Vulnerable mothers' experiences breastfeeding with an enhanced community lactation support program

Abstract

The Canada Prenatal Nutrition Program (CPNP) provides a variety of health and nutrition supports to vulnerable mothers and strongly promotes breastfeeding but does not have a formal framework for postnatal lactation support. Breastfeeding duration and exclusivity rates in Canada fall well below global recommendations, particularly among socially and economically vulnerable women. We aimed to explore CPNP participant experiences with breastfeeding and with a novel community lactation support program in Toronto, Canada that included access to certified lactation consultants and an electric breast pump, if needed. Four semistructured focus groups and 21 individual interviews (n = 46 women) were conducted between September and December 2017. Data were analysed using inductive thematic analysis. Study participants reported a strong desire to breastfeed but a lack of preparation for breastfeeding‐associated challenges. Three main challenges were identified by study participants: physical (e.g., pain and low milk supply), practical (e.g., cost of breastfeeding support and maternal time pressures), and breastfeeding self‐efficacy (e.g., concern about milk supply and conflicting information). Mothers reported that the free lactation support helped to address breastfeeding challenges. In their view, the key element of success with the new program was the in‐home visit by the lactation consultant, who was highly skilled and provided care in a non‐judgmental manner. They reported this support would have been otherwise unavailable due to cost or travel logistics. This study suggests value in exploring the addition of postnatal lactation support to the well‐established national CPNP as a means to improve breastfeeding duration and exclusivity among vulnerable women.

Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: a prospective cohort study

“…Skilled lactation support in the first two weeks postpartum is known to be critical for the management of breastfeeding difficulties [21,45]. Our qualitative work investigating mothers' experiences with the 5Ps CPNP lactation support program found that the lactation services were highly valued and helped address physical, practical and self-efficacy challenges related to breastfeeding [27]. These findings are encouraging given the 5Ps CPNP's mandate for reducing inequities in service provision for vulnerable women in the perinatal period.…”

“…Canadian guidelines acknowledge the importance of skilled lactation support in the community for new mothers and suggest direct assessment and follow up by skilled lactation professionals [9,37], but private IBCLCs are not covered by provincial health insurance in Ontario and thus are typically only accessible to higherincome women. Free community breastfeeding services are typically offered reactively and are harder to access by vulnerable women [27]. Together, the data from our current study and our qualitative work suggest that a demand exists for skilled breastfeeding support among vulnerable women and that such services can be delivered through a CPNP site.…”

“…All women who registered in the 5Ps CPNP as of August 17, 2017 were eligible for the study with the exception of those who participated in our qualitative study [27]. Potential study participants were identified through the 5Ps CPNP registration list maintained by program staff.…”

“…1). Of these, 14 were ineligible based on prior participation in our qualitative study [27]. Five became ineligible due to pregnancy loss and 5Ps CPNP staff advised that study participation would be inappropriate for three women.…”

“…This includes in-home International Board Certified Lactation Consultant (IBCLC) services and double electric breast pumps. A qualitative study showed that clients highly valued the lactation support and reported that it helped to mitigate a variety of breastfeeding challenges [27].…”