Human Milk Magazine / Issue 1, 2015 by Medela for Professionals US

humanmagazine milk Issue 1 | 2015

every drop counts

Breastfeeding… From Hospital to Home ™

Cover Story The breast, the body and the technology.

Practically Speaking Dr. Thomas talks with Human Milk Magazine about some common breastfeeding issues for new moms.

Outcomes Breastmilk and the impact to healthcare facilities.

editorial

From Hospital to Home

™

Medela is pleased to bring you the next issue of Human Milk Magazine. Our first issue of 2015 focuses on information to help you support moms in their breastfeeding journey “From Hospital to Home.” Your professionalism and compassion allow mothers to make this journey with confidence. This month we are pleased to share information and tools to help support you in this endeavor. At Medela, we applaud your dedication to these women, their infants, and their families. The journey from “From Hospital to Home” is a critical period for new moms. Our cover story is filled with insights into the stages moms’ breasts and body experience after birth. Because initiation of breastmilk supply is crucial to mom’s success in breastfeeding, we wanted to share a unique view into the strengths of Medela’s breastfeeding initiation technology, Preemie+™. Already this technology has made a difference in the lives of mothers and their ability to produce and deliver the health benefits of breastmilk. Physicians have noted the difference as well. Read the article on page 13 to learn more about this technology.

New moms experience a life-changing event when having a newborn. Most of us understand that having a baby is often a wonderful experience, but it is also a time filled with questions and worries, especially when it comes to producing and providing breastmilk. This month, we invited Dr. Jenny Thomas, Pediatrician/IBCLC, to talk to Human Milk Magazine about the top three breastfeeding issues new moms (and indeed, even experienced moms) face, and what clinicians can do to overcome them. We hope you find this article both interesting and helpful in your day-to-day interactions with breastfeeding mothers. Your support can inspire a mom to have a longer and more successful breastfeeding journey. The “News You Can Use” section is new to Human Milk Monthly and puts a spotlight on The Affordable Care Act (ACA) this month. How well do you understand the details, and have you shared that knowledge with your fellow clinicians and your patients? ACA has important benefits for breastfeeding moms, benefits which can make a big difference to their successful breastfeeding duration. How can you help new moms navigate the incredible amount of information out there, from hospital to home? Here you will find

specific facts to help increase your own understanding and key points you can take back to your patients and their families. The “NICU Perspectives” section is also new to Human Milk Magazine this month. This section is a compilation of professional perceptions and team communications brought to you by our NICU/Lactation Consultants and internal team. In this issue, NICU Perspectives addresses clinician and patient/parent connections. What are NICU parents expecting from you and how can you help them to have a deeper and more meaningful experience with their baby while the infant is under your care? Many times it is the simple act of communication which can have the largest impact, as you will read shortly. Thank you for your continued support of mothers on their breastfeeding journey. I hope you’ll find ideas and inspiration in this issue that you can apply to your own practice. Kind Regards, Kind regards,

Carolin Archibald President, Medela, Inc.

table of contents

in this issue outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Expectations for Human Milk in Healthcare

Breastmilk and the impact to healthcare facilities.

practically speaking . . . . . . . . . . . . . . . . . . . . . . 7 Top 3 Breastfeeding Issues for New Moms and What Clinicians Can Do to Overcome Them

With Dr. Jen Thomas, Pediatrician/IBCLC. Dr. Thomas talks with Human Milk Magazine about some common breastfeeding issues for new moms.

news you can use. . . . . . . . . . . . . . . . . . . . . . . 11

Millennial Moms

The Millennial, Breastfeeding Technology, and “Finding your tribe”: What you need to know about today’s new mothers. ABC’s of ACA

A quick primer to get you up to speed on breastfeeding and the Affordable Care Act.

cover story . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Mother’s Journey to Successful Breastfeeding From Hospital to Home™

The breast, the body and the technology.

nicu perspectives . . . . . . . . . . . . . . . . . . . . . . . 16 Professional Perceptions and Team Communications

community support and outreach . . . . . . . . . . . . . . 17 Medela Recycles

11 13

A new and inspiring breastpump recycling program. Mothers Milk Bank Walk

Medela participates in the 2014 Race to Save Tiny Lives.

Supporting Prematurity Awareness Month

Moms inspiring Moms, Medela giving back. Breastpump Hackathon

Medela sponsors second place prize at the MIT Breastpump Hackathon.

education. . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Human Milk Monthly Webinars

17 3

outcomes

Expectations for Human Milk in Healthcare

NICU image to come

outcomes

The Impact of Human Milk Human milk is the best source of nutrition for infants, known to offer valuable benefits which promote gut maturity, vital organ function and much more. In fact, its benefits far exceed infancy and childhood, and actually impact lifelong health. This is true whether an infant is born prematurely or full term. Recent studies demonstrate that a minimum of $3.6 billion would be saved in healthcare and community costs if breastfeeding or expression of human milk was increased from 64 to 75 percent.1 Breastmilk is especially necessary in the neonatal intensive care unit, where at-risk infants struggle daily with a myriad of health issues. It is here that human milk has the most immediate and significant impact, not only to fragile neonatal health and growth, but also to hospital financial impact and families served. NICU clinicians are quite familiar with the human milk statistic of reducing necrotizing enterocolitis by up to 86%,1 reducing re-admission by up to 60%1 and a lessened sepsis risk. For the very low birth weight infant (VLBW) population, increasing volumes of human milk during the first twenty-eight days can dramatically decrease the risk of sepsis, leading to an increased hospital savings of $20,000 to $30,000 per VLBW infant.2 Providing human milk to infants in the NICU also has a positive economic impact. These economic savings include direct costs such as formula and physician, clinic, hospital, laboratory and procedural fees. In addition, the savings would include the indirect costs of time and wages lost by parents attending to a sick child.

