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Letter of Instruction for Clinical Care Path

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July 3, 2003

Dear Health Care Provider,

I am delighted to share with you a "Clinical Care Path for Breastfeeding" developed in conjunction with the Camden Community Demonstration Project, funded by the Department of Health and Human Services, Office of Women's Health, National Campaign on Breastfeeding. This three-year Campaign will be launched by the Ad Council in 2003 with specific goals of increasing exclusive breastfeeding for the first six months of a baby's life, with a special emphasis on first-time mothers and African American families.

Since the Campaign will encourage more women to consider breastfeeding, the health care community needs to be ready to provide excellent breastfeeding care. This Care Path is designed to help you promote breastfeeding in the prenatal, and postpartum periods, identify concerns that should be flagged for further follow-up, and delineate issues that require additional care, counseling, and/or referral.

These are some suggestions for how to use this Care Path.

Getting Started The first two sides are mainly for maternal health care providers, and the last two sides are mainly for pediatric health care providers. The first page is also helpful for pediatric providers who perform prenatal visits.

How the Care Path is Organized Each page of the care path has three columns of information. The first column includes items that should be asked or performed to provide optimal breastfeeding care. The questions provide examples of open-ended questions. Asking questions in this manner provides an opportunity for discovery, validation and delivery of targeted messages related to mothers' concerns and other issues that affect breastfeeding.

The second column includes items that should be documented in the chart, and specifically addressed. For example, if a mother has had difficulty breastfeeding in the past, this should be addressed, and the previous problems should be noted. Communication with other health care providers about these concerns is recommended.

The last (right-hand) column includes a list of concerns that warrant additional care, another follow-up appointment, or referral to a lactation specialist (indicated by an asterisk). These problems should also be documented and there should be a plan for how this problem will be addressed. In addition, this last column, on the last three pages, includes recommendations for routine follow-up visits, and a reminder that additional problem oriented visits may be scheduled.

It may be most useful to work down each column, as opposed to working horizontally. For prenatal providers, the questions in the left-hand column do not need to be asked all in one visit. Mothers respond better to small pieces of information and guidance throughout the prenatal period. One or two questions can be addressed at each of the prenatal visits.

Thank you for allowing us to provide you with this Care Path and helping to make the national Campaign on breastfeeding the most successful it can be.

Lori Feldman-Winter, MD, FAAP, FABM, IBCLC

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