Pediatric Residents on Lactation Rotation

Lutheran General StaffThank you to the staff at Advocate Lutheran General Hospital for sharing part of their journey with us for the Hospital Breastfeeding Toolkit:

– Jennifer Albert, MSN, RNC-OB, APN/CNP, WHNP-BC, IBCLC, RLC
– Jody Heinrichs-Breen, BSN, RNC-OB, RNC-MNN, IBCLC
– Frank Belmonte, D.O., MPH, Director, Pediatric Residency Program Vice Chair, Pediatrics

While we have a high breastfeeding initiation rate (~95%) at Advocate Lutheran General Hospital, we also were aware of inappropriate supplementation, so our moms were not exclusively breastfeeding. Focused on providing evidence based care, we educated the nursing staff, but the pediatric residents are the first “go-to persons” for the nursing staff. We found them unable to make a plan of care with best practices, due to lack of breastfeeding knowledge.

Our program was the result of grassroots effort between the director of the pediatric residency program, Dr. Belmonte — who is a breastfeeding champion — and the lactation department. It was decided to create a mandatory, 2-week Lactation Rotation for all first year pediatric residents.

The program consists of at least 50 hours of bedside clinical rounding with the IBCLC, observation with the NICU LC, attendance at the Breastfeeding Support group, and an evidence-based PowerPoint presentation on a breastfeeding topic presented to the medical and nursing staff.

Some examples of the presentations include: Pacifier and Breastfeeding; Can Breastfeeding Help Prevent Obesity?; Galactogogues; Does One Bottle Matter?; Skin to Skin; Postpartum Depression and Breastfeeding; Supplementing the Breastfed Infant; Diabetes and Breastfeeding; Engorgement, Plugged Ducts, Mastitis; Breastfeeding – Painful? – Reasons, Implications and Interventions; and The Impact of Breast Surgery on Breastfeeding. The presentations are all peer reviewed, and later uploaded to the hospital intranet for those who are not able to attend.

Every resident receives an education binder that includes: Illinois Physicians’ Statement on Breastfeeding, ABM protocols, and Wellstart International Lactation Management self-study modules. They also view videos such as Jack Newman’s Visual Guide to Breastfeeding; Biological Nurturing Laid-Back Breastfeeding by Suzanne Colson; Managing Early Breastfeeding Challenges and Breastfeeding Best Practice from Injoy; and they receive their own copy of Thomas Hale’s Medications and Mother’s Milk.

In order to collect data, we chose to use the AAP Breastfeeding Residency Curriculum Pre-test four times: the first day of the rotation, the last day of the rotation, at 6 months and at one year. This has been IRB approved.

The Lactation Rotation was opened up as an elective for 2nd and 3rd year pediatric residents, and the slots were filled for a whole year. Recently, the Family Practice residents have requested that their director arrange for them to take the rotation – which is still in the works.

Here are some comments we’ve heard:

1) From a patient – “Are all the doctors lactation consultants? Because the residents came in this morning and the majority of their questions were about breastfeeding.”

2) From an attending pediatric physician – “The whole vibe in the nursery is different because the residents have advanced knowledge of breastfeeding and are better able to present the whole picture.”

3) From the residency director – “I overheard in the resident’s clinic last week that one of the second year residents, who had not taken the lactation rotation, came out from a patient who was having breastfeeding problems. Two of the residents who had taken the rotation gave her evidence based trouble shooting solutions to bring back to the patient, and further assessment questions to ask.”

4) From the LCs – Some residents that have had children and were taking the rotation said, “Now I know what I did wrong.” or “Now I know how I could have helped my wife.”

5) Recently one of the first year male residents and his wife had their third baby, and he commented on how comfortable he felt helping his wife this time with breastfeeding.

6) From the LCs – “It has been amazing to see how their knowledge, confidence, learned skills to assist patients and passion for breastfeeding support has grown. When presenting their evidence based PowerPoint project, they are well versed and their pride for their accomplishment is evident. Their peer reviews have been consistently outstanding.”


Hospital Breastfeeding Toolkit

HealthConnect One’s Hospital Breastfeeding Toolkit is a collection of strategies and resources, designed to help guide hospitals through implementation of breastfeeding supportive maternity care practices.  You can access the full toolkit here.