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Telelactation by Mind Map: Telelactation

1. Benefits for Baby: •Reduces the risk of diarrhea and chest infections •Reduces the risk of obesity and diabetes •Reduces the risk of sudden infant death syndrome •Reduces the risk of developing allergies

2. Benefits for mom: Health benefits for mom: •Reduces the risk of breast and ovarian cancer •Reduces stress •Prevents postpartum depression •Reduces the risk of obesity

3. Other roles in helping women to successfully breastfeed

3.1. outpatient lactation consultant

3.1.1. Drop in bases or by scheduled visits

3.1.2. determine if there is a payment structure through insurance or MediCal.

3.2. peer support networks such as

3.2.1. breastfeeding support workers (Lay workers, non-licensed)

3.2.2. local support groups Parents with Toddlers Church group of new moms

3.3. Outpatient lacation clinic

3.3.1. Payment option: Under the ACA

3.4. La Leche League

3.5. Pediatrician office

3.5.1. Would need added DRG or ICD 10 code for reimbursement

3.6. OB clinic visits (postpartum check up)

3.6.1. As above

3.7. Family practice clinic

3.7.1. As above

4. Benefits of Breastfeeding

5. Informed Choice: Mother's should be given all of the evidence based information available ensuring that it is not biased. this information should facilitate them to make a decision on how they would like to feed their baby.

6. How do you integrate the telehealth information back to Primary Care Provider (PCP)?

7. Telehealth support

7.1. Video Support

7.1.1. Interactive ability to see and hear Development of protocol for key elements to include in assessment age of baby How often baby eating Duration of feeding Number of wet diapers birth weigh Discharge weight How is mom doing Development of process to escalate concerns

7.1.2. Principles of virtual lactation support Allow mothers and babies to get lactation assistance in their home or from the clinic setting Improve timeliness of referrals Increase capacity of the lactation department / resources Improve satisfaction with lactation Improve continuation of breastfeeding through additional support and guideance

7.2. Voice only Support

7.2.1. Telephone based management of breastfeeding concerns Understand normal: concepts of breastfeeding, maternal and newborn physiology Recognize the potential for normal bias Development of phone triage protocols Be aware of risk factors and red flags that need to be addressed or follow up with provider

7.2.2. Soft touch needed Empathetic Nonjudgemental

7.3. Connection capabilities

7.3.1. Internet access

7.3.2. Mobile device Do patients have access to mobile tablets? Telephone?

7.3.3. Language barriers for both methods (telephone vs. virtual) Determine language needs

8. Business model

8.1. Licensed individual

8.1.1. RN: ARNP, IBCLC

8.1.2. State board regulations for independant practice

8.1.3. Interstate lincensure agreements Compact State agreements?

8.2. Staffing needs

8.2.1. 24/7 for two individuals--need 8.4 FTEs of RNs

8.2.2. Staffing model

9. Content and support

9.1. Standardized approach for common breastfeeding issues: latch and expression techniques

9.1.1. How to effectively attach your baby C - Chin leading towards breast and indent the breast when attached H - Hold them close for oxytocin release to allow the let down reflex of milk I - Have the baby inline with your body - horizontal and tummy to tummy N - Nose to nipple. This is help this baby to open their mouth wide.

9.1.2. How to recognise effective attachment Chin indenting the breast More areola above the baby's mouth than below Nipple is not flattened when the baby comes off the breast Nappy color change to areola by day 2-3. Baby has a large mouthful of breast Baby's cheeks remain rounded during suckling and is sucking rhythmically The baby comes off the breast and finished on their own accord

9.1.3. Expressing Storage Breast milk can be stored in a fridge below 50F. for 3 days. Breast milk can be stored for longer than 8 days if it is frozen.

9.1.4. Hand Expressing Step 1 - Make a 'C' shape with your fingers around the edge of the areola away from the nipple. Step 2 - Gentle press both fingers together, release and repeat Step 3 - When the milk starts to slow, reposition both fingers and express another area around the nipple.

9.2. Knowledge base and awareness of breastfeeding complications and treatment plans

9.2.1. Mastitis Red inflamed area that is sore to touch Hot to warm shower with water running over breasts Effective positioning and attachment Allow the baby to finish the feed at their own accord Avoid using nipple shields Frequent feeding Expressing with breasts are feeling engorged Not wear tight clothing around breasts Occurs due to milk not being sufficiently removed from the breast

9.2.2. Thrush Symptoms Mothers nipple are often red and shiny Pain that lasts long after the feed has finished Baby often has a white tongue Treatment Mother and baby must be treated with anti-fungal medication To prevent reoccurrence - wash clothes on high temperature to kill fungus

9.2.3. Low milk supply Often due to lack of support with breastfeeding and poor positioning and attachment To prevent - ensure good attachment is taught after birth and do not top up the baby with formula unnecessarily.