Abstract
Dear Editor:
W
As Dr. Eglash noted, one solution we suggested was to connect each breastfeeding dyad with a lactation consultant. Importantly, our suggestion was that this would occur before delivery, rather than at discharge. The Affordable Care Act 3 mandates coverage of “comprehensive lactation support and counseling by a trained provider during pregnancy and/or in the postpartum period.” We appreciate Dr. Eglash's trepidation about relying solely on lactation consultants to provide such support because doing so may perpetuate healthcare disparities, and we believe this is a valid concern. Although, according to the new law, such support should be covered for all women, in reality there are insufficient numbers of lactation consultants to provide such care. As a result, it may not be available or accessible to all women.
With this in mind, we would like to clarify and reiterate the breadth of our suggestions for improving continuity of breastfeeding-related care. Our suggestions included interdisciplinary collaboration in outpatient settings, implementation of baby friendly hospital initiative (BFHI) policies, improved breastfeeding training for physicians and other health professionals, and streamlining breastfeeding care through identification of a “captain of the ship” for breastfeeding across the continuum. We expand briefly on each of these hereunder.
Establishment of interdisciplinary clinics in which obstetrics, pediatrics, neonatology, and lactation services as well as other ancillary services come together may provide prime opportunity to incorporate breastfeeding care with other medical care for the mother–infant dyad. Such settings may also provide the opportunity for health professionals to converse about provision of breastfeeding care and increase the visibility and awareness of such services both among the healthcare team and with patients.
Increasing BFHI designations is also likely to improve breastfeeding care continuity through implementation of policies that create a more consistently supportive hospital environment for breastfeeding.
Training of health professionals with a consistent breastfeeding curriculum is likely to improve knowledge and continuity of messages about breastfeeding to patients. One such example is the single curriculum used previously for pediatricians, obstetricians, and family medicine physicians; use of this curriculum was associated with an increase in exclusive breastfeeding rates. 4
Finally, we suggested streamlining breastfeeding care through use of lactation consultants as “captains of the ship.” We made this suggestion based on lactation consultants' training and skills in addressing lactation concerns, as well as our health professional participants' suggestions for improving breastfeeding care. In Dr. Eglash's setting, “RN breastfeeding champions” seem to be taking on this captain role through their triage model of assigning lactation consultants to those with the most complex breastfeeding problems or needs. This seems like an excellent strategy for using and conserving the resource of lactation consultant time, especially if or when it is in short supply.
To conclude, we believe that multiple strategies are possible, and likely necessary to fully address the improvement of breastfeeding care continuity in the United States. Identifying a “captain of the ship” is a crucial part to this, but training, hospital policies, and interdisciplinary collaboration are also necessary to avoid silos of care and to improve continuity in messaging across the continuum.