Pumping Up Our Lactation Support

UVMMC nurse, Courtney Walker, RN talking with patient.

The American Academy of Pediatrics and the World Health Organization recommend that infants be exclusively breastfed for the first 6 months of their lives because of the abundant benefits, including lower risk of asthma, obesity, type 1 diabetes and sudden infant death syndrome (SIDS). However, nursing doesn’t always come easy for new moms.  

Enter Courtney Walker-Borch MSN, APRN, IBCLC who has stepped into the first dedicated Lactation Consultant Nurse Clinician role here at UVMMC. This role was created from a collaboration between clinical staff and leaders with the intention to expand services and meet lactation support needs of our patients and their families.  

“The concept of this role is to help provide education and consultation for patients and care providers for the breast/chest feeding parent/baby dyad across the patient population at UVMMC,” says Walker-Borch, who has worked on the Mother-Baby unit as an RN since 2008 and as International Board Certified Lactation Consultant (IBCLC) since 2011. She has also worked in the community as a Nurse Practitioner/IBCLC at a local pediatric office. “This has provided a wonderful experience of how inpatient and outpatient care can help families meet their feeding goals,” she says.  

“This role will utilize current lactation theories and research to develop evidence-based care and plans that address individual feeding issues and family feeding goals. I am hoping to collaborate with different providers/roles. Please Courtney.walker [at] uvmhealth.org (reach out) with ideas or needs you may have while caring for our families." 

Nurse-Driven Change: Expanding Access to Breast Pumps 

photo of a woman pumping breast milk

In the course of caring for new moms, Flora Jestice, MSN, FNP, IBCLC identified a barrier in access to quality electric breast pumps for UVM Medical Center patients who are uninsured or underinsured. Flora noted that for families with limited or no access to quality electric breast pumps, “the only solution is for breastfeeding parents to hand express, and/or use a single hand pump which comes with the pumping attachment kit.” Although both of those options may work for some breastfeeding parents who only need to express/pump one or two times per day, she explains, “the people we are referring to may need to pump both breasts potentially every single feed, which is up to 12 times per day. Hand pumping and hand expression take more than twice as long, and lead to parents not being able to keep up, which leads to a low milk production and/or giving up on breastfeeding entirely. This is not a viable solution in those situations.” 

Jestice submitted a grant proposal to the Children’s Miracle Network for $10,000 and was awarded the funds for “Breast Pumps for Moms in Need.” These funds will allow Flora to order breast pumps and distribute them to underinsured and uninsured families in need. She also notes that although breast pumps are supposed to be provided by insurance, “many insurance companies provide inferior pumps (hand pumps or single pumps or poor-quality pumps.)” Sometimes the insurance company will not allow a mother to apply for a breast pump until after the baby is born, and it can take up to five days to receive it. “In both of those instances, advocacy work with the insurance companies is imperative. We have begun that process with our own UVMHN benefits department, and Vermont Medicaid. Because many of our patients come from New York, we also have to work on advocating there. These are currently projects we are working on as a lactation team.” 

Furthering the challenge with access, she says, many durable medical equipment companies simultaneously decided to stop renting the hospital-grade breast pumps. “Convincing these medical supply companies to provide this service is another branch of advocacy work in both New York and Vermont,” she adds.