Running head: EFFECTS OF LACTATION CONSULTATION ON BREASTFEEDING 1

Effect of One-on-one Lactation Consultation on

the Rate of Maryland Breastfed Babies

Angèle C. Wright

Frostburg State University

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Introduction

At birth, a stable and healthy full-term neonate born in Maryland has one of two options

to receive nutritional sustenance: breast milk or formula. Research has shown that the benefits

of receiving breast milk (exclusively when possible) for the first six months of life are numerous;

including “lower risk of obesity, diabetes, respiratory and ear infections, and sudden infant death

syndrome (SIDS), and a lower number of doctor visits and hospitalizations” (Maryland DHMH,

October 2012), when compared to those babies who were exclusively formula fed. As of the last

data collection in 2012, 72.6% of Maryland babies were counted as “ever breastfed” and 48.5%

were still being breastfed at six months of age (Maryland DHMH, October 2012).

Clinical Problem

Research has shown that extrinsic factors, such as initial breastfeeding experience, pain,

and perceived lack of breast milk, family and community support (Maryland DHMH, October

2012), can weaken a mother’s resolve to continue breastfeeding. In an effort to both reach The

Healthy People 2020 goals for babies who were “ever breastfed” (81.9%) and babies who are

still breastfed by six months of age (60.6%), Maryland hospitals have adopted and implemented

ten policies based on the WHO/UNICEF Ten Steps to Successful Breastfeeding to help improve

breastfeeding initiation and duration (Maryland DHMH, October 2012). This project will focus

on the improvement of Step #10: “Foster the establishment of breastfeeding support groups and

refer breastfeeding mothers to them on discharge from the hospital or clinic” (Maryland DHMH,

October 2012).

Standard plans of care for recently discharged lactating mothers include a lactation visit

by a hospital-employed lactation consultation to oversee current breastfeeding technique, a

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poster placed on the wall which shows proper breastfeeding techniques, and a hand-out detailing

local lactation consultation support groups. The purpose of this study is to determine if periodic

and personalized post hospital discharge follow up with lactation consultants (via telephone

conversation or use of technology including Face Time or Skype) will increase the breastfeeding

rate of Maryland babies at six months of age. Through research, one will determine if the

addition of personalized lactation consulting will have a positive effect on the rate of breastfed

Maryland babies at six months of age when compared to the rate of breastfed Maryland babies at

six months who receive the standard plan of care.

PICO

The targeted populations studied are breastfed Maryland babies aged six months and

under and postpartum mothers who are lactating. The intervention used to increase the rate of

breastfed babies at six months of age is the use of personalized and periodic lactation consultants

via video teleconferencing technology such as FaceTime or Skype to follow up with newly

discharged mothers. The theory behind this intervention is more mothers would be apt to

breastfed if they had additional education about the benefits of breastfeeding for both mom and

baby, support and feedback while breastfeeding, and were able to do this without leaving their

homes. The independent variable is periodic, one-on-one instruction with lactation consultants

following hospital discharge while the dependent variable is the increased rate of Maryland

babies who are still being breastfed at six months of age. It is the hope that with the use of

personalized and periodic lactation consulting via video conferencing technology, the new

mother will have the support system necessary to ensure a successful foray into breastfeeding.

The lactation consultation can also fill in any knowledge gaps that the parent(s) may have about
INCREASE RATE OF MARYLAND BREASTFED BABIES 4

breastfeeding that may be missed with the cursory approach that is typically employed in support

groups.

Literature Review

Lin-Lin, S. et al. (2007) proved that breastfeeding rates at six months are higher when

mothers receive antenatal training and postpartum support (19% of intervention group were

exclusively breastfeeding versus 9% of the control group). Mothers are able to circumvent some

of the obstacles that prevent successful breastfeeding by undergoing the antenatal training. This

training also increases the amount of ownership the mother may have in the process of

breastfeeding because they possess a better understanding of breastfeeding benefits to both

mother and baby. The postpartum support provides the mothers with the necessary societal

support needed for successful breastfeeding with encouragement and instruction.

