Breastfeeding offers many medical and neurodevelopmental advantages for mothers and infants; however, the majority of mothers stop breastfeeding before it is recommended, with less than half of infants receiving breast milk at six months of age. Professional lactation support by International Board Certified Lactation Consultants (IBCLCs) increases breastfeeding duration and exclusivity (i.e., proportion of breast milk in an infant?s diet); however, many communities lack access to IBCLCs. Racial and ethnic minority mothers have lower breastfeeding rates, and limited access to professional lactation support may contribute to this disparity. Virtual ?telelactation? consults that use two-way video have the potential to increase access to IBCLCs among underserved populations. Telelactation is convenient because it does not require a new mother to travel with her infant and can be provided on demand. Telelactation is also less costly than an in-person visit. Since 2015, several companies have begun to offer telelactation through a direct-to-consumer (DTC) model, where women initiate video calls with providers using their personal devices (e.g., mobile phones); however, no published research has linked telelactation with breastfeeding outcomes. To address this evidence gap, we will expand on a successful pilot study that demonstrated the feasibility and perceived value of telelactation in a rural community, and conduct an innovative ?siteless? randomized controlled trial to evaluate the impact of DTC telelactation on breastfeeding outcomes. We will recruit 2400 primiparous pregnant women age >18 who plan to breastfeed and live in the 17 states most underserved by IBCLCs. Recruitment will occur via Ovia, a popular pregnancy tracker mobile phone application. Women will be randomized to: 1) on-demand telelactation video calls on personal devices or 2) usual care. Quantitative data on breastfeeding rates, as well as qualitative data on experiences with telelactation, will be captured via surveys and in-depth interviews and compared across racial and ethnic groups.
The specific aims are: 1) Assess the impact of DTC telelactation breastfeeding duration and exclusivity, compare effectiveness by race/ethnicity and rural/urban location, and explore whether self-efficacy serves as an explanatory mechanism; 2) Explore how acceptability of and experiences with telelactation vary across subpopulations of mothers.
This research aims to improve children?s health and reduce disparities in key maternal and child health outcomes. It will also inform the design and execution of future siteless trials among pregnant and postpartum women to enhance minority participation in research and reduce the time and resources required to surface evidence on the impacts of new eHealth interventions. Study results will inform policy debates about reimbursement of telelactation and will identify strategies to further tailor these services to meet the needs and preferences of racial and ethnic minority women.
This project will assess the impact of a novel breastfeeding support intervention (?telelactation?), delivered via video calls on personal devices including mobile phones and tablets. The goal of this intervention is to increase access to International Board Certified Lactation Consultants to improve, and reduce disparities in, breastfeeding rates. By implementing a ?siteless? randomized controlled trial that recruits participants through a popular pregnancy tracker mobile phone application, this study will efficiently recruit a national sample of 2400 diverse women to 1) provide evidence on the effectiveness of a widely available, yet understudied, service and 2) leverage technology to promote one of the most widely recommended health behaviors to improve children?s health and to reduce disparities in key maternal and child health outcomes.
