Lactation consultants' perceived barriers to managing early breastfeeding problems

Background: Gaps exist in breastfeeding knowledge, education, training, and counseling skills among providers, as well as inconsistent and poor communication between provider groups. Research suggests that lactation consultants provide more positive breastfeeding support than nurses or physicians and are important team members in the overall effort to improve breastfeeding rates. Despite the increase in IBCLCs from 245 in 1985 to over 25,000 today, there is virtually no research on the perspectives of lactation consultants regarding their challenges and perceptions of role. Purpose: To understand barriers faced by IBCLCs in providing breastfeeding support and management of early breastfeeding problems, and to explore IBCLCs' perspectives on interprofessional approaches to breastfeeding management. Methods: In-depth semi-structured qualitative interviews were conducted with 19 IBCLCs from across Florida. IBCLCs were from a range of practice settings, including hospitals, WIC/Health Department clinics, and private practice. Symbolic interactionism was applied as a guiding theoretical framework. Data were digitally recorded verbatim, transcribed, and analyzed in Atlas.ti using grounded theory methodology. Results: Communication between providers varies by setting, age, experience and geography. IBCLCs overwhelmingly wish to be perceived as valued members of a health care team, but often find interprofessional collaboration is a struggle. Issues related to anticipatory guidance, referral processes, conflicting information, and scope of practice are common challenges for IBCLCs. However, IBCLCs find creative ways to navigate challenges and describe their role as pivotal in empowering mothers and their families to meet their breastfeeding goals. Discussion: A lack of coordinated/integrated care impacts the delivery of best practices to support breastfeeding. Though rarely actualized, IBCLCs place strong value on coordinated, team approaches to breastfeeding management that employ transparent communication between providers and focus on empowering and educating mothers. Strategies for better collaboration and communication between IBCLCs and other providers are needed.