Leading Lactation Insights - July 2022

Women’s Preventive Services Initiative – Breastfeeding Services

Maria Lennon, MSN, CNM, IBCLC

In 2016, the American College of Obstetricians and Gynecologists (ACOG) launched the Women’s Preventive Services Initiative (WPSI). This five-year cooperative agreement with the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), ACOG brought together a coalition of national health professional organizations and consumer and patient advocates with expertise in women’s health to develop, review, and update recommendations for women’s preventive healthcare services, including the HRSA-sponsored Women’s Preventive Services Guidelines  The guidelines now serve as the basis for insurance coverage with no cost-sharing to patients, and these recommendations help ensure that women receive a comprehensive set of preventive services without having to pay a co-payment, co-insurance or deductible.

The Institute of Medicine (IOM) recommends reviewing and updating the guidelines at least every five years. 

In the Recommendations for Well-Woman Care there is a Well-Woman Chart which provides a framework for incorporating preventive health services for women into clinical practice. Recommendations for preventive services for pregnant and postpartum women are also provided in the Well-Woman Chart, which is updated annually.

The section on Breastfeeding Services and Supplies was updated in January of 2022. 

Clinical Recommendations 

ALL pregnant and postpartum women should have access to comprehensive lactation support services during the antenatal, perinatal and postpartum periods. and access to breastfeeding equipment and supplies. The recommendations include, “comprehensive lactation support services (including consultation; counseling; education by clinicians and peer support services; and breastfeeding equipment and supplies) during the antenatal, perinatal, and postpartum periods to optimize the successful initiation and maintenance of breastfeeding.

Breastfeeding equipment and supplies include, but are not limited to, double electric breast pumps (including pump parts and maintenance) and breast milk storage supplies. Access to double electric pumps should be a priority to optimize breastfeeding and should not be predicated on prior failure of a manual pump. Breastfeeding equipment may also include equipment and supplies as clinically indicated to support dyads with breastfeeding difficulties and those who need additional services.”

Implementation Recommendations

“Lactation support services include consultation, counseling and psychosocial support, education, breastfeeding equipment and supplies. Lactation support services should be delivered and provided across the antenatal, perinatal, and postpartum periods to ensure successful preparation, initiation, and continuation of breastfeeding. Lactation support services should be respectful, appropriately patient centered, culturally and linguistically competent, and sensitive to those who are having difficulty with breastfeeding, regardless of the cause. Clinical lactation professionals providing clinical care include, but are not limited to, licensed lactation consultants, the IBCLC®, certified midwives, certified nurse-midwives, certified professional midwives, nurses, physician assistants, nurse practitioners, and physicians. Lactation personnel providing counseling, education or peer support include lactation counselors/breastfeeding educators and peer supporters. Clinical trials of interventions including at least five in-person visits across antenatal, perinatal, and postpartum periods to promote and support breastfeeding showed benefit, but more visits may be required, including psychosocial counseling for breastfeeding.”

The WPSI examines the evidence relative to breastfeeding practices and equipment, and also makes recommendations for further research in this area. Several other WPSI resources are available for download: Well-Woman Chart, Clinical Summary Tables, a Coding Guide and Patient Education Materials. Check out the links below for more information.

Breastfeeding services and supplies women’s preventive services initiative evidence update:

https://www.womenspreventivehealth.org/wp-content/uploads/Evidence-Update-Breastfeeding-2021.pdf

https://www.womenspreventivehealth.org/wp-content/uploads/WPSI-ClinicianSummary-Breastfeeding-051322.pdf 

Institute of Medicine. 2011. Clinical Preventive Services for Women: Closing the Gaps. Washington, DC: The National Academies Press. 

This month we are spotlighting Sandra Gonzales, BSN, RNC, IBCLC

Sandra Gonzales, BSN, RNC, IBCLC is an experienced newborn nurse and lactation consultant residing in the San Antonio, Texas area. Sandra notes that she knew she wanted to be in newborn services since she was a young girl, after seeing a baby family member be hospitalized and feeling inspired after witnessing the attention and care being given to help them return to health. She says, “I instantly knew that was my calling and my clinical rotations in school confirmed my dream.”

Sandra says that, after eleven years of newborn services, she felt pulled to continue expanding her knowledge and professional expertise beyond the norm to see how she could better assist those families needing higher intensity care. She decided to study lactation to stay within the realm of newborn services, while also having the ability to most optimally assist those with longer inpatient lengths of stay. Sandra also draws from her own experience of becoming a mother in 2004 and delivering at 35 weeks after developing HELLP Syndrome – In fact, she says, “it gives you a different outlook at the struggles for those who have difficult, compromised deliveries and breastfeeding complications.”

Currently, Sandra is the dedicated lactation consultant for the NICU at her hospital. In this role, she provides every mom with a one-on-one consultation to discuss their feeding plan for their baby. She sees that lactation support – breastfeeding and pumping – is continued throughout the baby’s hospital stay, assists in discharge preparation, and also ensures appropriate follow-up if and when needed. Among her other responsibilities, Sandra provides staff education and training (both in-house and outreach) and collaborates with other NICU disciplines to achieve their goal of increased breast milk usage in the NICU. She is the Chair of the NICU Breastfeeding Committee, and is also heavily involved in other newborn/women’s services committees and task force groups. Sandra also helps manage her hospital’s “Breast Pump Depot” program, where she helps mothers select and obtain a personal-use double-electric breast pump on the same day. This helps bypass delays in receiving their breast pump due to shipping and handling times while getting a breast pump in their hands right away.

Sandra notes that her hospital receives transports from many areas in South Texas, where there is a significant lack of breastfeeding education and resources. “Many have no prenatal care, so they arrive with no breastfeeding knowledge,” Sandra explains. “Most mothers express that the travel times, lack of support outside of the hospital setting, and the stress of having a baby in the NICU prevent them from being able to keep up the routine needed to be successful.” Luckily, Sandra’s hospital offers lactation services in the newborn and women’s units, as well as Sandra’s dedication to the NICU. As a Baby-Friendly hospital, all staff is trained and educated in lactation and reviews their training annually.

Sandra is proud to share that she has begun to see small improvements in breast milk usage through their program, but believes an even bigger impact could be made with the development of more prenatal programs and classes. 

Outside of her professional commitments, Sandra is a proud basketball mom to her 17-year old son, who plays on a national team. They travel occasionally with his basketball league, which works out well because she loves exploring and experiencing new places with her son and showing him all they have to offer, particularly when it comes to food, history, music, architecture, culture, and land. 

Thank you, Sandra, for all that you do and for your dedication to helping South Texas families ensure their babies get the very best start in life!

Thank you to this issue's contributors!

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