O0321 Oct.4: 4:48pm - Addressing Community Gaps in Breastfeeding Support: From Hospital to First Visit

Background Although there is an increasing trend for more mothers to initiate breastfeeding in the US, there is a rapid decline after initiation, and racial disparities persist. A multidisciplinary team comprised of pediatricians, neonatologists, prenatal lactation providers, primary care lactation experts, and members of the community partnered to address the cessation of breastfeeding before the first “Newborn” visit at our institution’s busy primary care safety net clinics, using Quality Improvement methodology.

Methods The aim of this project was to increase the number of babies presenting to the safety net primary care clinics still receiving some of their mother’s milk at the first visit by 5% over a 12 month period. Key Drivers affecting early cessation were identified and interventions developed to affect change through PDSA (Plan-Do-Study-Act) cycles. Mothers identified as no longer breastfeeding at the first visit were interviewed to learn the reasons for cessation to help the team plan interventions.

Discussion Baseline breastfeeding continuation at the newborn visit was 88% in aggregate (of those babies who initiated breastfeeding in the 11 area birth hospitals). Variation between birth hospital of record was identified with a range of 82-92% still breastfeeding at the first visit. Mothers identified reasons for their discontinuation including: concerns about “not enough milk”, difficult latch, baby not satisfied, stress, work, and habits of the mother not safe for the baby. Early interventions launched through PDSA cycles included the addition of lactation support to the Primary Care Clinics with pre-visit calls before the first Newborn visit. Systematic procedures were developed, launched in a single hospital, and ramped up to all hospitals to improve identification of feeding type at discharge for more accurate classification of feeding. Community support resource guides were developed to share with birth hospitals and the community. A one page infographic is in development to share guidance on the most common concerns of mothers during the early days.
Over the 12 month period of the project, there was not a shift of the mean from baseline. Factors affecting success included the complexity of implementing new changes across institutions, with different readiness to change. Additionally the breastfeeding support in the home setting was variable. Next steps include connecting peers to prenatal and newly delivered mothers for breastfeeding support as “Breastfriends”, working on implementing a texting system to connect with mothers in the first day and beyond after discharge, and continued connection to community breastfeeding support, to create a culture of breastfeeding success.

Conclusions
A quality improvement collaborative has successfully engaged partners from across institutions and disciplines to work on improving breastfeeding continuation at the first visit using QI methodology.