The Chairperson of HMHB's Breastfeeding Licensure & Reimbursement Committee is Leah Aldridge, JD, IBCLC, RLC, HMHB Board of Directors. The purpose of this committee is to pursue breastfeeding licensure and reimbursement in the State of Georgia. This work is in response to the US Surgeon General's Call to Action 2011 and supported by USLCA - see both in the pull-down menu. This committee is in the process of being formed.
HMHB's Breastfeeding Initiative was announced at our Annual Meeting & Conference on 10/11/11. Below is the handout that accompanied the presentation.
Licensure and Reimbursement of International Board Certified Lactation Consultants (IBCLCs)
in the State of Georgia: Presented By Leah Aldridge, JD, IBCLC, RLC
October 11, 2011
- Breastfeeding is an important healthcare equalizer providing the healthiest start in life, and reducing the need for later health care services. Human milk is nutritionally adapted to the needs of infants and children worldwide, despite the quality of a mother’s diet or her socioeconomic status. Breastfeeding is one of the most valuable medical contributions to infant health, associated with the reduced incidence and/or severity of various infectious diseases, a lower lifetime risk of diabetes, obesity, certain cancers, and asthma, and enhanced neurodevelopment. Breastfeeding also imparts benefits to nursing mothers, including a reduced risk of pre-menopausal breast cancer, ovarian cancer, type II diabetes, hypertension, hyperlipidemia and cardiovascular disease.
- Breastfeeding saves money for families, businesses, and taxpayers.
- Breastfeeding has the potential to lower U.S. healthcare costs by up to $13 billion each year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance.)
- Babies who are exclusively breastfed for 6 months incur $475 less in direct health care costs during the first year of life.
- Thirty percent (30%) of hospital admissions in the first year of life would have been avoided in one study for each additional month of full breastfeeding.
- Are Georgia’s moms educated about the health and economic benefits of breastfeeding? According to the American Academy of Pediatrics and other respected medical associations, children should be breastfed for at least 1 year after birth and beyond, and exclusively breastfed for the first 6 months of life. Currently, less than 13% of Georgia’s babies are exclusively breastfed at six months of age, whereas nearly 70% of babies leave the hospital being breastfed. These numbers indicate that Georgia's moms understand some of the benefits of breastfeeding, but they do not have the support, know-how or resources to successfully breastfeed long enough to reap the health, social or financial benefits.
- How do we change this? Through greater access to IBCLC breastfeeding support services. According to the Surgeon General, “International Board Certified Lactation Consultants (IBCLCs) are the only health care professionals certified in lactation care. They have specific clinical expertise and training in the clinical management of complex problems with lactation.” The function of a lactation consultant is to work with the nursing mother, as well as the rest of her health care team to address the barriers to breastfeeding. Evidence shows that several specific practices (including IBCLC services, breastfeeding education, and access to breast pumps) in intrapartum medical care settings can significantly affect breastfeeding rates and the duration of breastfeeding, among women. Specifically, inclusion of, and reimbursement for, the services of IBCLCs can improve breastfeeding outcomes and contribute to improved mother and infant health outcomes.
- What is an IBCLC and why can’t a peer counselor provide the support Georgia moms need? Lactation consultants certified as IBCLCs must have accrued 300-1000 hours of supervised lactation-specific clinical experience and 45-90 hours of education in human lactation and breastfeeding. By comparison, WIC peer counselors are only required to receive 26 hours of training, with yearly updates. IBCLCs then must pass an independent international criterion-referenced exam which provides a standard for IBCLC certification in the US. In addition to the previous cited studies, the benefits of IBCLC services have been specifically documented in the Medicaid context—Medicaid mothers who experience contact with IBCLC certified lactation consultants in the hospital (as opposed to peer counselors) have been shown to be more than four times more likely to breastfeed at discharge.
- Why aren’t Georgia’s moms accessing the services of IBCLCs to achieve breastfeeding success? There are currently 319 IBCLCs in the State of Georgia; many of whom are not practicing clinically. The CDC and the USLCA both recommend a minimum of 1-2 IBCLCs practicing clinically in the inpatient setting per 1,000 live births. This number does not consider support which is desperately needed following discharge and which is provided in an outpatient, physician office or home setting. When considering lactation support in all settings, the Surgeon General recommends 8.6 IBCLCs per 1,000 live births. Currently the services of an IBCLC are neither reimbursed by Medicaid nor any private insurer in Georgia. Georgia does not have enough IBCLC’s to meet demand and Georgia’s moms can’t afford the expense associated with the consults. The Surgeon General recognized this issue when she called upon states to license IBCLCs in Action Item 11 of her Call to Action to Support Breastfeeding. Georgia’s moms and babies need IBCLC’s fully integrated into Georgia’s healthcare system in order to provide consumer protection and to ensure skilled clinical lactation services are available and provided equitably. The first step to meeting this goal is to license IBCLCs.
- What are the next steps to achieving licensure of IBCLCs in Georgia?
- Create a Collaborative Committee
- Establish a Mission, Phased Plan and Timeline
- Begin Phase 1: Education
- Begin Phase 2: Legislative Implementation
 American Academy of Pediatrics, “Policy Statement: Breastfeeding and the Use of Human Milk”, Pediatrics, 115(2):496-506 (Feb. 2005).
 M Bartick and A Reinhold, “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis,” Pediatrics 125, no. 5 (2010): e1048-e1056. Estimated savings if 90% of
 T.M. Ball, A.L. Wright, “Health Care Costs of Formula-Feeding in the First Year of Life”, Pediatrics 1999; 103:870-876.
 J.M.P.Talayero et al, “Full Breastfeeding and Hospitalization as a Result of Infections in the First Year of Life,” Pediatrics 2006; 118;e92.
 See, note 1.
Centers for Disease Control and Prevention, August, 2011. Breastfeeding Report Card- United States, 2011. http://www.cdc.gov/breastfeeding.
 U.S. Department of Health and Human Services, “The Surgeon General’s Call to Action to Support Breastfeeding” Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.
 Castrucci et al., “Availability of Lactation Counseling Services Influences Breastfeeding Among Infants Admitted to Neonatal Intensive Care Units,” Am J Public Health 21, no. 5 (2007): 410-415.
 Castrucci et al., “A Comparison of Breastfeeding Rates in an Urban Birth Cohort,” Journal of Public Health Management 12, no. 6 (2006): 578-585.
 Thurman SE, Allen PJ, “Integrating Lactation Consultants into Primary Health Care Services: Are Lactation Consultants Affecting Breastfeeding Success?,” Pediatric Nursing. 2008 Sep Oct;34 (5):419-425.
 See, note 10.
 See, note 7; See also, attached USLCA, July 2010 Staffing Recommendations For the Inpatient Setting
 See, note 8.
 See, note 8.