Breastfeeding a newborn can feel like a full-time job, especially in the first two weeks. It’s a stressful time with a lot of uncertainty, lack of sleep, conflicting demands, and some babies are cluster feeding – that is when infants want a lot of short feeds over a few hours.  

Brianna Jochman, (pronounced Jock-um) RNC-MNN, BSN, CLS, digital care nurse for OSF OnCall, the digital health arm of OSF HealthCare, knows this all too well. She’s a certified lactation consultant and a new, first-time mom herself so she understands the struggles. During National Breastfeeding Awareness Month, Jochman wants new moms to know they are not alone and can lean on experts for support. 

OSF OnCall is nearing the one-year anniversary of offering virtual education and coaching for new moms who are breastfeeding. Jochman says issues with lactation and latching are common. New or expectant moms can be referred to OSF OnCall for virtual breastfeeding education and coaching through their OB/GYN. Others are referred through the Medicaid Innovation Collaborative (MIC), aimed at supporting women during and after pregnancy.  

Jochman says patients love that they can ask questions and get help all from the comfort of their home. She works on camera during virtual visits to show new moms how to position the baby to get the deepest latch. Without that, she says a woman’s nipples can become sore and breastfeeding becomes painful. 

“We really do try to troubleshoot that latch.” Jochman adds, “First, make sure we've got a good deep latch and then if mom is still struggling, we will recommend coconut oil, olive oil, any oil-based product that you can lubricate with. We always want to lubricate before pumping and after breastfeeding.”

Jochum says coconut or olive oil is safe for babies if they get a little in their mouth. 

A common mistake is not positioning the baby correctly. Jochman says it’s best to position your hand under the baby’s neck and shoulders to allow them to move their head freely. She recommends using pillows for support and positioning the baby, so their chin touches the breast first.  

“You want to keep their chin up and you want to get that deep latch. You don’t want to nipple feed and have a superficial latch. Wait until baby gets that open mouth and place baby on as deep as you can.”

Self-expression is good for breastfeeding moms 

Jochman uses simple demonstrations using a stuffed bunny to show proper positioning and hold. She also encourages women in the early days to self-express milk by using their hands, beginning at the chest wall and then moving forward. To demonstrate, Jochman uses a crochet breast model that allows lactation experts to show the process to new mothers who might be concerned they’re not producing enough milk.  

That milk then can be saved for a “bonus” feeding. 

Another tip – save using the pacifier for about two weeks to help establish a feeding routine while moms are still establishing their milk supply.  

Jochman stresses, “We want to make sure in those early days that moms are watching closely for those hunger cues from babies and not getting it confused with comforting them. So, we want them to get that cluster feeding accomplished, get their supply in and then you can introduce that pacifier.”

Virtual sessions to select a breast pump and showing how it works are also part of the support. Jochman says it is important to have the correct fit and that if a feeding is missed, it’s important to hand express or pump milk to maintain a regular milk supply.  

If a partner or family member wants to give a baby a bottle in the early weeks to give new moms a break, Jochman says there are other ways to support a breastfeeding mother. 

“Helping the moms with meals and filling her water or changing baby’s diaper; just little things that really add up to a lot – making sure that mom is well nourished and getting breaks in between feeds so taking baby to another room, taking baby on a walk even.”

During the hot days of summer, some women are concerned their breastfeeding babies need water. Jochman says that’s not the case because the body produces the perfect nutrition for the first six months, so fully breastfed babies don’t need any water until they've started eating solid foods. 

OSF OnCall breastfeeding support is available to all women, even if they are not an OSF patient. Here is the complete list of resources available: 

• Lactation Consultation: One-on-one sessions with certified lactation consultants to address breastfeeding challenges, techniques and positioning.
• Education: Topics such as breastfeeding benefits, milk supply and pumping are addressed.
• Resource Provision: Access to breastfeeding supplies, such as pumps and nursing pads, and referrals to community resources.
• Nutrition Guidance: Advice on maternal nutrition and its impact on milk production.
• Prenatal Education: Preparing new moms for lactation and what to expect at delivery, in addition to assistance in selecting a pump.
• Behavioral Health: Nurses find appropriate support services for moms with signs of postpartum depression or anxiety.

For a virtual appointment, call 1-(844) 381-3603. 

