A Rural Medically Underserved Community Breastfeeding Intervention in Pediatric Primary Care

Objectives: The overall aim of this quality improvement (QI) project was to increase breastfeeding rates through a Nurse Practitioner (NP)-led breastfeeding intervention refining the care provided in a rural, medically underserved community with breastfeeding rates lower than state and national averages. Specific goals were to increase breastfeeding initiation (as measured at the newborn visit) and continuation rates (as measured at the 1-month, 2-month and 4-month well child visits) of “exclusive,” “partial” (breastfeeding families also supplementing with formula) and “any” breastfeeding by at least 10% after implementation of a comprehensive evidence-based practice breastfeeding clinical protocol. The Academy of Breastfeeding Medicine’s (2013) “Clinical Protocol #14: Breastfeeding Friendly Physician’s Office: Optimizing Care for Infants and Children” was the evidence-based practice (EBP) guideline chosen for implementation in the rural, low income, medically underserved pediatric primary care clinic.

Methods: A before-and-after design with two independent groups of mother-infant couplets, one pre-intervention (N=43) and a one post-intervention (N=45) were longitudinally evaluated on breastfeeding rates at four time intervals. The four time intervals were the newborn visit, 1-month, 2-month and 4-month well child visits for exclusive, partial and any breastfeeding rates. Recruitment for the pre-implementation group included the first 43 healthy newborns presenting for the newborn visit from November 2013 through the 4-month visit of the final enrolled infant, which occurred in June 2014. Recruitment for the post-implementation group included the first 45 healthy newborns presenting for the initial newborn visit from July 2014 through the 4-month visit of the final enrolled infant, which occurred in February 2015. Relationships for the two groups were compared using two sample t-tests Chi square, and Fisher’s exact tests. Statistical analysis was done using SPSS 22.0 with the level of significance set at p  = .05.

Results: Post-implementation rates for any breastfeeding progressively increased for each time point and achieved >10% increases at the 2-month (13.86%) and 4-month (47.25%) visits. Exclusive breastfeeding rates increased by 40.98% at the 1-month visit, 27.4% at the 2-month visit, and 139% at the 4-month visit.

Conclusions: Implementing an NP-led evidence-based breastfeeding-friendly office protocol in a rural pediatric primary care setting with low breastfeeding rates is associated with increased breastfeeding rates.