Fu, I. C. et al. (2014) proved that breastfeeding rates were higher in the group that

received postpartum lactation support and post discharge follow up. Continued postpartum

support increased the effectiveness of lactation support given prior to discharge. It did not,

however, show any significant improvement rate at six months when compared to the control

group. This research proves that with personalized follow up, mothers are more apt to breastfeed

than their counterparts that did not receive any personalized support. This research also shows

that there are obstacles that mothers face when one goes back to work that can be investigated in

future research.

Pugh, L.C. et al. (2010) proved that the study’s intervention group (those who received a

support team, home visits, telephone support, 24-hr pager access) were more likely to breast feed

at 6 weeks postpartum than their control counterparts, but findings for the 2 groups at 6 months
INCREASE RATE OF MARYLAND BREASTFED BABIES 5

were statistically insignificant. Pugh’s research showed that with support, breastfeeding rates

increased when compared to those who did not receive any additional support but it did not

identify why the rates of breastfeeding at six months of age were similar.

Tahir, N. M. et al. (2012) proved that when postpartum mothers received biweekly

lactation consultation via telephone for six months, there was an increase in breastfeeding rates

at one month, but improvements were indistinguishable at months four and six when intervention

and controlled groups were compared. The study did not compensate for the drop in

breastfeeding when mothers returned to work.

McDonald, S. et al. (2008) proved that with the inclusion of an extended postnatal

weekly education session as well as weekly home visits, there was an increase in breastfeeding

rates at one and four months, but improvements were indistinguishable in months six when

intervention and controlled groups were compared. Whereas other studies showed decreases in

breastfeeding rates at four months when mothers only received one postpartum visit, this study

reflected an increase at the four month mark due to a higher frequency of visits and/or contact.

Witt, A. et al. (2012) proved that routine postpartum support coupled or housed within

primary care improved breastfeeding initiative and intensity. The study is limited by the scope

of the study (it was contained to one provider’s practice). This study was one of the few that

delved into the concept that breastfeeding was baby-centric versus a postpartum function.

Mothers get more frequent instruction as well as feedback from the pediatricians and lactation

consultants in terms of the baby’s growth and development that can possibly encourage

continued practice.
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Practice Recommendations

The first recommendation would include both antenatal education and extended

postpartum support to breastfeeding mothers. By providing early education, mothers can be

introduced to the benefits of breastfeeding as well as anticipate many of the pitfalls involved

with the initial stages of breastfeeding; such as pain with latching, colostrum and milk

maturation, positioning and proper latching. This training will advise new parents on what to

expect and lay a solid foundation for successful breastfeeding. In addition to the antenatal

training, new mothers would receive additional support in the form of two face-to-face visits

from a lactation consultant; the first one to occur during their hospital stay and the second one

during their first routine postpartum follow up visit in their obstetrician office. The two visits

will provide personalized follow up to the foundation forged during the antenatal education.

The second recommendation includes lactation counseling via telephone or face to face

conferencing technology, such as Skype or FaceTime following discharge. By providing

lactation consultation over the telephone, new mothers would not have to leave the comforts of

home in order to have their questions answered and ensure that they are maintaining proper

breastfeeding form and technique. This mode would also provide a form of community support

to new mothers during the initial weeks of breastfeeding, when help and encouragement to

continue nursing is needed the most. By forming a relationship with the new mother through the

biweekly sessions during the first six months of the child’s life, the lactation consultant is able to

help the new mother manage through the typical issues (perceived low milk supply, returning to

work) that often derails successful breastfeeding (Tahir, et al., 2012) as well as reinforce the

benefits of breastfeeding.
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The third recommendation focuses on the integration of lactation counseling into the

newborn’s pediatric care. Because newborns follow a scheduled pattern of pediatrician visits to

ensure steady growth and development, a lactation consultant placed in the pediatrician’s office

has the unique opportunity to answer questions, provide demonstrations on proper latch and

form, while ensuring that the baby is gaining weight at an appropriate rate (Witt et al., 2012).

