Breastfeeding Baby Laughing

Breastfeeding Knowledgeable and Supportive Health Systems

A Breastfeeding Knowledgeable and Supportive Health System is a healthcare institution dedicated to promoting, supporting and sustaining breastfeeding within the population that it cares for.

Many hospitals are redesigning their policies and procedures to align with Baby Friendly Hospital Initiative principles, otherwise known as The Ten Steps. Lactating individuals who give birth in Baby Friendly Hospitals have a greater likelihood of breastfeeding initiation and longer breastfeeding duration rates. The Baby Friendly Hospital Initiative requires training for nursing staff and providers.

Once lactating dyads and their families leave the hospital, they require evidence-based breastfeeding guidance and management that is accessible and affordable. Unfortunately, unlike the staff at Baby Friendly hospitals, outpatient medical care providers and staff are often inadequately trained in breastfeeding during their professional education. This ongoing lack of education exists despite the fact that more than 84% of newborns in the USA are breastfeeding at the time of hospital discharge. In addition, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetrics and Gynecology have formal statements advising breastfeeding education during specialty training. Can you identify any other health behavior that the majority of mothers and babies are engaged in, for which medical professionals are not educated?

Families often sense that their pediatricians, family physicians, and/or obstetricians do not have sufficient knowledge for primary care management of their breastfeeding problems. Families therefore seek other sources of support, such as lactation consultants at the hospital, WIC (Supplemental Nutrition for Women, Infants and Children), and community groups such as La Leche League, or other mother-baby groups.

This places the United States population at risk for racial and ethnic disparity in breastfeeding support since families with more resources will have a greater chance of accessing lactation care in their communities. In addition, lactating dyads are at risk for breastfeeding complications because of inadequate breastfeeding medical care. Such complications include chronic breast infections, breast abscesses, insufficient milk production, infant hypoglycemia, insufficient weight gain, premature weaning, and side effects from medications given to mothers by physicians who are well intentioned but lack knowledge on evidence-based breastfeeding management.

Research has shown that providing breastfeeding and lactation training to physicians, other providers, and staff can increase breastfeeding initiation and duration rates. However, medical systems require integrated strategies beyond educating clinic staff to optimally support breastfeeding dyads in an equitable manner.

The Breastfeeding Knowledgeable and Supportive Health System (BFKSHS) is a model of support with basic principles including:

A committee dedicated to overseeing breastfeeding support throughout the BFKSHS charged with:

  • Establishing a policy of breastfeeding support within the medical system.
  • Determining means and budget for ongoing provider and staff education.
  • Creating avenues of communication between health care consumers and office staff in order to manage breastfeeding questions.
  • Addressing financial and other resources needed to provide breastfeeding support throughout the system.

Basic breastfeeding care within its primary care medical homes (PCMHs)

  • An adequate number of office staff and providers are trained in primary care breastfeeding management.
  • Patients can easily and promptly access knowledgeable staff for breastfeeding support.

A breastfeeding friendly physical environment

  • Display of breastfeeding, rather than bottle-feeding images.
  • No gift packs of formula.
  • Breastfeeding parents feel safe with an option to feed in private.
  • Provision of comfortable chairs and other supports such as pillows and foot stools.
  • Breastfeeding parents are offered the option to nurse their infant during procedures.

Coordination of care between the PCMHs and the hospital

  • Hospital staff have the means to communicate feeding plans and other breastfeeding concerns to office staff who will be assuming care of the breastfeeding dyad.
  • Hospital staff are available to help protect and support breastfeeding dyads who require admission to the hospital beyond the birth episode.

Breastfeeding support within specialty departments

  • Specialty departments are aware that patients are lactating/nursing, and adapt care to optimize the breastfeeding relationship.

Establishment breastfeeding and lactation medicine specialty services

  • Breastfeeding and lactation medicine physicians/providers are available to provide a higher level of lactation management.

Collaboration with community supporters

  • Provides resources in the community for ongoing breastfeeding support, such as public health nurses, home visitors, WIC, mother-infant support groups such as LLLI, and private practice lactation consultants.
  • Establishes coordination of care between community breastfeeding supporters and the medical system.

Ongoing breastfeeding education for the PCMH staff

  • Breastfeeding education within the PCMH is sustainable. Office staff and providers receive basic breastfeeding training and periodic updates to maintain evidence-based knowledge.

Lactation support for employees