P3A095: Improvements in Breastfeeding Exclusivity and Duration with Earlier Postpartum Visits

Background: The AAP recommends exclusive breastfeeding for the first six months of life due to maternal and child health benefits. According to the CDC, approximately 84% of American infants are breastfed at some point but only about 25% are exclusively breastfed for the first six months of life. 60% of parents stopped breastfeeding earlier than originally planned. A leading factor is “problems associated with breastfeeding.” The Fourth Trimester Model (4TM), a branch of the IMPLICIT Network, is an initiative to provide access for birthing parents within two weeks of childbirth to offer support and address parent and child needs in the immediate postpartum period. Among its many aims, the 4TM seeks to help parents reach their goals of breastfeeding exclusivity and duration.

Methods: The IMPLICIT 4TM initiative includes birthing parents in the perinatal period at health centers across the Northeast. Participants meet with providers before delivery, two weeks after delivery, and 6 weeks after delivery in parent-infant dyad 4TM visits to identify goals for postpartum contraception, feeding modality, and behavioral health. Parents are supported to meet their goals and any additional parent and/or child needs are addressed. We reviewed data from three Rochester, NY practices (458 participants) as well as from the national IMPLICIT Network’s 4TM Project (>1000 participants).

Results: Rochester, NY: Of the parents that had a 4TM visit, 48.2% were exclusively breastfeeding at the 4TM visit, 50.9% were exclusively breastfeeding at the 6 week postpartum visit, and 67.1% met their feeding modality goal. Of the parents that did not participate in the 4TM visit, 38.8% were exclusively breastfeeding at the 6 week postpartum visit and 46% met their feeding modality goal. Stratified by self-reported race, 38.7% of Black, 44.4% of Latina/x/e, and 65.1% of white individuals were exclusively breastfeeding at the 4TM visit. National: 47.7% of parents were exclusively breastfeeding at the 4TM visit. Stratified by parent self-reported race, 52.1% of Black, 45.2% of Latina/x/e, and 48.1 % of white individuals were exclusively breastfeeding at the 4TM visit.

Conclusion: The data suggest that earlier postpartum visits, that also combine care for the birthing parent and infant as a dyad, help parents reach their breastfeeding goals. The 4TM model is one way to help parents achieve breastfeeding goals, but there are significant disparities among parents of color that need to be addressed. Specifically, Black parents are more likely to initiate breastfeeding, but are likely to do so for a shorter duration than their white and Latina/x/e counterparts. Future directions include both a qualitative study interviewing 4TM participants about their experiences and continuing community collaboration with organizations led by people of color.