What Team Works for You? Expanding Mental Health and Lactation Support

Team-based breastfeeding support provides flexibility!

Not only does your practice have the ability to create a team that works best for your patients’ needs, but you also have the freedom to expand the model as resources become available. In our practice, we maintain our foundational team-based lactation consultant/primary care provider (LC/PCP) visits and, as resources became available, we expanded the team to include behavioral health and group visits.

As you explore options for your own practice, looking to other models often helps provide inspiration.

Years ago I heard about the Trifecta model of care which combines a lactation consultant, physician, and mental health provider in one visit. It was inspirational to see a practice routinely integrate more mental health support into visits, yet the Trifecta model was not an option at that time as we did not have therapists on site. I kept the inspirational idea in mind while talking to stakeholders through the years until it became feasible.

Expanding mental health support has become even more important with increasing rates of postpartum depression (PPD) and anxiety (PPA).

The landscape of perinatal health has shifted significantly since COVID. Research is emerging showing the impact of lockdown and decreased social support. One study published in 2023 found that this decrease in pandemic-related perceived social support increased the chance for both a positive PPD and PPA screen, and also was associated with impaired bonding between parent and baby. Research in Italy showed that from November 2021 to April 2022, 25% of women had an EPDS score of 9 or higher, compared to 11% in 2019. The Center for Disease Control and Prevention identifies that 1 in 8 women report symptoms of depression after giving birth with only about 50% receiving treatment. 

With the growing perinatal mental health needs, providers benefit from having the flexibility to adapt, and team-based care provides this fluidity!

Pre-Covid, the pediatric practice where we provide breastfeeding support utilized a one month group well child visit (GWCC). This was another type of team-based breastfeeding support, with both a pediatric provider and lactation consultant facilitating the group. The GWCC was suspended during COVID. After pandemic restrictions lifted, the practice looked to restart the group as an option for increasing social and mental health support. The practice had also recently expanded in-office behavioral health support, which provided the perfect timing to reconsider the Trifecta model as we brainstormed and reimagined the model of care.

At this point, we asked if it was feasible to create a new team model: GWCC plus LC plus a mental health provider specializing in perinatal support? 

Implementing a practice change required meeting, brainstorming, identifying needs, and getting stakeholder support. Through months of preparation we created a new program, WELLPlus Group, that expands the 4th Trimester support for families by combining lactation, well visits, and behavioral health care in one group. The first hour of the group focuses on pediatric well care, the second hour on postpartum mental health needs, with breastfeeding support integrated throughout.

The response to the groups have been overwhelmingly positive: 

• “We love the holistic approach of group appointments! The group visits have really helped us as we navigate as first time parents. The honest discussions and consistent lactation support have also allowed us to better care for ourselves and our son.”
• “The group visit setting was so valuable, simply for the chance to share stories, experiences, and advice with other parents in exactly the same boat as me! In addition to practical tips, I so appreciated the mental health education component. Even as a third-time parent, I was surprised at how validating and enlightening this information was. I would highly recommend participating in the group visit to any parent of a newborn!”
• “I like that I felt less alone and supported…. I liked hearing about the struggles of other moms and talking through them. I liked learning about the mental, physical, and emotional issues of postpartum and truly felt that I had received beneficial information...”
• “I highly recommend this group for new parents! The first month I was shell shocked. I thought I was handed the world’s most difficult baby and just kept looking for the return button. Then I went to the group and saw other families going through exactly what I was! Being able to talk about my mental health in a non-judgmental setting was crucial to keeping me sane. Knowing my baby and I were completely normal was really comforting and changed my perspective. Not to mention the amazing lactation support… I felt so close to giving up so many days, but with their support and cheerleading we are now happily going strong!”

These days, our baseline LC/PCP care remains, with every breastfeeding family's first visit to the office being scheduled with a lactation consultant and medical provider. To meet increasing mental health needs, we have expanded our model of team-based care to include an option for structured behavioral health support and expanded lactation support. It creates another touch point in the health care system and we have seen significant increase in PPD screening, and ongoing LC visits beyond the newborn period. 

So remember, even if now is not the time for your practice to implement a change, file away the idea, start the conversations, get inspired, and be ready for when opportunity knocks! We are here to support with all the resources needed to start developing a team-based LC/PCP breastfeeding support model that works for your practice.