Peer counselors double breastfeeding rates

To improve breastfeeding initiation and its continued practice, administrators at the Prentice Ambulatory Care (PAC) Clinic of Northwestern Memorial Hospital in Chicago set in place a peer counseling program. Their efforts boosted the rate of women initiating breastfeeding to 84%, from 40%. (See more statistics, below.)

"Their goal was to place a peer counselor in the clinic to provide education and support during pregnancy and up to a year postpartum to improve the rates of breastfeeding initiation, exclusivity, and duration," explains Pam Chay, RN, IBCLC, patient care coordinator for Multiple Births and Education at Northwestern Memorial Hospital.

PAC provides outpatient women's services, including obstetrics and gynecological care, to about 500 patients a year within the Chicago community. Many of these patients are underinsured or uninsured. "The breastfeeding rates in the clinic were quite a bit lower than our private insured patients. The data showed there was about 40% initiation of breastfeeding for the patients at PAC, compared to 85% for our private insured patients, so that is why the program was implemented," says Chay.

Money was given to fund the project in 2008 by The Evergreen Invitational Grand Prix Women's Health Grant Initiative. The program was ready to launch in 2009, and it continues to receive funding through this grant. The grant is called "Partnership to Improve Breastfeeding Rates Using Peer Counselor Education and Support."

Providing personal attention

The peer counselor, who is paid through grant monies, meets one-on-one with patients to discuss the benefits of breastfeeding, answer questions, and dispel myths. She meets with patients a second time during a clinic visit, whether or not they are intending to breastfeed their baby, just to see if they have anymore questions, says Chay.

Also she instructs a prenatal breastfeeding class for clinic patients once a month. It is two hours long and consists of lecture, discussion, demonstration, and a short video-clip on breastfeeding. The class is free and includes a catered lunch for the families attending. Couples also receive a book by Amy Spengler titled "Breastfeeding: A Parents Guide." They are also given a DVD called "Breastfeeding Intensive" by Mother of 7 at no cost to them.

The peer counselor puts patients who have a high desire to breastfeed on her caseload and usually has about 30, says Chay. These are the women she talks to after delivery while they are in the hospital. If they are having difficulty breastfeeding, she makes sure they get help from the nurses and, if needed, from a board-certified lactation consultant.

Once the mother and baby are discharged, the peer counselor calls to provide support and guidance. The patient has the counselor's number as well. The peer counselor calls at least every three weeks and meets with the mother at her six-week postpartum visit at the clinic. If she still is breastfeeding exclusively at the time of the clinic visit, an incentive package is given that includes a T-shirt for baby, a camisole for mom, and a baby sling. "Even the patients who are not on her caseload have her phone number, so if they have any questions or issues they can call her," says Chay.

To be a peer counselor for PAC, a woman must have successfully breastfed her baby exclusively for at least four months and have been a patient of the federally funded Women, Infants, and Children (WIC) health and nutrition program. Also she undergoes 20 hours of training through HealthConnect One. This Chicago-based nonprofit agency offers training and technical assistance to service providers promoting the health of mothers, infants, and families.


For more information about creating a peer counselor program, contact:

  • Pam Chay, RN, IBCLC, Patient Care Coordinator, Multiple Births and Education, Northwestern Memorial Hospital, Chicago, IL. E-mail:
  • Breastfeeding: A Parent's Guide by Amy Spangler is available at her web site Babygooroo. Web address: Click on "store" and scroll down to the book title. The book costs $12.50 plus shipping and handling for one copy, with discounts for bulk orders.
  • Breastfeeding Intensive produced by Mother of 7 available at for $57 plus shipping and handling.

Data supports peer counseling

Breastfeeding is on the rise

The data on the Breastfeeding Peer Counselor program and free breastfeeding classes for mothers receiving care in the Prentice Ambulatory Care Clinic in Chicago show it is successful.

From January 2009 to December 2010, the breastfeeding peer counselor has done the following:

• Counseled 861 women.

— 84% initiated breastfeeding; compared to 40% previously.

— 40% breastfed exclusively in the hospital.

• Conducted a total of 230 hospital visits with mothers in the postpartum unit.

• Provided 20 breast pumps for mothers that are separated from their babies.

• Taught a total of 23 breastfeeding classes; 340 people have attended a class.

• Enrolled 71 women were enrolled in a more intensively supported caseload.

— 94% initiated breastfeeding;

— 51% breastfed exclusively at the hospital; compared to 14% previously.

— 70% continued to breastfeed at six weeks; compared to 17% previously.

— 52% continued to breastfeed at three months;

— 36% continued to breastfeed at six months;

— 9% continued to breastfeed at 12 months.