“Breast is best” is the mantra most women hear when preparing for a new baby. But what happens when something that’s supposed to come naturally doesn’t? For new moms at Children’s Hospital Colorado, support comes in the form of the “Trifecta”—a multidisciplinary approach combining the expertise of a pediatrician specializing in breastfeeding management, a registered nurse lactation consultant and a psychologist with expertise in infant mental health and child development. (Pictured left to right: Melissa Buchholz, PsyD, Maya Bunik, MD, and Lorry Watkins, RN, IBCLC)
Typically, moms who have trouble breastfeeding work with specially trained lactation specialists. But according to Maya Bunik, MD, the team’s pediatrician and medical director of the child health clinic at Children’s Colorado, breastfeeding success can be hindered by medical and psychosocial challenges that might be difficult for a lactation specialist alone to address.
Lorry Watkins, RN, IBCLC, is the lactation specialist on the Trifecta team and admits that before Trifecta, the care new moms received felt fragmented.
“I’d get called into the exam room after the providers were finished with the appointment and had moved on to the next patient. It didn’t feel very cohesive. By visiting the patient and family together, as Maya and I have for 10 years, we’re able to better help new moms facing breastfeeding challenges.”
There are many reasons a mom might have difficulty breastfeeding. Everything from functional challenges, such as low milk supply or difficulties with latch, to psychosocial complications such as mental health issues can interfere with a mom’s ability to feed her baby. Significant fatigue and hormonal instability also complicate matters. That’s why an essential part of their success lies in the support provided by psychologist Melissa Buchholz, PsyD. Dr. Bunik believes that teamwork is key to the trifecta.”
“As the physician in this group, I benefit from sharing the responsibility of these challenging cases. By working together, we help to put back the pieces,” she said. “This work would be impossible if I had to do it alone.”
When a mom is referred to the breastfeeding management clinic, the first step is meeting with Dr. Bunik and Watkins together. They take a detailed history and screen for pregnancy-related mood disorders, and weigh the baby pre- and post-feeding. Together they assist with latch and positioning. “Breastfeeding is often blamed if the baby isn’t growing well, so occasionally we obtain lab studies to rule out other issues,” said Dr. Bunik.
“We’re in the room to educate them and to help them move to a point where they can visualize a goal,” said Watkins. “The goals have to be aligned with their physical capabilities. For example, a mom who doesn’t produce milk because of anatomical anomalies can still feel good about having special time breastfeeding baby even if she needs to feed baby using alternative methods.”
When Dr. Bunik and Watkins conclude the appointment, Buchholz talks with the family to review screening scores and take a deeper dive into previous mental health issues. She also provides advice about self-care.
“Having a psychologist on the team has been so helpful. She’s able to loop us back in if there are any lingering issues,” said Dr. Bunik. “We are able to get so much more information on how to best support moms by designating this counseling time immediately after the clinic consult. I’d love to see this type of ‘right here, right now’ approach to mental health consultation become standard practice.”
“Breastfeeding has amazing health benefits for mom and baby,” said Watkins, who has 30 years of experience helping moms in the NICU. “A lot of the women we see feel like failures, but we’re here to tell them that it’s not always automatic.”
Part of the issue, Watkins believes, is that pregnant women are rarely educated about anything beyond delivery. “We don’t talk to moms about parenting and setting realistic expectations,” she said.
Although Colorado is among the top five states for breastfeeding initiation, the duration rates of exclusive breastfeeding at six months fall behind.
“We think this is because there’s a lot of misinformation,” she said. “Many of the moms we see have been given conflicting and sometimes bad advice, which may lead to early termination of breastfeeding.”
The Trifecta’s multidisciplinary approach also has the added benefit of providing continuing education to the other providers. “I’ve learned so much from my friends in infant mental health,” said Watkins. “I’ve even changed my own vocabulary and how I talk to the women we see. They feel beaten down enough, and I know how to better use my words to help.”
For Dr. Bunik, the team’s approach is a great example of what compassionate care is all about. “We give them the time and space that’s necessary to ensure they feel they are being held in mind—that we recognize a new infant and breastfeeding issues can be stressful but they have us there to help guide them through it.”
“It’s a tremendous privilege to work with such a great team,” she said. “Doing this type of work alone isn’t possible. I think we should all dare to join forces with talented colleagues to provide the best, most compassionate care for our patients.”
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