The Use of a Medical Center-Based Outpatient Breastfeeding Support Program with Telelactation to Provide Ongoing Breastfeeding Support to a Diverse Patient Population

Perspective: Supporting Maternal Efforts to Provide Optimal Infant Nutrition in the Post-Partum Setting

Supporting optimal newborn nutrition and the positive maternal-infant relationship while encouraging safe sleep practices are essential components of maternal and newborn care in the hospital setting following birth. Breastfeeding is widely recognized as the best practice to support the nutritional needs and well-being of the infant, and recommendations have been developed by the WHO, the American Academy of Pediatrics (AAP), and the United States Centers for Disease Control to encourage and successfully support breastfeeding efforts before hospital discharge. The 10 Steps to Successful Breastfeeding, developed and promoted by the WHO, form the basis of the Baby-Friendly Hospital Initiative (BFHI) and have become the international framework for public health initiatives to promote breastfeeding. An evaluation of hospital performance implementing the 10 steps through the process of "Baby-Friendly Designation" (BFD) has been suggested by many breastfeeding advocates as the optimal pathway to attain the goals of the BFHI. However, the WHO has recognized that BFD may not be an appropriate goal in all settings, and indicated, as part of their updated 2018 guidance, that "facilities may make changes in their policies and procedures to obtain the designation, but these changes are not always sustainable, especially when there are no regular monitoring systems in place." In addition, unintended associated issues regarding newborn safety and maternal dissatisfaction with some of the 10 steps have emerged. This perspective discusses the challenges faced by hospitals attempting to implement the BFHI 10 steps and suggests potential solutions to make progress in those efforts with or without BFD and also the efforts needed to support formula feedings when appropriate.

Skilled lactation support using telemedicine in the neonatal intensive care unit

BACKGROUND

NICU mothers face unique challenges in initiating and sustaining breastfeeding, but previous studies have focused on outpatient breastfeeding support. We conducted a retrospective study of NICU breastfeeding outcomes before and after implementing telelactation.

METHODS

Pre-Telemedicine mothers received in-person support by NICU lactation consultants, while Telemedicine mothers received solely telemedicine consults after maternal discharge.

RESULTS

Exclusive breastmilk feeding at discharge increased in the Telemedicine group. Notably, babies in the Telemedicine cohort who were fed any formula on admission experienced significant improvement in exclusive breastmilk feeding at discharge, and those whose mothers received at least one NICU lactation consult had the greatest improvement in exclusive breastfeeding rates at discharge.

CONCLUSIONS

This study is the first to validate the use of telemedicine as a means of maintaining access to skilled lactation support in the NICU when in-person consults are not feasible. Incorporating telemedicine can ensure access and continuity of skilled lactation support, and sustain breastfeeding rates.

Development of a hospital-academic collaboration to implement an interprofessional telehealth breastfeeding support group

Accessible lactation support for breastfeeding parents, even in well-resourced areas, is often insufficient. At the same time, opportunities for real-life, sustainable interprofessional learning experiences for health professions students are scarce. Delivery of lactation support via telehealth allows for greater accessibility for both consumers and students. This study describes the development of an interprofessionally-facilitated telehealth breastfeeding support group, a partnership between a health professions graduate school and a teaching hospital in Boston, MA. Program conceptualization, theoretical basis, and development are reviewed. Occupational therapy and nursing students were involved in the group at various points of entry and with different degrees of engagement. Students developed skills in group facilitation, lactation support, and program evaluation. The group had consistent participation, ranging from 2 to more than 10 participants per session, serving parents across urban and rural areas. The group format and development could be replicated to provide needs for local communities of parents and interprofessional students.