Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Implementation of a clinically integrated breastfeeding peer counselor program

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

Reflecting disparities across the US, in 2015 publicly insured patients of the NorthShore Community Health Center (NSCHC) in Evanston, Illinois had lower breastfeeding rates than commercially insured patients. We used the Replicating Effective Programs framework to describe the design and implementation of a clinically-integrated breastfeeding peer counseling (ci-BPC) program to address these disparities.

Study design

Patient focus groups and surveys informed program design, and a multidisciplinary clinical support team developed workflows that integrated the breastfeeding peer counselor (BPC) into the clinic and the postpartum unit.

Results

ci-BPC improved breastfeeding intensity and duration by providing every NSCHC patient with (1) prenatal lactation education; (2) hands on lactation care in the hospital; and (3) on-demand postpartum support. Total cost per patient was $297–386. The program was sustained after demonstrating potential cost-savings.

Conclusion

An evidence-based, multidisciplinary collaboration resulted in a sustainable clinically integrated breastfeeding peer counseling program that improved breastfeeding outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Breastfeeding Peer Counseling (BPC) functions in relation to ecological contributors to breastfeeding disparities.
Fig. 2: Outpatient and Inpatient activities for the BPC.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. USDA/USHHS. Dietary Guidelines for Americans, 2020–2025. 2020 9th Edition: Available from: www.DietaryGuidelines.gov.

  2. Meek JY, Noble L, Breastfeeding So. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 2022;150:e2022057988.

  3. WHA71.9. 75th World Health Assembly: Statement on Infant and Young Child Feeding 2018 Available from: https://www.who.int/health-topics/breastfeeding#tab=tab_2.

  4. Vilar-Compte M, Pérez-Escamilla R, Ruano A. Interventions and policy approaches to promote equity in breastfeeding. Int J Equity Health. 2022;21:63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gonzalez-Nahm S, Grossman ER, Benjamin-Neelon SE. The role of equity in US States’ breastfeeding policies. JAMA Pediatr. 2019;173:908–10.

    Article  PubMed  Google Scholar 

  6. Mahoney SE, Taylor SN, Forman HP. No such thing as a free lunch: The direct marginal costs of breastfeeding. J Perinatol. 2023;43:678–82.

    Article  CAS  PubMed  Google Scholar 

  7. Temple Newhook J, Newhook LA, Midodzi WK, Murphy Goodridge J, Burrage L, Gill N, et al. Poverty and breastfeeding: comparing determinants of early breastfeeding cessation incidence in socioeconomically marginalized and privileged populations in the FiNaL Study. Health equity. 2017;1:96–102.

    Article  PubMed  PubMed Central  Google Scholar 

  8. O’Brien R, Neman T, Seltzer N, Evans L, Venkataramani A. Structural racism, economic opportunity and racial health disparities: evidence from US counties. SSM-Popul Health. 2020;11:100564.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bishop-Royse J, Lange-Maia B, Murray L, Shah R, DeMaio F. Structural racism, socio-economic marginalization, and infant mortality. Public Health. 2021;190:55–61.

    Article  CAS  PubMed  Google Scholar 

  10. NIMHD. National Institute on Minority Health and Health Disparities Research Framework 2017 [Available from: https://nimhd.nih.gov/researchFramework.

  11. Butler MS, Smart BP, Watson EJ, Narla SS, Keenan-Devlin L. U.S. breastfeeding outcomes at the intersection: differences in duration among racial and ethnic groups with varying educational attainment in a nationally representative sample. J Hum Lact. 2023;39:722–32.

    Article  PubMed  Google Scholar 

  12. Gianni ML, Bettinelli ME, Manfra P, Sorrentino G, Bezze E, Plevani L, et al. Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients 2019;11:2266.

  13. Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database Syst Rev. 2007:CD001141. Update in Cochrane Database Syst Rev. 2012;5:CD001141.

  14. Chung M, Raman G, Trikalinos T, Lau J, Ip S. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:565–82.

    Article  PubMed  Google Scholar 

  15. Louis-Jacques AF, Vereen S, Hernandez I, Običan SG, Deubel TF, Miller EM, et al. Impact of doula-led lactation education on breastfeeding outcomes in low-income, minoritized mothers. J Perinat Educ. 2021;30:203–12.

    PubMed  PubMed Central  Google Scholar 

  16. Seals-Allers K. The big letdown: how medicine, big business, and feminism undermine breastfeeding. First edition. ed. New York: St. Martin’s Press; 2017. 290.

  17. Swanson V, Power K, Kaur B, Carter H, Shepherd K. The impact of knowledge and social influences on adolescents’ breast-feeding beliefs and intentions. Public Health Nutr. 2006;9:297–305.

