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Lactation Education

Category

Child & Family Health

Child's Age

Prenatal

Participant

Parents/Guardian

Languages

English, Spanish, Other

Brief Description

Lactation education provides support to parents and caregivers using the Ready, Set, BABY curriculum provided by the University of North Carolina (UNC) at Chapel Hill. Implementation should include community awareness of UNC’s hotline, Breastfeeding Warmline, which can be accessed by calling (984)-974-8078 or toll free at (866) 428-5608 for anyone living in NC.

Expected Impact

  • Statistically significant improvements in Infant Feeding Intention (IFI) Scale scores 
  • Statistically significant decreases in comfort with the idea of using formula 
  • Statistically significant improvements in knowledge of Baby-Friendly practices, including skin-to-skin contact and remaining with their baby in the same room 
  • At post-test, significantly more likely to correctly identify early infant feeding cues 
  • At post-test, significantly more likely to recognize risks of substituting breastmilk and identifying crying as a late infant feeding cue, rather than an early cue

Core Components for Model Fidelity

  • Education Curriculum: NCPC requires use of the Ready, Set, BABY curriculum developed by the Carolina Global Breastfeeding Institute’s Department of Maternal and Child Health housed at UNC Chapel Hill. Ready, Set, BABY is designed for prenatal counseling on lactation and optimal maternity care practices. All resources are available for free through UNC Chapel Hill and the sole cost of implementation is printing any such resources and staff time for training and delivery. If a Smart Start Local Partnership is interested in using a different lactation education option, please present the model to the appropriate program officer for evidence review. 
  • Alignment with Baby-Friendly USA, Inc.: The selected curriculum and materials should align with guidelines set forth by Baby-Friendly USA, Inc., the national authority and accrediting body in the United States for the Baby-Friendly Hospital Initiative (BFHI launched by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) in 1991. BFUSA’s guidelines and evaluation criteria uphold the Ten Steps to Successful Breastfeeding in the United States, which are endorsed by major maternal and child health authorities, such as American Academy of Pediatrics, American Academy of Family Physicians, Centers for Disease Control and Prevention, and the U.S. Surgeon General, among others.

Languages Materials are Available in

English, Spanish, Other*

*Contact purveyor about additional available languages.

Delivery Mode

If possible, in-person during prenatal visits, home visits, or group meetings. Virtual group meetings are also effective.

Dosage

As needed, both prenatal and postnatal. Per BFUSA guidelines, breastfeeding education should begin early, ideally during the initial prenatal visits.

NCPC recommends that Lactation education be provided across multiple visits/workshops (as opposed to in a single stand-alone workshop or onetime visit) to give parents/caregivers time to reflect on materials and provide time for relationship building between parents and educators.

Infrastructure for Implementation

Materials: Ready, Set, BABY free resources may be printed from their website.

Staffing Requirements

No specific background experience required. Educators may be parents, peer counselors, educators, nurses, childbirth educators, doulas, nutritionists, dietitians, midwives, physicians, social workers, public health workers, public administrators, and other community members with lived experience.

If implementing Lactation Education without a Certified Lactation Consultant (CLC) or International Board-Certified Lactation consultant (IBCLC) on staff or as the educator, you must have a list of local CLC or IBCLCs to refer parents to when needed. 

Based on the research, it is recommended that Ready, Set, BABY educators receive training in the curriculum as well as supervision from an IBCLC.

Training for Model Fidelity

UNC Chapel Hill provides training through the Breastfeeding University, a series of three online learning modules designed for healthcare and child care providers. Each module takes approximately 30 minutes to complete. Each module includes additional learning opportunities that are optional and may require additional time.  

For those interested in furthering their education, please see the Lactation Consultation entry in Smart Solutions.

