Assessing the effectiveness of lactation consultant support on breastfeeding outcomes: a mixed methods study

While > 90% of Australian mothers initiate breastfeeding, breastfeeding exclusivity and duration rates remain below national guidelines. It is thought that breastfeeding outcomes can be optimized with adequate support, including education and care provided by International Board-Certified Lactation Consultants (IBCLC). Despite their assumed benefit, the direct impact of IBCLCs on breastfeeding outcomes remains under-researched. This investigation aimed to compare breastfeeding outcomes between two study cohorts, one cohort where free individual IBCLC support was offered to all participants, and another cohort where this support was not offered. Data on infant feeding practices were collected prospectively from birth to 12 months and were compared between the cohorts. Additionally, 33 mothers in the IBCLC support provided cohort were interviewed at 10–12 weeks postpartum and were asked an open-ended question about their experiences with IBCLC support. A qualitative investigation using an inductive thematic analysis was performed to describe maternal experiences of IBCLC support. Higher exclusive breastfeeding at 4 months (adjusted odds ratio [aOR] 1.81, 95% confidence intervals [CI] 1.45–2.26, p < 0.001), along with any breastfeeding at 4, 6 and 12 months (aOR 1.60, 95% CI 1.20–2.13, p = 0.001, aOR 1.61 (1.26–2.07), p < 0.001 and aOR 1.69, 95% CI 1.36–2.21, p < 0.001 respectively) were found in the IBCLC support provided cohort. An inductive thematic analysis revealed two major themes related to maternal experiences with IBCLC support. “Barrier free support” included cost free access, timely availability of IBCLCs, convenience, and feeling the safety net of having support provided if needed. “Quality care” consisted of practical guidance, expert knowledge and support that was tailored to maternal needs. This mixed-methods study found the rates of breastfeeding exclusivity at 4 months and duration to 12 months were higher in the cohort that had free access to IBCLC support. Qualitative findings indicate that the information, practical help and emotional support provided by IBCLCs is valued. Support without barriers increased accessibility and maternal comfort, while quality care directly improved maternal breastfeeding experiences. These findings highlight a need for future research that explores how IBCLC support can be best implemented to improve breastfeeding outcomes.