Assistant Clinical Professor Columbia University Columbia University Irving Medical Center New York, New York, United States
Background: Addressing breastfeeding (BF) issues is critical to prevent early BF cessation. We embedded a BF consultation service run by a pediatrician/International Board Certified Lactation Consultant (MD/IBCLC) in a pediatric medical home to improve access to high quality, insurance-covered breastfeeding support.
Objective: To understand among mothers who used this service, feelings of BF preparedness and the perceived benefits of the service.
Design/Methods: This qualitative study took place from December 2019-July 2020 at a pediatric primary care practice associated with an academic medical center. Mothers were referred by their infant's pediatrician for a BF consultation when issues were discovered at a well child visit. Mothers completed a BF self-efficacy scale-short form (BFSES-SF) at the in-person BF visit. Visits were converted to video due to the COVID-19 pandemic in March 2020. A chart review of each infant, a semi-structured phone interview, and the BFSES-SF were performed approximately 1 month after the visit. Using framework analysis, the study team identified, mapped, and interpreted interview themes. A paired sample t-test was used to compare BFSES-SF score means.
Results: Twenty-eight mothers participated (see Table 1). Infants were on average 22 days (range 5-79) at the visit. All were BF at initial visit (21 exclusively); 27 were BF at the time of the interview (15 exclusively). Seventeen had BFSES-SF scores available from both time points, and means increased from 41 to 55 (t(16) = 4.47, p < .001), demonstrating increased BF self-efficacy. Despite prenatal efforts, mothers did not feel adequately prepared for the reality of BF. Trust in their pediatrician’s recommendation, easy access, and insurance coverage were key factors in seeking the service. The added value of the dual MD/IBCLC qualifications to be able to address a range of medical concerns and provide reassurance (both about BF and related pediatric concerns) were major outcomes resulting in mothers feeling more confident to BF. Conclusion(s): While mothers in our study had sociodemographic factors often associated with successful BF and engaged in prenatal preparation, they generally felt unprepared for the reality of BF. Embedding a BF consultation service covered by insurance into the medical home is a key way to enhance accessibility and trust in the support. An MD/IBCLC was able to provide reassurance to mothers by addressing BF issues and related pediatric concerns, thus helping mothers reach their breastfeeding goals.
Table 1: Characteristics of Participants
Authors/Institutions: Melissa E. Glassman, Columbia University Irving Medical Center, New York, New York, United States; Kelly Blanchet, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States; Jane Andresen, Columbia University Irving Medical Center, New York, New York, United States; Rachel A. Lewis, Columbia University Irving Medical Center, New York, New York, United States; Susan Rosenthal, Columbia University Irving Medical Center, New York, New York, United States