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Am J Perinatol 2024; 41(S 01): e2313-e2325
DOI: 10.1055/s-0043-1771255
Original Article

Clinically Integrated Breastfeeding Peer Counseling to Promote Breastfeeding Equity

Lauren S. Keenan-Devlin
1   Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
2   Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
,
Britney P. Smart
1   Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
,
Lisa Hirschhorn
3   Medical and Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Paula Meier
4   Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
,
Urmeka Jefferson
4   Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
,
Anthony Solomonides
5   Research Institute, NorthShore University HealthSystem, Evanston, Illinois
,
Chi Ed Wang
5   Research Institute, NorthShore University HealthSystem, Evanston, Illinois
,
Arden Handler
6   Community and Health Sciences, University of Illinois Chicago School of Public Health, Chicago, Illinois
,
Richard K. Silver
1   Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
2   Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
,
Ann E.B. Borders
1   Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
2   Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
7   Institute for Public Health and Medicine, Northwestern University Center for Healthcare Studies, Chicago, Illinois
› Author Affiliations Funding Financial support for this study was provided by the Patient Centered Outcomes Research Institute contract no.: AD-2020C3-21231 (Principal Investigator: A.E.B.).
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Abstract

Objective This study aimed to determine whether clinically integrated Breastfeeding Peer Counseling (ci-BPC) added to usual lactation care reduces disparities in breastfeeding intensity and duration for Black and Hispanic/Latine participants.

Study Design This study is a pragmatic, randomized control trial (RCT) of ci-BPC care at two ci-BPC-naïve obstetrical hospital facilities in the greater Chicago area. Participants will include 720 patients delivering at Hospital Site 1 and Hospital Site 2 who will be recruited from eight prenatal care sites during midpregnancy. Participants must be English or Spanish speaking, planning to parent their child, and have no exposure to ci-BPC care prior to enrollment. Randomization will be stratified by race and ethnicity to create three analytic groups: Black, Hispanic/Latine, and other races.

Results The primary outcome will be breastfeeding duration. Additional outcomes will include the proportion of breastmilk feeds during the delivery admission, at 6-week postdelivery, and at 6-month postdelivery. A process evaluation will be conducted to understand implementation outcomes, facilitators, and barriers to inform replication and scaling of the innovative ci-BPC model.

Conclusion: This research will produce findings of relevance to perinatal patients and their families, the vast majority of whom desire to provide breastmilk to their infants and require support to succeed with their feeding goals. As the largest RCT of ci-BPC in the United States to date, this research will improve the quality of evidence available regarding the effectiveness of ci-BPC at reducing disparities. These findings will help patients and stakeholders determine the benefits of accepting and adopting the program and inform policies focused on improving perinatal care and reducing maternal/child health disparities. This study is registered with Clinical Trial (identifier: NCT05441709).

Key Points

  • Ci-BPC can promote racial breastfeeding equity.

  • Ci-BPC has not been tested as a generalized lactation strategy in prior trials and is underused.

  • This RCT will identify if ci-BPC can reduce breastfeeding disparities for Black and Hispanic patients.

Keywords

breastfeeding - peer counseling - clinically integrated - community health workers - disparities - health equity

Ethical Approval

This study protocol (EH20-406) was approved by the Institutional Review Board (IRB) in February 2021. All study participants will complete informed consent prior to enrollment in the study. This study was registered on clinicaltrials.gov on July 1, 2022 (identifier: NCT05441709). Additionally, waiver of consent was approved by the IRB for chart review and population-level breastfeeding outcomes conducted as a part of our Implementation Assessments.




Publication History

Received: 22 February 2023

Accepted: 14 June 2023

Article published online:
21 July 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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