1. Visualizing the Continuum of Care for Transfers: Where are my patients?
NMBTF 4th Annual Maternity Care and Infant Feeding Summit
Antoinette Kleiner, RN, BSN, MSN, IBCLC
November 16, 2017

2. Objectives-
Identify potential barriers to the continuity of lactation care
Identify the continuum of lactation care services
Illustrate the network of services and resources available

3. Barriers to continuity of lactation care
Geographic
Physical
Experience/expectations
Education/resources
Cultural
Systems

4. The continuum of lactation care services
Mother & baby
Community hospital
Tertiary hospital
Specialty clinics
WIC, Home visiting programs
Insurance & payment sources
Primary care clinics
Primary care clinics- prenatal, pediatric, family medicine
Delivery facility
Transfers for Care
Specialty clinics
Community/Public Health support
Primary care clinics
Insurance and payment sources
Family
Community
Community
Family
Family
Community

5. Building a Lactation Care Network
Organization
Contact info
Services provided
Refer to
Receive from
Northwest Region
Northern Navajo Medical Center -IHS
Antoinette Kleiner, IBCLC
Inpatient: OB, Neonatal Stabilization Unit, some Level II, Pediatric wards
Outpatient: OB/GYN, Centering, Pediatric, Family Medicine clinics
Public Health: home visits for all deliveries, IBCLC/PHN for hi-risk
Community outreach and education
Manual breast pumps
Facilitate/referrals for electric breast pumps
UNM & Presbyterian- antepartum/intrapartum hi-risk or NICU transfers for care
SJRMC- some Level II, some patients choose to deliver there
Specialty care (i.e. Cleft)
Navajo Nation WIC, BPC
NM WIC, BPC
Home visiting programs: NM & CO Public Health, First Born, Family Spirit
Other IHS/Tribal facilities
Returns from tertiary care
Returns from SJRMC
Northeast Region
Metro Region
Southeast Region
Southwest Region

6. References
Bixby, C., Baker-Fox, C., Deming, C, Dhar, V., & Steele, C. (2016). A multidisciplinary quality improvement approach increases breastmilk availability at discharge from the neonatal intensive care unit for the very-low-birth-weight infant. Breastfeeding Medicine, 11, (2). DOI: bfm
Briere, C., McGrath, J., Cong, X., & Cusson, R. (2014). An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization. JOGNN, 43, DOI: /
Evans, A., Marinelli, K., Taylor, J. (2014). ABM Clinical protocol #2: Guidelines for hospital discharge of the breastfeeding term newborn and mother: “The going home protocol”, revised The Academy of Breastfeeding Medicine. Breastfeeding Medicine, 9, (1). DOI: bfm
United States Breastfeeding Committee (2013). Continuity of care connections: Initial status report toolkit. Retrieved from
Wight, N. (2015). Breastfeeding the NICU infant: What to expect. Clinical Obstetrics and Gynecology, 58, (4), DOI: /GRF