In -person breastfeeding support
In addition to virtual services through OSF OnCall, the Breastfeeding Resource Center in Peoria also offers telehealth lactation consultations and has been doing so since 2018. It can also provide in-person evaluations if an infant is not gaining enough weight, or mother is concerned about her supply. It can offer weighed feeds to see how much a baby is consuming and other issues can be evaluated such as infant suck patterns and tongue movement. 

The center sees as many as 75 women in person each month with many more phone consultations. It also offers breastfeeding supplies. It can be reached at 1-(309) 683-6672. 

Contact an OSF hospital near you to learn what services might be available for in-person breastfeeding support and evaluation and for information about in-person support groups for breastfeeding women led by certified lactation consultants.  

Video clips with Brianna Jochman

B-roll for virtual breastfeeding support

Our OSF OnCall team will offer a variety of health resources for the community:

• Health screenings for blood pressure, pulse, blood glucose and total cholesterol
• Help with scheduling a primary care provider visit, a mammogram or finding an urgent care location
• Support for downloading and using health apps such as OSF MyChart; showing how to connect to OSF OnCall Urgent Care for a virtual visit available 24/7
•  Connection to social drivers of health resources for unmet needs such as food, housing or transportation in local communities

OSF OnCall Vice President Brandi Clark addressed those gathered at a blessing and dedication for the On the Go van at OSF Saint Anthony Medical Center in Rockford, Illinois today.

Empower Boone and Rockford Rescue Mission are key partners and will regularly host the On the Go van to help individuals navigate care options and digital tools. Organizations interested in hosting the OSF OnCall On the Go van can make that request online at osfoncall.org/onthego.

Clark stressed, “Our team of digital health navigators understand that there are often social and non-clinical barriers to health care. And we’re proud to help with those too. From housing to transportation, our team can provide direct referrals to community-based organizations that can help.”

OSF OnCall Connect On the Go is provided through the Medicaid Innovation Collaborative (MIC), a state-funded, five-year initiative is designed to transform health care delivery to improve outcomes, decrease disparities and reduce costs using sustainable programs. MIC provides digital care services and personalized support for Illinois Medicaid patients through programs developed by OSF OnCall including chronic condition support with remote patient monitoring, digital health and wellness education and coaching plus 24/7 pregnancy and postpartum care and digital support.

Digital health navigators will help individuals who qualify enroll in those Medicaid-supported innovative programs during the van stops. Two additional On the Go vans will be deployed in other communities early next year. 

Elexys Rosales, a 25-year-old petite pregnant woman from Bloomington, Illinois, was plagued by anxiety that seemed to get worse at night during her third trimester. Her concern was not only limited to her anxiety affecting the baby girl she’s carrying, but also having a low-weight baby due to her own below-average weight. Fortunately, her doctor suggested a mobile app and online platform providing her 24/7 contact with a care team made up of a nurse, pharmacist, social worker and licensed therapist.

The tool was developed by Get Well, a digital health company founded by cancer survivor Michael O'Neil, who wanted to be more involved in his own care. Together with Peoria, Illinois-based OSF HealthCare and its OSF OnCall digital health arm, they deliver the kind of experience that provides the necessary support for patients such as Rosales where, when and how they want it.

 For Rosales, it means being able to reach out at 3 a.m. when her anxiety is keeping her awake.

“Being pregnant and having anxiety, you get so emotional, and I would be crying to myself at night. I would call the nurses and they would be on the phone with me for hours sometimes, or just 30 minutes to help me calm myself down. They would talk about different things, including my future with the baby.”

Women enrolled in the OSF OnCall pregnancy and postpartum program receive a blood pressure cuff and regularly report their readings through routine check-ins to avoid having high blood pressure that can lead to pre-eclampsia – a potentially, life-threatening condition. High readings or certain patient messages send alerts through the GetWell Loop platform and prompt an OSF OnCall nurse to reach out. In some cases, the call is escalated to a video visit, or an ambulance run to the hospital emergency department.

OSF HealthCare serves 1 million patients a year. Brandi Clark, vice president of Digital Care, OSF OnCall, says digital tools and platforms such as Get Well can expand access to care and provide wrap-around services to improve a patient’s experience, no matter where they are physically and in their health care journey.

