One of the recommendations made in the Surgeon General's Call to Action to Support Breastfeeding is to ensure access for breastfeeding mothers to services provided by International Board Certified Lactation Consultants (IBCLCs). IBCLCs are healthcare professionals who specialize in the clinical management of breastfeeding; they are the only healthcare professionals with this type of certification and so far the only ones potentially reimbursable by insurers. They work with mothers to solve breastfeeding problems and educate families and healthcare professionals about the benefits of breastfeeding. One of the main barriers to increasing lactation support in this manner is the lack of reimbursement by private and public insurers. Rates of exclusive breastfeeding and of any breastfeeding are higher among women who have had babies in hospitals with IBCLCs on staff.

A statewide Breastfeeding Coalition was established in 2008 and is supported by a part-time director and leadership team, who have provided education, leadership and support for breastfeeding initiatives statewide.

Currently, there are 4.13 IBCLCs per 1000 live births in Nebraska, with a disproportionate number of these lactation professionals located in the Eastern part of the state. Increasing access to IBCLCs is a key recommendation found in the Surgeon General’s Call to Action to Support Breastfeeding and the Centers for Disease Control & Prevention Guide to Evidence-Based Interventions.

Nebraska SHIP Priorities 1 & 2: Nebraskans will have reduced heart disease, stroke and cancer mortality, morbidity and associated risk factors.

For this SHIP goal, several activities were planned for implementation:

• Provide training opportunities for lactation professionals that are designed to support IBCLC certification.
• Develop a preceptor model and preceptor sites for lactation professionals.
• Provide trainings for community health workers about lactation support services.

Additionally, with support from the State Health Improvement Plan, a three part webinar series was presented with speakers from the International Board of Lactation Consultation Examiners, the United States Lactation Consultant Association, The Nebraska Perinatal Quality Improvement Collaborative, local pediatricians, IBCLC’s, and nurses.These webinars aimed to increase lactation support throughout the state and to inform potential IBCLC candidates of the different pathways available to them in pursing their certification. Research shows that adoption of the practices to encourage and support breastfeeding could result in a $51,000,000 annual reduction of healthcare costs in Nebraska if 60% of babies were fed exclusively breast milk for the first 6 months (based on Bartik & Reinhold, 2010). Savings include costs associated with NEC, otitis, gastroenteritis, hospitalization for lower respiratory infection during infancy, atopic dermatitis, SIDS, childhood leukemia, asthma, type1 diabetes and obesity.

The Nebraska Breastfeeding Coalition has developed The Community Breastfeeding Initiative (CBI), which aims to bring breastfeeding support and resources to local communities across Nebraska willing to engage community stakeholders impacting breastfeeding support.Built off the success of the Lincoln Community Breastfeeding Initiative and pilot tested in Norfolk, the Nebraska Breastfeeding Coalition offers mini-grants and trainings to communities in need of resources, education and support to advance their community breastfeeding efforts with the goal of strengthening community breastfeeding support networks by engaging stakeholders, providing trainings and connecting local and state breastfeeding advocates.

This map illustrates the gap of IBCLC support across Nebraska’s 62 birthing hospitals.

The uneven blue areas indicate the location by zip code of the IBCLC. The light blue areas indicate there is 1 IBCLC in that zip code and the darkest blue areas indicate there are 4 IBCLCs in that zip code. For some counties, Lancaster for example, you need to add the IBCLCs up for all the zip codes. There are 7 IBCLCs in Lancaster County to serve approximately 5000 births.Hall County (Grand Island) has 1 IBCLC for over 1000 births – same as Scottsbluff County. And then there is dozens of smaller hospitals with 50 – a few hundred births annually and they have no IBCLC in their counties.

The red dots are the sites of our birthing hospitals.The larger the dot, the more births occurring at that site.

Even though nearly half (48%) of the 26,000 births occur in Lancaster and Douglas Counties, there is a clear need for increased Lactation Support Providers – IBCLCs - in rural, central, north eastern and western Nebraska.

The Really?Really. campaign:

The Really? Really. campaign was developed through a partnership between Live Well Omaha Kids and the Nebraska Breastfeeding Coalition to increase knowledge around the importance of breastfeeding for physicians and other healthcare providers, and moms and their support network. The easy-to-understand and eye-catching materials are available for anyone to download and to date, they have been downloaded in 47 states, 9 countries and 4 tribal communities. This link contains additional information on how to obtain the material for distribution: http://www.reallyreally.org/