Background: Despite evidence for breastfeeding benefits, hospitals fall short in breastfeeding rates and duration. Recent CDC data suggests < 4% of US hospitals offer full support necessary to meet enduring, committed breastfeeding while nearly 75% don’t provide maternal support after discharge. This challenges an institutional ability to meet Healthy People 2020 goals of having 81.9% of mothers initiate breastfeeding, 60.6% breastfeeding at 6 months and 34.1% breastfeeding at one year. The Surgeon General’s “Call to Action to Support Breastfeeding” underscores this critical need, noting low priorities for breastfeeding and use of non evidenced-based practices as barriers to enduring breastfeeding. A comprehensive breastfeeding program is one way to meet challenges stated above.

Framework for the talk: CCHS has built an enduring lactation program available across the continuum of perinatal care aimed to meet these action calls. Support is offered to mothers and other perinatal clinicians by experienced lactation consultants to overcome breastfeeding obstacles. This promotes the development of knowledgeable mothers and healthcare providers.

Our facility maintains a free, breastfeeding “hotline” staffed by lactation consultants. Mothers may initiate a call at any time during their breastfeeding experience when they encounter questions/concerns. As part of this program, logs document telephone conversations. To assure that mothers are being offered relevant information, logs were subjected to qualitative analysis, determining the nature of maternal concerns. Ten themes emerged. Specific, predictable breastfeeding topics developed at key points during the first year of life.

Data from 1025 breastfeeding mothers who called during 2009 were examined. Findings were then compared to nurses’ perceived breastfeeding barriers by care area, as defined in a separate PI project. Results of both projects clearly indicated need to initiate breastfeeding education activities during prenatal classes, maintaining momentum during the inpatient phase and providing anticipatory post-discharge guidance so that a successful support program was in place to meet aforementioned goals.

Implications for practice:  A team approach focused on breastfeeding to support maternal/child nurses and mothers is one way to improve hospital practices and meet goals. Inpatient nurses should address predictable areas of concern with new mothers particularly concerning milk supply, baby behaviors, and pumping. Outpatient clinicians can offer anticipatory guidance based on consistent patterns of data across postpartum such as drug/diet interaction with milk, stooling patterns, weaning among other issues. Appropriately timed information coupled available resources offered when mother is ready to learn, improves chances that mother is able to process and retain shared information.