As healthcare continues to advance, the reality of human milk potential and benefits has become an expanded highlight impacting many professionals across the healthcare spectrum. This includes facets of clinicians, educators and consultants, as well as supply chain and value analysis teams who must evaluate systems for efficiency, benefits and economic outcomes. While awareness of human milk health impact increases, another broad message of support and action comes from government and insurance carriers. The Affordable Care Act (see “The ABCs of ACA”, page 12) guarantees pregnant women a breastpump option, a clear move in support of utilizing breastmilk to reduce future healthcare impact and improve patient health. This encourages more women to provide valuable human milk nutrition to their infants. Additional expansion and direction is sure to come, inspiring clinicians and supply chain teams to fully utilize the health benefits of breastmilk for all infants in their healthcare systems. The question is, will your facility be prepared to take action?

Assess Your Current State Now is the time to evaluate internal clinical human milk collection and delivery systems for versatility, efficiency and productivity. A thorough inventory of all products will deliver insight into a facility’s capability to take on the everevolving breastmilk initiatives currently being encouraged throughout the healthcare industry. Implementing a full solution set now is key. Those with a well-defined process, staff education and products in place to support the human milk continuum for best continued ❱ 5

outcomes

Mothers’ Milk Support System Educate (Staff & Family)

upcoming initiatives: Educate, Pump, Collect and Store, Transport, Diagnose, Prepare, and finally, Feed. Feed

Pump

Prepare

Collect & Store

Diagnose

patient outcomes will benefit from their preparation efforts now and into the future.

The Complete Solution: Your Human Milk Partner Facilities looking to stay ahead of the curve and offer human milk collection, storage and delivery solutions need an action plan and strong product foundation to support the human milk

1 2

Transport

continuum. Medela is here to help you achieve your human milk goals with versatile products and education opportunities for clinical professionals. Medela’s Mother’s Milk Support System was created to offer facilities the tools and products necessary for a complete range of human milk collection and feeding options. This integrated solution set is composed of seven human milk components designed to assist healthcare facilities meet current and

Medela starts the Mother’s Milk Support System with education because it is the basis for understanding human milk production, benefits, and best clinical practices, including industry standards and new developments. From there the system cycles through the full product spectrum of breastmilk pumping, collection, storage, and all the way to feeding. Medela has been helping clinicians with patient breastfeeding and milk delivery needs for over 40 years with quality breastpumps, kits and accessories. Now, due to the recent acquisition of Acacia Neonatal enteral feeding products, the Mother’s Milk Support System feeding Solution Set allows infants in neonatal intensive care to receive much-needed human milk with a complete Medela enteral feeding system. This includes syringes, feeding tubes, extension sets, and milk warmer, as well as the Medela Enteral Feeding Pump. The Mother’s Milk Support System is a full human milk solution set designed for optimal human 1547874 B 0814 milk practices across patient care units. Learn more here: http://www. medelabreastfeedingus.com/ for-professionals

*Schanler, R.J., et.al.;”Feeding Strategies for Premature Infants: Beneficial Outcomes of Feeding Fortified Human Milk Versus Preterm Formula.” Pediatrics. Vol. 103, No.6 June 1999. Patel AL, Johnson TJ, Engstrom JL, et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol. Jan 31 2013.

practically speaking

The Top 3 Breastfeeding Issues for New Moms… ...and What Clinicians can do to Overcome Them Getting on the Same Page and Yoda: “I see a lot of confusion.” That quote from pediatrician and breastfeeding medicine specialist, Jenny Thomas, M.D., effectively captures the experience of many new breastfeeding mothers – and also the clinicians who care for them. Dr. Thomas is the award-winning writer of “Dr. Jen’s Guide to Breastfeeding” and one of only a few physicians internationally to be recognized as a Fellow of the Academy of Breastfeeding Medicine (FABM) for her expertise in breastfeeding. Dr. Thomas also is a frequent presenter on Medela’s clinical education team, so she has many opportunities to talk with healthcare providers all across the United States about their roles and experiences on the frontlines of breastfeeding. Human Milk Magazine recently sat down with Dr. Thomas to talk about the top three breastfeeding issues that she sees with new mothers and then offers three things clinicians can do to overcome those issues.

practically speaking

Issue No. 1: What is ‘Normal’

