Improving Breastfeeding Supports in Primary Care Settings

Breastfeeding in exam roomThe Improving Breastfeeding Supports in Primary Care Settings project is a collaborative partnership between VCHIP and Vermont WIC at the Vermont Department of Health. The project’s overall aim is to measurably increase the number of VT mothers and babies who are exclusively breastfeeding to six months. To realize the project’s aim, this statewide project is working with pediatric and family medicine practices to achieve three goals: 1) improve breastfeeding related office systems and supports; 2) increase practitioners’ levels of knowledge and comfort regarding breastfeeding related care; and 3) train practitioners to use a standardized tool for assessment and evaluation of breastfeeding.

Specifically, mother/infant pairs (0-6 months infant age) will have greater access to and availability of evidence-based, breastfeeding related care in “breastfeeding-friendly” primary care settings. Participating providers will have the tools to knowledgeably and comfortably assess and evaluate breastfeeding status; recognize breastfeeding problems; and if indicated, intervene early, plan appropriate follow-up and document all.

Objectives (March – August, 2014)

  • 95% of breastfeeding mother/baby pairs will receive a documented assessment at each of 5 well-child visits (0-6 days; 1-4 weeks; 2 months; 4 months; 6 months)
  • 95% of breastfeeding mother/baby pairs who have been identified with a breastfeeding related problem will receive a documented follow-up plan
  • 35% or more of patients 0-6 months of age will be exclusively breast milk feeding at each well-child visit (5 separate time points, identified in first objective, above)
  • 70% or more of patients 0-6 months of age will be breast milk feeding (any breast milk) at each well-child visit (5 separate time points, identified in first objective, above)


  • Breastfeeding Toolkit developed
  • Sixty-two providers in 25 practices have been trained to use a standardized assessment tool to evaluate breastfeeding and provide developmentally appropriate treatment to breastfeeding mother/infant pairs or referral to a lactation consultant if indicated
  • Practice teams in Vermont practices located in 9 of 14 VT counties have improved office systems, by running monthly PDSA cycles around one or more change strategies from a clinical protocol shown to improve office systems for breastfeeding support
  • The Project won the U.S. poster prize at the Academy of Breastfeeding Medicine Annual International Meeting in Cleveland, Ohio, in November 2014

Based on a first round of data (the project is still in progress):

The percentage of providers performing breastfeeding evaluations increased from 70% at the start of the study to 88%
The percentage of breastfeeding mother/baby pairs in which either the mom or baby were diagnosed with a breastfeeding-related problem and received a documented follow-up plan increased, exceeding the 95% goal
Overall breastfeeding rates did see overall improvement; while a statistically significant increase in exclusive breastfeeding has not been shown for any age group, the percentage of infants at 6 months infant age receiving exclusive breast milk did increase from 40% to 51% - a big “bump” that came after five months of putting to use the training in which providers participated.