D4 2 informed decision making learning how to have meaningful infant feeding conversations

Informed Decision Making: Supporting all Families Presenters: Catharine Lowes Doris Balcarras

Declaration

Presenter Disclosure

Presenters: Doris Balcarras, Catharine Lowes Relationships to commercial interests: None The BFI Strategy for Ontario has received financial support from the Ministry of Health and Long Term Care This program has received in-kind support from BestStart, the Provincial Council for Maternal Child Health and Michael Garron Hospital in the form of advice, risk management and administrative support.

The BFI Strategy for Ontario does not have any known conflicts of interest

Objectives  Describe and demonstrate the elements of informed decision making (IDM)  Recognize how to use formula responsibly while still protecting, supporting and promoting breastfeeding  Identify resources available to support staff in having IDM conversations with families

What is the average exclusive breastfeeding rate at discharge from hospitals in Ontario? 25% 25% 25% 25% A. 34.7% B. 45.6% C. 53.8%

76 .4 %

53 .8 %

45 .6 %

34 .7 %

D. 76.4%

4

If you are providing direct patient care, how confident are you in having a conversation to help a mother make an informed decision related to infant feeding?

25% 25% 25% 25%

A. Very comfortable B. Somewhat comfortable C. Not comfortable

re su Un

bl e

No t

co

m fo rta

bl om fo rta tc

So m ew ha

Ve ry co m fo rt

ab l

e

e

D. Unsure

5

Breastfeeding Rates – Ontario

Indicator

Hospital BF initiation Exclusive BF at hospital discharge Supplementation at hospital discharge Medically indicated supplementation Adjusted breastfeeding rate

2013-14 2014-15 2015-16 2016-17

78 52.1 26 4.6 56.7

80 51 26 8.4 61.7

82 52.8 24.6 8.5 59.8

83.6 53.8 26.9 10.1 61.1

According to data, the majority of women who use formula start with breastfeeding 6 Source: BORN Ontario

The Frame Work When making an informed decision, a client makes a decision based on:  A clear appreciation and understanding of the facts  Implications and consequences of an action

The Process  It is important to look at infant feeding practices through the lens of best practice and the Baby-Friendly Initiative  Many health care providers voice concern with how to have conversations when formula feeding is requested  Assist and support women to identify and overcome barriers in order to achieve their infant feeding goals

8

Helpful Resources

http://breastfeedingresourcesontario.ca

9

Informed Decision-Making Workshop Resources for health care providers including: • A four hour interactive train-thetrainer workshop • A 30 page printed resource This can be downloaded from Breastfeeding Resources Ontario website. breastfeedingresourcesontario.ca 10

Types of Decision Making PATERNALISTIC

SHARED

INFORMED

Paternalistic Decision Making The HCP makes the decisions

Shared Decision Making A collaborative approach that allows patients and their providers to make health care decisions together. It takes into account the best clinical evidence available, as well as the patient’s preferences and values

Informed Decision Making The client makes a decision based on a clear appreciation and understanding of the facts, implications, and consequences of an action

Informed Decision Making

* Informed choice vs informed decision

* IDM is not solely the responsibility of the mother often there are others that are part of the decision making process

Results of Informed Decision Making  Mother is knowledgeable about infant feeding  Mother is comfortable with her decision  In some cases, mother is able to reconcile the need to act outside her beliefs and values Making an informed decision may impact:

Confidence

Guilt 13

Other Applications A conversations focused on making an informed decision can happen when families are considering:

* Feeding aids – cups, lactation aids, syringe, bottle * Supplement options – EBM, banked milk, informal milk sharing, formula * Pacifiers and nipples * Safe sleep environments that promote breastfeeding 14

Keep the Conversation Mother Centered        

Agree on an agenda Ask open-ended questions Listen actively Reflect back Find out and build on information she knows Show empathy Remain unbiased Present evidence for options Adapted with permission from UNICEF UK (2014) Having meaningful conversations with mothers: A guide to using the Baby- Friendly signature sheets

15

Our Lens In all that we do we strive to:

 Ensure we are supporting, protecting and promoting breastfeeding  Ensure that we do not present all feeding options as being equal  Keep babies as healthy as possible  Use formula responsibly

The Power of Words Avoid:  You should…  You ought…  Why don’t you…  You should have…  Why didn’t you…  You shouldn’t have…  But…..  At least….

(Toronto Public Health, 2015) 17

Factors to Consider

      

Reinforce and revisit information often Frequent, short conversations are helpful HCPs may only have small blocks of time Prenatally, mothers may be focused on delivery Concerns and information needs may change Mothers may need help to identify needed information Be clear on your role and prepared to describe it

18

https://www.youtube.com/watch?v=zXH0HJ0xl6Q&feature=youtu.be 19

DEBRIEF

20

Once a Decision is Made  Assist parents to identify and overcome barriers to their plan  Recognize that the plan may change

 Arrange for support as needed

Summary: Putting It All Together  Ensure that families have the information they need to make an informed decision  Be intentional regarding how you approach these discussions

 Words are powerful  Support families in making the decision that is best for the family and their situation  Reflect often on biases and approach

We Can Change To improve is to change; to be perfect is to change often.

Winston Churchill

Growing a Baby-Friendly Ontario!

Contact Our Team: Project microsite at: www.tehn.ca/bfistrategy

bfistrategy@tehn.ca

Growing a Baby-Friendly Ontario!

Growing a Baby-Friendly Ontario!