By leveraging remote patient monitoring, education, coaching, navigation and virtual care, OSF OnCall optimizes the expertise of highly engaged nurses, many of whom work remotely, ensuring personalized care for patients through many encounters. It also helps retain experienced nurses who embrace the new opportunity to care for patients in a different way, without some of the physical stressors of in-person care.

The ultimate goal is to improve patient outcomes and experiences while reducing costs. Clark says early metrics reveal supplementing in-person care with additional support is paying off.

“We've enrolled thousands of patients who have been discharged from our hospitals and have demonstrated a 10% or greater reduction in hospital readmissions for those patients who are enrolled in that hospital discharge program. Additionally, we're really beginning to learn about the outcomes that we're achieving with our pregnancy program and beginning to actually see some of those patients that we're taking care of delivering healthy babies.”

OSF OnCall Digital Care Manager Kara Roat says Get Well has a nationally recognized library of medical education that includes videos and tutorials that can be customized for specific OSF patient populations. The company’s digital platform was also used to quickly respond to patient needs, such as remote patient monitoring for babies and young children when RSV hit earlier and harder last year. The GetWell loop can offer education to individuals with a new diagnosis, in addition to training for a patient and their- family when preparing to leave the hospital. Roat says communications can include reminders and questions.

“We ask questions like did you pick up your medications from the pharmacy after you left? Do you have a follow-up visit with your provider? Do you have transportation to that visit with your provider to ensure that they're successful as they leave our hospitals, so they don't get readmitted to our hospital if we can prevent it?”

Helping navigate care options

Following the COVID-19 pandemic, engagement via digital technology has rapidly become the preferred form of communication for many, but not all. For patients who need help getting enrolled and learning the basics, OSF OnCall digitally enabled community health workers help patients get connected. Clark explains tools are easy to use and the Get Well platform makes it simple to assess if patients need other support such as food, transportation, rental assistance or other drivers of health.

“If needs are identified, we're able to connect them through our digitally upskilled community health workers who are able to help ensure those members of our community and our patients are getting all the services that they need.” 

Those community health workers are often deeply engaged in neighborhood activities and can be embedded within organizations such as the Salvation Army or the YM or YWCA. They can also be stationed at OSF OnCall Connect Bars that are in select, easy-access medical offices.

 Roat emphasizes the various programs available through GetWell Loop offer a digital safety net that builds trust through a growing relationship with patients.

“All of our services are in addition to the in-person care that patients should be receiving each and every day. We really strive to fill in the gaps for these patients. It allows them to receive care at any time of day or night and have the opportunity to meet with the provider (virtually) or chat with a nurse whenever is needed.”

Part of the education through GetWell Loop includes live, online birthing classes. Rosales likes that she can keep her camera off if she doesn’t feel like engaging. She says sessions dealing with anxiety have been helpful, particularly when she hears other would-be moms talk about how they cope with their struggles. With her own family in Colorado, Rosales says she’s comforted by having round-the-clock support.

“The nurses are like my family of course. So I know they will always be there for me and support me so I would definitely ask many questions about this pregnancy of mine, especially my first time. I just don't want anything to happen to me or the baby so I think it's best to ask as many questions as you can.” 

Rosales also plans to enroll in the postpartum support option available through OSF OnCall, which offers depression screening, education and 24/7 support after delivery. The pregnancy and postpartum program has been able to provide five times the amount of depression screening than is traditionally provided.  Mental health is a growing concern for all ages across health care. Clark says her team is developing more mental health digital support options in the coming months. OSF already offers SilverCloud – a free, secure, anonymous and interactive platform to manage the feelings and causes of mild to moderate stress, anxiety or depression.

Elexys Rosales, Brandi Clark and Kara Roat

The Medicaid Innovation Collaborative (MIC) – a partnership between Peoria-based OSF HealthCare and four Federally Qualified Health Centers (FQHCs), celebrated its one-year anniversary by highlighting a long list of milestones achieved. MIC provides a variety of digital care services and personalized support for Illinois Medicaid patients through programs developed by OSF OnCall.

The state-funded, five-year initiative is designed to transform health care delivery to improve outcomes, decrease disparities and reduce costs using sustainable programs.

The FQHC partners in the program include Heartland Health Services (Peoria, Illinois), Chestnut Health Systems, Inc. (Bloomington, Illinois), Eagle View Community Health System, Inc. (Oquawka, Illinois), and Aunt Martha’s Health & Wellness (Danville, Illinois).

