January 03, 2020
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Team-based care with breastfeeding consultant shows promise, but uptake may be limited

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Ann Witt 
Ann M. Witt
Lori Feldman-Winter 
Lori Feldman-Winter

Team-based care that incorporated a lactation consultant in a primary care setting doubled monthly lactation visit volume, according to a recent study.

The study also showed that primary care providers thought that the lactation consultants increased breastfeeding support within a clinical practice.

“A new model of outpatient breastfeeding support is needed,” study researcher Ann M. Witt, MD, FABM, IBCLC, of Breastfeeding Medicine of Northeast Ohio, told Healio Primary Care. “Breastfeeding initiation has increased in the United States. “However, the majority of women wean and do not continue breastfeeding for the recommended duration. Two common reasons cited for weaning are pain and low milk supply. These are concerns that can be addressed with lactation consultant and physician support.”

However, Lori Feldman-Winter, MD, MPH, who was not affiliated with the study, said implementing Witt and colleagues’ model may be difficult.

Low on resources, time

National organizations recommend that breastfeeding counseling be part of routine pediatric care, but PCPs face time constraints and are often unprepared to address patients’ concerns, researchers said. Additionally, breastfeeding women face barriers of their own.

“Citing pain and low milk supply, the majority of women wean and do not continue breastfeeding for the recommended duration,” Witt said. “Practices commonly cite lack of time, space, education and money as barriers to implementing the model of lactation consultant support at the infant primary care visit in the first week postpartum.”

According to Witt, primary care practices should perform these assessments to see if their practice would benefit from a new breastfeeding model:

  • prenatally, assess parents’ intent to breastfeed and/or the practice’s current breastfeeding rates to determine how much breastfeeding support will be needed;
  • identify WIC peer helpers, lactation counselors and PCPs with breastfeeding knowledge to determine if these resources can be utilized to support the practice’s breastfeeding counseling needs or if further training is needed. ask the practice’s providers to identify barriers to providing breastfeeding support at the office visit, and their needs for further training
  • understand reimbursement policies, insurance profiles and contracts to develop business calculations and determine whether teaming a lactation consultant with the primary care visits is financially sustainable.

Breastfeeding 
Team-based care that incorporated a lactation consultant in a primary care setting doubled monthly lactation visit volume, according to a recent study.
Source:Adobe

Witt said her model calls for a lactation consultant and PCP to work together at the baby’s first outpatient visit. The lactation consultant can address difficulties with latching and assist in resolving pain and engorgement by evaluating an infant’s weight, feedings and the maternal milk supply. The PCP can monitor the child for jaundice and appropriate weight gain.

“The lactation consultant is available to spend time with the patient at the visit and address these concerns, which then supports the infant in gaining weight,” she explained. “The lactation consultant also establishes a plan to resolve any other breastfeeding difficulties.”

Witt added that before the team-based model was implemented at the clinic where the study took place, 16 of the clinic’s 20 PCPs said that they did not have enough time to provide lactation support, and that their patients had “not received adequate help” with breastfeeding concerns.

According to Witt, after the model was implemented, all of the PCPs reported that they had provided better breastfeeding support, and 84% reported that their patients “had a positive breastfeeding support experience.”

Model slowly gaining momentum

Feldman-Winter, who is chair of the AAP section on breastfeeding and a professor of pediatrics at Rowan University’s Cooper Medical School, said the model described by Witt and colleagues is slowly gaining momentum, in the United States but there are some primary care practices that will not have enough ambitious and properly educated personnel to make it work.

“The lead author and key driver to the team-based approach is a physician with additional training and certification as a lactation consultant. While this type of cross training is becoming more common, most practices are not served by such a motivated and trained PCP,” Feldman-Winter said.

She added, “it is important to emphasize that though this model may be the ideal, there are many places in the U.S. where there are very few lactation consultants. Furthermore, it is also vital that the care provided be culturally congruent with the community and that there is a trusted health care professional that can serve as an ally to the families of the community.”

Feldman-Winter emphasized that many clinicians need additional training when it comes to breastfeeding.

“We learn ‘first do no harm,’ yet so often physicians make incorrect assumptions, diagnoses and management suggestions related to breastfeeding,” Feldman-Winter said. “We have work to do in order for all physicians to acquire a minimum standard of breastfeeding knowledge, skills and attitudes. This standard should apply to all physicians and not only those in primary care.” – by Janel Miller

Reference:

Witt AM, et al. J Am Board Fam Med. 2019;doi: 10.3122/jabfm.2019.06.190118.

Disclosures: Feldman-Winter and Witt report no relevant financial disclosures.