Physician Lactation Education Collaborative

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Alarmed by persistently low breastfeeding rates in the U.S. and the associated maternal and child illness, numerous health authorities, including the Surgeon General, have called for the improvement of physician knowledge about and support for breastfeeding. Studies clearly show that breastfeeding initiation and duration rates increase when physicians recommend breastfeeding to their patients. Research also shows physicians do not receive adequate training about how to best support breastfeeding. Numerous studies recommend that evidence-based lactation training be included in residency programs and continuing medical education (CME) workshops to improve physicians’ skills in breastfeeding promotion and support.

During 2002 and 2003, King County WIC clinics reported a perceived increase in the number of infants unnecessarily supplemented with formula while in the hospital. Mothers who had expressed a strong desire to breastfeed antepartum were partially breastfeeding and supplementing with formula or completely formula-feeding by their first postpartum WIC appointment. WIC personnel also reported that mothers were complaining that they received little support and/or inaccurate information regarding breastfeeding while in the hospital.

The Public Health-Seattle & King County WIC Program, WithinReach (formerly Healthy Mothers, Healthy Babies) and the Breastfeeding Coalition of Washington convened a meeting in the fall of 2003 to address the need for improved lactation training for physicians. Key community stakeholders were invited to become involved, and the Physician Lactation Education Collaborative of Washington (“the Collaborative”) was established.

The mission of the Collaborative is to increase the incidence, exclusivity, and duration of breastfeeding by providing support and evidence-based education to physicians in hospitals, clinics and other community health settings. Specifically, the Collaborative aims to:

• promote optimal infant health particularly among families who have greater health disparities and lower rates of breastfeeding
• increase the number of exclusively breastfed infants by providing support and evidence-based education to physicians in order to prevent acute and chronic illness

During 2005 and 2006, ten evidence-based lactation education modules were developed by Collaborative members. These hour-long modules cover a variety of topics including breast pain; insufficient weight gain; feeding the near-term infant; medications and breastfeeding; controversies in parenting advice; multicultural aspects of breastfeeding; latch; blood glucose in the breastfed infant; immunology; and lactation policy development. Each module includes a guide for presenters, PowerPoint presentation, culturally-appropriate photographs and bibliography from peer reviewed publications. Modules include a topic outline, learning objectives and questions to stimulate discussion on how to improve practice.

During 2006 and 2007, eight of the modules were piloted in hospitals and clinics in King County (greater Seattle area) and Spokane County reaching nearly 250 health care providers. Approximately 42% of participants were physicians or residents. Other health care providers included medical students, midwives, nurse practitioners, nurses, IBCLCs and dietitians.

Feedback from presenters and participants has informed revision of the modules. Four of the modules were going to be released on a compact disk at the end of 2007. As of November, the decision was made to release all 10 modules on two disks in July, 2008. These will be made available to Washington state residents at no charge. Included with the disk will be suggestions for organizing trainings using the modules. Please check this website for updates.

The Collaborative is made up of more than 20 members, including seven physicians, who represent eight hospitals, county public health agencies, Washington Department of Health and non-profits. Funding for this work has come primarily from WIC (Public Health-Seattle & King County and Washington State); CDC Steps to a Healthier US (through Public Health-Seattle & King County); the Office of Women’s Health, Region X; Washington State Department of Health; WithinReach; private funds and hours of in-kind support.

Lisa DiGiorgio (Nutrition Consultant & Breastfeeding Coordinator, WIC & Nutrition Services Public Health- Seattle & King County) and Kimberly Radtke (Coordinator of the Breastfeeding Coalition of Washington) gave a presentation about this project in August at the 2007 International Lactation Consultants Association Conference in San Diego. In January, 2008, Kimberly Radtke, Nancy Danoff, MD (Washington Chapter of the AAP, Breastfeeding Coordinator) and MaryAnn O'Hara, MD (Seattle Breastfeeding Medicine and Western Chair of the BCW) presented this project at the National Conference of State Breastfeeding Coalitions in Virginia.

Physician Lactation Education Collaborative of Washington Members