“The first issue of concern for moms definitely is knowing what is ‘normal,’ in terms of infant behavior and specifically infant feeding behavior,” stated Dr. Thomas. “We need to do a better job educating moms about this.” Dr. Thomas noted the policy statement from the American Academy of Pediatrics, which states that new babies should go to breast eight to 12 times in a 24-hour period. “That is what a new mom is encouraged to do. But what happens is that people start doing math, so it becomes, ‘Feed your baby every two-to-three hours,’ and that just isn’t correct or natural.” What is natural, said Dr. Thomas, is responding to the innate feeding cues from a hungry baby, such as smacking lips, rooting and squirming. Other normal infant behaviors: • A new baby may cluster feed. Or perhaps not. Both feeding patterns are completely normal. • Babies are very likely to be up at night. Dr. Thomas pointed to a hypothesis that it is a mammalian safety response to stay up at night and be alert, when predators would typically hunt. • Babies have a constant drive to be at the breast and be held. “This isn’t just about feeding. This is about safety. It’s immunity. It is comfort,” said Dr. Thomas. She also noted it is critical for babies to be touched to set up important brain pathways. Moms may have an expectation their babies will want to be put down in a separate place. But this is not the case.

Physical touch is critical to newborn’s brain development.

practically speaking

Issue No. 2: Mixed Messages “Sifting through mixed messages is a major complaint,” stated Dr. Thomas. “Moms want a consistent message.” Unfortunately, many moms receive widely disparate advice from family, friends and even within their community of healthcare professionals. “A mom may get advice from a prenatal breastfeeding class. Then, she’s in the hospital post-delivery and opinions can vary from shift to shift and clinician to clinician. Then she is discharged and goes into the community and gets other advice.” This includes contradictory counsel on the quality of a latch, pain during nursing, duration of breastfeeding sessions and more. The result, said Dr. Thomas, is a fragmented experience and an unsure, stressed new mother. “It is confidence-rotting for a mom.”

According to Dr. Thomas, one of the early mixed messages moms receive is around newborn weight loss. The threshold in most hospitals is a weight loss of 10 percent of the infant’s birth weight. At 10 percent, it’s often the practice to supplement. “So you have a mom who comes in expecting to breastfeed. But then her baby’s weight drops and supplementing is recommended by the clinicians, simply because of the number,” cited Dr. Thomas. Recent research demonstrates that much of this weight loss is tied to the IV fluids that mothers receive during delivery. “Moms get a tremendous amount of fluid, and their babies are then physiologically getting rid of that extra fluid,” underscored Dr. Thomas. “Don’t rush to supplement. When in doubt, take a look at the baby. Does she look well? A number should

not be the reason to override a mom’s choice to breastfeed.”

Issue No. 3: Believing in Yourself “This is the saddest part of all for me,” sighed Dr. Thomas when discussing moms’ self-confidence when breastfeeding. “We seem to have turned over a lot of the parts of birth and motherhood to medicine and the ‘experts.’ I want moms to reclaim that power. This is her journey. We clinicians are here to help.” Dr. Thomas noted that the role of the clinician should be to ensure mom has a healthy baby and feels empowered as a mother. “We shouldn’t tell her what is right or wrong, but instead educate her about what she can expect and help her to trust her own instincts,” said Thomas. Instead, mothers are plagued with insecurity. As soon as something feels or happens different from what she was told, “moms immediately then think, ‘There is something wrong with me.’”

85%

moms plan to exclusively breastfeed 3+ months 1

“I tell my moms that breastfeeding is like ‘Star Wars™,’” laughed Dr. Thomas, quoting Yoda, “ ‘Do or do not. There is no try.’ ” As an example, she highlighted perceived insufficient milk supply, which is the top reason women stop breastfeeding. A newborn breastfed infant will take in about 1 ounce or 30 cc total in the first 24 hours of life. “This is definitely not the experience of mothers who are feeding their infants formula,” said Thomas, noting how mothers also will point to their

only

32%

achieve goal 1

aby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention Perrine, et al. Pediatrics B peds.2011-3633

practically speaking

immediate family and say, “My mother had a low supply of breastmilk. My sister didn’t have enough milk. So I won’t.” She added, “Around day 5, they give up. We need to ask them to look at their babies and revel in what they created. The body that brought that baby into the world can breastfeed. They need to feel empowered to learn their babies and trust themselves.” Following are the top three things clinicians can do to overcome these issues new breastfeeding moms face, according to Dr. Thomas: 1. Educate moms about the range of ‘normal’ infant behaviors. “This includes teaching moms to look for feeding cues. Don’t watch the clock. Watch the baby. Babies will let their mothers know when they are hungry, and in all likelihood…it will be eight to 12 times in a 24-hour

period. Further, create and manage the expectation that newborns will want to be held, and they need to be held…and this is a good, normal and natural behavior.” 2. Get on the same page. “Know your team within the entire healthcare organization and get on the same page. There shouldn’t be different sets of values and instructions from different clinicians attached to the same organization. Find out what curriculum is being taught and work collaboratively with other educators on your team. Then, find out what trustworthy community resources are available and work to close that post-discharge support chasm. Moms need a smooth, connected breastfeeding journey with consistent messaging.” 3. Be a cheerleader. “This is the greatest opportunity we have as clinicians. The literature is clear that