Contact Information

https://sph.unc.edu/cgbi/ready-set-baby/

Kathy Parry: Project Director at Carolina Global Breastfeeding Institute; (828) 242-6881, kathyparry@unc.edu

Cost Estimates

Ready, Set, BABY is free and non-commercial. The primary costs of implementation are staffing considerations and printing resources created and shared by Ready, Set, BABY.

Purpose Service Code (PSC)

5413 – Prenatal/Newborn Services

Program Identifier (PID)

Lactation Education

Minimal Outputs for NCPC Reporting

FY 24-25:

  • Number of parents/caregivers participating† 

†Select Family Support Programs data collection will include basic demographic data for parent/caregiver participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate.

Minimal Outcomes for NCPC Reporting

FY 24-25:

  • Increase in parent knowledge

Minimal Measures for NCPC Reporting

FY 24-25:

  • Parent Use of Services Calculation
  • TBD Breastfeeding Education Participant Post Survey

NCPC Evidence Categorization

Evidence Informed- Lactation education is an industry standard practice supported by Baby-Friendly USA, Inc. and other medical authorities. The Ready, Set, BABY curriculum developed by the Carolina Global Breastfeeding Institute (CGBI) housed under UNC Chapel Hill’s Department of Maternal and Child Health is evidence informed, based on two evaluations.

Research Summary

Three of the most relevant publications on lactation education include two evaluations of Ready, Set, BABY (RSB)1 2 and the guidelines established by Baby-Friendly USA, Inc.3 Study participants included pregnant women ages 18 and older who primarily identified as White or Hispanic/Latinx. Participants were primarily located in suburban areas of North Carolina and spoke English or Spanish. Participants’ education levels varied, ranging from some high school education to holding a doctorate. Primiparous and multiparous parents received RSB virtually, in person, in group settings, and individual sessions. Results indicated statistically significant improvements in Infant Feeding Intention (IFI) Scale scores, decreases in comfort with the idea of using formula, and improvements in knowledge of Baby-Friendly practices, including skin-to-skin contact and remaining with their baby in the same room. At post-test, RSB recipients were significantly more likely to correctly identify early infant feeding cues and to recognize risks of substituting breastmilk and identifying crying as a late infant feeding cue, rather than an early cue. 

Baby-Friendly USA, Inc. (BFUSA), the national authority and accrediting body in the United States for the Baby-Friendly Hospital Initiative (BFHI), provides guidelines and evaluation criteria to uphold the Ten Steps to Successful Breastfeeding in the United States. This includes the need for providing pregnant women with basic information about breastfeeding as well as support regarding their decisions around breastfeeding. Primary care facilities are urged to provide counseling about the benefits, management, and potential challenges of breastfeeding so pregnant women can make informed decisions. Ultimately, breastfeeding education must be responsive to the family's questions and concerns while remaining informative and culturally sensitive.