    Article  PubMed  Google Scholar 

  18. Rossman B. Breastfeeding peer counselors in the United States: helping to build a culture and tradition of breastfeeding. J Midwifery Women’s Health. 2007;52:631–7.

    Article  Google Scholar 

  19. USDA. WIC 2017 Eligibility and Coverage Rates 2017

  20. LLLI. Structure of LLL 2021 Available from: https://www.llli.org/about/whos-who-in-la-leche-league/structure-of-llli/.

  21. WIC Works Resource System UDoA. WIC Breastfeeding Model Components for Peer Counseling 2023 Available from: https://wicworks.fns.usda.gov/resources/wic-breastfeeding-model-components-peer-counseling.

  22. Kozhimannil KB, Attanasio LB, Hardeman RR, O’Brien M. Doula care supports near-universal breastfeeding initiation among diverse, low-income women. J Midwifery Women’s Health. 2013;58:378–82.

    Article  Google Scholar 

  23. Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien M. Doula care, birth outcomes, and costs among Medicaid beneficiaries. Am J Public Health. 2013;103:e113–21.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kozhimannil KB, Vogelsang CA, Hardeman RR, Prasad S. Disrupting the pathways of social determinants of health: doula support during pregnancy and childbirth. J Am Board Fam Med. 2016;29:308–17.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Thomas MP, Ammann G, Brazier E, Noyes P, Maybank A. Doula services within a healthy start program: increasing access for an underserved population. Matern Child Health J. 2017;21:59–64.

    Article  PubMed  PubMed Central  Google Scholar 

  26. MacDorman MF, Declercq E. Trends and state variations in out-of-hospital births in the United States, 2004-2017. Birth. 2019;46:279–88.

    Article  PubMed  Google Scholar 

  27. Osterman MJK, Martin JA. Timing and adequacy of prenatal care in the United States, 2016. Natl Vital Stat Rep. 2018;67:1–14.

    PubMed  Google Scholar 

  28. Anderson AK, Damio G, Young S, Chapman DJ, Pérez-Escamilla R. A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community. Arch Pediatr Adolesc Med. 2005;159:836–41.

    Article  PubMed  Google Scholar 

  29. Caulfield LE, Gross SM, Bentley ME, Bronner Y, Kessler L, Jensen J, et al. WIC-based interventions to promote breastfeeding among African-American Women in Baltimore: effects on breastfeeding initiation and continuation. J Hum Lact. 1998;14:15–22.

    Article  CAS  PubMed  Google Scholar 

  30. Chapman DJ, Damio G, Young S, Pérez-Escamilla R. Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial. Arch Pediatr Adolesc Med 2004;158:897–902.

    Article  PubMed  Google Scholar 

  31. Merewood A, Chamberlain LB, Cook JT, Philipp BL, Malone K, Bauchner H. The effect of peer counselors on breastfeeding rates in the neonatal intensive care unit: results of a randomized controlled trial. Arch Pediatr Adolesc Med. 2006;160:681–5.

    Article  PubMed  Google Scholar 

  32. Pugh LC, Milligan RA, Frick KD, Spatz D, Bronner Y. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Birth. 2002;29:95–100.

    Article  PubMed  Google Scholar 

  33. Gross SM, Caulfield LE, Bentley ME, Bronner Y, Kessler L, Jensen J, et al. Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding. J Am Dietetic Assoc. 1998;98:143–8.

    Article  CAS  Google Scholar 

  34. Hopkinson J, Konefal Gallagher M. Assignment to a hospital-based breastfeeding clinic and exclusive breastfeeding among immigrant Hispanic mothers: a randomized, controlled trial. J Hum Lact. 2009;25:287–96.

    Article  PubMed  Google Scholar 

  35. Reeder JA, Joyce T, Sibley K, Arnold D, Altindag O. Telephone peer counseling of breastfeeding among WIC participants: a randomized controlled trial. Pediatrics. 2014;134:e700–e9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wambach KA, Aaronson L, Breedlove G, Domian EW, Rojjanasrirat W, Yeh H-W. A randomized controlled trial of breastfeeding support and education for adolescent mothers. West J Nurs Res. 2010;33:486–505.

    Article  PubMed  Google Scholar 

  37. Srinivas GL, Benson M, Worley S, Schulte E. A clinic-based breastfeeding peer counselor intervention in an urban, low-income population: interaction with breastfeeding attitude. J Hum Lact. 2014;31:120–8.

    Article  PubMed  Google Scholar 

  38. Bronner Y, Barber T, Vogelhut J, Resnik AK. Breastfeeding peer counseling: results from the National WIC Survey. J Hum Lact. 2001;17:119–25.

