Virtual Care: A case study on the impact of providing Public Health Breastfeeding Services via video visits

Breastfeeding is one of the most effective ways to support optimal child health, with breastmilk being the ideal food for infants and providing all the energy and nutrients for the infant’s first months of life and beyond¹. The skin-to-skin contact and suckling facilitated through breastfeeding has been associated with physical and emotional benefits for both the baby and the mother.² Women who breastfeed also have a reduced risk of breast and ovarian cancers.^3,4

In Ontario, many mothers are at an increased risk of poor breastfeeding outcomes due to barriers that may impact breastfeeding, including accessibility to services.⁵ The World Health Organization recommends that children be exclusively breastfed for at least the first six months (and beyond, with the introduction of solid foods) and provides guidelines on breastfeeding counselling, as a public health intervention, to improve breastfeeding practices.⁶ The rate of breastfeeding among new mothers is an important public health performance indicator and Public Health Units across Ontario offer breastfeeding clinics to support new mothers to initiate and maintain breastfeeding.^5,6

The onset of the COVID-19 pandemic posed a significant challenge in providing breastfeeding support to new mothers. With change management support from the eHealth Centre of Excellence, the Region of Waterloo Public Health adopted virtual care to continue the delivery of their breastfeeding support services through secure, online video visits.

What were the benefits?

In April 2020, in response to COVID-19, approximately 70% of appointments moved to being video visits, with a smaller percentage of assessments being conducted by telephone, and the smallest percentage of visits being conducted in-person. The rising need for public health to respond to emergency measures (e.g., contact tracing for COVID-19) 7 posed a limitation on public health resources to support the Pregnancy and Breastfeeding Services program, even though the demand for this public health service remained constant. The use of a virtual model of care supported optimized and efficient use of resources. A comparison of no-shows and cancelled appointment rates was completed using the 7-month period after virtual care was first implemented and the same period in the previous year, illustrating that the use of video visits was associated with a reduction in no-shows and cancelled appointments as indicated below:

• Were quick to implement into practice, reducing the risk of exposure to COVID-19 for both staff and clients
• Provided clients with convenient access to public health services, including health teaching and breastfeeding consultation in a virtual setting
• Securely supported the provider’s ability to visually assess the infant behaviour and provide recommendations accordingly
• Provided an efficient appointment for public health nurses to conduct virtual care

Video visits…

Virtual care has had a positive impact on decreasing the number of no-shows and cancelled appointments. Both staff and patients saved mileage and time from travelling, more efficient appointments were conducted virtually, and clients were provided with a convenient option to access this important public health service.

¹American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827-e841. Retrieved November 18, 2020, from https://pediatrics.aappublications.org/content/129/3/e827.

²Feldman-Winter, L., & Goldsmith, J. P.; Committee on Fetus and Newborn, Task Force on Sudden Infant Death Syndrome. (2016). Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics, 138(3), e20161889. Retrieved November 18, 2020, from https://pediatrics.aappublications.org/content/early/2016/08/18/peds.2016-1889.

³Collaborative Group on Hormonal Factors in Breast Cancer. (2002). Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. The Lancet, 360(9328):187-195. Retrieved November 18, 2020, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)09454-0/fulltext.

⁴Babic, A., Sasamoto, N, & Rosner, B. A. (2020). Association Between Breastfeeding and Ovarian Cancer Risk. JAMA Oncol., 6(6):e200421. Retrieved November 18, 2020, from https://jamanetwork.com/journals/jamaoncology/article-abstract/2763398.

⁵Best Start Resource Centre. (2015). Populations with Lower Rates of Breastfeeding: A Summary of Findings. Toronto, Ontario, Canada: author. Retrieved November 19, 2020, from https://resources.beststart.org/wp-content/uploads/2018/12/B09-E.pdf.

⁶WHO. (2018). Guideline: counselling of women to improve breastfeeding practices. Retrieved November 18, 2020, from https://www.who.int/publications/i/item/9789241550468.

⁷MOHLTC. (2020). Public health management of cases and contacts of COVID-19 in Ontario. Retrieved November 19, 2020, from http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_PH_Mgmt_guidance.pdf