BREASTFEEDING PROMOTION & SUPPORT WPPM #620-20 Subject: Lactation Support Equipment Item: Breast Pumps: Issuance, Documentation, & Follow-Up/Support PURPOSE: To provide information on the issuance, documentation and follow-up of breast pumps. POLICY: I. Manual and electric breast pumps may be issued to participants who wish to breastfeed and need help establishing or maintaining their milk supply or are in situations where local agency (LA) staff deem a breast pump is necessary. PROCEDURE(S): I. Breast Pump Issuance A. Breast pumps must not be issued to participants prenatally, as an incentive item nor as reward for breastfeeding. B. Trained LA staff must complete a breastfeeding assessment for pump requests to determine the following: 1. That a pump is necessary for the participant. 2. That the participant meets prioritization criteria for a pump, according to availability. C. When it is determined that a breast pump is necessary for a breastfeeding participant, trained LA staff must: 1. Demonstrate pump assembly and use of the pump and milk collection kit. 2. Provide instructions for keeping the pump clean. 3. Assess the understanding of the participant by having the participant: a. Verbally explain and/or demonstrate how to assemble, use, and clean the pump and milk collection kit. b. Explain proper milk storage guidelines. c. Describe how to establish and/or maintain milk supply. d. Describe when to seek help and who to contact if questions arise. 4. Provide information on hand expression as another option to effectively express milk for a later feeding. 5. Observe participant expressing breast milk with the electric pump onsite when needed. 6. Not issue a single-user electric pump and multi-user electric breast pump to a participant at the same time. The multi-user electric pump must be returned to California WIC Policy and Procedure Manual Page 1 of 4

March 27, 2019

BREASTFEEDING PROMOTION & SUPPORT WPPM #620-20 Subject: Lactation Support Equipment Item: Breast Pumps: Issuance, Documentation, & Follow-Up/Support California WIC Policy and Procedure Manual Page 2 of 4

March 27, 2019 the site before a single-user electric pump may be issued. A single-user electric pump may be issued the same day a multi-user electric pump is returned, if it is determined the participant needs the pump to maintain the milk supply. 7. Issue another breast pump to the participant at the discretion of the LA Breastfeeding Coordinator, Clinic Supervisor, or other designated staff in instances when a participant has failed to return a previously issued multi- user breast pump. D. Requests for formula 1. If after receiving a multi-user or single-user breast pump the participant requests formula, a trained LA staff will discuss the effects of formula supplementation on milk supply and possible ways to avoid supplementation, prior to issuance of formula. II. Criteria for Pump Issuance A. Multi-User Electric Breast Pumps 1. LA staff may issue multi-user electric breast pumps to participants who wish to breastfeed and need help establishing their milk supply or in situations where LA staff assess that a multi-user electric breast pump is necessary. Multi-user electric breast pumps may be available to participants: a. Who have infants with special needs. b. Who must be separated from their infant due to hospitalization. c. Who choose to pump milk and feed infant breast milk exclusively, but not at the breast. d. As determined by trained staff. B. Single-User Electric Breast Pumps 1. Single-User Electric Breast Pumps may be issued to participants who wish to breastfeed and need help maintaining their milk supply or in situations where staff determine a single-user electric pump is necessary. Once milk supply has been established, single-user electric breast pumps may be issued to: a. Participants who are separated from their infants, such as when returning to work or school. b. Participants who are having difficulty breastfeeding due to illness. c. Participants with multiples who have an established milk supply. d. Participants who choose to pump milk and feed infant separately.

BREASTFEEDING PROMOTION & SUPPORT WPPM #620-20 Subject: Lactation Support Equipment Item: Breast Pumps: Issuance, Documentation, & Follow-Up/Support California WIC Policy and Procedure Manual Page 3 of 4

March 27, 2019 e. As determined by trained staff. C. Manual Breast Pumps 1. Manual breast pumps may be issued to participants who wish to breastfeed and need help maintaining their milk supply or in situations where staff determine a single-user manual pump is necessary. Manual breast pumps may be issued due to: a. Short-term breastfeeding issues. b. Infrequent separation from baby. c. Other reasons as determined by trained staff. III. Loan Agreement for Multi-User Pumps A. LA staff must require participants to sign a loan agreement prior to issuing a multi-user electric pump. The loan agreement should include sufficient information to attempt to recover the breast pump. The loan agreement must outline the responsibility of the participant to: 1. Provide the name and contact information of a secondary contact. 2. Notify the LA immediately if there is a change to their name, address, telephone number and the co-signer, if applicable. 3. Use the electric breast pump and milk collection kit according to instructions for assembly, use, and cleaning. 4. Keep the electric breast pump in their possession. 5. Return the electric breast pump in clean condition by the due date, or earlier, if requested, or immediately under any of the following circumstances: a. The pump becomes damaged or ineffective. b. The participant is no longer using the pump. c. The participant is no longer receiving WIC services. d. The participant has transferred to another agency or out of state. Sample breast pump loan agreements can be found in the Appendix of the Breast Pump Procurement and Inventory Guide. IV. Documentation A. LA staff must document multi-user and single-user electric breast pump issuance in the WIC Management Information System (MIS), in “Family Comments”. Documentation includes the following: 1. Pump model.

BREASTFEEDING PROMOTION & SUPPORT WPPM #620-20 Subject: Lactation Support Equipment Item: Breast Pumps: Issuance, Documentation, & Follow-Up/Support California WIC Policy and Procedure Manual Page 4 of 4

March 27, 2019 2. Pump identification number (serial number or other number the LA designates for the pump) needed for issuance of multi-user pumps only. 3. Reason for issuance. 4. Place a Breast Pump hold in WIC MIS for multi-user electric breast pumps only. B. LA staff must document all subsequent breast pump follow-up contacts according to LA protocol. V. Follow-Up and Support A. LA staff must contact participants who have received a multi-user electric breast pump or a single-user electric breast pump for follow-up within three business days of pump issuance. The follow-up contact includes: 1. The participant’s need for breastfeeding support. 2. Referrals to local support services, if needed. 3. Documentation, according to LA protocol. B. LA staff must provide regular follow-up contacts to participants who were loaned a multi-user electric pump. These contacts must be documented according to LA protocol, and must occur at least monthly to: 1. Evaluate the continued need for a multi-user electric pump. 2. Provide breastfeeding support. 3. Track the multi-user electric pump. AUTHORITY: 7 CFR §246.11(c) (7)(iii) and (iv) 7 CFR §246.14(b)(1)(iii) WIC Nutrition Services Standards 8 USDA - WIC Breastfeeding Policy and Guidance July 2016 CROSS REFERENCE: CDPH/WIC Breast Pump Procurement and Inventory Guide