    Article  CAS  PubMed  Google Scholar 

  39. Chapman DJ, Morel K, Anderson AK, Damio G, Perez-Escamilla R. Breastfeeding peer counseling: from efficacy through scale-up. J Hum Lact. 2010;26:314–26.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Morrow AL, Guerrero ML, Shults J, Calva JJ, Lutter C, Bravo J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet. 1999;353:1226–31.

    Article  CAS  PubMed  Google Scholar 

  41. Schafer E, Vogel MK, Viegas S, Hausafus C. Volunteer peer counselors increase breastfeeding duration among rural low-income women. Birth. 1998;25:101–6.

    Article  CAS  PubMed  Google Scholar 

  42. Kilbourne AM, Neumann MS, Pincus HA, Bauer MS, Stall R. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci. 2007;2:42.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Keenan-Devlin LS, Hughes-Jones JY, Borders AEB. Clinically integrated breastfeeding peer counseling and breastfeeding outcomes. J Perinatol. 2021;41:2095–103.

  44. Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, et al. Suboptimal breastfeeding in the United States: maternal and pediatric health outcomes and costs. Matern Child Nutr. 2017;13:e12366; erratum in Matern Child Nutr. 2017;13:e12450.

  45. Keenan-Devlin LS, Smart BP, Hirschhorn L, Meier P, Jefferson U, Solomonides A, et al. Clinically integrated breastfeeding peer counseling to promote breastfeeding equity. Am J Perinatol. 2023. https://doi.org/10.1055/s-0043-1771255.

  46. Meier PP, Engstrom JL, Rossman B. Breastfeeding peer counselors as direct lactation care providers in the neonatal intensive care unit. J Hum Lact. 2013;29:313–22.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding for the NorthShore Community Health Center Breastfeeding Peer Counseling program was provided by the North Suburban Foundation, March of Dimes, the NorthShore Auxiliary (Borders), the Department of Obstetrics and Gynecology at NorthShore University HealthSystem, and the Women’s Hospital lactation service line. The original PAC clinic ci-BPC program was funded by the Pritzker Family Foundation Evergreen Invitational Grant Award (Borders). The authors gratefully acknowledge the clinical, administrative, and research colleagues who supported this project. Special thanks to Paula Meier for her mentorship. We are most grateful to the Breastfeeding Peer Counselors both past and present who provided expert lactation care for the NSCHC and Prentice Ambulatory Center BPC programs, and for HealthConnect One for their support and expertise.

Funding

Financial support for this study provided by the Patient Centered Outcomes Research Institute contract #AD-2020C3-21231 (Borders) and the Agency for Healthcare Research and Quality 1 K01 HS027906-01A1 (Keenan-Devlin).

Author information

Author notes

  1. Janel Y. Hughes-Jones

    Present address: Milk of the Heart Inc., 4005 Oaktree Lane, Plainfield, IL, 60586, USA

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, NorthShore University HealthSystem; University of Chicago Pritzker School of Medicine, Evanston, IL, USA

    Lauren S. Keenan-Devlin

  2. NorthShore Community Health Center, NorthShore University HealthSystem, Evanston, IL, USA

    Janel Y. Hughes-Jones

  3. Department of Health Systems Management, Rush University Medical Center, Chicago, IL, USA

    Tricia Johnson

  4. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Lisa Hirschhorn

  5. Department of Obstetrics and Gynecology, NorthShore University HealthSystem; University of Chicago Pritzker School of Medicine; Northwestern University Center for Healthcare Studies – Institute for Public Health and Medicine, Evanston, IL, USA

    Ann E. B. Borders

Authors
  1. Lauren S. Keenan-Devlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janel Y. Hughes-Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tricia Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Hirschhorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ann E. B. Borders
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Lauren Keenan-Devlin: Conceptualization (lead), Methodology (lead), Investigation (lead), Data Curation (supporting), Resources (lead), Project Administration (equal), Writing – Original Draft (lead), Writing – Review and Editing (equal), Funding Acquisition (equal). Janel Hughes-Jones: Resources (supporting), Data Curation (lead), Writing – Review and Editing (supporting). Tricia Johnson: Conceptualization (supporting), Methodology (supporting), Writing – Review and Editing (equal). Lisa Hirschhorn: Conceptualization (supporting), Methodology (supporting), Writing – Review and Editing (supporting). Ann Borders: Conceptualization (supporting), Methodology (supporting), Project Administration (equal), Writing – Original Draft (supporting), Writing – Review and Editing (equal), Supervision (lead), Funding Acquisition (equal).

Corresponding author

Correspondence to Lauren S. Keenan-Devlin.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keenan-Devlin, L.S., Hughes-Jones, J.Y., Johnson, T. et al. Implementation of a clinically integrated breastfeeding peer counselor program. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01995-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41372-024-01995-3

Search

Advanced search

Quick links