Improved Breastfeeding Outcomes Following an On-site Support Intervention in an Academic Family Medicine Center

Abstract

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.

Common maternal health problems and their correlates in early post-partum mothers

“…In a local qualitative study by Ong et al, 46 participants expressed a need for more guidance for breastfeeding in the home setting. Studies have supported an improvement in breastfeeding ability and duration when staff trained in lactation consultation were available in the primary care clinics 51 , 52 while others acknowledged that besides healthcare professionals, there is a role for home visits, 53 peer support networks 54 or online guidance 55 such as videos for breastfeeding so that mothers could get enough support and help to overcome breastfeeding difficulties after childbirth. NUP has since started providing limited lactation nursing support in our clinics as of late 2022, after the conclusion of the study.…”

Impact of Breastfeeding Support Services on Mothers’ Breastfeeding Experiences When Provided by an MD/IBCLC in the Pediatric Medical Home

“…While nationally there are many dedicated breastfeeding clinics and pediatric practices which employ MD/IBCLCs, there is only limited published literature describing these models. 14,33 There needs to be greater implementation and evaluation to determine feasibility and efficacy of these models in the future.…”

“…13 Several retrospective studies in the past 10 years found that IBCLC breastfeeding support services in primary care settings increased the rates of breastfeeding of any amount and/ or exclusive breastfeeding significantly. [14][15][16][17][18] As mentioned in the US Surgeon General's Call to Action to Support Breastfeeding, IBCLCs are the only health care professionals certified in lactation care, with specific clinical expertise and training in the management of problems with lactation. 5 While there are other educational programs that train lactation counselors and other types of breastfeeding support providers, the International Board of Lactation Consultant Examiners, which certifies IBCLCs, require either a health sciences background or completion of specific health science coursework in addition to the greatest number of hours in lactation-specific education and hands-on training.…”

“…13 Several retrospective studies in the past 10 years found that IBCLC breastfeeding support services in primary care settings increased the rates of breastfeeding of any amount and/or exclusive breastfeeding significantly. 14-18…”