Calling for support
24-hour hotline aims to improve state’s breastfeeding rate
Veteran mom Leslie Meehan made her first call to the Tennessee Breastfeeding Hotline at 2 a.m. After successfully breastfeeding her first-born son for 13 months, she was surprised to have such a different experience with her 4-day-old son, Ethan. She wasn’t producing enough milk and started to panic.
“My supply tanked,” said Meehan, who lives in Nashville, Tenn. “He was only getting about an ounce. I worried about dehydration.”
Meehan, who learned about the hotline on a brochure she was given in her hospital’s labor and delivery unit, continued to use the hotline – staffed solely with Le Bonheur Children’s Hospital certified lactation consultants – for the next eight months. She credits the consultants for offering the evidence-based information and moral support she needed to continue breastfeeding her son for the first year of his life. She’s one of thousands of mothers and caregivers across the state turning to Tennessee’s free, 24-hour telephonic breastfeeding support program to help them tackle the challenges of breastfeeding.
Le Bonheur Children’s Hospital is using a five-year grant from the Tennessee Department of Health to operate the Tennessee Breastfeeding Hotline, which launched in September 2013. Tennessee breastfeeding rates are significantly below the national average. In Tennessee, only 14.8 percent of mothers were breastfeeding at 12 months, compared to a national average of 26.7 percent. The service provides nursing mothers, their families and partners, expectant parents and health care providers 24-hour access to certified lactation consultants and counselors. Those counselors offer strategies to empower clients to breastfeed, identify barriers to successful breastfeeding and provide techniques to cope with and overcome barriers to breastfeeding.
“We know breastfeeding is important because babies who are breastfed tend to have fewer infections and are at a lower risk for asthma, type I and type II diabetes and other issues,” said Allison Stiles, MD, the program’s medical consultant.
The hotline has received more than 5,200 calls for help with issues ranging from medication use to breast or nipple pain and latching.
While most of the calls are from first-time callers, 25 to 30 percent of callers, like Meehan, use the hotline repeatedly. In the program’s sixth quarter, nearly 400 callers had used the hotline as least once.
“Our hotline is continually being used for a variety of breastfeeding issues and challenges. Mothers and caregivers are showing they need this type of support,” said Helen Scott, RN/IBCLC/RLC, hotline’s program coordinator.
After the hotline’s lactation counselors helped her overcome the supply issue that prompted the first call, Meehan had more questions weeks later when a prescribed medication left her unable to exclusively breastfeed Ethan. And then more questions months later when she returned to work and began using a breast pump and bottle feeding. A lactation consultant was there each time to offer support and strategies to resolve her issues – sometimes on the weekends, and sometimes in the middle of the night.
“It was such a relief to know that I could call from anywhere at any time of day or night and on the weekends,” said Meehan. “The medical advice I was given is one thing, but you can’t put a value on the moral support the hotline provided me.”
Removing barriers to breastfeeding
With her first child, Sean, Meehan visited a lactation consultant near her home. She had to pay out-of-pocket for the visit; it cost her $150. At the time, she wondered what she would do if she couldn’t afford such a service. Considered educational by many insurance companies, lactation consultation is not a covered benefit of many insurance carriers in the state.
“If a woman wants to visit a lactation consultant, she must make an appointment, prepare to spend $150 for each visit out-of-pocket, and must take her child to the appointment, during which time the baby may be asleep or not hungry,” said Meehan. “The Tennessee Breastfeeding Hotline alleviates the financial, scheduling and transportation burdens. Women can call 24 hours a day.”
Le Bonheur staffs the hotline with a team of 10 international board-certified lactation consultants (IBCLC) and certified lactation counselors (CLC). They work in four-, eight- and 12-hour shifts on weekdays, weekends and nights, answering calls in the office and at home. It’s a rewarding job, says Victoria Roselli, BS, IBCLC, RLC, who became an international board-certified lactation consultant in 2010.
Like others on her team, Roselli has a passion for maternal and child health. She worked in a hospital labor and delivery unit while finishing school and is a trained doula and Lamaze instructor.
“I know the benefits of breastfeeding for both mothers and babies, and it’s incredibly rewarding to know you’re helping support a mother’s breastfeeding goals. Moms need that support,” said Roselli.
When necessary, lactation consultants are able to refer callers to additional resources or to a physician for further help. The hotline offers interpretive services for more than 200 languages, and special operators are available to assist hearing-impaired callers.
Le Bonheur tracks data from each call, recording information like the reason for the call, the baby’s age and method of delivery, as well as the caller’s age, location and ethnicity. Consultants provide a follow-up to each mom at four-, eight- and 12-weeks after the initial call. Some callers whose issues require additional support and encouragement receive a follow-up call after 24 hours. Follow-ups gauge a client’s confidence in breastfeeding, intent to continue breastfeeding and whether their issue has improved. The caller is asked two survey questions: how satisfied are you with the hotline and how likely you are to refer someone to the hotline?
Results, thus far, are promising. In the program’s sixth quarter, nearly 83 percent of clients were still breastfeeding 12 weeks after their initial call, and 91 percent of callers said they felt an increased confidence and comfort level with breastfeeding at their 12-week follow-up. Data also showed that, for the majority of callers, issues like milk supply, breast engorgement and nipple pain had improved just 24 hours after the call.
Only in its second year, the Tennessee Breastfeeding Hotline will continue to track data to ensure the state is making strides in its primary goal: to foster the healthy development of children by promoting and supporting the practice of breastfeeding in Tennessee.
“Breastfeeding is widely accepted as an effective strategy to promote positive health outcomes for both mothers and their babies,” said Scott. “Despite growing data on these benefits, 25.1 percent of babies born in Tennessee in 2011 were never breastfed*. We’re working to foster the healthy development of children in our state by promoting and supporting breastfeeding mothers and caregivers – and in doing so, we’re increasing breastfeeding rates in Tennessee. We’re making a difference.”