Background and Objectives: Despite the importance of breastfeeding, most US women do not meet recommendations for length of any or exclusive breastfeeding. Support in primary care settings is recommended (US Preventive Services Task Force, 2016), but optimal implementation strategies are not established. We evaluated the effect on breastfeeding rates of on-site breastfeeding support within an academic family medicine center with a diverse patient population. Methods: We conducted a retrospective chart review 10 months before and 10 months following the implementation of integrated breastfeeding support provided by an International Board Certified Lactation Consultant (IBCLC) or MD-IBCLC. Two hundred eighty-one infants were identified, 140 before implementation and 141 after. A research assistant extracted data from the electronic medical record. We performed bivariate and multiple logistic regression analyses using STATA. Results: There were no significant demographic differences before and after the intervention. The proportion of infants with any breastfeeding at 2, 4, and 6 months was greater in the postimplementation group (71.7% vs 86.7% at 2 months, P=.05; 61.5% vs 77.1% at 4 months, P=.08; and 50.7% vs 64.4%, P=.09 at 6 months). The proportion of infants exclusively breastfed was also greater in the postimplementation group (58.7% vs 77.8% at 2 months, P=.04; 50.5% vs. 54.2% at 4 months, P=.06; and 44.0% vs 49.3% at 6 months, P=.12). Conclusions: Providing on-site IBCLC breastfeeding support services within an academic family medicine clinic is associated with significant increases in breastfeeding, supporting the provision of lactation services on-site where mothers and children receive primary care.

Introduction: New clinical guidelines recommend comprehensive and timely postpartum services across 3 months after birth. Research is needed to characterize correlates of receiving guideline-concordant, quality postpartum care in federally qualified health centers serving marginalized populations. Methods: We abstracted electronic health record data from patients who received prenatal health care at three health centers in North Carolina to characterize quality postpartum care practices and to identify correlates of receiving quality care. We used multivariable log-binomial regression to estimate associations between patient, provider, and health center characteristics and two quality postpartum care outcomes: (1) timely care, defined as an initial assessment within the first 3 weeks and at least one additional visit within the first 3 months postpartum; and (2) comprehensive care, defined as receipt of services addressing family planning, infant feeding, chronic health, mood, and physical recovery across the first 3 months. Results: In a cohort of 253 patients, 60.5% received comprehensive postpartum care and 30.8% received timely care. Several prenatal factors (adequate care use, an engaged patient–provider relationship) and postpartum factors (early appointment scheduling, exclusive breastfeeding, and use of enabling services) were associated with timely postpartum care. The most important correlate of comprehensive services was having more than one postpartum visit during the first 3 months postpartum. Discussion: Identifying best practices for quality postpartum care in the health center setting can inform strategies to reduce health inequities. Future research should engage community stakeholders to define patient-centered measures of quality postpartum care and to identify community-centered ways of delivering this care.

Background and Objectives: The high quality of obstetric care provided by certified nurse midwives (CNMs) has led some to hypothesize that collaboration with CNMs may encourage more family medicine (FM) residents to subsequently practice maternity care. Our goal was to understand the current state of CNM involvement in FM resident education. Methods: We conducted two surveys: one to a random sample of 180 FM program directors, and one to 147 CNMs involved in medical education. The surveys examined the nature, prevalence, and attitudes regarding CNM involvement in FM residency training. Results: The surveys’ response rate was 59% from FM program directors and 58% from CNMs. Thirty-six percent of FM directors reported no CNM involvement in their residency programs, 26% reported minimal interaction, and only 6% reported a fully integrated model with CNMs on faculty. Eighty-eight percent of CNMs and 64% of program directors reported a prefence for increased interaction. Programs with highly involved CNMs reported 33% of graduates subsequently practicing prenatal care, with only 13% of graduates practicing in programs with low CNM involvement (P<.003). However, there was no difference in those providing inpatient maternity care. Thirty-one percent of FM program directors and 25% of CNMs felt that physicians and CNMs have different ideas about how to treat patients; 26% of FM program directors who worked with midwives felt that CNMs should not be involved in residency curriculum planning. Conclusions: CNM participation in FM residency education is very limited. Our study identified a gap between the current state and the preferences of CNMs and FM program directors for greater educational collaboration. Residency program director attitudes may contribute to the low rate of collaboration between the two fields.

In the spring of 2020, Chatham County, North Carolina became a COVID-19 pandemic hotspot and rural epicenter for SARs-CoV-2 infection. During this time seroprevalence among adults was as high as 9%. The objective of this study was to measure the prevalence of SARs-CoV-2 viral infection among pregnant women seeking care at two rural federally qualified health centers primary in NC. METHODS: This was a retrospective cohort study of women and neonates who (1) received prenatal care at the above-mentioned medical clinics between March 2020 and July 2020 and (2) received nasopharyngeal SARs-CoV-2 PCR testing as a part of their prenatal care. Data were collected from outpatient and inpatient records beginning at first prenatal visit until first postpartum visit. Neonatal data were collected from time of birth until first well child visit. Descriptive Statistics are reported. RESULTS: 51 women received prenatal care at the study sites and were tested for SARs-CoV-2. Hospital records are available from 48 deliveries. The median age of pregnant women was 29.8 years. Race/ ethnicity were as follows: Hispanic/Latina (90.0%), non-Hispanic white (2.0%), Black/African American (3.9%) and Asian (3.9%). Thirty-five (68.6%) women were identified as having no insurance, 10 (19.6%) Medicaid or other federal or state supported program, and 5 (9.8%) private insurance.The majority of women (88.2%) were multiparous. The mean gestational age at delivery was 39.8 weeks with one preterm delivery at 34 weeks due to preeclampsia. The majority of women (93%, 45 of 48) had a vaginal delivery.A total of 17 (33%) of 51 women tested positive for SARS-coV-2 virus. Eleven women had positive tests at prenatal testing; 3 tested positive at delivery, and 3 tested positive during the postpartum period. Two out of the three neonates born to mothers who tested SARs-CoV-2 at time of delivery were tested at 24-48 hours of life and neither tested positive. Two of three infants tested after hospital discharge had positive test results prior to the first well child visit. CONCLUSIONS: One-third of this cohort of pregnant women in a rural setting in a COVID pandemic hotspot in NC tested positive for SARs-CoV-2 infection, significantly higher than the population seroprevalence at the time.

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