Breastfeeding increases when moms are supported by International Board Certified Lactation Consultants (IBCLCs), study finds

Dec. 26, 2013

Researchers at UNC’s Gillings School of Global Public Health and School of Medicine and Yeshiva University’s Albert Einstein College of Medicine have completed two studies that found that periodic meetings with an IBCLC supported women, who are traditionally resistant to breastfeeding, to succeed and to increase breastfeeding intensity for at least for a few months—long enough for mother and child to gain measurable health benefits.

The results of the trials were published online Dec. 19 in the American Journal of Public Health.

Dr. Miriam Labbok

Karen Bonuck, PhD, professor of family and social medicine and of obstetrics and gynecology and women’s health at Einstein College, is lead author. Miriam Labbok, MD, MPH, IBCLC,  Professor of the Practice of maternal and child health and director of the Carolina Global Breastfeeding Institute at the UNC Gillings School, and Alison Stuebe, MD, assistant professor of obstetrics and gynecology in the UNC medical school and of maternal and child health in the Gillings School, are among the co-authors.

The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend exclusive breastfeeding for the first six months of life, followed by continued breastfeeding for one year or, according to WHO, two years longer as other foods are introduced.

However, according to the Centers for Disease Control and Prevention (CDC), only about 75 percent of infants nationwide are breastfed at all, and fewer than half are still being breastfed at six months, while intensive, exclusive breastfeeding falls off much more rapidly. Health benefits of breastfeeding can include reduced incidence of ear infections, stomach illness, obesity, SIDS, cancers, heart-related illness and pyloric stenosis rates for children and, for mothers, a reduced risk for breast cancer, Type 2 diabetes and heart disease.

This study found that women regularly counseled by IBCLCs with instruction and support for breastfeeding were more than four times as likely to exclusively breastfeed their infant at one month and nearly three times more likely to do so at three months, compared with the control group.

“The effects of the interventions in our trials—and our use of IBCLCs in particular—were more impressive than those reported by two recent reviews that evaluated the effects of the numerous previous trials aimed at improving breastfeeding rates,” Bonuck said.

Some of the lowest rates of breastfeeding are known to occur among black/non-Hispanic, younger, overweight and less-educated mothers and exclusive breastfeeding is low among Hispanics. Together those women made up a large majority of those enrolled in the two trials. Patients included in the trials received their care at Montefiore Medical Center, Einstein’s University Hospital.

The intervention groups were exposed to support consisting of two prenatal sessions. In addition, electronic prompts to remind physicians and midwives to discuss breastfeeding with the women occurred during five prenatal visits. Postpartum, support by an IBCLC included one post-birth hospital session and regular phone calls postpartum for three months or until breastfeeding ceased.

Two thirds of the women in the trials were either overweight or obese, which caused physical and psychological obstacles to breastfeeding. Support from the lactation consultant significantly improved these women’s changes to breastfeed for three months – “sufficient time,” Bonuck said, for mother and baby to obtain important health benefits.”

While the intervention never came close to attaining exclusive breastfeeding for six months, as advocated by the AAP, Bonuck points out that about 95 percent of the women in the two trials at least initiated breastfeeding—which exceeds the goal of 82 percent that the CDC has proposed in its Healthy People 2020 report. She also says that the odds that the women enrolled in these trials would achieve long-term, exclusive breastfeeding were quite low.

“This paper underscores that for breastfeeding moms to succeed in their feeding intentions, there should be prenatal preparation,” Labbok said. “In addition, there should be at least one visit by a lactation consultant in the maternity setting that includes observing an infant feeding, teaching hand expression and offering anticipatory guidance for what to expect after going home. The study shows that even with populations less likely to breastfeed optimally, ongoing contact with an IBCLC – having the ability to ask a question, day or night – clearly supports continued breastfeeding.”  She added, “All mothers deserve to have constructive and supportive feedback on their feeding skills, no matter how they feed their infants, but this study confirms that those who receive proper support are clearly more likely to decide to breastfeed.”

The authors are optimistic that professional lactation support might soon become more widely available, since private insurers must cover it under the Affordable Care Act (ACA). But they concerned that the ACA does not stipulate which providers qualify for reimbursement. New York State and North Carolina, for instance (home states for the authors), interpret the ACA to mean that licensed health-care providers, such as medical doctors, are reimbursed for lactation support, but international board-certified lactation consultants (the type of professional who participated in her clinical trials) are not.

In its 2012 policy statement on breastfeeding, the AAP states that “any breastfeeding” is associated with a 23 percent reduction in the incidence of middle ear infections; a 64 percent reduction in the incidence of gastrointestinal tract infections; a 45 percent reduction in the incidence of sudden infant death syndrome; and a 15 percent to 30 percent reduction in adolescent and adult obesity rates.

In addition to Drs. Bonuck, Stuebe and Labbok, co-authors include Josephine Barnett, MS, Jason Fletcher, PhD, and Peter Bernstein, MD, all at Einstein.

Full paper available online
Abstract available here
Einstein College of Medicine release here