encouragement from healthcare professionals is incredibly important. You don’t have to be an expert yourself. Just say, ‘Good job! Keep it up!’ And then know where the resources are in your community to direct your moms. Give her resources and encouragement.” “I tell my moms that breastfeeding is like ‘Star Wars™,’ ” laughed Dr. Thomas, quoting Yoda, “ ‘Do or do not. There is no try.’ ” If you say, ‘I will try to breastfeed,’ there is an acknowledgement right away that you might fail. Ultimately, new mothers who trust their own instincts and their knowledge of their babies will have the self-confidence to persevere and will have a successful breastfeeding experience.”

Jennifer Rebecca Thomas

MD, MPH, IBCLC, FAAP, FABM

Dr. Jenny Thomas is a pediatrician and breastfeeding medicine specialist in Franklin, Wisconsin. She is now serving on the American Academy of Pediatrics (AAP) Section on Breastfeeding Executive Board after spending several years as the Chief of the Chapter Breastfeeding Coordinators. She also serves on the Executive Board of the Wisconsin Chapter of the AAP, and is a founder and the immediate-past Chairperson of the Wisconsin Breastfeeding Coalition. She is the author of “Dr. Jen’s Guide to Breastfeeding.” She has received awards for teaching, advocacy for children, and innovation with in her practice and community. She is one of only a few physicians internationally to be recognized as a Fellow of the Academy of Breastfeeding Medicine (FABM) for her expertise on breastfeeding. Dr. Thomas’ interests and research have focused on issues related to the use of social media to support breastfeeding mothers.

news you can use

Millennial Moms Millennials, Breastfeeding Technology, and “Finding your tribe”: What you need to know about today’s new mothers According to demographers, Millennials (also known as Gen Y) are those individuals born between the early 1980s and early 2000s – making them the primary childbearing group in the world today. As “digital natives,” they have grown up in a world of technology so it makes sense that these new mothers look to technology to help shape their breastfeeding experience. “New moms will look to create a support system – a family of supporters – to share their journey. And it doesn’t have to be a blood relation,” said pediatrician and breastfeeding medicine specialist Jenny Thomas, M.D. [For more on Dr. Thomas, see p. 10.] In fact, with technology hardwired in their lifestyles, Millennials have taken to the Internet to “find their tribe,” as Dr. Thomas has coined it. Blogs, discussion boards and Facebook abound with communities of mothers who come together to share experiences, ask advice and generally offer support in a way quite different and yet fundamentally similar to the earliest communities of mothers.

However, unlike their predecessors, Millennials turn to the Internet in unprecedented ways. “They come into the office with pages printed off the Internet or displayed on their smart phones, and they want to verify the accuracy,” stated Dr. Thomas, noting how “they get anxious because they saw something on the Internet and it doesn’t jive with their experience.” Millennial Moms require all the same support that moms of every generation have required [see “Top Three Breastfeeding Issues” on page 7], according to Dr. Thomas, as well as some unique support. Dr. Thomas encouraged all clinicians to be prepared with credible online resources for their Millennial patients, including websites like Medela’s (www. medelabreastfeedingus.com). While Millennials are proactive digital highway information-seekers, nothing can replace the power and impact of really solid clinical advice and encouragement.

news you can use

ABC’s of ACA

AWARENESS AND ACQUISITION OF INSURANCE BREASTPUMPS

Research is clear that new moms rely on their clinical providers as a primary and trustworthy information resource. However, a recent Medela study shows that only about 50 percent of new mothers are aware of the breastfeeding benefits covered under the Affordable Care Act (ACA)1. The Affordable Care Act was signed into law in 2010 and went into effect in 2012. There are many parts of the ACA, but one of the most valuable is that ACA requires health plans to cover breastfeeding support and supplies without copay, including breastpumps, accessories and lactation counseling. Here is a quick primer to get you up to speed, so you can continue to offer the best support to your patients:

INSURANCE PUMP

AWARENESS

Aware

55%

Not Aware

36%

• Awareness levels have stabilized

1908480A 1114

• ACA applies to private and commercial insurance carriers. • Most plans require moms to get their pumps from an The breastfeeding provisions of the ACA do not apply to in-network provider. But, 76 percent of plans surveyed Medicaid or WIC. However, breastpumps are available are also flexible if the covered pump isn’t available, letting through WIC and many state Medicaid programs. For moms choose another pump or even reimbursing their ABOUT THEIR INSURANCE PUMP THEIR INSURANCE PUMP information on how to obtain a breastpump through WIC purchase from a retail store1. or Medicaid, contact your state WIC agency. • Sixty percent of plans surveyed allow moms to upgrade Friend/family member 2%of their choice – mom • Insurance companies are still17% shaping their breastpump from their basic option to the pump Hospital Online 9% 7% 1 43% to speak up for coverage policies. Encourage your patients just pays the difference . Direct from pump Doctor’s office manufacturer what they want – it just 19% might make a difference, for them 19% Moms can use their flexible spending and health savings My insurance• company 8% Direct from insura and for many other breastfeeding moms. accounts to cover the cost of breastpumps, pump

