Many new mothers plan to breastfeed their babies. But breastfeeding isn't always easy, and more than half of new moms find they are unable to meet their breastfeeding goals after dealing with problems with milk production, pumping, nipple pain, and difficulty getting their babies to latch.
Highly trained lactation consultants, certified by the International Board of Lactation Consultant Examiners, can help moms navigate these issues.
But many moms who plan to breastfeed don't have access to high-quality, affordable support services after they are discharged from the hospital, says Melissa Glassman, a pediatrician and breastfeeding and lactation medicine specialist.
Melissa Glassman
In 2017, she established the Outpatient Breastfeeding Support Program at NewYork-Presbyterian/Columbia University Irving Medical Center to help address this gap in care.
To expand access, Glassman created a telelactation service in collaboration with the NewYork-Presbyterian Ambulatory Care Network.
Why create the telelactation service?
The CDC estimates that around 60% of women who try to breastfeed in the United States do not meet their breastfeeding goals. The same is true for women in New York City. While there are certainly disparities when it comes to breastfeeding rates, the problems that women face when it comes to breastfeeding are universal.
A lot of problems with breastfeeding arise in the first postpartum week. In the Ambulatory Care Network's Newborn Clinic, moms and babies are seen by providers within one or two days after being discharged from the hospital. At this first outpatient visit, our pediatric providers and our board-certified lactation consultants, who are also registered dietitians, answer a lot of breastfeeding-related questions and provide hands-on in-person breastfeeding support.
But not all moms who give birth at our hospital come to the Newborn Clinic for that visit. Then they may be on their own trying to find that level of breastfeeding support in the community. The majority of our patients are not able to pay out of pocket for this service, which isn't always covered by insurance.
The idea behind the telelactation service was to broaden our ability to work with patients in these early days and do a lot of troubleshooting, address their breastfeeding concerns and issues, and hopefully get them on the path to achieving their breastfeeding goals.
We started doing telelactation visits in March 2020, and patients can now self-schedule these visits as needed. The service is available at no cost to parents who deliver at NewYork-Presbyterian Morgan Stanley Children's Hospital or NewYork-Presbyterian Allen Hospital and whose babies are patients at the NewYork-Presbyterian Ambulatory Care Network and Columbia Pediatrics..
What's unique about our program is that it's offered to everybody from the moment they leave the hospital after delivery. We are focused on providing access for patients who are insured by Medicaid and those who historically have the most barriers to accessing timely, high-quality breastfeeding support from board-certified lactation consultants.
What does telelactation do well?
Telelactation is great for hearing the patient's history and gaining a deeper understanding of the issues that they are dealing with. Based on that, providers can make suggestions, provide guidance, and then do a follow-up visit later on to see how things are progressing.
Follow-up is key when it comes to lactation support because after the patient makes changes, you need to see what happens over the next couple of days. With everything that's going on during those crazy early postpartum days and weeks, telelactation makes follow-up easy: The parent can choose an appointment that fits their schedule, doesn't need to leave their home with their newborn, and can follow up with the same provider, which is really important.
With video, the patient can show you what they're doing, for instance, what's their positioning as they try to latch the baby, what's their pumping technique. And our lactation consultants can demonstrate positioning and other techniques with baby dolls and props.
Because our service offers access to the same lactation consultant on subsequent visits and is connected to the electronic health record with encounter notes included for every visit, the patient's physicians and care team can see what's happening.
Is the telelactation service having an impact?
As of September 2023, our lactation consultants have conducted over 3,500 telelactation visits among a largely Latinx population, most of whom are publicly insured.
What everybody wants to know is if telelactation is helping mothers breastfeed more. It's really hard to get that number, partly because that data is not always documented in the medical record and not all patients who make telelactation visits receive their ongoing pediatric care in the NewYork-Presbyterian Ambulatory Care Network or at Columbia Pediatrics.
It is very important to ask patients about their breastfeeding goals and see how close we can get patients to achieving those goals. Not everybody's goal is to increase the amount they are breastfeeding. For example, there are some patients who do not plan to exclusively breastfeed or need help with weaning. We listen to our patients and work closely with them to help them achieve whatever their feeding goals are and enable them to achieve personal success.
So far, we've seen a small but meaningful change in our patients' ability to meet their breastfeeding goals with recurrent visits.
References
More information
Melissa Glassman, MD, MPH, IBCLC, is associate professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons and a pediatrician at NewYork-Presbyterian Morgan Stanley Children's Hospital and NewYork-Presbyterian/Columbia University Irving Medical Center. She is also the founder and medical director of the NewYork-Presbyterian Ambulatory Care Network's Newborn Clinic and its Outpatient Breastfeeding Support Program in collaboration with the ACN's Division of Nutrition.
