I practice in a rural area where few lactation consultants are available to support new moms with breastfeeding. In the current pandemic, access to this support has become even more limited as many lactating patients are uneasy about face-to-face interactions. Consequently, some patients have asked me about telehealth options for breastfeeding support. Is this an appropriate and evidence-based alternative?--M.P., ARIZ.
Olga Elena and Bridget Parsh, EdD, RN, CNS reply: Besides meeting the nutritional needs of a newborn, breastfeeding plays an important role in establishing an emotional bond between a mother and her newborn (see Why breastfeed?). With the demands of work and family life, however, new mothers who wish to breastfeed can feel overwhelmed and isolated.1 Due to insufficient breastfeeding support and a lack of knowledge, less than 50% of infants in the US are exclusively breastfed through 3 months, and only about 25% breastfeed exclusively through 6 months.2,3 The breastfeeding process can be physically and emotionally challenging, and the need for social distancing during the pandemic has raised new barriers.
International board-certified lactation consultants (IBCLCs) are specifically trained to manage breastfeeding problems. Improving women's access to IBCLCs is a policy priority in the Surgeon General's Call to Action to Support Breastfeeding.4 To improve access to IBCLCs, many providers are offering telelactation services. Like other forms of telemedicine, telelactation uses technology to deliver care at a safe distance.
Safe, round-the-clock access
Telelactation is a 24-hour-a-day video call resource that gives lactating mothers access to IBCLCs, peer counselors, or nurses from their homes via personal devices such as tablets and smartphones.5-7 With the advent of COVID-19, this distance support can provide a safe and private means for IBCLCs to assess and evaluate breastfeeding mothers and demonstrate techniques.8 The International Lactation Consultant Association (ILCA) offers numerous posters online to help IBCLCs better prepare themselves to provide virtual consultations.9 These posters include information about necessary materials and resources such as a strong internet connection, web camera, breast model and doll, and educational illustrations. Additionally, ILCA encourages lactation consultants providing telelactation to add a specific frame to their Facebook profile so it is visible for potential clients.9
Increasing access in rural areas
Even before the pandemic, a disparity in breastfeeding rates existed between rural and urban communities associated with an uneven distribution of IBCLCs.5,6,10 Likely factors include geographic disparities, socioeconomic status, ethnicity, and participation in free formula programs.4,10-12 Studies have shown that integration of lactation consultants via telelactation may increase breastfeeding intensity and exclusivity at 3 months.11,12
Two recent studies explored the experience with telelactation among rural breastfeeding mothers. Both studies revealed a high demand for virtual consultations, especially in the first weeks postpartum. Calls often took place outside of regular business hours, which indicates a demand for 24-hour access to IBCLCs. First-time mothers are more likely to use telehealth services as they experience breastfeeding problems.5,6
The evidence shows that telelactation is a convenient and efficient resource for supporting breastfeeding mothers in rural areas where access to IBCLCs is limited.5,6 Both mothers and IBCLCs prefer to participate in telelactation via videoconferencing, which makes the connection more personal than a phone call alone.5 Other valued options include texting, audio calls, scheduled calls, and the ability to request a specific IBCLC.5,6
Barriers to telelactation include poor access to technology such as smartphones and high-speed internet, and lack of awareness.5,11 Nurses can help patients overcome barriers by supporting mothers through evidence-based practice and providing timely referrals to telelactation to help prevent or manage problems that discourage women from breastfeeding.
Why breastfeed?
As an important strategy for improving public health, breastfeeding exclusively is recommended for infants for the first 6 months after birth and should continue for at least 1 year alongside the introduction of complementary food.2 Breastfed infants have lower rates of acute and chronic diseases such as respiratory and gastrointestinal infections as well as lower obesity rates in childhood and adolescence. Additionally, breastfeeding mothers have a lower risk of ovarian and breast cancer.13
Telelactation resources
Besides the resources listed here, nurses should become familiar with lactation services offered by their local hospitals and community organizations.
* California Breastfeeding Coalitionhttp://californiabreastfeeding.org
* International Board of Lactation Consultant Examinershttps://iblce.org
* Nursing Babies, Nurturing Familieshttps://lllusa.org/lllonfacebook
* United States Lactation Consultant Associationhttps://uslca.org/resources/find-an-ibclc
REFERENCES