Lactation Care Management: Advancing Rural Health Equity With an Integrated Care Delivery Model

Access to International Board Certified Lactation Consultants (IBCLC) significantly improves infant feeding outcomes and yet there are substantial barriers to accessing such care in rural populations. Guided by a transitions care management model of care delivery and led by an IBCLC committed to improving health equity, a lactation care management program was developed and implemented to serve rural communities within an accountable care organization (ACO) in western New York State in the United States. The program provided patients with access to seamless IBCLC care initiated in their obstetric care setting, and then provided them care during hospital delivery as well as throughout their transition to ambulatory pediatric care. Patients were followed for 6 months postpartum. The IBCLC worked within their scope of practice to provide person and family-centered patient care, and to access community resources as needed; to support and educate patients and health care providers; and to advocate for necessary systemic changes that improve lactation health outcomes. The program was effective in improving human milk feeding initiation and duration rates compared to baseline regional and national benchmarks. Patients and health care providers benefited from the program. Patients reported improved lactation experiences in obstetric, in-patient, and pediatric settings while health care providers in these settings reported more satisfying experiences of care delivery. The program was sufficiently successful to warrant sustained ACO funding, including its replication in another rural community within the region. Implications for adapting and expanding the potential influence of this model are discussed.