Building a Lactation Program of Excellence

A colleague and I were recently discussing the things that would be on our “wish-list” if we could build the lactation program of our dreams in a hospital setting. Let’s see – excellent staffing with IBCLCs available to each mother every day, all nursing and providers having received lactation training, weekly support group, comfortable fully-staffed outpatient clinic, time for research and administrative duties, an active task force, outstanding prenatal education which is well attended, and more! Outside of two friends dreaming though, what do the experts recommend?

Guidelines in the literature for lactation programs

The United States Lactation Consultant Association (USLCA) recommends the following:

• A lactation care provider should be available by request to every mother/baby dyad within the first 24 hours following birth
• An IBCLC should be available to every mother/baby dyad by request prior to discharge
• Every medical/birth professional should complete at least one college-level breastfeeding course  (1) 

Mannel and Mannel, from Oklahoma University Medical Center, in 2006 published staffing guidelines based on multiple factors including acuity, population and community support. (2)

• 3 FTEs (full-time equivalents) per 1000 post-partum dyads
• 3 FTEs per 1000 NICU admissions
• 8 FTEs per 1000 births for outpatient appointments
• 3 FTEs per 1000 births for telephone triage
• 1 FTEs per 1000 births for education
• 1 FTEs per 100 births for program development and administration
• 0.2-1 FTEs for research

  (Note: 1 FTE = 40 hours)

The International Board of Lactation Consultant Examiners^® (IBLCE^®) and the International Lactation Consultant Association^® (ILCA^®) developed the IBCLC Care Award for hospitals who demonstrate commitment to supporting breastfeeding families by having:

• At least one dedicated IBCLC position
• A dedicated lactation program available at least 5 days a week

• Evidence-based projects that protect, promote and support breastfeeding 
• Breastfeeding education for staff (3)

Action 11 of the US Surgeon General’s Call to Action to Support Breastfeeding states:

• Ensure access to services provided by International Board Certified Lactation Consultants
• Include support for lactation as an essential medical service for pregnant women, breastfeeding mothers, and children
• Provide reimbursement for certified lactation consultants independent of their having other professional certification or licensure
• Work to increase the number of racial and ethnic minority certified lactation consultants to better mirror the U.S. population (4)

What do mothers want?

Reported perceptions of lactation care in the hospital setting are limited, but an article published in 2016 in Breastfeeding Medicine asked over 1000 women to complete a questionnaire on the topic.(5) The women were mothers with infants aged 0-2 years old, and who had planned to breastfeed.  Here is what mothers told them:

• Breastfeeding education is valued
• Breast is not best; it’s normal: Move away from “breast is best,” toward “breastfeeding is normal”
• Don’t focus solely on health impact: Emphasize more than health benefits of breastfeeding (ex: closeness, saves time & money)
• Take it a day at a time-every feed counts: Acknowledge that every feed, rather than just 6 months exclusive matters
• Tell us the truth-it can be challenging: Provide realistic information about what breastfeeding is like
• Target a wider audience: Promote and educate others in addition to mothers - (ex: family members, society) - because they are a key influence in maternal decision making and the ability to successfully breastfeed

While this doesn’t inform us how to build a lactation program per se, what it does tell us is that women want to breastfeed, they want education and they want to be given credit for breastfeeding for any length of time and for any level of exclusivity. In order to do this, we need to provide the availability of staff who can adequately meet those needs – someone to support the mother with each feeding in the early days if needed.  Someone to educate her family members.  Someone who can reach out to the community and build bridges of support for her and her infant after discharge.  These efforts should be a part of a quality lactation program. 

How does this compare to the program where you work? Do you have these components or are there gaps you can identify?  Do you have other program elements that you find useful? State breastfeeding collaboratives and coalitions are ideal places for ideas and challenges to be discussed. They provide a platform for sharing innovations, challenges and quality improvement initiatives. So, while you’re working on your dream program, think about joining and becoming active with your state coalition. If your state doesn’t have one, think about starting one! Because while we all like to dream about the ideal program, remember that, “The distance between your dreams and reality is called action.”

 References

1. Lober A, Harmon D, Thomas-Jackson, SC. Position Paper—Professional lactation support staffing in the hospital setting. Clin Lact. 2021;12(4)157-158.
2. Mannel R, Mannel RS. Staffing for hospital lactation programs: Recommendations from a tertiary care teaching hospital. J Hum Lact. 2006;22(4),409–417.

3. International Board of Lactation Consultant Examiners. (2023, February 24). Hospital-based facilities. IBCLC Care Award.

4. US Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breast-feeding. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General, 2011.

5. Brown A. What do women really want? Lessons for breastfeeding promotion and education. Breastfeed Med. 2016;11(3),102-110.