Link in- and outpatient breast-feeding services
Support inside and outside hospital key to success
Question: What is the effectiveness and efficiency of lactation consultants? Where are they functioning in the hospital or the community? What kind of breast-feeding programs are benchmarking in the country for successes in meeting the needs and satisfaction of breast-feeding mothers?
Answer: To set up the breast-feeding program it rolled out in June 1997, management at Sacred Heart Medical Center in Spokane, WA, benchmarked with 20 hospitals in the region. The process yielded helpful information for program design.
"We found that breast-feeding programs that were most successful in helping new mothers overcome problems had inpatient and outpatient services," says Sherry Maughn, RN, women services director at Sacred Heart.
Also, most successful programs had one or more full-time employees devoted to lactation counseling, and the majority of the people who held the position were certified lactation nurses.
Teaching is done at follow-up center
The first 24 hours after having a baby is not the best time to teach, says Karen Baker, BSN, CLC, coordinator of the Small Wonders Maternity Services, an OB follow-up center at Union Hospital in Terre Haute, IN. That’s why outpatient services are important. Although there is a nurse with lactation training in the inpatient setting to help with problems, a lot of the teaching is done at the follow-up center. All mothers visit the follow-up clinic the second day after discharge for a basic assessment on the baby and to receive hands-on instruction with breast feeding, if needed.
"We schedule hour-long appointments for each mom and baby so we don’t rush them. Now that the mothers have been home with the baby for 24 hours or more, they have questions," says Baker. They can come back for breast-feeding instruction as long as they need to. Baker has had some mothers come to the clinic every day for two weeks.
If problems aren’t solved in the hospital, most new mothers will quit breast feeding unless they have support. The support can be family members and close friends or professional services, says Nicki Ward, BSN, IBCLC, a lactation consultant at Northwestern Memorial Hospital in Chicago. With an outpatient clinic in the planning stages, women are referred to private lactation consultants if they need further help.
"The consultants are hired to do some home visits to assist with feedings. That helps decrease a mom’s anxiety," says Ward.
Yet the going rate for private consultants in Chicago is $75 an hour, which makes them too expensive for low-income mothers. To help solve the problem, a prenatal clinic associated with Northwestern trained peer counselors to help support low-income breast-feeding mothers.
If mothers succeed at breast-feeding, part of that success is related to the kind of support they receive both on the inpatient and outpatient setting, says Lori Salisbury, RN, BSN, lactation specialist at Sacred Heart. Every mom is briefly seen by a lactation nurse at the hospital. Then as problems are identified by the floor nurses, the lactation nurses are called in as needed. They carry a beeper so they can be notified when the mother is nursing to give hands-on help. (For more information on the benefits of staffing lactation consultants, see story, above.)
Phone lines are always open
When the mother is discharged, a helpline nurse follows up with a telephone call, and the new mom can call any time with questions. The lactation nurses and helpline nurses work as a team. Each exchange information about moms with breast-feeding problems. If the moms are still having problems, they can come into the outpatient clinic, and a lactation consultant will watch them feed their baby.
Each morning, Vicki Bodley, IBCLC, co-owner of Lactation Associates of Montana in Billings and her partner drive to the hospital to make rounds. They are under contract with a pediatric clinic to work with moms who are nursing and accompany them to their first well baby visit at the clinic.
"More than half of the babies born at the hospital are with the clinic. We see between 700 and 900 mothers a year," says Bodley.
With the hands-on help at the hospital, only about 10% to 15% need follow-up. For those who do, Bodley offers a three-month care plan that includes two to three home visits and unlimited phone calls. The cost is $60.
Moms prepare early for breast-feeding
Prenatal breast-feeding classes are also an important component of a good program. Bodley and her partner offer a two-hour class bi-monthly. It is held at an obstetrician’s office and marketed with the aid of fliers and by word-of-mouth. A core part of the education focuses on positioning the baby to prevent sore nipples and tips on how the baby might act when first home from the hospital. For example, the baby is often fussy.
"We talk about how milk is made. It is important to understand how breasts work. Knowing that before you deliver your baby is very reassuring just like taking Lamaze classes and knowing what to expect in delivery is reassuring," says Bodley. New moms attend one prenatal breast-feeding class.
While a good breast-feeding program boosts patient satisfaction, it is difficult to support financially.
"We are paying registered nurses, yet we can’t charge patients for the service," says Maughn.
To offset the cost of the salaries, Sacred Heart began a breast pump rental program last month. They lease the same kind of breast pumps that are used in the hospital for $14 and rent them to women for $55 a month. Many women become familiar with the pumps in the hospital, so they don’t have to be taught how to use them. Sacred Heart rented 12 pumps in the first month and expect to rent 30 per month and make $1,000 when the program has been established for awhile.
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