“All in Breastfeeding” - An Approach to Improving Breastfeeding Support at the Rainbow Center for Women and Children

Purpose/Objectives: The goal of this project was to create a Breastfeeding Intervention Bundle (BIB) targeted at improving breastfeeding rates at the Rainbow Center for Women and Children (RCWC), an urban health center serving low-income mainly African-American families.

Design/Methods: Aim 1 was to identify stakeholder-perceived barriers to improving breastfeeding rates and possible mitigation strategies. We administered an open-ended 9-question interview to 12 RCWC and co-located WIC stakeholders with diverse roles (MDs, RNs, LPNs, IBCLCs, a CLC and an RD). Responses were transcribed and commonalities summarized. Aim 2 was to create a Breastfeeding Intervention Bundle (BIB) utilizing this input, and assess any impact via provider, staff and mother surveys. The BIB included 10 minute education sessions integrated into meetings, office posters, a new resource card and a streamlined process to reach our IBCLC. Providers and staff were surveyed on a 5 point Likert scale about knowledge and confidence post sessions, and 10-12 consecutive eligible mothers of infants 0-75 days were surveyed pre-BIB (7/20) and then monthly x 6 (9/20-3/21) during BIB roll out about their comfort with breastfeeding and whether anyone offered to help with their breastfeeding. Informed consent was obtained from all survey participants.

Results: Aim 1 - The most frequent noted barriers were limited times for lactation help and confusion about availability, deficits in provider and patient knowledge, cultural barriers including early return to work and lack of a clinic breastfeeding space. Strategies to reduce barriers included provider and patient education, immediate lactation help availability, increased resource availability and encouraging breastfeeding during pregnancy. Aim 2 - Response rates for providers and staff were low ( <25%) but those that did respond were positive (4s and 5s). The monthly number of RCWC IBCLC consults did not robustly increase: 7/20-3/21- 8, 5, 6, 9, 8, 8, 14, 9 and 15, respectively. Responses from mothers are presented in Table 1 and did not show a change.

Conclusion/Discussion: We used stakeholder surveys to develop a BIB aimed at increasing breastfeeding support, and then surveyed faculty, staff and mothers regarding impact. We hoped to see an increase in mothers who were offered breastfeeding help or who now felt comfortable with breastfeeding, but did not. Possibly the number surveyed was too small to be representative, or alternately, key causes of low breastfeeding rates were not directly addressed by the BIB. We hoped to see an increase in IBCLC consults but did not, and postulate that provider awareness may not be the most important barrier to uptake, with possibly low perceived consult value more relevant for mothers with breastfeeding difficulty. We postulate that "downstream" efforts including education and resource availability as in our BIB are less effective than systemic "upstream" efforts that may include more fundamental changes in health care services.