attain and sustain optimal health and developmental potential (Ministry of Health and Long Term Care, 2008).
- The Provincial Council of Maternal Child Health's (an advisory group to the MOHLTC) Breastfeeding Services and Supports Work Group (2010) which firmly recommended the implementation of the Baby-Friendly Initiative for all hospital and community health services in Ontario.1
- As part of the dissemination and implementation of the WHO Growth Charts, an evidence-based, 5-module, on-line learning package designed for primary care and public health practitioners was developed in 2011 through a collaboration led by Dietitians of Canada and other professional groups including the Community Health Nurses of Canada. The WHO Growth Standards are based on the growth of healthy breastfed infants and clearly establish breastfeeding as the normative model for healthy growth and development. The content of the WHO Growth Chart Training Program - reviews the importance of breastfeeding for infant and young child growth, identifies the Baby-Friendly Initiative as an avenue for increasing breastfeeding rates and includes several case studies related to the breastfed infant. The content is consistent with the principles and practices of the BFI.
- Health Canada has just released (September 2012) the revised national infant feeding guidelines Nutrition for Healthy Term Infants Recommendations from Birth to Six Months. This work began 2.5 years ago, replacing the last complete guidelines (1998). Work will continue on the next stage of the document which will cover 6 months to 2 years. These new guidelines include many changes aimed at improving the support provided by health care providers for the protection, support and promotion of breastfeeding including a full endorsement of all components of the Baby-Friendly Initiative (See details below).
1 Some of the recommendations and tools to support BFI implementation developed by the Breastfeeding Supports and Services Work Group are available at the link below. These include breastfeeding policy templates for both hospitals and community services (Step 1 BFI) and a Curriculum and Learning Resources package to support Step 2 (Staff Education). http://pcmch.on.ca/ClinicalPracticeGuidelines/ BreastfeedingSupportsandServicesWorkGroup.aspx
Policy Translated into Action: The Status of the Baby Friendly Initiative (BFI) in Ontario
As many MCNIG members will be aware, in the Fall of 2011 the Ministry of Health and Long-Term Care established the requirement for each of Ontario's Public Health Units to pursue Baby Friendly status as part of their 2011-2013 accountability agreements. The Ministry will be measuring each health unit's progress in working towards, achieving and/or maintaining Baby Friendly designation. The principles of the Baby Friendly Initiative align closely with the Ontario Public Health Standards and this work represents a very exciting and encouraging step.
The Baby Friendly Initiative is also referenced in the Accreditation Canada's Qmentum Program - Obstetrics Services Standards for hospitals, as of September 4, 2012. In section three of this document, the Baby Friendly Initiative is identified as a resource/guideline that provides: "structured education promoting a collaborative interdisciplinary team approach to safety and quality improvement." To clarify, Baby Friendly designation is not specified as a requirement for accreditation, however, it is encouraged by Accreditation Canada.
The Breastfeeding Committee for Canada reports that there are currently three hospitals, seven public health units and two community health centres in Ontario that have received the BFI designation. There are many other organizations working diligently through the application/designation process (including all 36 public health units). No doubt, the recent publication of the new Health Canada guidelines along with the recommendation from the Accreditation Canada will provide a boost for BFI implementation in hospitals.
RNAO is also very excited about the Spring 2012 launch of a Breastfeeding elearning offering to assist nurses and health-care professionals to develop the knowledge and skills required to implement internationally recognized best practices in breastfeeding. This e-learn, an amalgamation of RNAO's Breastfeeding Best Practice Guideline for Nurses and the WHO/UNICEF Baby-Friendly Hospital Initiative's 20-hour course for maternity staff (http://elearning.rnao.ca) is being used by many agencies as part of their Staff Training requirements (BFI Step 2) as they work towards achieving official BFI designation (including my own health unit - City of Ottawa).
MCNIG should be proud of the work we have done as individual professionals, and as a group, in providing better support for families to optimize their health through breastfeeding. Some members may recall that it was a resolution from this RNAO Interest Group with collaborative support from CHNIG and PedNIG which took a resolution related to the implementation of the Baby Friendly Initiative to the 2006 RNAO AGM which was unanimously approved by the members. This seems like a long time ago now - but it was certainly an important step along the way as RNAO has used its considerable political and practice influence in a variety of realms to work towards this common goal.
Although we have much improved breastfeeding initiation rates - about 88% in Canada, we have a long way to go before we meet the objectives. There is a sharp drop off in breastfeeding rates in the first few months, only 25% of babies are exclusively breastfed for 6 months and the minority are breastfed into the second year. But - it is important to focus on progress and recent policy changes at the highest levels are extremely encouraging.
I have had the privilege of serving as an expert advisor on these provincial and national groups and bring you this news with pleasure!! This summary should be helpful to any agency staff attempting to take the initial steps towards becoming Baby Friendly and in convincing a team of colleagues that BFI is a proven approach to improving child and maternal health outcomes by increasing breastfeeding rates - initiation, exclusivity and duration. The Ontario Breastfeeding Committee is actively supporting these efforts in our province. Please feel free to share and disseminate this information.
CHECK OUT RNAO'S NEW BREASTFEEDING E-LEARNING Posted on Nov 1, 2012
This e-learn has been created as a means to assist nurses, other health-care professionals and organizations to access education that is appropriate to their role in promoting breastfeeding. As such, it aims to develop the knowledge, skills and attitude required to implement internationally recognized best practices in breastfeeding to create a baby-friendly environment.