Can Telehealth Lactation Services Provide Effective Breastfeeding Support for Rural Areas?

In recent years, local and national organizations have emphasized the importance of exclusive breastfeeding and increasing access to lactation support. However, rural areas consistently have lower breastfeeding rates than urban areas and access to lactation consultants is limited. Telehealth lactation services is an emerging resource that can provide rural areas with access to a lactation specialist when one is not available for in-person consultations. In the rural central Utah hospital where this project was completed, only 45% of infants were exclusively breastfed on discharge from the hospital and lactation consultants were not available. The purpose of this project was to facilitate implementation of telehealth lactation services in a rural hospital to increase lactation support, with the eventual goal of increasing breastfeeding rates. This project also evaluated the patient, nurse, and lactation consultant experience with telehealth lactation services. This project took place in a rural, 20-bed hospital in central Utah. This hospital performs between 20-50 births per month and serves primarily white, low to middle income women. Prior to initiation of telehealth lactation services, nursing staff members were educated on how to assist patients during telehealth lactation consultations. To improve patient education, this training also included breastfeeding education considering most nurses had never received prior lactation education. Surveys were administered to nursing staff prior to and following this training session to evaluate their comprehension of the education and need for further training. Following this training, telehealth lactation services were implemented for 25 in-patient postpartum mothers. Following each consult, the patient, lactation consultant, and assisting nurse were asked to complete voluntary surveys on their experience. Exclusive breastfeeding rates were evaluated to analyze project impact. Descriptive and parametric statistics measured mean differences of survey responses. Following telehealth consultations, patients reported increased breastfeeding confidence (M= 3.8, SD= 0.9 vs. M= 4.5, SD= 0.7; Z= -2.809; p= 0.004) and 100% of mothers felt encouraged to continue breastfeeding after hospital discharge. Only 12% of nurses felt they had enough time to assist with consults and only 17% felt a bedside nurse was necessary during consults. Although a bedside nurse was present for 100% of consults, nurses reported providing hands-on assistance with only 29% of consultations. Contrarily, 95% of lactation consultant responses indicated a bedside nurse was essential. Lactation consultants felt the consults were comparable to in-person consultations (87%) and technology was adequate for the consults (90%). Of nurse and lactation consultant responses, 100% felt the service should be expanded to the outpatient setting. Exclusive breastfeeding rates during this project increased by 25% from an average of 45.4% to 70.8%. This project suggests telehealth lactation consultations can improve breastfeeding rates and are acceptable to patients and consultants. This technology may be a cost effective way to increase lactation support in rural areas. Future projects might evaluate consult effectiveness if a bedside nurse is not available for assistance. Strategies should also be discussed on how to expand this service to the outpatient setting to provide lactation support after hospital discharge.