P3A097: Integrating Provider-led Lactation Support in the Pediatric Primary Care Medical Home

Background: Human milk is widely accepted as the normative standard for infant feeding and nutrition. The medical and neurodevelopmental advantages of breastfeeding are key to improved public health outcomes in the United States. While most newborns start out breastfeeding, fewer than 25 percent of U.S.-born infants meet the American Academy of Pediatrics and Centers for Disease Control recommendation of exclusive breastfeeding for the first six months.
Accessible, affordable, high-quality, and personalized lactation support is needed to positively impact new parents to reach their breastfeeding goals. The Surgeon General’s Call to Action to Support Breastfeeding urges health care providers to make breastfeeding-supportive practices standard of care with specific focus on pediatricians as an essential resource to support breastfeeding dyads and manage lactation challenges. Integrating provider-led lactation support in the pediatric medical home reduces parental burden to navigate new healthcare systems, scheduling challenges, delays, and cost barriers.

Methods: Children’s Primary Care Medical Group (CPCMG) is a large single-specialty pediatric group in Southern California with 28 outpatient offices in San Diego and Riverside counties. More than 8000 newborns are welcomed to CPCMG each year as their medical home.
Integrating lactation support within CPCMG reduces barriers to breastfeeding success and ensures continuity of care. CPCMG encourages and financially incentivizes interested pediatric providers–physicians and nurse practitioners–to become International Board Certified Lactation Consultants (IBCLCs).
A plan and policy was designed to streamline referrals to the Lactation Program: Primary care providers place a request via the EMR for established CPCMG patients. A full-time, bilingual Spanish/English Lactation Program Specialist manages requests, contacts parents, and schedules consultations. Provider-led lactation visits typically last 40-60 minutes, include a detailed health history of the dyad, infant feeding assessment, and are billed to insurance. Dyads are invited to attend CPCMG’s weekly virtual lactation support group.

Results: From March 2022 to April 2023, primary care providers across CPCMG referred 2295 infants to the Lactation Program. Provider IBCLCs across the region completed 1895 lactation visits. The majority of dyads were seen in-person while 14% of visits were conducted via telemedicine. Twenty-eight percent of visits were billed to Medicaid and 13% to TriCare.
In March 2022, CPCMG employed nine pediatric providers dual-credentialed as IBCLCs at eight locations. By April 2023, CPCMG expanded integrated lactation support to fifteen provider IBCLCs at twelve clinic locations and introduced an additional weekly virtual support group specifically welcoming Spanish-speakers.

Conclusion: Provider-led lactation support in the primary care pediatric medical home is a well-received, well-utilized, reimbursable model to efficiently and expertly support breastfeeding dyads. Integration at additional clinic sites can further increase accessibility, reduce disparities, and improve parental self-efficacy to increase breastfeeding, chestfeeding, and human milk feeding success.