News: PQI Profiles

Virtual Lactation Support Program in Arkansas

Thursday, April 9, 2020  
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By Siena Davis, MPH, Project Manager, PQI

“A lot of times we think, ‘Moms have to come to us. They have to come to the clinic or they have to come to the hospital.’ We should extend our support of moms to where they are.” –Sarah Rhoads

Sarah Rhoads, PhD, DNP, WHNP-BC, FAAN, is a Professor and Research Faculty Member at the University of Tennessee Health Science Center. Sarah researches the human impact of technologies on both health care providers and their patients. “I have a passion for helping moms in rural areas. There has got to be a nationwide push to help improve connectivity, for healthcare reasons, in rural areas,” said Sarah.



In April 2018, Sarah was employed as an Associate Professor & Education Director with the University of Arkansas for Medical Sciences College of Medicine and Center for Distance Health. She piloted a provider-initiated lactation support program in two hospitals (an academic science center and a private hospital) in Arkansas. The goals of the project were to improve at home support for new mothers who are breastfeeding, determine whether it would be feasible to provide lactation support to mothers through phone calls and two-way audio/video calls, and assess the acceptance of virtual lactation visits with lactation consultants and mothers. Sarah wondered, “Would mothers be receptive to this? Would the lactation consultants be receptive to it? Logistically, could we work out all the patient enrollment issues with the app and connectivity?”


Before conducting the project, Sarah learned that some of the lactation consultants were worried about using the technology. Sarah trained the lactation consultants to make sure they were comfortable using the HIPPA compliance software, downloading and navigating the app, and making an assessment over the virtual visit using a two-way audio/video call. Once a few lactation consultants were on board, the entire team quickly became champions for the project. Sarah said, “They were a cohesive team, but getting one or two lactation consultants to be cheerleaders for the project was very important.”


At the start of the pilot study, Sarah randomized mothers into a phone only group or a two-way audio/video group. During the phone call or the virtual visit with two-way audio/video, lactation consultants would ask mothers a series of questions to assess their breastfeeding status, triage any issues, and provide breastfeeding education as needed. The mothers in the virtual visit could see their lactation consultant via the app and the lactation consultants could assess conduct an assessment of the breast and view the latch-on of the infant as needed. Because Sarah had heard from both mothers and lactation consultants that mothers were not always calling in when they had breastfeeding issues, Sarah made sure lactation consultants were contacting mothers regularly to provide breastfeeding support. “I set the study up so that we would automatically call the mothers 24-48 hours after discharge, one week after discharge, and then 3 weeks after that,” said Sarah. 



Sarah included all mothers in the study, regardless of how many children they had or how many times they had breastfed. She said, “Many breastfeeding studies limit interventions to first-time mothers. I’ve had several personal experiences where I met mothers who struggled even after their first two babies because each baby is different and the mom’s health can change over time. Having that additional support even with their third baby just made a world of difference and they breastfed longer. I was very purposeful with making sure we didn’t have those restrictions.”


Before calling study participants, the lactation consultants practiced audio/video calls with a mother who was in the hospital and another mother who had recently returned home. During the first few calls, Sarah asked an IT specialist to wait outside the rooms and help the lactation consultants if any technical issues arose.


Sarah decided to put up a poster board to recognize the lactation consultants who were making the connections. Her research assistant suggested putting a Mardi Gras baby on the board whenever a lactation consultant completed a call. “You would be amazed how happy it made the lactation consultants when they got a Mardi Gras baby on the board,” Sarah said.



Throughout the project, Sarah saw that the lactation consultants were highly effective at supporting breastfeeding mothers. She explained, “Sometimes just telling a mom she’s doing everything right is just what she needs at that moment in time. Lactation consultants do such a good job with mothers in the hospital. They build connections with the mothers that they’re helping. They’re the natural people to help them once they leave the hospital.” As a result of this project, the lactation consultants have embraced a new way to support mothers after they return home.


The primary challenge of this project was related to connectivity. Sarah said, “Any time there were IT issues, most of them surrounded around connectivity. Whether it’s Wi-Fi connectivity or cellular connectivity in the mother’s home, it’s just not great in some areas of our nation, especially in rural areas. To have a poor connection was very frustrating for the lactation consultants and for the mothers.”


As Sarah evaluated the qualitative data from the project, she discovered that many women in either group would not have called for lactation assistance on their own and they appreciated the scheduled calls. They would have waited until their breastfeeding issue became worse to reach out for help or would have just stopped breastfeeding altogether. A theme that was also found in both groups was reassurance. Many of the mothers needed reassurance during the first few weeks of breastfeeding. They also voiced that the convenience of having the breastfeeding assistance at home was very helpful. Sarah is currently evaluating the quantitative data to determine whether the women in the study breastfed longer compared to other women at 12 weeks after delivery.


Sarah’s advice to others who are thinking about engaging in QI:


  • “We wouldn’t be in healthcare and helping moms and babies if we didn’t want the best type of care for them. Keep that in mind when you’re thinking of a QI project.”
  • “Everybody has to start somewhere. Start small.”
  • “Find a partner.”
  • “Engage the people who are going to participate, get them comfortable, get them to be a cheerleader, and then recognize them throughout the process.”
  • “Strive to provide better care for moms and babies.”

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