To date, MIC has been able to stand up several programs to expand services by:

• Providing pregnancy and postpartum support 24/7 to enrolled patients; featured on this Health Accelerated podcast.
• Offering remote patient monitoring for chronic disease management including asthma, diabetes hypertension, COPD and heart failure.
• In a collaboration with Illinois Central College, training OSF digitally-enabled health navigators to be embedded within communities across the state and FQHC community health workers; within their facilities and co-located in community-based organizations, including homeless shelters. 
• Expanding breast cancer screenings through digital outreach, making it easy for patients to schedule this important test
• Extending health and wellness education with the goal of reducing chronic disease risks associated with diet and nutrition, exercise, unhealthy weight and smoking
• Launching culturally sensitive, easy-to-use communication tools.
• Developing a systematic approach to assessing social determinants of health and tracking data to prioritize patient outreach, optimize workflow and to identify which patients might fit into specific programs. Future work will integrate all information with a patient’s electronic record for providers to have a holistic view of their patients.

Jennifer Junis, senior vice president for OSF OnCall who also chairs the MIC Governance Council, says community health workers embedded in vulnerable communities also screen individuals for social service needs and they’re connected with local resources to provide support for food, transportation, child care and affordable housing, among other factors that contribute to improved health and wellness.

During a day-long session earlier this week, FQHC leaders and frontline employees reviewed progress toward goals outlined for the first year.

Chestnut Health Systems in Bloomington:

•  Began work on a building renovation and hiring for a new dental clinic that will serve Medicaid participants. 
•  Collaborated with a local homelessness service provider/food pantry to organize and implement a Food Pharmacy. Providers at Chestnut screen patients for eligibility criteria and prescribe use of the food pharmacy services. The pharmacy provides fresh and healthy food options often worth hundreds of dollars.
• The CHW program has solidified co-locations for staff at six partnering agencies.

Heartland Health Services in Peoria:

• Built a new team within HHS and the framework to support digital care programs and to provide virtual primary care in homeless shelters.
• Began building trust with leaders and residents of homeless shelters through food and clothing drives and providing COVID-19 rapid kits.
• Hired a digital support manager and community health navigators who have also been trained on tele-diagnostic equipment that can be used to support virtual visits.
   

Aunt Martha's Health and Wellness in Danville: 

•  Trained and hired community health workers.
•  Established monthly Healthy Behavior meetings at the YMCA and Public Library.
•  Educated more than 100 people in the community about resources and how to take control of their health.
•  Expanded training for CHWs on cultural diversity, domestic violence and sexual assault.

Eagle View Community Health System in Oquawka:

• Deployed CHWs who are providing services in three locations in the community.
• Implemented a new electronic health record system (Epic) that allows for better data collection and reporting on health outcomes.
• Hired a new transportation van and hired a transportation director.

Junis says these efforts are designed to wrap a 24/7 digital safety net around patients that is available 365 days a year

“So if you have a question in the middle of the night, you don't have to go to an emergency department, or you don't know who to call. You can reach out to us and it's through text messaging or calls and we're available. So that's really the transformation piece. Is that we're not episodic but we're really meeting patients where they are and where they need us the most, at the times that they need us.”

The effort is expected to lower health care costs by keeping people out of the emergency department or the hospital, the most costly point of care. Savings can also be created by scaling the effort with telehealth providers overseeing care for many patients at a time.

MIC will continue into year two with goals of improving dental care for patients, providing virtual health to residents of homeless shelters, and enrolling new patients in existing MIC programs. Junis says it’s also about improving based on feedback.

“Year two is about optimization, and coordination and collaboration, and really continuing to work together to understand all of our different components of the holistic care of a patient and how we all play such a big role in that.”

Video Clips with Jennifer Junis, Senior Vice President for OSF OnCall Digital Health

Samantha, a 25-year-old woman who recently had her second baby, enrolled in a new program through OSF OnCall Connect that provides support to pregnant women with Medicaid insurance.

The program likely saved her life. Eight days after she delivered a healthy baby girl, Samantha messaged her care team through an application that can be accessed on a tablet or smartphone that serves as a key connection and education tool.

