Program Supports and Encourages Breastfeeding, One Text at a Time

This story, written by Rachel Mangini, originally appeared in the spring 2019 issue of Pitt Magazine, the University’s flagship alumni publication.

It’s the first day of a newborn’s life. Mom holds her swaddled baby in her arms. A nurse steps in, suggesting baby’s next feed is overdue. Mom is overwhelmed. Breastfeeding is hard. Must she wake her peacefully sleeping babe?

She turns to her phone to read a semi-automated supportive text she recently received: “Babies are motivated to breastfeed when they feel and smell your skin, especially if they are sleepy babies. You can do skin-to-skin anytime to help jump-start or improve your breastfeeding experience!” Mom unwraps baby and tucks him inside her robe. Baby stirs, and without fully waking, roots for the breast. 

Jill Demirci remembers spending most of her time in her first job, as a staff nurse on the mother-baby unit at UPMC Magee-Womens Hospital, helping new moms breastfeed. This surprised Demirci, now assistant professor in the School of Nursing’s Department of Health Promotion and Development. Back then, she assumed breastfeeding came naturally. But now, as a breastfeeding support researcher, she knows there is a universal need for more education and encouragement.

The MILK texting program aims to do just that. “Have you ever seen another woman breastfeeding?” reads a text sent in week 33 of pregnancy. “Many women haven’t. Join a breastfeeding support group or follow this link for a close-up of how it works.” 

To develop the MILK texts, Demirci and her colleagues had moms use an app to track breastfeeding issues. If, on day three for example, baby was cranky and seeking to nurse constantly, moms could note that. Researchers used this data to learn what issues arose at what stage. They then developed a text-messaging breastfeeding support program based on those trends. Focus groups with new moms provided feedback on the MILK program, as did consultations with experts in the fields of lactation, media and marketing. Moms enrolled in the pilot study received texts during pregnancy and until eight weeks postpartum. 

MILK texts aren’t fully automated — they follow branch logic, and moms are invited to interact by texting keywords in reply. Moms can also text “help” at any time, and a lactation consultant will contact them. A program like this can allow one lactation consultant to help hundreds of nursing mothers. 

Now an International Board Certified Lactation Consultant, when Demirci (NURS ’05, ’10G, ’12G) began her education at Pitt’s School of Nursing, she didn’t realize the possibilities a nursing degree held. During her undergrad coursework, she heard a lecture about breastfeeding and its many benefits, for both mom and baby.

“I was so surprised and impressed that a woman’s body can do that,” she said. Although she enjoyed her job as a nurse, Demirci “wanted to do more to influence clinical care,” so she pursued a PhD focusing on breastfeeding support. 

Demirci’s research focuses on developing clinical and community-based interventions to help mothers meet their breastfeeding goals. Aside from health communication, such as the MILK texts, her studies look at breastfeeding issues exclusive to special populations — like moms of preemies — and understanding and preventing the perception of insufficient milk.

Research in breastfeeding support and lactation is in its infancy, said Demirci, who wrapped up the MILK study of 250 women and is working with colleagues on the results. “There is a lot of folk wisdom but not a lot of research to back it up.”

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life and continuing until age one. The World Health Organization recommends continuing until age two. Yet, says Demirci, “many medical school programs don’t touch on breastfeeding support at all.” 

She believes educating medical professionals — not only postpartum hospital staff, but other points of contact for new parents like pediatricians and pharmacists — about breastfeeding would likely improve outcomes. 

Offering moms more support is essential as well. “Breastfeeding takes time to learn and establish,” said Demirci. “It works best when moms are relaxed and relying on their babies and their body for cues.