Implementation of a Language-Concordant, Culturally Tailored Inpatient Lactation Program.

Abstract

Importance: Benefits of breastfeeding are extensive, but racial and ethnic disparities persist. Mama Sana (Spanish for healthy mother) is a bilingual, culturally tailored program that aims to reduce breastfeeding inequities.

Objective: To examine differences in lactation support and breastfeeding outcomes among Spanish-speaking Hispanic birthing parents who participated in Mama Sana compared with a historical control (pre-Mama Sana) group.

Design, setting, and participants: In this cohort study, patients who participated in the Mama Sana program during their delivery hospitalization from January 2022 to September 2023 were compared with a historical control group who delivered prior to the implementation of the program (July 2019 to December 2021). The study took place at an academic medical center in Boston with a high-risk obstetric service. Data were analyzed from January to September 2024.

Exposure: Beginning in January 2022, a bilingual native Spanish-speaker licensed as a registered dietitian and certified lactation counselor provided lactation support to participants during their delivery hospitalization with follow-up phone calls after discharge (until 6 months post partum).

Main outcomes and measures: The primary outcome was exclusive breastfeeding at discharge. Secondary outcomes included any breastfeeding at discharge, any breastfeeding and exclusive breastfeeding at 6 weeks post partum, and change in maternal body mass index (BMI). Process measures included inpatient lactation consult placement and receipt of any and language-concordant lactation support. The χ2 test was used to analyze outcomes, process measures, and balancing measures.

Results: In this study, 417 patients were included (Mama Sana group, 175 patients; mean [SD] age, 28.9 [6.1] years; pre-Mama Sana group: 242 patients; mean [SD] age, 29.8 [6.1] years). Sociodemographic characteristics including age and BMI were similar between groups. Mama Sana participants were less likely to be multiparous or to have diabetes compared with the pre-Mama Sana group. At hospital discharge, 36 of 175 Mama Sana participants (20.6%) were exclusively breastfeeding compared with 39 of 242 pre-Mama Sana (16.1%) (adjusted risk difference [aRD], 2.5%; 95% CI, -1.2 to 6.4). Significantly more Mama Sana participants engaged in any breastfeeding prior to hospital discharge (172 of 175 [98.3%] vs 222 of 242 [91.7%]; aRD, 7.1%; 95% CI, 2.8% to 11.5%) and at the 6 week postpartum visit (81 of 102 [79.4%] vs 109 of 170 [64.1%]; aRD, 15.6%; 95% CI, 4.8% to 26.4%) compared with the pre-Mama Sana group. More Mama Sana participants had a lactation consult placed (109 of 175 [62.3%] vs 108 of 242 [44.6%]; P < .001) and received lactation support in Spanish (175 of 175 [100%] vs 49 of 242 [20.3%]; P < .001) than those in the pre-Mama Sana group.

Conclusions and relevance: In this cohort study, Mama Sana's language-concordant, culturally tailored lactation program was associated with higher rates of lactation support and some breastfeeding outcomes, which suggests the program may be a useful approach to perinatal care equity.