It’s available through the OSF OnCall Connect pregnancy-postpartum program and connects patients instantly to a nurse. Samantha explained she was suffering from a terrible migraine headache and chest pains. The OSF OnCall nurse immediately recognized the significance of her symptoms and notified the advance practice provider who recommended Samantha go directly to the Emergency Department. She had a serious condition called postpartum pre-eclampsia, which can lead to brain damage, stroke and death if left untreated. Samantha was to make a full recovery. She’s also is a Black woman, and in the United States, pregnant Black women are three times more likely than white women to die as a result of pregnancy.

A report from the Centers for Disease Control and Prevention (CDC) found 80% of maternal deaths between 2017 and 2019 were due to preventable causes, and many of the deaths occurred within the first year after giving birth. The statistics are behind the new OSF program that was launched under the umbrella of a state-funded program called the Medicaid Innovation Collaborative.

Kate Johnson, clinical supervisor for Digital Care at OSF, says 970 women with Medicaid insurance have signed up for the pregnancy and postpartum program since it was launched in August. Currently, nearly 500 women are actively enrolled. Johnson says pregnant women, especially those who have a lack of resources, are eager to have the 24/7 connection offered through an app they can download on their smart phone or tablet

“It provides check-in questions, routine questions, like ‘Are they having any signs of infection, UTI symptoms? Are they struggling with breastfeeding; having any depression symptoms?’ And if they answer in any kind of an alarming way, that lets our nurses know right away … sends them an alert, and we're able to contact those patients via telephone and triage if we need to.”

Women on Medicaid can self-enroll in the free program starting eight weeks into their pregnancy by going online to register. After they enroll, women will be sent a blood pressure cuff to take regular readings and the program can connect them to other equipment they might need such as a breast pump.

Women can also enroll in the postpartum program without having participated in the pregnancy support. Johnson says women will receive new education messages each week throughout their pregnancy and postpartum.

“I think the education that we provide those moms during their pregnancy is awesome because it's getting them ready to deliver their baby. So, helping them think about things like how they want to feed their baby, birth plan, pain management for their delivery, things of that nature.”

Connecting women to mental health support

The CDC study found mental health issues were among the preventable, pregnancy-related conditions that lead to higher mortality rates. Johnson says that’s why the program offers depression screening upon enrollment in the pregnancy program, and when they deliver, they have the option to enroll in the postpartum portion. For postpartum support, they can indicate the type of support they need, such as selecting whether they delivered vaginally or via C-section or if they require information on infant care.

Even though women are screened for depression in the hospital after they give birth, it’s often six weeks before they have a follow-up appointment. Johnson says that’s sometimes too late, and women too often suffer in silence.

“So, we will be screening her right upon enrollment into the postpartum loop. And then we'll do a two-or three-week check-in to make sure emotions are doing okay. There is such a huge change in emotions postpartum with the changes in your hormones and bringing a baby home plus the sleep deprivation. So, we want to be there to support them in that initial six weeks before they see their provider.”

A patient named Jane enrolled and indicated she suffered from untreated postpartum depression after her first child, which is a risk factor she could experience that with another pregnancy. Jane had messaged regularly after delivering her second child, and by her third week, made contact and told the OSF OnCall nurse she had worsening depression to the point she had suicidal and homicidal thoughts. The woman was taken to a local hospital to get help, and remained calm while waiting for the ambulance because of the connection and trust she felt with a nurse she had had regular contact with through the program.

The OSF OnCall Connect pregnancy and postpartum initiative also screens for social determinants of health – all those factors outside of a medical office, such as food insecurity, financial struggles, housing and transportation challenges, to fill the gaps that could contribute to the woman’s health and the health of their baby. Johnson shares there are common struggles.

“I think what we're seeing mostly is patients who are struggling with transportation to get to their actual OB provider appointments, so we are able to align transportation for them in most cases. Just this past weekend, we had a patient that had no car but needed a prescription. So, we aligned her with a pharmacy that delivered those medications directly to her door.”

Women with Medicaid insurance enrolled in the program have the option of being connected with a digitally-enabled community health worker who can help them navigate ongoing support from community-based organizations. Translation services are part of the support provided to make sure women get the medical care and outside resources that can help meet their social service needs met.

Video clips with Kate Johnson, clinical supervisor of Digital Care, OSF OnCall Connect