643 - Development of a Breastfeeding & Lactation Medicine Division Over a Seven-year Period: Clinical, Academic, and Educational Components

Publication Number: 643.4064

Casey Rosen-Carole, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Michele Burtner, University of Rochester, Pittsford, NY, United States; Anna Jack, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Bridget Young, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States

Background: Breastfeeding & Lactation Medicine (BFLM) programs at academic medical centers are uncommon but expanding. Our hospital system initiated a BFLM program in 2016, and formed the first division in 2022.

Objective: To describe a multidisciplinary academic BFLM division, along with its impact on services and breastfeeding rates in its first 7 years.

Design/Methods: To support our clinical mission, we established outpatient BFLM clinic and support group, increased BFLM and Lactation Consultant (LC) coverage, and dedicated a medical director and nurse manager for lactation. In 2017, our NICU instituted a donor milk program. The educational mission was served by expanding University-wide education, starting an in-person fellowship in 2017, and a virtual fellowship program in 2022. In 2019, we founded a lactation research consortium, and named a research director in 2023. These services coalesced to form the first Division of Breastfeeding and Lactation Medicine in 2022, including multiple specialties (pediatrics, obstetrics, family medicine, nutrition research, toxicology, public health, dentistry) and provider types (nursing, LCs, physicians, midwife, nurse practitioner, PhD, dentist) across the medical center. Simple frequencies and p-control charts were used to track access to care and breastfeeding outcomes.

Results: From 2016 to 2022, we increased inpatient and outpatient care by BFLM providers and LCs (Table 1). Breastfeeding rates on the maternity floors increased by 5% between 2016 to 2019 (p < 0.0002). In the NICU, there was a trend towards increased patients receiving any breastmilk and discharged receiving any maternal milk (Figure 1). Challenges included staff training, reimbursement, medical record infrastructure, and data reports. In 2023, the Division published 7 manuscripts, submitted 10 grants and received 3 related to BFLM.

Conclusion(s): A multidisciplinary BFLM program at a large academic medical center showed promise for improving patient access to care and breastfeeding outcomes. Main challenges surrounded reimbursement, data, and infrastructure.

Table 1: Breastfeeding and Lactation Medicine Provider Visits, Lactation Consultant Visits, and Frenotomies, 2016 to 2022
*BFLM=Breastfeeding and Lactation Medicine
**BFLM providers include a fellowship trained pediatrician, a fellowship trained midwife/IBCLC and a Nurse Practitioner/IBCLC. Outpatient BFLM provider visits include a 45 minute assessment by an IBCLC and a visit with a provider.
*** Frenotomy is incision of lingual frenulum, as pulled from medical records billing (CPT code 41010)
****NA= Not applicable


Figure 1. Percent of Patients Admitted to the Neonatal Intensive Care Unit Receiving Any Maternal Breast Milk at Discharge 2012-2022, p-Control Chart with Key Dates of Interventions and Events
Legend: p-control chart displaying percent of Neonatal Intensive Care Unit patients discharged on breast milk. y-axis represents total infants discharged on breastmilk over the number of total discharges. x-axis is year of discharge. Horizontal lines indicate the upper control limit (UCL) and lower control limit (LCL). n=11,775
*BFLM=Breastfeeding and Lactation Medicine


Table 1: Breastfeeding and Lactation Medicine Provider Visits, Lactation Consultant Visits, and Frenotomies, 2016 to 2022
*BFLM=Breastfeeding and Lactation Medicine
**BFLM providers include a fellowship trained pediatrician, a fellowship trained midwife/IBCLC and a Nurse Practitioner/IBCLC. Outpatient BFLM provider visits include a 45 minute assessment by an IBCLC and a visit with a provider.
*** Frenotomy is incision of lingual frenulum, as pulled from medical records billing (CPT code 41010)
****NA= Not applicable


Figure 1. Percent of Patients Admitted to the Neonatal Intensive Care Unit Receiving Any Maternal Breast Milk at Discharge 2012-2022, p-Control Chart with Key Dates of Interventions and Events
Legend: p-control chart displaying percent of Neonatal Intensive Care Unit patients discharged on breast milk. y-axis represents total infants discharged on breastmilk over the number of total discharges. x-axis is year of discharge. Horizontal lines indicate the upper control limit (UCL) and lower control limit (LCL). n=11,775
*BFLM=Breastfeeding and Lactation Medicine