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Using Text Messaging to Support Breastfeeding in WIC

Written by Maryanne Perrin, MBA, Graduate student in Nutrition Science, and ILCA volunteer

Recently, we talked to a private practice IBCLC and several of her clients about using mobile* phone based text messaging to support breastfeeding.  We’re continuing the exploration of this innovative topic by talking to IBCLCs within the Women, Infants and Children (WIC) program about how they use text messaging to help low-income mothers succeed with breastfeeding. (NOTE: WIC provides nutritional support to over 50% of infants born each year in theUnited   States which means that this federally funded program has a unique opportunity to play a significant role in promoting and supporting breastfeeding.)

The American Red Cross WIC office inSan Diego,California and the Shasta County WIC office in Redding,California both recently began using text messaging within their Breastfeeding Peer Counselor (PC) programs. Jennifer Nolan, Peer Counselor Supervisor and IBCLC (American Red Cross), and Sara Stone, Lead Peer Counselor and IBCLC (ShastaCounty), shared their stories with us…

Getting Started

Shasta County WIC PCs

Both WIC offices received federal grant funding which they used to purchase mobile phones for their Peer counselors (PCs).  American Red Cross has 3 people on the peer counseling team and Shasta County has 8.  When a new mother enrolls in the peer counselor service, each office asks the mother about her communication preferences and no one ever initiates text messaging without first receiving the mother’s approval (depending on an individual’s phone plan, they could potentially incur additional expenses for receiving unwanted text messages).

ShastaCounty also had to request a modification to the contacts database so that “text messaging” was an option for tracking contacts. (Note: they only count the text message as a contact if they get a reply from the mother; unreturned texts are not counted.)  Once the database modifications were made, they became available to other California WIC agencies as well, allowing them to track text messaging use.

A lesson learned in Shasta County was the importance of having an effective phone for text messaging.  Initially they got very basic phones for their PCs, but soon upgraded to phones with full keyboards so that the PCs could be efficient in sending texts.

How Text Messaging Is Used

Both Jennifer and Sara stressed that text messaging is never a starting point for building a relationship with a client, but instead a complementary communication method they use after first establishing face-to-face or phone contact. “We get better participation in our program by using a communication mode that is most comfortable for mothers,” says Jennifer.  Sara echoed this sentiment, describing text messaging as a cultural shift that allows WIC PCs to stay better connected with their clients.  Examples of the types of messages exchanged between PC and mother include:

  • Prenatal contacts that involve inviting the mother to classes or scheduling/confirming appointments
  • Sharing tips about baby’s development and checking in during pregnancy to help build rapport
  • Receiving texts from mother while she is in the hospital to learn about baby’s arrival
  • Asking and answering simple breastfeeding questions or scheduling calls to follow-up on more complicated breastfeeding issues
  • Checking in on postpartum status and sending encourage messages

Why Use Text Messaging?

San Diego WIC office

Text messaging is portable (mobile phones are typically with mothers at home, at work, and in the hospital) and also non-invasive (won’t wake a sleeping baby or interrupt someone during an important meeting at work).  One WIC mother, upon receiving a call from her PC, whispered into the phone, “I’m at work, can you please text me?”

Jennifer says that the majority of their clients use text messaging, and she thinks it has the potential to prolong breastfeeding because it keeps mothers engaged and gets them the information they need (a critical mass of WIC data should allow future analysis of this).  ForShastaCounty, “It’s taken off like wildfire,” says Sara.  Text messaging has grown from 7% of their non face-to-face contacts (phone, email or text) in July 2011, to almost 25% as of February 2012.  Sara’s words of advice to other WIC agencies – “Just jump in and do it!”

Are you using text messaging or alternative technologies in creative ways to promote and support breastfeeding within WIC or other settings (e.g. third-world countries)?  If so, we’d love to hear your story!

* Other terms used around the world including cell phone, cellular phone, and hand phone.

By Maryanne Perrin

MBA, Graduate student in Nutrition Science, and ILCA volunteer

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Supporting Breastfeeding with New Technologies

A few months ago a story out of Australia caught my attention.  A research study conducted at Queensland University of Technology showed that new mothers who received cell-phone based text-messaging support (also referred to as SMS, which stands for Short Message Service) were four times less likely to stop breastfeeding than those who did not.  This collision of technology with nature’s perfect infant nutrition piqued my interest and I wanted to learn more (self disclosure – I’m a bit of a technophile).  While details of the study have not yet been published, I was able to talk with an IBCLC who uses SMS, as well as hear the perspectives of several nursing mothers.  This post is intended to share this story and also generate a conversation about what other practitioners have experienced using text-messaging to support breastfeeding moms.  Please join in the discussion!

An IBCLC’s Perspective

Robin Kaplan, IBCLC and founder of San Diego Breastfeeding Center, LLC, offers mothers the option to communicate with her via SMS after she conducts an initial in-home consultation.  She estimates that about 25% of her follow-up communication is through text-messaging, with some clients using it for 100% of their contacts.  The nature of Robin’s texts are primarily responding to questions from new mothers (moms can include a photo with the question to help in diagnosing some problems), as well as checking in with mothers to see how they are doing.  One of the benefits of text messaging is that it isn’t interruptive, like a phone call may be, and it can be managed from a time perspective (versus not knowing how long a phone call might last).  This seems to be important for new mothers, as Robin gets more responses from texting than she does from phone calls.  Texting is also conducive to the round-the-clock hours that nursing mothers keep.  “They can leave me information any time they want,” says Robin.  From a business perspective, she sees texting as time and cost-effective.  “It makes a lot of sense!”

Mothers’ Perspectives

“When you have a sleeping baby, or you’re just too tired to get into a long conversation, texting is so convenient,” said texting mother, Tracy.  “Robin was able to get straight to the point and offer quick responses to my questions, which were very helpful… Though some might think it’s impersonal, texting is still a conversation and a readily available one at that, I really appreciated the instant gratification.”

Adoptive mother, Danielle, said text-messaging support was a huge help in establishing her breastfeeding practice.  “The reason texting worked for me is that my consultant, Robin, was always quick to reply…  This [breastfeeding an adopted infant] is a new frontier and being able to text when your baby is asleep in your arms is so helpful…  For me, texting as opposed to verbalizing sometimes kept me a bit calmer. I always know I can call if I need to. The ability to have both options, however, was great.”

According to Erin, “Because newborns require so much attention around the clock, texting was the easiest form of communicating with Robin.  It allowed me to send her a quick message, an update or ask a question without regard to the hour or any of the long winded social niceties that a telephone conversation would require. By the same token, Robin was able to check in on my progress, offer much needed practical advice and soothe my worries with most welcome words of support.”

On the Bleeding Edge

How does text-messaging fit into healthcare privacy laws that might impact lactation consulting care?  This will vary country by country, and many governments are still trying to figure this out.  Robin said she is moving towards printing and then deleting text messaging conversations and adding them to patient records.  She deletes photos immediately.  Having a password lock on your phone is another measure of security.  It’s always important to get a mother’s consent before you begin sending text messages.

What has your experience been with adding text-messaging support to your lactation practice?  We’d love to hear your stories!

By Maryanne Perrin MBA, graduate student in Nutrition Science, and ILCA volunteer

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