Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 01.01.2023

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Breastfeeding: Scope of Practice

Policy: WIC regulations require the roles and responsibilities be defined for all staff in the support and promotion of breastfeeding.

Regulations: CFR 246.3e, USDA FNS WIC Breastfeeding Policy and Guidance (July 2016), Colorado WIC Policy

Procedure/Additional Guidance: The core competencies of staff as defined by USDA include: • Recognize own beliefs and attitudes regarding breastfeeding and the impact of those beliefs and attitudes on WIC participant decisions. • Know the benefits of breastfeeding for infants, mothers, families, community and environment, and apply to daily clinic activities. • Self-identify as part of the WIC “Team” that promotes, protects and supports breastfeeding. • Understand how the WIC food packages for the breastfeeding dyad support breastfeeding. • Understand how to assist mothers to overcome common barriers to initiation of, exclusive and continued breastfeeding. • Develop rapport and foster open dialogue to successfully communicate with pregnant women and mothers. • Identify factors that can impact breastfeeding during the prenatal assessment process. • Identify physiological factors that impact breastfeeding. • Understand optimal breastfeeding practices that help mothers initiate and maintain breastfeeding. • Recognize common breastfeeding concerns and protocols for obtaining additional assistance for mothers. • Assist women who are employed or in school with tailored strategies for continuing to breastfeed after returning to work or school. • Apply knowledge of lactation to supporting breastfeeding in varied situations. • Understand the role of clinic and community support for breastfeeding. • Collaborate with other programs/groups that provide breastfeeding education and support in the community.

Staff Training • Staff can receive breastfeeding education to meet the above core competencies by completing the Level II Colorado WIC Breastfeeding Module. • Staff can become WIC Lactation Specialists (WLS) [and/or Designated Breastfeeding Experts (DBE)] by attending a Colorado WIC training specifically designed to equip staff with knowledge to counsel women and infants with nutrition risk factors (NRFs) related to breastfeeding complications (NRFs 602 & 603). • All WIC Directors and High Risk Counselors are required to have advanced lactation training by becoming a WLS (by attending the training and passing the exam within one year of hire), DBE, and/or obtaining advanced lactation credentials (e.g., Certified Lactation Counselors (CLC), Certified Lactation Educators (CLE), International Board Certified Lactation Consultants (IBCLC)). • Educators are invited to participate in WLS trainings and must successfully pass the exam and observations of participant interactions to become WLS and perform initial counseling on high risk breastfeeding complications. • Breastfeeding peer counselors (BFPCs) with at least 12 months of work experience, or per the discretion of the LA BFPC Coordinator, may participate in WLS trainings and must successfully pass the exam and observations of participant interactions to become WLS. • Staff who have advanced lactation credentials are not required, but recommended, to attend the WLS training, regardless of their WIC title. Observations of participant interactions are not required.

The table on the following page defines general roles which staff with various training, education and credentialing can practice.

*Note: WIC agencies with staff who are RN, IBCLCs and who also perform public health nursing positions which require greater technical expertise may have expanded scope of practice beyond that described in this policy.

Colorado WIC Program Policies and Procedures Section 2: Nutrition Services Revised: 01.01.2023

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Breastfeeding Roles in the Colorado WIC Program

Roles

(BF=breastfeeding) Basic Lactation Training WIC Lactation Specialist (WLS) Advanced Lactation Credentials (CLC/CLE/DBE/IBCLC) Clerical staff BFPC Educator

BFPC WLS Educator WLS RD/RN WLS Educator CLC,CLE RD/RN CLC,CLE DBE, IBCLC Provides info on benefits of BF and WIC services X X X X X X X X X Aids in or conducts BF promotion projects in the clinic X X X X X X X X X Creates and sustains a clinic environment supportive of BF X X X X X X X X X Refers clients to community BF resources X X X X X X X X X Conducts BF support groups X X X X X X X X Conducts BF education classes X X X X X X X Refers moms to appropriate staff for pumps and BF aids X X X X

Assesses need and issues appropriate pump and/or BF aids. Instructs on use, milk collection and storage X* X X X X X Contacts participants 24-72 hours after pump issuance and monthly thereafter. X* X X X X X Provides basic BF information through counseling and support calls

X X X X X X X X Assesses and provides counseling on common BF problems (e.g. sore nipples, latch, weaning)

X X X X X X X X Assesses and provides counseling on complex BF problems X X X X X X Provides high risk counseling on BF Complications risk factors (NRFs 602 & 603) X**

X X X X Mentors Educator and BFPC WLS staff

X

X X Serves as agency’s or clinic’s BF coordinator X X X X X Serves as agency’s BFPC program coordinator X X X X Serves as agency’s breastfeeding expert X

*BFPC WLSs can only issue pumps and complete follow-up calls for BFPC clients and must document contacts in the Participant Care Plan.

**When Educator WLSs provide the initial high risk counseling for NRFs 602 & 603, which is required within 24 hours of risk assignment, a high risk follow up appointment should be scheduled with a High Risk Counselor, DBE, or Educator Advanced Lactation Credentials (CLC, CLE, or IBCLC) within two weeks of the risk assignment.