Relationship Between Perinatal Counseling and Incidence of Breastfeeding in an Inner-City Population Barbara K. Russell, DO Maria Aviles, RN Luc P. Brion, MD OBJECTIVE: We hypothesized that the cost of a lactation program can be reduced without significantly affecting the incidence of breastfeeding. STUDY DESIGN: We conducted a retrospective analysis of breastfeeding among all 7942 moth- ers whose neonates were admitted to the well baby nursery at Jacobi Medical Center ( JMC) over a 44-month period We used multiway frequency analysis to compare the incidence of breastfeeding in three successive models of coun- seling: (1) full-time lactation coordinator, (2) obstetric personnel trained in breastfeeding counseling and full-time lactation coordinator, and (3) obstet- ric personnel and half-time lactation coordinator. Mothers were further clas- sified into three groups according to location of prenatal care and attendance at breastfeeding education sessions. RESULTS: Breastfeeding increased with the initiation of education and the involve- ment of obstetric personnel and did not significantly decrease when the lactation coordinator became half-time. The transition to model 3 re- sulted in decreased costs without significantly affecting the incidence of breastfeeding. Breastfeeding was significantly associated with counseling by obstetric personnel, with prenatal care at JMC, and with breastfeeding education sessions. CONCLUSION: Involving obstetric personnel in breastfeeding counseling may enhance the effectiveness of a lactation program. In our population, the most cost-conscious model included counseling by trained obstetric personnel and a half-time lactation coordinator. Studies have shown that maternal education and counseling pro- grams increase the incidence and duration of breastfeeding in low-income populations. 1–8 Factors affecting the incidence and dura- tion of breastfeeding include: maternal education, ethnicity, socioeco- nomic class, age, family support, maternal participation in the Spe- cial Supplemental Nutrition Program for Women, Infants, and Children Program, and support from the medical community and institu- tional policy. 1–10 Recent studies have also shown that the medical com- munity itself is ill-prepared to adequately support breastfeeding at both the physician and institutional levels. 10 –14 A prospective, randomized, con- trolled study by Brent et al. 1 showed that perinatal education and counsel- ing of primipara women in a low-income, inner-city population doubled the incidence of breastfeeding from 32% to 61% and its median duration from 33 to 88 days. These data suggest that a comprehensive education program can increase both the incidence and duration of breastfeeding. The New York City Bureau of Maternity Services and Family Plan- ning estimates the incidence of breastfeeding (exclusive or partial) at discharge to be 45% in the municipal hospital system, compared with 63% in private institutions. 15 In 1989, Jacobi Medical Center ( JMC) established a breastfeeding program as part of an initiative to increase breastfeeding rates in the municipal hospital system. The program consisted of a single lactation coordinator who was responsible for administration of the program as well as for the education and coun- seling of the mothers. As a result of this program and others like it, the incidence of breastfeeding in the New York City municipal hospi- tal system had been increasing steadily until 1996. Data on the dura- tion of breastfeeding are unavailable. In 1995, the lactation coordina- tor at JMC began training the obstetrical nurses in an effort to further increase breastfeeding rates and comply with the recommendations for the World Health Organization “Baby Friendly” designation. 16 The lactation program was jeopardized in 1997 when the hospital admin- istration reduced the lactation coordinator to a half-time position. The restructuring of the program led us to look more closely at the successes of the past and present programs as part of a quality im- provement issue. OBJECTIVES The objective of the present study was to compare the incidence of breastfeeding during the first 6 weeks postpartum among three mod- els of perinatal counseling. METHODS Lactation Counseling Program at JMC and Basis for the Three Models JMC serves a mixed inner-city population that is mostly insured by Medicaid. The Women’s Health Center at JMC established a compre- Departments of Pediatrics 1 (B. K. R., L. P. B.) and Nursing (M. A.), Albert Einstein College of Medicine and Montefiore Medical Center, Jacobi Medical Center, Bronx, NY. Preliminary results were presented at the First Annual International Meeting Academy of Breastfeeding Medicine, Rochester, NY, October 11, 1996, and were published in abstract form (Pediatr Res 1998;43:329A). Address correspondence and reprint requests to Luc P. Brion, MD, Albert Einstein College of Medicine and Montefiore Medical Center, Weiler Hospital, Room 725, Division of Neonatol- ogy, 1825 Eastchester Road, Bronx, NY 10461. Journal of Perinatology (1999) 19(7) 501–504 © 1999 Stockton Press. All rights reserved. 0743– 8346/99 $12 http://www.stockton-press.co.uk 501 Original Article              