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Clinical Challenges

“Change in the hospital setting is hard,” the Academy of Breastfeeding MedicineExit Disclaimer: You Are Leaving  acknowledges in its model breastfeeding policyExit Disclaimer: You Are Leaving . The following table lists some common challenges and offers some possible solutions.



Frustration arises from inconsistent, conflicting information about breastfeeding.

Encourage ongoing education of current breastfeeding science and care skills through use of:

  • college-based certification (To find a certification course, try searching on these terms: certified breastfeeding lactation course;
  • current professional texts (To find a relevant textbook, try searching on these terms: breastfeeding lactation); and
  • the Phoenix Indian Medical Center helpline, 1–877–868–9473.

Provide pathways for staff to achieve certifications as:

  • certified lactation educators—childbirth professionals who are qualified to teach, support, and educate the public on breastfeeding;
  • certified breastfeeding counselors—health care professionals who help new mothers learn how to breastfeed and overcome breastfeeding challenges; or
  • international board-certified lactation consultants—professionals certified by the International Board of Lactation Consultant Examiners who provide expert lactation care and promote changes that support breastfeeding.

Confusion about progress exists: “How do we know if we are making a difference?”

Record the mother’s infant feeding choice in the Electronic Health Record (EHR) or in the Patient Care Component—at the six-week postpartum visit and at all pediatric visits during the first year of life, and then regularly communicate the results from the Clinical Reporting System to your staff and community by:

  • providing information at staff meetings and monthly e-mails;
  • creating charts that show progress; and
  • announcing, advertising, or listing progress measures and outreach efforts.

To make sure the infant feeding choice is being recorded, consider linking the use of the infant feeding tool in the EHR or other breastfeeding support behaviors with employee evaluations.

Attitudes about breastfeeding range from indifference to overenthusiasm.

Foster an organizational culture that respects a family’s informed feeding choice.

Educate staff about why breastfeeding and lactation care are important, and dispel misinformation about breastfeeding.

Display culturally appropriate posters (and similar media) in strategic locations that demonstrate the benefits of breastfeeding or that reinforce a lactation policy.

Use the facility’s intranet or online training system to educate about the benefits of breastfeeding.

Emphasize the fact that breastfeeding is a tool to reduce health disparities. Sample message: “Breastfeeding could mean less diabetes for you and your baby.”

Ask staff members to ideate their own ways of promoting breastfeeding.

Participate in public education campaigns like World Breastfeeding WeekExit Disclaimer: You Are Leaving .

Post information about employee lactation accommodations.

Clinicians don’t have adequate training and education in breastfeeding.

Require a minimum competency in lactation care as a basis for employment and continuing practice.

Offer continuing education opportunities in lactation care and require the maintenance of competency in the hospital’s breastfeeding policy. See the solution above about certification opportunities.

Clinicians’ personal experiences and misinformation interfere with breastfeeding support.

Establish a written breastfeeding policy that is communicated to staff in keeping with the 10 Steps to Successful Breastfeeding.

Formula care packages given to new mothers when they leave the hospital discourage breastfeeding.

Eliminate free care packages with formula and formula advertising.

Purchase and store formula in the same manner as other medications.

The hospital encourages breastfeeding, but new mothers get little encouragement after discharge from the hospital.

Make sure clinicians in the home and community settings are trained in lactation care and are encouraging breastfeeding.

Partner with the Women, Infants, and Children (WIC) representative to set up a continuum of care for WIC participants. Work with WIC peer counselors—mothers in the community with personal breastfeeding experience who provide information and support to other mothers—to ensure bedside support for new families.

Work with tribal lawmakers and business leaders to enact and enforce policies that support lactation at work and in the community. The Navajo Nation Breastfeeding Coalition is an example of a successful community-based organization. The coalition spoke in Navajo chapterhouses (community meetings) in favor of a tribal law supporting breastfeeding in the workplace, and, in 2008, the Navajo Nation Tribal Council unanimously passed the Navajo Nation Healthy Start Act.