Podcast: Lactation consultants increase breastfeeding rate

The podcast is available at http://www.nichd.nih.gov/news/releases/Documents/NICHD_Research_Dvlpmts_040814.mp3 (MP3 - 8.5 MB).

Ms. Rebecca Lazeration: To someone who has never done it, breastfeeding an infant might seem easy, but for many new mothers, it’s anything but. A demanding schedule, soreness, difficulty producing milk and an infant who has trouble latching on are just some of the problems that many first-time mothers face.

The health benefits of breastfeeding are well known. Breastfed infants have fewer ear infections and stomach illnesses. Some studies indicate that breastfed infants and their mothers may have lower obesity rates. Women who breastfeed are also at a lower risk for premenopausal breast cancer, Type 2 diabetes and heart disease.

Experts recommend that women feed their infants only breast milk for six months. After that, experts recommend a mix of breast milk and other foods through at least the first year. Despite breastfeeding’s many benefits, more than a quarter of U.S. babies are never breastfed at all. Women who are overweight or are from low-income families are least likely to breastfeed.

Recently, Dr. Karen Bonuck and her colleagues at the Albert Einstein College of Medicine of Yeshiva University reported that arranging visits with a lactation consultant will encourage women who have been reluctant to breastfeed. The researchers published their study in the American Journal of Public Health. They found that women visited by lactation consultants were four times as likely to exclusively breastfeed their children for a month than were woman who didn’t receive the visits. New mothers working with lactation consultants also were three times as likely to still breastfeed after three months, enough time for mother and baby to receive at least some of the benefits of breastfeeding.

From the National Institutes of Health, I’m Rebecca Lazeration, and this is Research Developments, a podcast from the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development — the NICHD. With me now is Dr. Karen Bonuck, professor of women’s health and family and social medicine at the Albert Einstein College of Medicine. Dr. Bonuck, thank you for joining us. Welcome.

Dr. Karen Bonuck: Welcome.

Ms. Lazeration: Dr. Bonuck, in addition to lower rates of illness and obesity, are there any other advantages breastfeeding has over formula feeding?

Dr. Bonuck: Well, I think that the research has shown that there are significant both short- and long-term benefits for both mothers and children. Several years ago, the AHRQ put out a 400-page document which has really too many health benefits for me to list, but even in the long term, children — it’s been shown to have a reduced risk of things like leukemia, asthma severity, atopic dermatitis. For mothers, there's, as you mentioned, a reduced risk of premenopausal breast cancer. There is some sense that she’s able to get back into better health quicker. But for the infants, we also see certain, perhaps, changes in their — how do I say it — intellectual abilities. This has been very difficult to show, but there was actually a large study in Belarus that randomized women to breastfeeding promotion interventions and was able to show some differences in verbal attainment, which is an important thing.

Ms. Lazeration: Now, some groups are less likely to breastfeed than others. Do we know why?

Dr. Bonuck: That’s really the million dollar question. There’s lots of reasons. I mean, just the sociodemographics are that there are significant disparities, based on ethnic — minority women tend to be less likely to breastfeed, although one has to be careful about where women are coming from. In our studies, women who were not born in the United States actually had higher rates, initially, of breastfeeding. African-American women are often less likely to breastfeed. There’s been some studies that actually show that providers are a bit less likely to inform them of the benefits of breastfeeding, which may contribute to it.

There are cultural beliefs. In the Hispanic community, there’s a lot of what’s called mixed feeding, or los dos, where Hispanic women see perhaps less risk in combining formula with breast milk, believing that formula has important vitamins for children and that a child will stay fuller longer if they have the formula in them. So there’s lots of cultural beliefs as well as structural barriers.

Ms. Lazeration: And your study involved encouragement for breastfeeding in primary care practices. Could you explain how that worked?

Dr. Bonuck: Exactly. Our study was innovative in many ways. We had IBCLCs, which are International Board Certified Lactation Consultants, really integrated in the practice. We gave them lab coats that didn’t interfere with or confuse with regard to the other health professionals. They were perceived as part of the health care team. That’s really important. They saw the women in the exam rooms, during that down time when some women might just be sitting, waiting for their provider, thumbing through a magazine. We were able to deliver an intervention, which is really important, so it’s highly translational.

Our protocol called for two visits, prenatally, right there at the site of prenatal care. The women didn’t have to go to an extra visit; they didn’t have to do anything special. They were there already. The first visit kind of focused on establishing rapport and some general education and dialogue about breastfeeding and any feeding history that may have occurred for that woman or in her family. The second session was a bit more hands-on and technical assistance.

There was also another component to the intervention. One of the studies tested whether inserting electronic prompts, or prompts in the electronic medical record at five points that would prompt the prenatal care provider to engage in discussions of anticipatory guidance, might have an effect on feeding outcomes. Those were actually aimed at what the literature has shown had been a problem — that women often see that breastfeeding is healthy but don’t know the specifics, so they encourage the provider to engage in dialogues about the specific benefits of breastfeeding and the risks of not breastfeeding. So actually one of the two studies was able to do a head-to-head comparison of our lactation consultants, versus electronic prompts, versus the two of those interventions combined, versus the standard of care.

But yes, the important thing is that it was integrated in routine care. The other key aspect is that this intervention was offered to all comers. A lot of breastfeeding promotion interventions in the past have been, let’s say, at the bedside in the hospital saying, “Are you intending to breastfeed? OK. Then here, let me help you, let me offer you this intervention.” We approached all women, regardless of their stated intention to breastfeed, so our findings could be seen as actually quite robust in that regard.

Ms. Lazeration: Yet, even with the support of lactation consultants, it would seem that women in your study still weren’t as likely to exclusively breastfeed at the recommended six months. Do you know why that was?

Dr. Bonuck: Oh, God, absolutely. In fact, you could literally — and this was, some people really keyed into this — the number of women exclusively breastfeeding was less than 20 at six months. I think that there are a lot of difficulties. I think many of the women in our study that were of low income — not all of them, some of them — if they’re returning to work, may not have the luxury of a private office where they could pump breast milk. There’s also maybe cultural norms about the duration of breastfeeding. There’s a lot of stigma, also, about breastfeeding in public. A lot of the women in our study had — let’s say, going to WIC or other sorts of appointments — even just feeding a hungry child on the bus becomes a challenge and could be a very difficult scenario for many of the women.

Ms. Lazeration: Now, you said that you brought everybody in that wanted to be a part of this study, but outside of participating in a study like yours, where can women who need support and encouragement for breastfeeding find it?

Dr. Bonuck: Well, if women are enrolled in the WIC program, every WIC program must have a breastfeeding coordinator and peer counselor, and they’re really a great resource. One problem, though, is that often — let’s say a woman is exhausted, so to speak, after the birth of the baby — it’s often difficult to drag herself into that clinic. There are, sometimes, La Leche Leagues, locally. The hospital often has a warm line where women can call up about information, but what we really found was key was the fact that our lactation consultants knew the women across the continuum of care. They knew them when they were pregnant and about 80 percent of the time, we got to them in the hospital. That establishes a rapport and an imprimatur whereby these women trusted our lactation consultants. So it could be a little bit more difficult if there’s not that established trust in the prenatal period.

Ms. Lazeration: Well, Dr. Bonuck, thank you very much for speaking with us today.

Dr. Bonuck: You’re welcome.

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About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov/.