HOW MOMS LEARNED

14%

WHERE MOMS ACQUIR

Social media

Don’t know / Hav

upgrades, and other supplies, such as breastshields, ordered bra yet • If your patient or her baby has a medical26% issue, like Childbirth the educator/LC/class 19% 2 pads, and more . need to initiate milk supply or if the infant is in the NICU, Breastpump manufacturer 16% LC/Doctor 26% chances are mom will get the hospital-grade pump website she • Moms should consult with their Flexible Spending Account Other needs. Seventy-seven percent of insurance companies provider with any questions regarding what expenses their surveyed cover themFriend/Family – but most require pre-authorization. o Hospital- 9% plan covers. Member: 43% o Direct from pump manufacturer- 8%

Online 26%

• The majority of plansDoctor’s don’tOffice allow pump pick up until o Direct from insurance- 16% 26% For more information on ACA, flexible spending and health o Instead of “other” rename is Don’t know/Have not Ordered yet- 19% My Insurance 19%early to ask the baby’s delivery or after. But it’sCompany never too o Add LC/Doctor- 2% Social Media 14% savings accounts, and resources to help moms learn more Childbirth Educator/LC/Class 19% and when you insurance company what pump they offer Breastpump Manufacturer website 7% about what is covered by their insurance plans, visit can get it. Other 17% www.breastfeedinginsurance.com. THEIR INSURANCE PUMP • Nearly all plans cover lactationABOUT counseling without a

WHEN MOMS LEARNED

co-pay.

• 88% of Moms learned prenatally

40% Conception/ 1st Trimester

32% 2nd Trimester

16% 3rd Trimester

Medela’s supplier lookup feature on its website allows moms to find an insurance-covered Medela breastpump by simply selecting their insurance provider and location. Medela launched the supplier lookup so that moms have an easy way to access information on whether 2% 5% will provide 43% them with 10% 15% 12% their insurance a Medela breastpump. For more 14% 1st 2nd 3rd During Within More than Other (haven’t Trimester Trimester Trimester hospitallookup stay tool, 1 week 1 week received or information, or to access the supplier visit: prenatally

prenatally

5% During hospital stay

WHEN MO ACQUIRE

THEIR INSURANCE

• 50% of Moms acq their pump prenat

ordered yet)

http://www.medelabreastfeedingus.com/tips-and-solutions/168/ where-can-i-get-my-pump 1

2 3

MOMS WHO

Took advantage

AN INSURANCE PUMP

Did not take advantage

Medela “FSA Funds” Internal Research, April 2014. “Using a Flexible Spending Account (FSA).” Centers for Disease Control., (n.d.) Web. 18 November 2014. https://www.healthcare.gov/flexible-spending-accounts/ Medela Proprietary Research, September and November 2014

TOOK ADVANTAGE OF

7% After go hom

44% 56%

cover story

Mother’s Journey to Successful Breastfeeding From Hospital to Home™

cover story

Breastfeeding is natural, but at times, less likely to discontinue when they face does not come naturally to mothers a challenge. Clinical drawing of and their breastfeeding journeys breast interior The Breast may sometimes have a rocky start. There is no question BREASTPUMPS that human milk OF INSURANCE Reviewing the human milk path isOF INSURANCE BREASTPUMPS is best for all babies, and even more beneficial for healthcare providers to critical to those born prematurely. The make informed clinical decisions and colostrum they receive in those first to support mothers in achieving their INSURANCE PUMP few hours has beenINSURANCE called “liquid PUMP gold”. breastfeeding goals, both in the hospital Many studies have shown the value of and after they are home with their colostrum as it relates to and impacts babies. 55% Awareoutcomes and length of stay, health 55% Aware nutrition for premature infants. The36% According to the Breastfeeding Report Not Aware 36% Not Aware breastfeeding journey begins inside of Card for 2013, published by the • Awareness levels have stabilized the •breast. It is important remember National Center for Chronic Disease Awareness levels havetostabilized the stages of lactogenesis of the breast Prevention and Health Promotion, the and understand that even though the percentage of US infants who begin in the concentrations of many milk baby is ready, mother’s breasts may still breastfeeding is high at 76.5 percent. constituents. be developing to deliver this important Of those, there are only 16.4 percent Once a woman initiates, she has nutrition to her baby. who are exclusively breastfed at six reached Lactogenesis II. From this months, despite the recommendation In Lactogenesis I, the mammary glands point she is building up her milk supply of the American Academy of Pediatrics ABOUT THEIR INSURANCE PUMP THEIR PUMP experience secretory differentiation for INSURANCE about 30 days. ABOUT THEIR for INSURANCE THEIR INSURANCE PUMPAnd after that, she to exclusively breastfeed the first sixPUMP before the baby is born. Secretory will reach a maintenance period where months of an infant’s life. Friend/family member differentiation represents the stage she can sustain breastfeeding and/or 2% 17% Friend/family member Hospital Online 9% 2% 17% 7% Hospital of pregnancy when the mammary So there is an opportunity extended duration. 43% to assist Online 9% pumping for an Direct from pump 7% Doctor’s office 43% Direct from pump manufacturer 19% Doctor’s office epithelial cells differentiate into19% these mothers in the periods where My insurance company manufacturer 19% The8%Body 19% Direct from insurance My insurance company lactocytes with the capacity to the decline occurs. In addition to the 8% Social media Direct from insurance 14% Don’t know / Have not Each mom and baby breastfeeding media synthesize unique milk constituents 26% 14% breastfeeding support providedSocial byChildbirth educator/LC/class Don’t know /yet Have not ordered 26% 19% journey is different. Childbirth educator/LC/class ordered yetSome mothers have Breastpump manufacturer such as lactose. Secretory activation, 16% LC/Doctor lactation 19%consultants, 26% Labor & Delivery Breastpump website manufacturer 16% no difficultyLC/Doctor initiating breastfeeding. 26% the second stage of Lactogenesis, is and NICU staff, there are a number of website Other They are breastfeeding every two to Other valuable technologies available to assist the initiation of copious milk secretion three hours and between days two and o Hospital- 9% Friend/Family Member: and is associated with major changes mothers with initiation43% and building up o Direct Online 26% o Hospital9%from pump manufacturer- 8%

