Trinity Health of New England (THONE), a four-hospital, integrated delivery network based in Hartford, Connecticut, that is part of the national, Livonia, Mich.-based Trinity Health network, has a long history of providing breastfeeding support to families who give birth at its three birthing hospitals in Connecticut and Massachusetts. Compared to infant formula, breastfeeding is associated with improved health for both babies and their mothers, yet 60 percent of women don’t breastfeed as long as they had intended. Walter Trymbulak, M.D., Ph.D., chair of the Women and Infants Service Line at THONE, wanted to bring as many breastfeeding resources to parents as possible and make it easier for parents to receive support, especially during the Covid pandemic.
In 2022 THONE teamed with Nest Collaborative to provide virtual breastfeeding support to all parents who deliver at the health system’s flagship hospital, Saint Francis Hospital in Hartford. The program has now expanded across all three of the health system’s birthing hospitals.
“When moms hit that critical moment at 48 or 72 hours after discharge it’s either do or die,” Dr. Trymbulak says, speaking of that key post-discharge period. “It’s either ‘I’m going to continue (breastfeeding) or I’m going to quit.’”
The challenge, Trymbulak says, is that, without support both during the prenatal phase and in the first few days at home after birth, many parents are tempted to turn to ready-to-use infant feeding formula, especially if there’s no history or shared knowledge of breastfeeding within their family. To complicate matters, access to lactation consultants is extremely limited and expensive.
“We needed a way to help new moms when they’re at home alone, trying to put what they’ve learned into practice at 8 p.m. or 9 p.m. and they just need a little extra guidance to breastfeed,” s Mary Carnemolla, R.N., baby-friendly/prepared childbirth coordinator at Saint Francis Hospital.
In 2021, with home visits and in-person peer support no longer an option during the worst of the pandemic, THONE began looking for a solution. The goal was to provide its diverse population of patients with evidence-based, culturally competent support that addressed the physical, cultural and economic barriers to breastfeeding. Trymbulak found Nest Collaborative, a Connecticut-based company that provides telehealth lactation consultations with International Board Certified Lactation Consultants (IBCLCs) in 11 languages and all 50 states. Nest Collaborative consultants are available without copay, out-of-pocket costs or deductibles for any families with active insurance or Medicaid coverage. They work with families in the prenatal stage and after baby is born, helping to solve any challenges new parents may face along the way. Launched at Saint Francis in January 2022, Nest Collaborative so quickly impressed Trymbulak and team that THONE quickly expanded its partnership with the company to its other two birthing hospitals -- Saint Mary’s Hospital in Waterbury, Conn. and Mercy Medical Center in Springfield, Massachusetts.
A primary goal of the program was to increase the number of new mothers who exclusively breastfed while they were in the hospital. Numerous studies have demonstrated that in-hospital use of infant feeding formula is associated with shorter durations of both exclusive and “any” breastfeeding when mothers return home.
The results have exceeded expectations. Over the first nine months of the partnership, thanks largely to Nest Collaborative’s prenatal work with parents, an ever-increasing number of new mothers exclusively breastfeed while they were hospitalized. Measured at Saint Francis Hospital, the average monthly number of new mothers exclusively breastfeeding increased by 21.7% from January through September 2022. In the third quarter of 2022 the average rate of hospitalized mothers exclusively breastfeeding was 59%, up from 43% in the same period in 2021.
“We know every new mother is going to run into breastfeeding hurdles and frustrations and we want to provide families with support, so they’re able to overcome those challenges and reach their feeding goals,” Trymbulak says. “Nothing’s been easier than this relationship (with Nest Collaborative) and we’re hoping other Trinity Health hospitals across the country will also adopt this program.”
Recently, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with three leaders at Trinity Health St. Francis about the NEST program: Judy Hill, R.N., director of the Women and Infants Service Line at St. Francis; Janet Alejandro, R.N., the hospital’s Neonatal Intensive Care Unit nurse manager; and Jane Marozzi, R.N., a nurse manager on the Maternity Unit. Below are excerpts from that interview.
Can you share a bit more about the origins of this initiative?
Janet, Alejandro, R.N.: Partnership began based on feedback that breastfeeding moms need more lactation support. We do have internationally board-certified lactation consultants on staff and in-house. Ideally, though, you want the breastfeeding education to begin prenatally. This starts on an app, prenatally. And so the partnership began based on feedback that we know that moms need more breastfeeding support. We know that breast milk is best for our babies, so in order for it be successful…
What internal processes did you have to go through?
The biggest process was to get our staff to buy in. We know that a lot of parents like hands-on. Once we were able to educate the nursing team on what NEST was able to provide, it was a success.
Where there any challenges in developing or implementing the program?
Judy Hill, R.N.: On the maternity unit, it’s looked at more closely than when it originated. And we certainly have more consults. But we really had to educate the nurses [on how to work with the moms]. They do a lot of education in a limited period of time; sometimes, moms go home within 24 hours. We wanted them to know the importance of NEST. And there’s a pamphlet that goes into every mom’s packet. I also do follow-up phone calls. We’ve come a long way in getting the education to the patient.
And we all know that, historically in U.S. healthcare, there hasn’t been enough support for or education around, breastfeeding, correct?
Hill: I can attest to that, because I had children 30 years ago. It’s totally changed. The support is amazing now.
Alejandro: Breastfeeding is more socially accepted now, and we have more professionally educated board-certified lactation consultants.
What have been your team’s biggest learnings?
Hill: Just having buy-in and education about this program. Once the moms know what it is, and that it’s any time of the day. If they’re struggling in the middle of the night, they can reach out, and the many languages. It was getting used to the process and buy-in.
Alejandro: And also, often, having that virtual option is great. I have to say I doubted it at first that the virtual option of lactation consulting can be successful.
What would you like to say about the technology?
Alejandro: That’s part of the success as well. The process has been simplified. A very simple form the lactation consultants fill out; it’s faxed out, the NEST receives it, and they go into action.
Hill: And the women nowadays are technologically savvy. Give them a QR code, they know what to do. It’s natural to them.
Most new moms take naturally to breastfeeding, but there are always a number of exceptions, correct?
Jane Marozzi, R.N.: Most moms come in wanting to breastfeed, and it’s natural and easy. But for some it’s not. In years past, they would have given up easily. But especially with the support of the NEST—that virtual support that the NEST offers, will keep the moms trying.
Hill:: And some moms leave the hospital before their milk production has fully kicked in. So they now have this support. That encourages and keeps the mom carrying through. It would be easy to give up.
Would you be able to offer our readers any advice in terms of developing lactation support programs?
Marozzi: We highly encourage it. Not everyone’s an expert in every aspect of women’s and infants’ care. Having experts directly connected to you offers a huge amount of support.