Implementing International Board-Certified Lactation Consultants Intervention into Routine Care: Barriers and Recommendations

Abstract

The Surgeon General’s 2011 Call to Action on Breastfeeding (U. S. Department of Health and Human Services, 2011) encourages greater use of International Board-Certified Lactation Consultants (IBCLCs) to increase breastfeeding rates. The objective was to examine IBCLCs’ experiences as part of a routine, primary-care based team serving low income, minority populations, and to elicit their recommendations for implementing IBCLC support as routine in prenatal care. Using a predesigned interview guide, a debriefing session was held with three IBCLCs who served as interventionists in two NIH-funded randomized controlled trials (RCTs) of breastfeeding promotion interventions. Themes were identified through coding and analysis of the session transcript. The results indicated that healthcare provider (HCP) support for breastfeeding was undermined by inadequate education and experience, often resulting in support "in name only." In addition, IBCLCs rapport and expertise—with both women and the healthcare team—helped overcome individual- and system-level barriers to breastfeeding. IBCLCs’ acceptance and integration into the primary-care team validated their work and increased their effectiveness. IBCLCs comments suggest that mothers cannot rely solely upon their healthcare providers for breastfeeding education and support. IBCLCs integrated into routine antenatal and postpartum care are pivotal to encouraging and reinforcing a woman’s choice to breastfeed through education, as well as emotional and skill-based support.