AWARENESSAND ANDACQUISITION ACQUISITION AWARENESS

AWARENESS AWARENESS

HOW MOMS LEARNED HOW MOMS LEARNED

Friend/Family Member: 43% Office 26%that they Online 26% milkDoctor’s production so My Office Insurance Company 19% Doctor’s 26% Social Media 14% My Insurance Company 19% Educator/LC/Class 19% SocialChildbirth Media 14% Breastpump Manufacturer Childbirth Educator/LC/Class 19%website 7% Other Manufacturer 17% Breastpump website 7% Other 17% ABOUT THEIR

might be

WHEN MOMS LEARNED WHEN MOMS LEARNED INSURANCE PUMP ABOUT THEIR INSURANCE PUMP

• 88% of Moms learned prenatally • 88% of Moms learned prenatally

WHERE MOMS ACQUIRED WHERE MOMS ACQUIRED

o o o o

o Direct from insurance16% 8% Direct from pump manufacturero Instead of “other”16% rename is Don’t know/Have not Ordered yet- 19% Direct from insuranceo Add LC/Doctor2% is Don’t know/Have not Ordered yet- 19% Instead of “other” rename Add LC/Doctor- 2%

40% 32% 16% 5% 7% 40% 16% 3rd 5%During 7% Conception/ 32%2nd After going Conception/ 3rd 1st Trimester 2nd Trimester Trimester During hospital stayAfter going home 1st Trimester Trimester Trimester hospital stay home

2% 5% 43% 10% 15% 12% 14% 2% 1st 5% 2nd 43%3rd 10% 15% 12% 14% (haven’t During Within More than Other 1st 2nd 3rd than (haven’t or Trimester Trimester Trimester During hospital stay Within 1 week More 1 week Other received Trimester Trimester Trimester hospital stay 1 week or yet) prenatally 1 week prenatally received ordered prenatally prenatally ordered yet) 1

WHEN MOMS WHEN MOMS ACQUIRED ACQUIRED THEIR INSURANCE PUMP

THEIR INSURANCE PUMP

• 50% of Moms acquired • 50%their of Moms pumpacquired prenatally their pump prenatally 1

1908480A 1114

Medela proprietary research. September and November 2014

MOMS WHO

44%

cover story

seven and lactation has been wellestablished. There are others who have difficulty with latch or other breastfeeding issues or who have had a C-section birth. They are breastfeeding less than six to eight times per day and may need some additional assistance through the use of a breastpump until they have established lactation. There are still others, usually mothers of preterm or critically ill infants, that are separated from their babies and completely dependent on a hospital grade breastpump to provide breastmilk for their baby. In the NICU environment one can argue that human milk holds the most value and can be the most difficult to get if the baby was born before the mother’s mammary glands have gone through the two phases of lactogenesis to prepare for breastfeeding.

Medela Initiation Technology Those mothers who are experiencing difficulty or are pump dependent due to separation from baby are often given a Symphony® hospital grade breastpump for use to help initiate supply. Supplementing feeding at breast with Preemie+™ Initiation Technology can help these moms to increase their breastmilk production during this critical time. The Medela Initiation Technology in Preemie+™ is a unique combination of pumping patterns that mimics the natural nursing pattern of a healthy term infant at initiation and in the first few days following birth.

The Importance of 2-Phase Expression® Technology It goes without saying that Medela Initiation Technology should be used to

initiate milk supply, but Medela 2-Phase technology should be utilized thereafter to provide a foundation for the build and maintain periods where mom is pumping at work or to maintain an active lifestyle. First, a fast pumping rhythm stimulates the milk ejection reflex and starts the milk flow. This phase is called The Stimulation Phase. Then a slower pumping rhythm follows to express milk gently and efficiently. This phase is called The Expression Phase. High frequency patterns used in 2-Phase Expression have been rated by mothers as feeling most like a baby (minimum 100 cycles per minute/similar to a baby’s non-nutritive sucking of about 2 sucks per second).

