Hospital-based Paraprofessional Lactation Clinic

Methods:

Eligibility: Hispanic mothers who intended to breastfeed and were scheduled for simultaneous discharge with their healthy infants were eligible for enrollment. Women were excluded if factors indicating elevated risk for hyperbilirubinemia were noted in the infant's chart (<37 weeks gestation at birth, < 48 hours of age at discharge, jaundice within 24 hours of birth, Rh incompatibility; cephalohematoma, positive coombs test, family history of disorders of RBC enzyme defects or defects of RBC shape and size, and exclusive breastfeeding in the hospital).

Setting: Subjects were recruited between during the 2004 calendar year at a large metropolitan Hospital in Houston Texas. Ninety percent of mothers delivering at the facility are first generation immigrants, and 85% are monolingual Hispanic. Infants spend > 4 hours in the newborn nursery before being reunited with their mothers. Feeding counselors assist mothers with latch-on at hospital bedside and encourage exclusive breastfeeding. Ninety-seven percent of mothers initiate breastfeeding and all but 2% of them choose to offer "las dos cosas" (both breast and formula) in the hospital. Infants at elevated risk for hyperbilirubinemia are screened for medical and breastfeeding problems at 3-5 days in a Newborn Follow-up Clinic (NBFC). All mothers receive the telephone number of the hospital's breastfeeding clinic and the WIC office with instructions to call for breastfeeding assistance if needed after discharge. For infants at low risk for hyperbilirubinemia, there is a gap of approximately two weeks between hospital discharge and the first well child exam. The first WIC visit also occurs approximately two weeks postpartum.

Intervention: The intervention consisted of scheduling mothers of infants at low risk for hyperbilirubinemia to visit the hospital-based breastfeeding clinic at 3-7 days post partum. An appointment reminder card was included with the discharge papers. At the breastfeeding clinic, mothers received counseling from bilingual, bicultural paraprofessionals under the supervision of an International Board Certified Lactation Consultant / registered nurse. A breastfeeding history, breast and nipple exam, infant oral-motor assessment, infant weight, observation of a breastfeeding episode with evaluation of latch and milk transfer, and discussion of maternal concerns and support system were included in the counseling sessions. The importance of exclusive breastfeeding was reviewed, and plans for attaining exclusivity were discussed if the mother desired to achieve that goal. Information and skills training were provided as indicated for identified deficits, concerns, and breastfeeding problems. Additional visits and / or telephone consultations were provided if deemed necessary by the mother and the clinic staff.

All clinic contact was recorded by staff. Women who missed appointments received a phone call from a clinic counselor. Visits were rescheduled if possible; if not, counseling was provided over the phone. During phone counseling, mothers were screened for breastfeeding problems and concerns regarding adequacy of milk supply. Problem management was discussed where indicated.