Redefining Breastfeeding Help as Preventive Health Care

A Black mother is breastfeeding her infant

"Preventive health services” are designed to keep people from getting sick, or to recognize conditions early enough that they can be better treated – think immunizations or screenings. But a recent project in Nationwide Children’s Hospital Primary Care Centers is highlighting a preventive service that is often overlooked: breastfeeding assistance.

Data shows that breastfeeding is linked to an array of health and well-being benefits for both the parent and the child. It’s one of the reasons that Nationwide Children’s includes breastfeeding rates as part of the innovative Pediatric Vital Signs initiative, a first-of-its-kind effort in the United States to measure and improve the health and well-being of all children in a region. 

“Breastfeeding may seem like an obvious thing, so people don't think about it, but it really is impactful for the whole community,” says Alana Milton, MD, a staff physician in the Section of Primary Care Pediatrics at Nationwide Children’s and an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. 

Alana Milton

Alana Milton, MD, is leading a team of health professionals who are working to integrate breastfeeding support and education into regular primary care visits.

Dr. Milton is leading a team of health professionals who are working to integrate breastfeeding support and education into regular primary care visits, with the goal of improving local breastfeeding rates and overall population health. 

This initiative is critical for Franklin County, which has spent the last decade battling what was once one of the nation’s higher infant mortality rates. According to Dr. Milton, the breastfeeding rates within the patient population at Nationwide Children’s are lower than the national average by approximately 25%.

Breastfeeding has been shown to decrease the risk of Sudden Unexplained Infant Death Syndrome (SUIDS). As a child gets older, breastfeeding is linked to a decreased risk of asthma, obesity, type 2 diabetes, allergic conditions, gastrointestinal infection, lung infections and pediatric cancers. These conditions can be more effectively prevented the longer a child receives human milk.

There’s a wide and important range of preventive health benefits for the parent as well, including a decreased risk of breast and ovarian cancer, diabetes, obesity, heart disease, postpartum bleeding and depression. 

These benefits extend well beyond just the parent and child because increased rates of breastfeeding would have a substantial impact on population health. A 2010 study published in the journal Pediatrics estimated that if 90% of families in the U.S. would breastfeed exclusively for six months, the country would save $13 billion annually in reduced medical and related costs.

While breastfeeding may seem simple, it is often anything but. Over 60% of mothers stop breastfeeding sooner than they had planned due to obstacles like embarrassment about breastfeeding in public, returning to work, or merely because of a lack of knowledge about its benefits. Breastfeeding is difficult, and according to Dr. Milton, it’s the equivalent of a full-time job. 

Mothers may encounter lactation issues like nipple pain or a delay in milk coming in. Without support or education, parents don’t know how to manage these problems, and they want to ensure their baby is well fed. Parents can find bottle feeding reassuring because they can see how much the baby is eating, and formula is often pushed on new mothers by hospitals and formula companies. 

Many of these issues can be addressed by incorporating breastfeeding assistance into primary care visits. Research shows that breastfeeding interventions in primary care increase the rate of initiation and duration of breastfeeding. 

Dr. Milton and her team emphasize the importance of prenatal education, as parents should ideally decide to breastfeed their child prior to the child’s birth. By the time of the baby’s first health check, typically three or four days after birth, it is more difficult to start a conversation about breastfeeding. Nationwide Children’s has also developed a curriculum for residents on the importance and benefits of breastfeeding, something that many health care providers previously did not learn in medical school.

After education, the team focuses on parent support. Nationwide Children’s and its Centers offer certified lactation consultants (CLCs), hand and electric pumps for families in need, and resources like Global Health Media videos on lactation in 30 different languages. Dr. Milton and her team also connect families to community support networks like the Ohio Statewide Breastfeeding Hotline, staffed 24 hours a day by lactation professionals, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which provides prenatal breastfeeding education, support from breastfeeding peer helpers and pumps.

As this initiative continues, the team is beginning to collect data from clinics across Franklin County. Progress will be measured by assessing what percentage of babies are receiving human milk at their two-month health check. 

“There needs to be more focus on normalizing breastfeeding and not stigmatizing it, and supporting families in providing human milk to their baby,” says Dr. Milton. “It is actually helping everyone in a community, not just the parent and child, by creating a healthier society.”