Best Practices in Breastfeeding Support Feeding at breast is the best way for babies to get the customized nutrition that only mother’s milk can provide. When there is a need, pumping with Medela Initiation Technology and 2-Phase Expression can assist mothers in initiation and building milk supply for extended breastfeeding duration. In combination with professional support by healthcare providers, mothers have the tools they can rely on to help them meet their breastfeeding goals.

2-Phase Expression Technology is proven to get more milk in less time (when pumping at Maximum Comfort Vacuum™ in the Expression Phase).

human milk monthly webinars Education to Support Breastfeeding Success

The Medela Education Team is now offering a webinar series: Human Milk Monthly. You can sign up to get the latest in breastfeeding research and clinical information in a convenient and timely manner. Human Milk Monthly Live Webinars will cover a variety of topics relevant from NICU to well-baby.

For more information visit www medelaeducation com

nicu perspectives

NICU Perspectives Professional Perceptions and Team Communications | This month: Clinician and patient parent connections | Neonatal intensive care nurses, educators and other specialists hold demanding positions requiring versatility, knowledge and snap decision-making skills. The expectations for their capabilities are high. Added to these skills and talents is the necessary finesse of interacting and communicating with others intimately involved in patient care: patient parents.

Three Key Things Russell, et al., 2014, found three specific areas of parental concern in the NICU. Their study included parents of infants born less than thirty-two weeks gestation. This is what they found: 1. Parent’s Involvement: Interaction, Expression and Access Parents clearly expressed interest in being involved with simple tasks, such as infant diaper changes and uncomplicated washing. If they were not asked to be included, they often felt left out and more helpless than ever, which contributed to a breakdown between the clinician-parent relationship. 2. Staff Competency and Efﬁciency: Communication, Experience and Conﬁdence, and Information and Explanation Communication was stated as a major factor determining a positive or negative NICU experience. Clinicians may be highly skilled and talented, yet a failure in communication with parents can ultimately lead to a decline in parents’ confidence with staff. In line with communication, parents associated a clinician’s confidence with their competence.

3. Interpersonal Relationships With Staff Sensitive and emotional support cements a successful relationship between NICU staff and parents. Staff empathy came up as a high-ranking factor for parental experience in the NICU. This would include emotional support, reassurance and making a parent feel as an individual. When in the grip of anxiety for a loved one, a direct and compassionate communication from a clinical professional can ease fears and allow a parent to feel recognized. These three findings which influence neonatal care satisfaction can help clinicians understand what parents are looking for in the NICU. Parents of babies in the NICU are frightened, worried and confused. Not all interactions will go smoothly; emotions run high and fear for the life of a loved one overtakes most rational thought in situations such as this. NICU nurses and educators are the lifeline of communication, education and support. Your position as a trusted advisor, professional, caretaker and friend can make an enormous difference not only to the babies you care for, but for their families as well.

Russell, et al. Parents’ views on care of their very premature babies in neonatal care units: a qualitative study. Published online September 13, 2014. http://www.ncbi.nlm. nih.gov/pmc/articles/PMC4190336/

community support/outreach

Mother’s Milk Bank Walk Breastmilk is the best nutrition for all babies and critically important for premature infants. Mothers’ milk significantly decreases the odds of life-threatening complications and infections in premature infants during the first months of life.1, 2, 3, 4 Mothers’ own milk is ideal, but sometimes she may not

be able to provide any or all of the milk needed. That is when human milk donations from incredibly giving moms are needed most. On a September 6th, 2014 Medela participated in the 2014 Race to Save Tiny Lives in Long Grove, IL. The proceeds benefited the Mothers’ Milk Bank of the Western Great Lakes, Inc. They currently operate an extensive collection depot network throughout Wisconsin and Illinois, one of the largest networks in the country5. Funds raised will go towards building a local processing facility to pasteurize breastmilk. Currently, donations for the Western Great Lakes are sent to Indiana for pasteurization and then local hospitals ship it back to provide to the region’s most vulnerable infants5. Medela was proud to be a part of the Race to Save Tiny Lives, bringing more human milk to more babies. To learn more about breastmilk banks please visit the Human Milk Banking Association of North America website www.hmbana.org or visit the Mothers’ Milk Bank of the Western Great Lakes website at www.milkbankwgl.org.

