Building breastfeeding knowledgeable health systems: Focus groups with physician leaders

Despite the growth of breastfeeding and lactation medicine as a specialty, the care of breastfeeding families is compromised because few standards and recommendations exist for its practice and integration into health systems. We conducted a qualitative study involving three focus groups (N = 13) with breastfeeding and lactation medicine physician leaders who currently work within large health systems across the United States. Our study aimed to gather the perspectives of physician leaders regarding breastfeeding care in health systems, to summarize current practices and recommendations for optimal care, and to explore barriers and facilitators to the implementation of these recommendations. A deductive content analysis approach guided by the Exploration, Preparation, Implementation, and Sustainment Framework was used to analyze the transcripts. Resulting themes revealed the important role that health systems play in modeling breastfeeding supportive practices and the strong influences of leadership and staff personal breastfeeding experiences on health system policies. Recommendations included the creation of breastfeeding and lactation medicine divisions, adequate staff education, staffing and coordination of lactation care across the system and community, support for lactating employees, and public awareness of resources and programs. Barriers to implementation included siloing of lactation services by department, lack of breastfeeding-supportive workplaces, deficient clinical billing for lactation services, and low prioritization by training programs. Facilitators included multidisciplinary collaborations, employee supportive lactation policies, appropriate dyadic lactation billing, and electronic health record workflows. Our focus groups revealed many barriers to the delivery of optimal breastfeeding care within health systems, but strategies were identified for systemic changes. Next steps include identification of breastfeeding and lactation medicine divisions and health systems already implementing the best practices described here. Further research should engage additional stakeholders to better understand administrative and financial points of view regarding barriers and facilitators of breastfeeding support.