Lactation consultants can boost breastfeeding

Having access to even a few hours with a professional specially trained to help women breastfeed may raise the number of women who start breastfeeding and stick with it, according to a new study.

Lactation consultants are certified through the International Board of Lactation Consultant Examiners and may work in hospitals, offices or public health programs.

Women in the new study who spent an average total of three hours with a lactation consultant were almost three times more likely to start breastfeeding their newborns and to still be breastfeeding three months later.

The American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for all babies’ first six months. In reality, at least 25 percent of babies in the U.S. are never breastfed at all, according to the Centers for Disease Control and Prevention.

As the amount of a baby’s nourishment coming from breastfeeding increases, and the length of time its mother breastfeeds grows, baby’s risk of pneumonia, colds, leukemia and throat and ear infections goes down, author Karen Bonuck told Reuters Health.

Bonuck, a professor of family and social medicine and of obstetrics & gynecology and women’s health at Albert Einstein College of Medicine in New York City, led the investigation.

Many factors influence whether or not a mother breastfeeds, she said.

“Right after birth, there are often difficulties with positioning the infant and knowing they are drinking enough,” Bonuck said. “Hospital help is great, when a nurse has long enough to spend with you, but they often don’t.”

When mothers get home, few have the energy to seek out breastfeeding resources in the community, she said. Long term, many women are still uncomfortable breastfeeding in public and may not have the time or opportunity to pump milk when they return to work or school.

For the study, Bonuck and her team conducted two clinical trials, one among low-income women and one among more economically diverse women. Participants were primarily Hispanic and black, and two-thirds were overweight or obese.

For the first trial, half of the women had pre- and postnatal lactation consultant visits and their doctors were reminded by electronic prompts to speak to the patients about breastfeeding during office visits. The other half of the women just got usual prenatal care.

Among the women who received extra attention to breastfeeding, 16 percent were feeding their babies only with breast milk at three months of age, compared to 6 percent of the women who got no extra attention.

The second trial included four groups of women: one with lactation consultants, one with electronic prompts for doctors, one with both interventions and one with neither. The women who only got electronic prompts to their doctors didn’t seem to breastfeed any more than the comparison group, but those who got lactation consultants or consultants plus electronic prompts did.

Twenty percent of the women who had lactation consultants only were frequently breastfeeding at three months, compared to 17 percent of those who got the consultant and electronic prompts and only 8 percent in the comparison group, Bonuck’s team reports in the American Journal of Public Health.

Even though most of the women were overweight or obese, a population that usually has particular difficulty breastfeeding, according to Bonuck, lactation consultants did seem to make a measurable difference.

Expectant moms can visit the website of the International Lactation Consultant Organization to find a consultant nearby, Bonuck said.

According to Rebecca L. Mannel, director of lactation services at the University of Oklahoma Health Sciences Center in Oklahoma City, lactation consultants “are the only healthcare professional specifically trained to manage the full spectrum of breastfeeding, from prenatal to postpartum, from normal healthy moms and babies to complicated situations involving maternal risk factors or illness or infants born preterm or with some other health complication.”

Ideally, consultants should be available for women before giving birth and immediately after, not only to help them navigate the physical ins-and-outs of breastfeeding, but to talk through any misconceptions, family or social support needs and make a plan for incorporating breastfeeding into a return to work plan, said Mannel, who was not involved in the new study.

“They should be a standard member of the health care team when it comes to pregnancy, childbirth and infant growth and development,” she added.

Most mothers don’t have easy access to lactation consultants, since hospitals are rarely staffed adequately, Mannel said. Hospitals tend to treat the consultants as luxury items and not necessities, she said.

“While other prenatal providers, including nursing staff can provide some of the basic breastfeeding education to prepare women for the hospital experience and initiation of breastfeeding, this does not happen consistently,” Mannel said. “Other prenatal care providers have multiple issues they need to address with pregnant women and breastfeeding is easy to put off and ultimately not address.”

One of the biggest barriers to accessing lactation consultants, Mannel said echoing the study authors, is insurance coverage. The Patient Protection and Affordable Care Act, commonly called Obamacare, requires coverage of lactation care but does not specify who should provide the care or how many times a mother can access it.

“Many insurance companies haven’t changed anything, other than to say mom can go the MD or nurse practitioner for breastfeeding care - who are often not adequately trained to provide care for breastfeeding difficulties or complications,” Mannel said.

SOURCE: American Journal of Public Health, online December 19, 2013

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Effect of Primary Care Intervention on Breastfeeding Duration and Intensity

Results. In BINGO at 3 months, high intensity was greater for the LC+EP (odds ratio [OR] = 2.72; 95% confidence interval [CI] = 1.08, 6.84) and LC (OR = 3.22; 95% CI = 1.14, 9.09) groups versus usual care, but not for the EP group alone. In PAIRINGS at 3 months, intervention rates exceeded usual care (OR = 2.86; 95% CI = 1.21, 6.76); the number needed to treat to prevent 1 dyad from nonexclusive breastfeeding at 3 months was 10.3 (95% CI = 5.6, 50.7).

Conclusions. LCs integrated into routine care alone and combined with EP guidance from prenatal care providers increased breastfeeding intensity at 3 months postpartum. (Am J Public Health. Published online ahead of print December 19, 2013: e1–e9. doi:10.2105/AJPH.2013.301360)

Karen Bonuck, PhD, Alison Stuebe, MD, MSc, Josephine Barnett, MS, Miriam H. Labbok, MD, MPH, Jason Fletcher, PhD, and Peter S. Bernstein, MD, MPH
Karen Bonuck, Alison Stuebe, Josephine Barnett, Miriam H. Labbok, Jason Fletcher, and Peter S. Bernstein. (2013). Effect of Primary Care Intervention on Breastfeeding Duration and Intensity. American Journal of Public Health. e-View Ahead of Print.
doi: 10.2105/AJPH.2013.301360

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