The added benefit of having a lactation consultant in the child’s pediatrician office lessens the

stress of having to attend a separate visit to ensure proper breastfeeding progress, so the mother

is less apt to miss meetings. Additionally, breastfeeding is presented as part of the baby’s

holistic, integrated plan of care where the benefits can be revisited and explained within the

context of maintaining the child’s health versus an activity that the mother does independent of

the child. It is one’s hope that this will have a positive effect on the mother’s resolve to continue

breastfeeding throughout the first year of the child’s life.

Conclusion

Research has shown that extrinsic factors, such as initial breastfeeding experience, pain,

and perceived lack of breast milk, family and community support (Maryland DHMH, October

2012), can weaken a mother’s resolve to continue breastfeeding. Research has shown that

consistent support and personalized education has had a positive effect on the breastfeeding rates

in other countries at one and two months of age but the difference between those receive the

additional support and the control group is indiscernible, statistically speaking. Perhaps future

research can focus on the identification of the unknown extrinsic factors that causes

breastfeeding rates to fall at six months postpartum. Armed with this additional knowledge, one

can then incorporated tailored education and support techniques within our postpartum
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infrastructure that will yield improvements in Maryland’s rate of breastfed babies at six months

of age.
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References

Fu, I.C., Fong, D.Y., Heys, M., Lee, I.L., Sham, , Tarrant, M. (2014). Professional breastfeeding

support for first-time mothers; a multicentre cluster randomized controlled trial. BJOG,

(13):1673-83. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24861802

Lin-Lin Su., Yap-Seng Chong, Yiong-Huak Chan, Yah-Shih Chan, Folk, Doris, Kae-Thwe Tun,

Ng, Faith, Rauff, Mary. (2007). Antenatal education and postnatal support strategies for

improving rates of exclusive breast feeding: randomised controlled trial. BMJ, 335:596.

Retrieved from: http://www.bmj.com/content/335/7620/596

Maryland Department of Health and Hygiene. (2012, October). Maryland Hospital

Breastfeeding Policy Recommendations. Retrieved from

http://phpa.dhmh.maryland.gov/mch/Documents/MarylandHospitalBreastfeedingPolicyR

ecommendations.pdf

McDonald, S.J., Henderson, J.J., Faulkner, S., Evans, S.F., Hagan, R. (2008). Effect of an

extended midwifery postnatal support programme on the duration of breast feeding: a

randomized controlled trial. Elsevier Ltd. Retrieved from:

http://www.ncbi.nlm.nih.gov/pubmed/18486287

Pugh, L.C., Serwint, J.R., Frick, K.D., Nanda, J.P., Sharps, P.W., Spatz, D.L., Milligan, R.A.

(2010). A randomized controlled community based trial to improve breastfeeding rates

among urban low-income mothers. Academic Pediatric Association. Retrieved from:

http://www.ncbi.nlm.nih.gov/pubmed/19854119
INCREASE RATE OF MARYLAND BREASTFED BABIES 10

Tahir, N.M., Al-Sadat, N. (2012). Does telephone lactation counseling improve breastfeeding

practices? A randomized controlled trial. International Journal Nursing Studies, (1): 16-

25. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/23084438

Witt, A.M., Smith, S., Mason, M.J., Flocke, S.A. (2012). Integrating routine lactation

consultant support into a pediatric practice. Breastfeeding Med, (1): 38-42. Retrieved

from: http://www.ncbi.nlm.nih.gov/pubmed/21657890
INCREASE RATE OF MARYLAND BREASTFED BABIES 11

Appendix A

Level of Number Summary of Findings Overall

Evidence of Quality
Studies
I 3 Fu, I. C. et al. (2014) proved that breastfeeding rates were A
higher in the group that received postpartum lactation
support and post discharge follow up. Continued
postpartum support increased the effectiveness of
lactation support given prior to discharge. It did not,
however, show any significant improvement rate at six
months when compared to the control group.