awrence RM. Host-resistance factors and immunologic significance of human milk. In: Lawrence RA, Lawrence RM, eds. Breastfeeding: a guide for the medical profession. 7th ed. Maryland Heights, L Missouri: Elsevier Mosby; 2011. Hurley WL, Theil PK. Perspectives on immunoglobulins in colostrum and milk. Nutrients. Apr 2011;3(4):442-474. 3 Labeta MO, Vidal K, Nores JE, et al. Innate recognition of bacteria in human milk is mediated by a milk-derived highly expressed pattern recognition receptor, soluble CD14. J Exp Med. May 15 2000;191(10):1807-1812. 4 Bode L. Human milk oligosaccharides: every baby needs a sugar mama. Glycobiology. Sep 2012;22(9):1147-1162. 5 http://milkbankwgl.org/volunteer/investinourfuture/ 1

community support/outreach

Medela Recycles to Benefit Breastfeeding Mothers Medela is committed to helping breastfeeding mothers meet their breastfeeding goals with quality, personal-use pumps, kits, and accessories. But what happens when mom has finished using her personal pump? Where should it go? Clearly the backyard recycle bin can’t deliver it to a proper disposal, not to mention, how does one part with something carrying such significant personal meaning? Now an inspiring solution is here. Medela has partnered with Ronald McDonald House Charities® (RMHC®) to donate new hospital-grade breastpumps to Ronald McDonald Houses in the U.S. based on an exciting and creative recycling program. This program, “Medela Recycles” is focused on recycling used breastpumps from participating moms. All pumps recycled through the Medela Recycles program will go toward a donation of hospital-grade Medela Symphony® Preemie+™ Breastpumps and breastfeeding supplies to Ronald McDonald Houses. Mothers no longer needing their personal use pumps can easily participate in this opportunity by going online to www.medela.com and reading the “Introducing Medela Recycles” page. From there, they can request a shipping label for their used pump, along with shipping instructions. In addition to providing moms a dedicated resource for pump disposal and recycling, this program also allows them to make a difference in the life of another breastfeeding mom who will share those benefits with her hospitalized infant. With nearly 40% of the families served by RMHC caring for babies in the NICU, Medela worked with RMHC to support those mothers who choose to breastfeed their babies. In an effort to provide greater ease and comfort to RMHC families, while reducing the stress of having a baby in the NICU, Medela will provide moms with the same high-quality equipment they use at the hospital for their stay at a Ronald McDonald House.

As of 12/19/14

community support/outreach

Supporting Prematurity Awareness Month November is Prematurity Awareness Month and Medela supported the cause with a Facebook event. Having a premature baby can be overwhelming; each day brings new challenges and successes. To encourage and inspire others, we asked moms to share their preemie story. Many were touched by the 119 stories that were shared. The campaign grew to over 3,000 Facebook likes, spreading awareness of prematurity.

Moms Inspiring Moms, Medela Giving Back For many parents who have had a premature baby, a local Ronald McDonald House® is home while their little one is hospitalized. For every story shared, a $5 donation was made to Ronald McDonald House Charities® (RMHC®). Ten stories were chosen and a $500 donation was made in the mom’s name to RMHC. Many moms shared what hospital helped them in their preemie journey.

Three hospitals mentioned were randomly chosen to receive a Symphony® Breastpump with Preemie+™ technology and a one year membership to Hand to Hold resource library. To learn more about Ronald McDonald House Charities, please visit www.rmhc.org. If you would like to learn more about Hand to Hold please visit www.handtohold.org.

Ashley T. —Lee’s Summit, MO Cassie S. —Front Royal, VA Annie B. —Ava, MO

Jennie K. —Hermitage, PA

Amy L. —Peru, NY Vanessa N. —Cooperstown, PA

Cathryn B. —Alexandria, VA Donated breastmilk in memory of her daughter Lily

Medela Sponsor of MIT Hackathon On Sept 20-21, 2014, 150 parents, engineers, designers and healthcare providers gathered at the Massachusetts Institute of Technology (MIT) Media Lab for the “Make the Breastpump Not Suck” Hackathon. MIT describes a hackathon as “a high-energy, collaborative event that seeks to bring together a diverse group of people to explore key issues and challenges in a particular field.” As an innovative company, Medela strives to continuously expand our knowledge of current trends and mom needs. From breastpump innovations to improved nursing apparel, the hackathon was brimming with inspiring ideas. Medela was honored to be a part of this event and sponsored the second place prize. For more information about the hackathon and to see a list of winners, please visit http://breastpump.media.mit.edu/. The make the breast pump not suck hackathon .” MIT Media Lab. Massachusetts Institute of Technology , 20 September 2014. Web. 11 November 2014. http://breastpump.media.mit.edu/.

Ronald McDonald House Charities is a trademark of McDonalds Corporation

Medela, Inc., 1101 Corporate Drive, McHenry, IL 60050 Phone: (800) 435-8316 or (815) 363-1166 Fax: (800) 995-7867 Email: customer.service@medela.com www.medela.com Medela, Every Drop Counts, Symphony, 2-Phase Expression are registered trademarks of Medela Holding AG. Preemie+, Maximum Comfort Vacuum, From Hospital to Home are trademarks of Medela, Inc. Star Wars is a trademark of Lucasfilm, Ltd. Ronald McDonald House Charities, RMHC, Ronald McDonald House, Ronald McDonald Family Room, and Ronald McDonald Care Mobile are all registered trademarks of McDonaldâ&#x20AC;&#x2122;s Corporation or its affiliates and are used with permission. 1548046A 0115 ÂŠ 2015 Medela, Inc.