Abstract
I
The authors unveil many barriers to providing a strong network of support for breastfeeding dyads when they leave the hospital. A suggested solution by the authors is to connect every breastfeeding dyad with a lactation consultant at the time of discharge. I would like to offer an alternative strategy for a successful model of outpatient breastfeeding support.
The University of Wisconsin (UW Health) has created a breastfeeding friendly medical system by training office nurse breastfeeding champions. Nearly every primary care OB/gyn, pediatric, and family medicine office within UW Health has at least one nurse who has undergone a 16-hour clinical course focused on telephone triage and problem solving the most common basic outpatient breastfeeding issues.
These RN breastfeeding champions play many roles. They are the office contacts for hospital staff who want to communicate a feeding plan to the newborn's primary care medical home. The breastfeeding champions provide a variety of services for breastfeeding dyads, including telephone triage, office visits for issues such as latch/positioning, growth checks, and pump use. The office physicians will often ask the breastfeeding champion to counsel the mother during a well-child visit. They provide coordination of care for breastfeeding dyads who have other health issues.
Because the breastfeeding champions are keen primary care nurses, not lactation consultants, the UW Lactation Clinic works closely with the breastfeeding champions to coordinate breastfeeding support for families. Dyads needing a higher level of lactation care are referred by the champions to the Lactation Clinic. In turn, dyads who are improving and would prefer to have ongoing support at their medical homes return to the care of a breastfeeding champion, through coordination of care between the Lactation Clinic and the breastfeeding champion. The UW Lactation Clinic provides educational in-services to the breastfeeding champions every 3–4 months, as well as telephone and electronic support.
From our experience, primary care office nurses are perfect in this role. They are experts in telephone triage and counseling, coordination of care, and identification of the ill or distressed mother/infant. Office nurses typically provide continuity of care in offices where the providers might have more erratic schedules. In addition, office nurses are very enthusiastic to help breastfeeding mothers because they have experienced the satisfaction of successfully helping families with all sorts of medical problems.
Recent results from a pilot survey of UW breastfeeding champions (n = 21) indicate that 100% of the breastfeeding champions found their work helpful to patients and 90% found their work helpful to providers.
We found that our providers also benefit from the breastfeeding champion network. Among 10 providers surveyed, 9 of the 10 found them helpful. Only one did not realize that a breastfeeding champion was in the office. Ninety percent of the providers used the breastfeeding champions and found that they were helpful. Seven of the 10 providers indicated that having a breastfeeding champion increases patient satisfaction.
Breastfeeding knowledge need not be sequestered by a specialty. All breastfeeding dyads who leave the hospital are expected to be seen by their primary care medical home. Breastfeeding care needs to happen at that medical home, just like all other basic primary care needs for the dyad. If we assume that no one else except lactation consultants can support normal infant feeding, we will perpetuate healthcare disparity. Only the resourceful, wealthier families will be able to find care with a lactation specialist, and the standard of not trusting the doctor's office for breastfeeding advice will continue. In addition, we are implying that primary care offices cannot and should not provide basic breastfeeding management.
With more than 79% of new mothers initiating breastfeeding in the United States, primary care offices need basic breastfeeding knowledge and skills to provide optimal, equitable, and consistent care to breastfeeding dyads. It behooves medical systems, most of whom have a vision of innovative public health for their patients, to develop a simple, low-cost model of training their talented staff to provide breastfeeding support. This would provide a higher level of satisfaction from breastfeeding families, help families achieve their breastfeeding goals, and result in increased work satisfaction from office staff who struggle to provide the right information because of lack of education.