Pugh, L.C. et al. (2010) proved that the study’s B

intervention group (those who received a support team,
home visits, telephone support, 24-hr pager access) were
more likely to breast feed at 6 weeks postpartum than
their control counterparts, but findings for the 2 groups at
6 months were statistically insignificant

Lin-Lin, S. et al. (2007) proved that breastfeeding rates at B

six months are higher when mothers receive antenatal
training and postpartum support (19% of intervention
group were exclusively breastfeeding versus 9% of the
control group).
II 3 Tahir, N. M. et al. (2012) proved that when postpartum A
mothers received biweekly lactation consultation via
telephone for six months, there was an increase in
breastfeeding rates at one month, but improvements were
indistinguishable at months four and six when
intervention and controlled groups were compared. The
study did not compensate for the drop in breastfeeding
when mothers returned to work.

Witt, A. et al. (2012) proved that routine postpartum B

support coupled or housed within primary care improved
breastfeeding initiative and intensity. The study is limited
by the scope of the study (it was contained to one
provider’s practice)

McDonald, S. et al. (2008) proved that with the inclusion B

of an extended postnatal weekly education session as well
as weekly home visits, there was an increase in
breastfeeding rates at one and four months, but
improvements were indistinguishable in months six when
intervention and controlled groups were compared.
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III
IV
V
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Appendix B

Individual Evidence Summary

Databases Used: Search Terms Used: Filters Used:

The BMJ, PubMed breastfeeding babies, breast feeding support
groups, breastfeeding rates, improving
breastfeeding rates, postpartum lactation
support, in-home breastfeeding support
# Author Year Evidenc Sample Size Results Limitations Strength
e Type Recommendation /
Quality
1 Lin-Lin 200 Research 450 women Breastfeeding Those with I/B
Su., Yap- 7 with rates at six months complicate
Seng uncomplicated are higher when d
Chong, pregnancies mothers receive pregnancie
Yiong- antenatal training s were not
Huak and postpartum included
Chan, support (19% of
Yah-Shih intervention group Previous
Chan, were exclusively experience
Folk, breastfeeding with
Doris, versus 9% of the breastfeedi
Kae-Thwe control group) ng
Tun, Ng, unknown
Faith,
Rauff,
Mary
2 Fu, I.C., 201 Research 722 Breastfeeding Those with I/A
Fong, 4 primiparous rates were higher complicate
D.Y., mothers with in the group that d
Heys, M., uncomplicated received pregnancie
Lee, I.L., , full – term postpartum s were not
Sham, A., pregnancies lactation support included
Tarrant, and post discharge
M. follow up.
Continued
postpartum
support increased
the effectiveness
of lactation
support given
prior to discharge
3 Tahir, 201 Research 357 mothers, There was an Those with I/B
N.M., Al- 2 vaginal increase in complicate
Sadat, N. delivery, full- breastfeeding rates d
INCREASE RATE OF MARYLAND BREASTFED BABIES 14

term, healthy at one month, but pregnancie

infant via improvements s or
SROM were cesarean
indistinguishable deliveries
in months four were not
and six when included
intervention and
controlled groups
were compared
4 McDonald, 200 Research 849 women There was an Those with I/A
S.J., 8 who had given increase in complicate
Henderson birth to breastfeeding rates d
, J.J., healthy, full at one and four pregnancie
Faulkner, term singleton months, but s or
S., Evans, baby and improvements cesarean
S.F., wished to were deliveries
Hagan, R. breastfeed indistinguishable were not
in months six included
when intervention
and controlled
groups were
compared
5 Witt, 201 Research 340 mothers Routine Small I/B
A.M., 2 postpartum sample size
Smith, S., support coupled or limited to
Mason, housed within one
M.J., primary care practice
Flocke, improved
S.A. breastfeeding
initiative and
intensity