  1. ^ See Wouk et al. (2023). This study evaluated the acceptability and impacts of Ready, Set, BABY (RSB) Live, an adaptation of RSB specifically for virtual group delivery considering the COVID-19 pandemic. Groups were facilitated virtually through a HIPAA-compliant software and led by an International Board Certified Lactation Consultant (IBCLC) or a trained RSB Live facilitator supervised by an IBCLC. An anonymous, virtual Qualtrics survey was used to measure outcomes after completing an RSB Live session. The assessment included questions about knowledge of Baby-Friendly practices (corresponding with Step 3 of BFUSA Guidelines and Evaluation Criteria), early infant feeding cues, and a retrospective pre/post question regarding participants' breastfeeding intentions before and after RSB Live, based on the Infant Feeding Intentions (IFI) Scale. The sample population included 146 pregnant women ages 18 and older with an average gestational age of 30 weeks (SD = 7.3). Of these participants, 42.4% identified as White, 20.8% identified as Hispanic/Latinx, and 18.8% identified as Black/African American. Most participants reported being from North Carolina (78.8%), speaking English as their primary language (82.1%), and living in a suburban area (46.2%). Education levels varied, with the greatest percentages of participants reporting some college education (22.2%), holding a four year degree (27.8%), or holding a professional/master's degree (23.6%). Most participants were pregnant with their first child (81.5%). Results indicated statistically significant increases in IFI Scale scores, from 14.37 out of 16 (retrospective pre-intervention) to 14.76 post-intervention (p < 0.0005). Statistical significance was not reported for other outcomes. Nonetheless, participants reported high levels of knowledge about Baby-Friendly practices, early infant feeding cues, and the benefits of breastfeeding after RSB Live. For example, most participants (78.1%) recognized the benefits of breastfeeding include reducing risk of diabetes and breast/ovarian cancers, protecting babies from ear infections and stomach bugs, speeding recovery and slowing bleeding after birth, and providing the perfect nutrition for the baby. All participants agreed that skin-to-skin contact after birth is important and 93.2% of participants expected to be in the same room as their baby while at the hospital. Responses about the COVID-19 adaptation were overwhelmingly positive with high rates of acceptability. About half of respondents (51.4%) indicated that their RSB Live session lasted 75-90 minutes. Most participants reported increases in their knowledge of COVID-19 and its relevance to perinatal populations (72.7%) as well as an increase in confidence to make informed decisions guided by COVID-19 recommendations (70.5%). Study limitations include a lack of control/comparison group and a sample limited to people with reliable internet access and time to participate in a virtual meeting.  
  2. ^ See Parry et al. (2018). This study evaluated the acceptability and impacts of Ready, Set, BABY (RSB). Breastfeeding education services were provided by health care workers (nurses, physicians, lactation professionals, and others) who were recruited via email after downloading RSB materials. These professionals completed online educator training and orientation to RSB materials as well as a human subjects ethics course. Sites were located in San Juan, Puerto Rico (2 sites), North Carolina (4), and Louisiana (1). The sample population included 416 pregnant women ages 18-44 (M = 28) with an average gestational age of 32 weeks. Education levels varied widely, although most participants reported having some college education (22.3%), a 2-year college degree (15.6%), or a 4-year college degree (23%). The sample consisted of a diverse group of women, including Hispanic (46.4%), non-Hispanic White (38%), non-Hispanic Black (11.9%), and Asian/Pacific Islander, American Indian/Alaskan Native, or multiracial participants (3.7%). Most participants were pregnant with their first child (71%) and received RSB in a group education setting (72.9%). While the length of RSB delivery varied, the greatest proportion of respondents indicated that their session lasted over an hour (38.4%). Measures included pre- and post-intervention questionnaires that collected socio-demographic data, assessed comfort level with using formula, assessed knowledge of Baby-Friendly practices (corresponding with Step 3 of BFUSA Guidelines and Evaluation Criteria) and early infant feeding cues, and used the Infant Feeding Intentions (IFI) Scale. Results indicated statistically significant improvements in IFI Scale scores from a median of 14.0 out of 16 at pre-intervention to 15.5 post-intervention (p < 0.001). Participants reported statistically significant decreases in comfort with the idea of using formula from a mean of 2.88 out of 4 at pre-intervention to 2.16 at post-intervention (p < 0.001). IFI Scale scores and reports of comfort with formula feeding remained significant when assessing primiparous mothers (p < 0.001 and p < 0.001 respectively) and non-Hispanic Black mothers (p < 0.001 and p < 0.01 respectively). Participants also reported statistically significant improvements in knowledge of Baby-Friendly practices, including skin-to-skin contact (p < 0.001) and remaining with their baby in the same room (p < 0.001). After completing RSB, respondents were significantly more likely to correctly identify early infant feeding cues such as sucking on hand or tongue (p < 0.001), opening mouth while turning their head side to side (p < 0.001), bringing their hand to their mouth (p < 0.001), fluttering their eyes (p < 0.001), and nuzzling into the breast (p < 0.01). Participants were significantly more likely to recognize risks of substituting breastmilk and identifying crying as a late infant feeding cue, rather than an early cue.  
  3. ^ See Baby-Friendly USA, Inc. (2021). Baby-Friendly USA, Inc. (BFUSA) is the national authority and accrediting body in the United States for the Baby-Friendly Hospital Initiative (BFHI) which is an initiative launched by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) in 1991. BFUSA provides guidelines and evaluation criteria to uphold the Ten Steps to Successful Breastfeeding in the United States. These Ten Steps are endorsed by major maternal and child health authorities, such as American Academy of Pediatrics, American Academy of Family Physicians, Centers for Disease Control and Prevention, and the U.S. Surgeon General, among others. Step 3 of the Ten Steps is to "discuss the importance and management of breastfeeding with pregnant women and their families" (Baby-Friendly USA, Inc., 2021, p. 7). This tenet describes the need for basic information about breastfeeding as well as support regarding their decisions around breastfeeding. Primary care facilities are urged to provide counseling about the benefits, management, and potential challenges of breastfeeding so pregnant women can make informed decisions. This includes information on the risks of using substitutes such as formula, practical skills like attachment and recognizing feeding cues, best practices regarding skin-to-skin contact and safe sleeping environments, challenges such as engorgement and breastfeeding while returning to work, and more. Ultimately, breastfeeding education must be responsive to the family's questions and concerns while remaining informative and culturally sensitive. BFUSA encourages facilities to begin breastfeeding conversations in the initial prenatal visits to allow time to discuss challenges as needed (including risks of preterm delivery, high-risk pregnancies, and other concerns). It is recommended that resources be provided in a variety of formats and languages while ideally presenting information at or below a 5th grade reading level. Providing resources alone, however, is insufficient; BFUSA emphasizes the need for meaningful conversations about breastfeeding that address the needs and concerns of the individual woman and her family. 

