By Allison Gallegos-Jeffrey, Naomi Billups, and Spencer Stein, Maternal, Child, and Family Health Services
San Diego County’s Racial and Ethnic Approaches to Community Health (SDREACH) is working to persuade new moms in under-resourced communities to breastfeed by increasing the number of certified lactation educators in the workforce and connecting pregnant women with breast pumps.
The organization has now helped to support over 100 individuals to become certified lactation educators, many of whom have been hired by or were recruited from Federally Qualified Health Centers. The American Academy of Pediatrics recommends that children be exclusively breastfed for the first six months of life and continue to breastfeed with complementary foods for two years or beyond. Breastfeeding is an optimal source of nutrition for infants and can also reduce the risk of developing chronic diseases for both mothers and babies.
While eight in 10 infants are ever breastfed, less than half of infants born in the U.S. are exclusively breastfed through the first three months of life (American Academy of Pediatrics Policy Statement, 2022). In San Diego County, breastfeeding rates differ among racial and ethnic groups. After delivery, less than seven in 10 African American parents report exclusively breastfeeding; less than eight in 10 Hispanic parents report exclusively breastfeeding at this same time; in comparison, more than eight out of 10 White parents exclusively breastfeed, the highest rate among all racial and ethnic groups (CDPH Genetic Disease Screening Program, Newborn Screening Data, 2019).
See also: Breastfeeding Coalition Takes Bold Steps to Combat Rising Infant Mortality Rates
Several factors play a role in whether and how long babies are breastfed, including access to education from experts and the availability of medical support in the first week after birth when breastfeeding issues most commonly arise. These supports impact a mother’s confidence to continue to try to breastfeed. A certified lactation educator is a breastfeeding support professional trained to assist women with the normal course of breastfeeding. Certified lactation educators are trained to teach breastfeeding classes, run breastfeeding support groups, and provide general training and counseling on breastfeeding. These experts are critical supports in the early postpartum period for mother and baby breastfeeding success.
The Affordable Care Act included groundbreaking provisions for increasing breastfeeding support, which importantly included requiring insurance plans to provide mothers with breast pumps at no additional cost. However, due to barriers such as lack of knowledge or clinical processes, these benefits may not reach mothers when they are eligible, further impeding breastfeeding duration. Certified lactation educators are important infrastructure resources to identify and support mothers’ access to breast pumps in addition to knowledge around breastfeeding.
San Diego County’s Racial and Ethnic Approaches to Community Health collaborated with Dr. Shaila Serpas, a physician at the San Ysidro Health Center, to partner with breast pump vendor Hygeia Health to establish a workflow to inform pregnant patients of their right to a breast pump at no additional cost through their insurance. This workflow includes clinic staff submitting patients’ insurance information on their behalf through the online ordering system. Hygeia Health breast pumps also include an app to connect users with certified lactation educators and breastfeeding support.
Lactation support for some of San Diego’s most vulnerable populations has increased as a result of San Diego County’s Racial and Ethnic Approaches to Community Health work to expand the certified lactation educator workforce and adopt workflows to connect expectant mothers with breast pumps. Since 2019, there have been over 10,000 clients served by lactation educators at clinics and community health workers partnering with San Diego County’s Racial and Ethnic Approaches to Community Health. These appointments offer mothers the support, knowledge, and skills needed for successful breastfeeding.
Since the implementation of the improved workflows in April 2020, the number of women ordering breast pumps increased from an average of seven to 30 per month at the San Ysidro Health Center. Mothers receive their breast pumps in the third trimester so that they have them available immediately after birth. A similar process has been implemented at Family Health Centers of San Diego and La Maestra Community Health Centers, both serving San Diego’s most culturally diverse and under-resourced communities. The implementation of breastfeeding support is helping to increase access to valuable breastfeeding resources for more mothers in South and Central San Diego County.
Easy and early access to breastfeeding support helps new mothers with challenges that arise early in the postpartum period. The work of the San Diego County’s Racial and Ethnic Approaches to Community is supporting mothers to continue to breastfeed with the goal of improving health outcomes for both mothers and babies. Both expanding the certified lactation educator workforce and improving clinical workflows to ensure expectant mothers have breast pumps ordered are practices that can be expanded and adopted by other Federally Qualified Health Centers.
