Written by Jennie Bever Babendure, PhD, IBCLC
In the February issue of Breastfeeding Medicine, Ann M. Witt and her colleagues analyze the impact of integrating lactation consultants into a pediatric practice1. Although providing referral to or in-office lactation services if requested is not a new idea, what makes this study unique is the systematic change made to schedule ALL breastfeeding newborns with a lactation consultant for their first pediatric office visit.
How did this work? At the time of the study, the American Academy of Pediatrics (AAP) policy dictated that all healthy term breastfeeding infants be seen at the pediatric office within 3-5 days of hospital discharge2. In 2009, the study practice changed their policy to routinely schedule these visits with an in-office IBCLC precepted by a physician. IBCLC’s spent 45-60 minutes with the patient, then discussed the history and breastfeeding evaluation with an available physician who spent about 5 minutes in the room evaluating the patient and deciding on a treatment plan. Follow up phone calls and in-person visits were scheduled, as well as a routine visit with the primary physician at 2 weeks of age. More than 45% of patients had multiple visits with a practice IBCLC, and a limited survey indicated high maternal satisfaction with the new policy. IBCLC’s were employed 4 hours a day 5 days a week in the practice to meet the need for these visits and follow up. As the physician evaluated the patient at the 3-5 day visit, it was reimbursed as a general medical visit, which sufficiently covered IBCLC salaries.
How did this impact breastfeeding? In 2007, all infants were seen in the office by 2 weeks of age unless jaundice or weight gain problems were identified in the hospital. The practice employed an RN, IBCLC 3 days a week to provide phone support for breastfeeding problems as well as in-person consultations. When researchers compared infant feeding method in retrospective chart review between 2007 and 2009 patients, they found that non-formula feeding (breastfeeding) went up by 10-15% at all time points from 2-9 months, demonstrating a significant increase in breastfeeding intensity following the intervention.
When I first read this study, I was struck by the brilliant simplicity of this idea. By integrating lactation consultants into the existing medical structure, mothers and babies got automatic breastfeeding help and follow-up, and physicians could follow AAP policy and monitor jaundice and weight gain as well have a large influence on the on-going health of their patients with minimal input of time or cost and no additional formal training. As I continued to think about this study, I realized that this policy has a much broader impact. By making this systematic change to their office policy, they have changed the culture of infant feeding in their practice. Routinely scheduling the first office visit with an IBCLC sends a strong message to patients. It says: “Your physicians know you want to breastfeed, and feel breastfeeding is so important to your child’s health that we will do everything we can to help you through the challenges.”
I can’t help but imagine the impact if all pediatric practices were to adopt this model. Would these actions speak louder than our words? Would they whisper or shout: Breastfeeding is a public health issue3, we’re here to help you make it happen.
1. Witt AM SS, Mason MJ, Flocke SA., Source1 Department of Family Medicine CWRU, Cleveland, Ohio. Integrating routine lactation consultant support into a pediatric practice. Breastfeeding Medicine 2012;7(1):38-42.
2. BREASTFEEDING SO. Breastfeeding and the Use of Human Milk. Pediatrics 2005;115(2):496-506.
3. BREASTFEEDING SO. Breastfeeding and the Use of Human Milk. Pediatrics 2012;129(3):e827-e841.
Jennie Bever Babendure, PhD, IBCLC
I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.
I think this is a brilliant idea, as long as the IBCLC has enough time to spend with each patient. It cannot be cut down to a 15 min visit, as this shortchanges the clients, and they can go home feeling more discouraged if not everything was addressed and a thorough plan made. The IBCLC RN is a specialist , similar to a burn nurse, or an ostomy nurse, or a pain nurse, employed by the hospital as a clinical specialist. Payment for services should not be a huge problem, but this will only become the gold standard when breastfeeding is valued as the gold standard, instead of a “nice thing if you can do it,” with formula being the standard infant feeding method, and breastfeeding being the bonus if it is possible. The insurance model needs to back IBCLCs as an integral part of the health care team, as the health of the breastfeeding mother baby dyad and the success of breastfeeding can depend on early and plentiful contact with the breastfeeding specialist as well as the pediatrician. Kathleen Bruce RN IBCLC