Team-Based Breastfeeding Support at a Federally Qualified Health Center: Efficacy, Utilization, and Patient Satisfaction

Background: A team-based, integrated lactation consultant (LC) and primary care provider (PCP) program improves breastfeeding rates in some outpatient settings, but only a limited number of studies have assessed efficacy in socioeconomically and racially diverse communities. Objectives: Following implementation of team-based LC/PCP care at a Federally Qualified Health Center (FQHC), quality improvement efforts assessed utilization, breastfeeding rates, and patient satisfaction. Method: A retrospective chart review examined feeding status pre- and postimplementation. Analysis compared feeding rates at the 2-week, 2-month, 4-month, and 6-month well visits (well child care). Subanalysis of patients who initiated breastfeeding postimplementation examined feeding status and LC support. Patient survey evaluated satisfaction. Results: Among patients who initiated breastfeeding, those who received a LC/PCP visit were significantly more likely to be breastfeeding at 2 weeks (94% versus 80%, p = 0.004) and 4 months (68% versus 45%, p = 0.01). However, breastfeeding rates for the whole practice were not significantly different before and after implementation. Seventy-two percent of breastfeeding families saw a LC (n = 204). Median LC visit per breastfeeding patient was 1.18 (standard deviation [SD] +1.2). Patient survey reported that the three most commonly helpful aspects of the visit were "latch instruction" (60%), "breastfeeding questions answered" (80%) and "learning about massage and hand expression" (50%). Discussion: Team-based LC/PCP care is feasible at a FQHC. Patients found it helpful. Among families who initiated breastfeeding, receiving LC/PCP care was associated with increased breastfeeding duration through 4 months.