Get People Talking: Survey Your Primary Care Team on Lactation Support

Primary care breastfeeding support needs to be individualized to your practice. Asking questions and learning your clinic’s perspectives about breastfeeding helps generate discussion and encourage collaboration. We've found that, in general, health care providers and administrators know breastfeeding is beneficial, but quantifying the needs of your practice and gauging interest provides a personal touch. 

Previously, I suggested conducting a provider survey at your practice to:

• prompt discussion about breastfeeding
• identify potential barriers to providing more comprehensive lactation support
• identify educational needs of providers
• determine interest for change.

Below are examples of survey questions we have found useful. To access a full survey with questions and responses, see Appendix A and B from our paper on Translating Team-Based Breastfeeding Support into Primary Care Practice.

Survey questions to get people talking

Are there barriers to discussing breastfeeding with your patients?  

Our study found that 74% of providers thought there were barriers to discussing breastfeeding at visits.  Specific challenges included:

• limited time during visits
• limited clinical training on how to manage breastfeeding issues
• families not interested in discussing breastfeeding

By far the most common concern was not having enough time, with approximately 80% of participants identifying this barrier.

There is not enough time in the day for primary care providers to provide all recommended counseling. A recent study estimated that if PCPs were to provide all recommended US Preventive Services Task Force recommendations, it would account for 131% of available physician time. The expectations are unrealistic. When there is not enough time, patients do not receive all the needed support. Breastfeeding support is time intensive, and to address the “not enough time” concern we need creative solutions. Team-based lactation care is one option.  

Which of the following is a barrier to infants being breastfed at your practice?

Rather than looking at all potential barriers to breastfeeding like social norms, returning to work, and lack of family support, this question assesses the barriers at the health care provider level of care. Common challenges described in our study included: families are not well informed about breastfeeding, providers are not receiving the help they need, and there is not enough lactation consultant staff available. Almost 80% of providers thought families did not receive lactation support they needed.

How confident are you of your ability to manage common breastfeeding problems competently?

Studies repeatedly identify limits in medical education regarding breastfeeding, and physicians report being ill-prepared to counsel families with lactation challenges. Our survey personalized this to the practice level and found that only 6% of the surveyed clinicians stated their medical training prepared them well to support breastfeeding families who are navigating challenges. Most medical providers were not comfortable managing issues like tongue tie, difficulties with infant milk transfer, and methods of supplementation. By conducting the survey, the practice was able to target specific areas of education. Targeted education can help improve clinical outcomes.

If your patients are having breastfeeding difficulties beyond what you can address in the office visit, what do you do?

This question opens up the discussion on providing breastfeeding support at your practice. By locating a clinical need and the fact that patients are referred out (in the study, 50% of providers needed to refer outside the practice!), you have identified a need for more clinic time. If you have a breastfeeding champion at the practice, this question may quantify a need for further support and help advocate for protected time on that provider's schedule. It also provides the opportunity to discuss the creation of another service line and explore the development of team-based LC/PCP lactation support. 

What would help you provide better breastfeeding support to your patients? 

When asked, PCPs consistently request more time and education, along with having a lactation consultant on staff. Studies in hospitals show improved outcomes with IBCLC on staff. The US Preventive Task Force recommendations include direct support for families during breastfeeding and training primary care providers about breastfeeding and how to support.  

Identify the low hanging fruit

Conducting a survey may help identify changes that will get quick buy-in without much cost. This can be a great jump starter to encourage change. 

Generate and share your story

Once you have survey information for your clinic, you can create a personalized narrative describing a path forward for your practice. This narrative becomes a critical component of the business case for clinical changes. Each practice’s narrative will be different, but here is a template that might help you get started:  

The AAFP recommends breastfeeding counseling should be part of routine pediatric preventive care. Yet, primary care providers (PCP) are limited by training and time during routine visits to provide all recommended counseling. Eighty percent* of our providers do not think mothers received adequate support and 58%* identified inadequate lactation consultant staff as a barrier. Given a core mission of our practice is primary care support and optimizing the health of our patients, early breastfeeding support is critical to this mission. We have the opportunity to improve this support by having PCP’s partner with lactation consultants during the primary care visit to address these barriers. 

~ Ann M. Witt, MD, FABM, IBCLC

*(individualize based on your practice’s survey)