Research ArticleOriginal Research

Translating Team-Based Breastfeeding Support into Primary Care Practice

Ann M. Witt, Rachel Witt, Lauren Lasko and Sue Flocke
The Journal of the American Board of Family Medicine November 2019, 32 (6) 818-826; DOI: https://doi.org/10.3122/jabfm.2019.06.190118

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Team-based Lactation Consultant (LC)/Primary Care Provider (PCP) model of care.

  • Figure 2.
    Figure 2.

    6-Point Practice Assessment tool with rationale. WIC = Special Supplemental Nutrition Program for Women, Infants, and Children; LC = Lactation Consultant; PCP = Primary Care Provider.

Tables

  • Table 1.

    Patient Characteristics

    Frequency,* n (%)
    Race
        White72 (62%)
        Black or African29 (25%)
        Asian12 (10%)
    Ethnicity
        Non-Hispanic78 (67%)
        Hispanic or Latino39 (33%)
    Public insurance99 (92%)
    Mother age†26 (13 to 43)
    First delivery38 (38%)
    Vaginal delivery98 (84%)
    Infant age at first visit†4 (2 to 19)
    Infant gestational age† (in weeks)39 (34 to 43)

    • ↵* For categorical variables, frequency n (%) is reported.

    • ↵† For continuous variables, median (range) is reported.

  • Table 2.

    Volume of LC/PCP* Visits First 4 Months after Team-based Practice Change

    MonthMarchAprilMayJune
    Total newborns21172421
    Breastfeeding infants†16132017
    LC at first BF infant visit: n (%)5 (31%)7 (54%)12 (60%)15 (88%)
    Total LC visits8353550

    • LC, Lactation Consultant; PCP, Primary Care Provider.

    • ↵* LC/PCP team-based visit for breastfeeding(BF) infants.

    • ↵† Breastfeeding infants is defined as any breastfeeding. It reports on newborns seen in that month and on breastfeeding at the first infant visit to the clinic.

  • Appendix A:

    Provider Survey on Barriers and Ideas for Improvement

    Barriers
        Q: Which of the following is a barrier to you discussing breastfeeding with your patients?*
            1. Not enough time
            2. Not my responsibility
            3. Does not make a difference in breastfeeding outcome
            4. Do not feel competent in managing breastfeeding issues
            5. Parent not interested
            6. Not reimbursable
            7. Other (text box provided to explain)
        Q: Which of the following is a barrier to infants being breastfed at the practice?*
            1. Families want to supplement with formula
            2. Medical providers in the hospitals recommend formula before discharge without medical reason
            3. Families are not well informed about the importance of breastfeeding
            4. Support staff (i.e. medical assistants/reception) are not encouraging breastfeeding
            5. Medical providers (physician/APN) are not encouraging breastfeeding
            6. Mothers are not receiving the help they need
            7. Inadequate lactation consultant staffing
            8. Other (text box provided to explain)
    Practice Breastfeeding Support Current Practices and Suggestions:
    If your patients are having breastfeeding difficulties beyond what you can address in the office visit, what do you do?
        A: Open ended question with text box to write in suggestions
    What would help you provide better breastfeeding support to your patients?
        A: Open ended question with text box to write in suggestions

    • APN, advanced practice nurse.

    • ↵* Adapted from “Surveying the Knowledge, Attitudes and Practices of District of Columbia ACOG Members Related to Breastfeeding” by Sims et al.29

  • Appendix B:

    Provider Breastfeeding Counseling/Training/Experience

    Provider Breastfeeding Counseling:
        Q: How confident are you in your ability to manage common breastfeeding problems competently?
        A: Very confident, confident, fairly confident, not very confident, not at all confident.
        Q: How comfortable are you in evaluating whether a baby's latch is successful?
        A: Very confident, confident, fairly confident, not very confident, not at all confident.
        Q: How comfortable are you in assessing whether there is a good milk transfer from mother to baby during breastfeeding?
        A: Very confident, confident, fairly confident, not very confident, not at all confident.
        Q: How comfortable are you teaching mothers how to use a breast pump?
        A: Very confident, confident, fairly confident, not very confident, not at all confident.
        Q: How often do you ask patients how breastfeeding is going in the first year of their life?
        A: Never, sometimes, often, always
        Q: How often do you ask mothers to breastfeed in front of you so that you can assess the feeding?
        A: At least once with every breastfeeding mother; Only if mother voices concerns; Never; Almost never
    Provider Breastfeeding Training/Experience:
        What is your specialty of practice?
        What percentage of your practice consists of children under 1 year of age?
        How many years have you been in practice?
        Are you a parent? A: Y/N
        Were your children breastfed? A: Y/N
        Was breastfeeding a positive experience for you/your partner? A: Y/N
        Q: Where did you learn about breastfeeding?3
        A: My own experience; Medical/Nursing school; Residency; Self-direct learning; Other
        Q: How well did your medical training prepare you to support breastfeeding mothers?4
        A: Very well; Somewhat well; Somewhat poorly, Very poorly
        Q. Do you hold a certification in breastfeeding support (e.g. the International Board of Lactation Consultants)? A: Y/N

    • *Q, survey question; A, answer choices, N, No; Y, Yes.

    • If no answer choices listed than question is an open ended question to write in text response. A: Y/N notation for Yes/No response.

    • Questions adapted from survey from Breastfeeding Knowledge, Confidence, Beliefs and Attitudes of Canadian Physicians study by Pound et al.28

  • Appendix C:

    Post-Implementation LC/PCP Team-Based Care Survey

    Q: Since the practice started on-site lactation support do you feel you provide your patients better breastfeeding support? A: Y/N
    Q: Do you feel your patients who visit the lactation support are breastfeeding longer? A: Y/N
    Q: How did your patients feel about the lactation support during their visit?
    A: Positive experience, neutral experience, negative experience, unsure, I did not ask.
    Q: Did you feel you and your patient had adequate support/access to lactation when needed? A: Y/N
    Q: Have you been involved as a medical provider in the breastfeeding visits?
    A: Y/N/occasionally
    Q: What did you like about the visits? (check all that apply)
        1. On site immediate lactation support
        2. Lactation consultant joining an already scheduled visit so patient does not need an extra visit
        3. MD/NP able to help more patients in shorter amount of time
        4. Breastfeeding support available for patient that NP/MD previously did not have time to provide
        5. Increased time during well visit for lactation support
        6. Other
    What are your suggestions for improving the visits? (check all that apply)
        1. Visit efficiency
        2. Better coordination of providers involved in the visit
        3. Lactation consultant support expanded to times LC is currently not available?
        4. Lactation consultant support at other sites
        5. More education on specific breastfeeding topics to support the lactation consultant
        6. What educational topics on breastfeeding would be helpful for you?
    How did your patients feel about the lactation support during their visit?
    A: Positive experience, neutral experience, negative experience, unsure, I did not ask.

    • *Q, survey question; A, answer choices, N, No; Y, Yes.

    • If no answer choices listed than question is an open ended question to write in text response. A: Y/N notation for Yes/No response.

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