We all know that breastfeeding support in hospitals is important. But we also know that the need for support doesn’t end at hospital discharge. If anything, the show is just beginning.
Much of the current emphasis at reforming breastfeeding policies is directed at hospitals. And for good reason. But since pediatric support can also make or break a breastfeeding experience, it’s critical to focus effort there as well.
Until this month, it hasn’t been clear that what happens when a pediatric practice follows a full set of evidence-based policies. It sounds good, but does it actually change breastfeeding rates?
A landmark study in Pediatrics this month answers the question. It offers the best evidence so far that evidence-based breastfeeding support in a pediatric setting can have a significant effect on breastfeeding rates.
The Academy of Breastfeeding Medicine (ABM) offers a protocol which represents the whole package of practices which support breastfeeding in the pediatric setting. It’s akin to the Ten Steps to Successful Breastfeeding, but for pediatricians and family physicians, but its effect as a whole hadn’t been measured until now. Until this study, as the authors of the study put it, “there were no known studies regarding the effect of a ‘breastfeeding friendly’ protocol in pediatric primary care in the United States.”
So in 2009 a pediatric practice in Virginia undertook a project to measure what would happen if the practice adopted the ABM protocol.
They conducted a retrospective before/after study, measuring breastfeeding and exclusive breastfeeding rates for groups of about 380 mother baby pairs. They implemented the protocol over 10 months, and then measured breastfeeding rates.
The two most significant intervention were 1) the automatic scheduling of each breastfeeding mom and baby with an RN who was also an IBCLC (billed to insurance) at the newborn visit, and 2) the use of an AAP/WHO-approved breastfeeding curriculum for training medical staff.
Other interventions included:
- Adoption of a breastfeeding policy
- Encouragement of exclusive breastfeeding
- Culturally competent care
- Prenatal visits
- Commending breastfeeding (“good job!”)
- Collaboration with local hospital and community
- Schedule newborn visit within 48-72 hours and provide access to a lactation consultant
- Provide educational resources
- Encourage open breastfeeding in the waiting room (and private space if desired by moms)
- Discourage formula marketing
- Telephone support
- Commending breastfeeding (“good job!”)
- Recommending exclusive breastfeeding to six months
- Work site lactation policy for employees
- Establish community resources (weekly moms group, information on other resources)
- Insurance and billing for breastfeeding support
- Assist with workplace support (breastfeeding and working class)
- Formal staff training and IBCLC services available to staff
- Mentor health care providers
- Data tracking
So, what did they find?
Rates for exclusive breastfeeding were higher in the postintervention group at every time point, and the differences in the rates were statistically significant at all 5 time points (hospital, one week, 2 months, 4 months, 6 months). Of particular note, when comparing exclusive breastfeeding rates, the postintervention group rates were at least 10 percentage points higher than those in the preintervention group at all 5 time points.
Exclusive breastfeeding rates even went up in the hospital, likely because this pediatric practice sees their patients in the hospital, too. Rates of “any breastfeeding” were higher at every time point as well, but were only statistically significant at the 1 week time point.
Unfortunately the study did not indicate differences in outcome by race or other demographic variables, due to inconsistent collection of that information. But it did find that mothers who were insured through Medicaid had lower rates of breastfeeding – a difference noted in other research.
There have certainly been other studies which have look at the effects of some of certain pats of this protocol. My favorite of these is the AAP breastfeeding residency curriculum which I discussed with Dr. Lori Feldman-Winter. That curriculum, taught to pediatric residents, has been shown to improve breastfeeding rates. But this study is the first to look at what happens when all of the pieces are in place.
In my view, this study marks a turning point in our understanding of how pediatric support can change breastfeeding rates. It offers the first evidence that doing the right thing works, and we can only hope that pediatric practices will take note.