Researched Population

  • 146 pregnant women ages 18 and older with an average gestational age of 30 weeks (SD = 7.3)
  • Participants who identified as White, Hispanic/Latinx, Black/African American, Asian/Pacific Islander, American Indian/Alaskan Native, or multiracial 
  • Participants located in various areas, such as rural, urban, and suburban settings in North Carolina, Puerto Rico, and Louisiana 
  • Individuals whose primary language was English or Spanish 
  • Participants with varied education levels, ranging from some high school to PhD
  • Primiparous and multiparous parents
  • 416 pregnant women ages 18-44 (M = 28) with an average gestational age of 32 weeks
  • Participants who received RSB virtually, in person, in group settings, and individual sessions

Baby-Friendly USA, Inc. (2021). Step 3 – Prenatal Care. Guidelines and Evaluation Criteria for Facilities Seeking Baby-Friendly Designation, Sixth Edition (pp. 38-43). Baby-Friendly USA. https://www.babyfriendlyusa.org/wp-content/uploads/2021/07/Baby-Friendly-GEC-Final.pdf

Parry, K. C., Tully, K. P., Hopper, L. N., Schildkamp, P. E., & Labbok, M. H. (2018). Evaluation of Ready, Set, BABY: A prenatal breastfeeding education and counseling approach. Birth: Issues in Perinatal Care, 46(1), 113-120. https://doi.org/10.1111/birt.12393  

Wouk, K., Parry, K. C., Bridgman, J., Palmquist, A. E. L., Perkins, M., Smetana, A., Woods-Barr, A., & Sullivan, C. S. (2023). Evaluation of an Evidence-Based Prenatal Breastfeeding Education Curriculum Adapted for the COVID-19 Pandemic: Ready, Set, Baby Live COVID-19 Edition. The Journal of Perinatal Education. 32(1), 48-66. https://doi.org/10.1891/JPE-2021-0035



Local Partnerships Currently Implementing

Local Partnerships in purple have adopted Lactation Education. Local Partnership contact information can be found here.