Using Telehealth to Expand Patient Access to Breastfeeding Support

Breastfeeding provides several benefits for babies and mothers but navigating the process can prove challenging, particularly amid the ups and downs of the newborn phase. Like other aspects of maternal and infant care, virtual care programs can help support new mothers who want to breastfeed by connecting them to the needed resources.

The benefits of breastfeeding are well-documented. Breast milk is a comprehensive source of infant nutrition, can help stave off some short-and long-term illnesses, and enables babies to gain valuable antibodies from their mothers, according to the Centers for Disease Control and Prevention. Further, breastfeeding can reduce the mother's risk of developing several conditions, including breast and ovarian cancer and type 2 diabetes.

Though a majority of babies are breastfed initially, there appears to be a drop-off at the six-month mark, and rates continue to decline from there. In total, about 84 percent of babies were breastfed in 2018, but only 57 percent were breastfed at six months and 35 percent at 12 months, according to CDC data.

To support breastfeeding, the five-hospital Trinity Health of New England system joined forces with Nest Collaborative last month to launch a telehealth program.

THE VIRTUAL BREASTFEEDING SUPPORT PROGRAM

The telehealth-enabled breastfeeding support program, launched at the end of June, connects pregnant women and new mothers to a nationwide network of lactation consultants.

"Nest Collaborative's [lactation consultants] help families reach their breastfeeding goals and assist them in making informed decisions about infant feeding options," said Judith Nowlin, CEO of Nest Collaborative, in an email.

The company provides an online platform through which people can book same-day virtual visits with the consultants, who offer guidance on various topics, including "the importance of proper latch, milk storage, pumping, increasing milk supply, weaning and any complications related to breastfeeding," she added.

Patients at Trinity Health of New England's three birthing hospitals can access the telehealth program before and after delivery.

"It's incredibly important to me as an obstetrician that our patients see and learn about breastfeeding prior to delivery because you're going to convert a patient from a bottle feeder to a breastfeeder long before the baby's born," said Walter Trymbulak, MD, PhD, chair of the women and infants service line at Trinity Health of New England, in a phone interview. "And knowing that they have support and knowing that they have the information that they need to be successful prior to delivery is key."

Before the patient is discharged from the hospital after delivery, the staff once again notes the availability of Nest services so that patients are set up with access to lactation consultants before they go home, as the first few weeks after delivery tend to be the most challenging with regard to breastfeeding, he added.

The lactation consultants are available in all 50 states, making them accessible in different time zones.

"So those of us on the East Coast can take advantage of those lactation consultants who are working regular hours on the West Coast at hours when we might not find help typically available here to us," Trymbulak said. "Nine o'clock at night [here], somebody's still at work in California."

WHY THE HEALTH SYSTEM IMPLEMENTED VIRTUAL BREASTFEEDING SUPPORT

Like many other organizations, Trinity Health of New England provided breastfeeding support well before collaborating with Nest. But the support services were offered in person.

The pandemic disrupted these in-person programs. About 18 percent of hospitals reported reduced access to in-person lactation support in the summer of 2020, according to data from the CDC. At the same time, around 48.7 percent of hospitals offered virtual breastfeeding consultations after discharge.

"When the pandemic hit, and in-person visits both in the prenatal office, as well as home visits, were really challenged by the pandemic, we needed to pivot, and we, in our own way, pivoted to remote care and peer breastfeeding for our patients," Trymbulak said. "But honestly, we were built and grew up on an in-person model, and that pivot was relatively difficult for us."

At that time, Trymbulak connected with Nest Collaborative and learned about their services.

"So [we] reached out and got together and started talking, and there was clearly [an] opportunity that we're taking advantage of now," he said.

According to Trymbulak, the increased need for breastfeeding support can be tied to the rise of infant formula in the 1960s. Before that, generational knowledge of breastfeeding was passed down within families and communities.

"There are certainly some subgroups of folks and some families that have been successful in keeping breastfeeding as the primary modality of baby feeding in their families and in their groups," he said. "But generally speaking, overall, our communities really lost that expertise. Our country has really lost that expertise."

Further, the recent infant formula shortage crisis has highlighted the need for breastfeeding expertise.

In early May, the out-of-stock rate for baby formula rose to 40 percent, according to CNN. This was largely due to the recall of several baby formula products made by Abbott Laboratories, supply chain issues due to the pandemic, and strict regulatory and trade policies that prevented the purchase of products from countries abroad.

"Our program and Nest are both working together to try to return this expertise to our community, or at least provide the support that used to be provided by your mother, or your aunt, or your cousin, or the lady that lived next door," Trymbulak said.

THE ADVANTAGES OF BREASTFEEDING SUPPORT THROUGH TELEHEALTH

One significant benefit of the program is expanding access to breastfeeding support. New parents can connect with lactation consultants and access the guidance they need from their smartphones or computers, Trymbulak said.

"And for anybody that's ever had a newborn baby and having trouble breastfeeding, being able to bring that service to you in your house, even if it is remote services, is really great, because packing up a kid and trying to get in a car and go somewhere for help is like a monumental feat in and of itself," he added.

Not only that, but the program enables new parents to connect with a nationwide network of lactation consultants on a single platform.

In the US, there are a limited number of lactation consultants, with CDC data showing that there were only 3.7 international board-certified lactation consultants per 1,000 live births in 2015. By providing breastfeeding support virtually, Trinity Health of New England hopes to increase the number of consultants new parents have access to when needed, according to Trymbulak.

Further, the lactation consultants report back to the maternal care team at Trinity Health of New England, allowing health system staff to pick up with the parents from where the consultants left off, providing a "completely wraparound program," he said.

The program has been rolled out at Mercy Medical Center in Springfield, Massachusetts, Saint Mary's Hospital in Waterbury, Connecticut, and Saint Francis Hospital in Hartford, Connecticut — the health system's birthing hospitals.

But there are plans to expand the program across birthing hospitals within Trinity Health, the 93-hospital system that Trinity Health of New England is a part of. 

"The overall advantage to this program is one more baby may be able to get one more feeding of breast milk, and if we're able to do that, then the program's a success," Trymbulak said.