Breastfeeding in Harris County

Breastfeeding Support Services in Harris County: A Summary

An assessment of breastfeeding support available to women in Harris County was conducted using a telephone survey of area hospitals and clinics that provide obstetric and prenatal, postpartum or well-child services. Respondents included nurse managers, staff nurses, lactation counselors, lactation consultants, and health educators.

Information on WIC services was obtained from individuals responsible for Breastfeeding programs at each of the three area WIC projects.

Responses are summarized by type of institution offering the service:

Hospitals

Health clinics (full service)

School based clinics

WIC projects

Hospitals

Statistics
Most hospitals surveyed do not collect and maintain accurate statistics on their breastfeeding rates.

Healthy People 2010 Goal for breastfeeding initiation: 75% of mothers will initiate breastfeeding in the hospital

48% estimate that they meet or exceed this goal.
17% estimate that exclusive breastfeeding was initiated by at least 75% of women delivering at their facility

Skilled assistance with breastfeeding

50% of hospitals surveyed have Lactation Consultants (LCs) on staff.
10% of hospitals have a specific person to assist with breastfeeding.
40% of hospitals have no designated person to assist with breastfeeding.
The ratio of Lactation Consultants to deliveries at those hospitals employing LCs ranges from 1:32.5 to 1:500.

Education for nursing staff on breastfeeding

There is no consistency in lactation management education requirements for nursing staff.
Continuing education requirements for nursing staff range from 0 to 18 hours of lactation management training.

Breastfeeding Classes

59% offer separate breastfeeding classes.
41% offer breastfeeding classes as a component of prenatal classes.
10% of hospitals offer both.
10% offer a postpartum breastfeeding class.
7% offer no breastfeeding classes for patients.

Written Information given about breastfeeding in the hospital

90% of hospitals surveyed provide written information on breastfeeding to their clients.
There is little consistency in the source of information. Materials distributed include formula company handouts, in-house publications, commercial pamphlets and TDH handouts.

Postpartum follow-up for breastfeeding

Telephone Counseling
40 % of hospitals offer proactive telephone follow-up for clients.
7% have proactive telephone follow-up only if a problem has been identified in the hospital.
20% of hospitals have a "warm line" for breastfeeding questions.

Breastfeeding Clinics in hospitals:

One hospital has a breastfeeding follow-up clinic which serves only women who deliver at the hospital sponsoring the clinic.
Two additional hospitals plan to open breastfeeding clinics in 2003.
One hospital allows mothers with breastfeeding problems to come back to the hospital to see the lactation consultant.

Home visits:

No hospitals offer home visits for breastfeeding problems.

Health Clinics (full service)

Twenty-seven community clinics were surveyed, 24 of these clinics provided prenatal care and 22 provided newborn and infant or pediatric care. Only one of the 27 clinics surveyed did not provide prenatal, postpartum, newborn, infant or pediatric care.

Prenatal Classes
Of the clinics providing prenatal care, 58% offer childbirth classes and another 13 % refer to other clinics for prenatal classes. Health Educators are responsible for providing childbirth classes at the clinics. The number of people who attend prenatal classes varied widely. Most sites reported 4-12 individuals/class with a range from 4 women per class up to 25-35 mothers and fathers at one clinic.

Two of 24 clinics had separate breastfeeding classes.
33% of clinics referred to WIC for breastfeeding classes.

Written Information about Breastfeeding

78% of the clinics provide breastfeeding information.
4 of the 5 clinics that do not have written information requested information on breastfeeding handouts.

Postpartum Services
85% of the clinics surveyed provide postpartum care. 29% have, employ or refer to breastfeeding peer counselors.
No clinic has a postpartum support group.
One clinic has a breastfeeding support group.
One clinic has peer counselors at their facility to help with breastfeeding.
6 clinics (25%) refer mothers to WIC peer counselors at the WIC office associated with their health clinic.

Referrals for breastfeeding problems

75% of clinics surveyed could identify an agency to which they would refer a mother for help with breastfeeding problems. Agencies identified were:

WIC
The mother's health care provider
La Leche League
The clinic's Health Educators
Nutritionists
Others (Texas Health Steps Nurse, LBJ clinic, social worker, Breastfeeding Clinic at BTH).

25% of clinics surveyed could not identify an agency to which they would refer a mother for help with breastfeeding problems.
All clinics indicated that they would like to have a referral list available to know where to refer clients for assistance with breastfeeding problems.

Education for nursing staff on breastfeeding
None of the clinics require lactation management education for their staff.

School Based Clinics

Harris County Hospital District has six school-based clinics, which provide care for children two weeks to 18 years of age.

Written Information about Breastfeeding

None of the clinics have patient education materials on breastfeeding.
All requested information on available handouts and videos.

Education for staff on breastfeeding

Director of Clinics and some staff recognized the need and requested information on staff education on lactation management (Staff includes LVNs, NPs, and one Texas Health Step screener).

WIC Projects

Three WIC projects, with 40 WIC service locations provide services in Harris County. These are the City of Houston - 22 locations, Harris County Public Health and Environmental Services - 11 locations, and University of Texas Health Science Center at Houston (UTHSC) - 7 locations.