There are critical gaps in the rates of breastfeeding and safe sleep practices among newborns in Texas. Breastfeeding is widely recognized as the most beneficial feeding method for infants, associated with reduced risks of infections, chronic conditions, and improved maternal health. Adherence to safe sleep practices is critical for reducing preventable sleep-related infant deaths, which disproportionately impact historically underserved populations in Texas. In 2019, sudden infant death syndrome (SIDS) was the fourth leading cause of infant mortality in the state, following congenital anomalies, prematurity, and complications of low birth weight. Lactation and Safe Sleep Opportunities in Texas (LASSO-TX) is a new statewide quality improvement initiative (QI) focused on improving exclusive breastfeeding rates and the use of a mother’s own milk for Texas infants while promoting safe infant sleep best practices. LASSO-TX is modeled after the IHI Breakthrough Series Collaborative framework, which involves enrolled hospital collaborative learning and support as they work toward strengthening evidence-based care practices.
To support hospitals in their QI efforts, the Texas Collaborative for Healthy Mothers and Babies (TCHMB) will host three in-person learning sessions (February 2026, June 2026, and October 2026) with monthly action period calls in between. Hospitals will periodically submit de-identified aggregate-level data to track their progress and receive ongoing collaborative support, expert coaching, and technical assistance. As of August 2025, LASSO_TX hospital recruitment is underway.
Gillian Gonzaba, NNP-BC, a neonatal nurse practitioner and longtime partner in maternal-newborn quality improvement, sat down with me to highlight why the project matters.
1. What is LASSO-TX, and why is it important?
LASSO-TX is a unique opportunity for TCHMB to bring together maternal and newborn care teams across Texas. It’s [TCHMB’s] first opportunity to really partner across both maternal and neonatal care to improve the overall health of the mother-baby dyad. This effort is about making sure evidence-based standards show up in everyday practice. That takes more than just education and training; it requires a change in hospital culture and improving how systems work. Hospitals can lead the way by showing what good, evidence-based care looks like, partnering with families and building a supportive environment where all care teams work together.
We’re excited to begin this worthwhile pursuit of providing collaborative support to hospital improvement teams as they improve maternal and infant health outcomes across the state.
2. Why is this work particularly important in Texas?
Despite the well-established benefits breastfeeding provides for infants, not every baby born in the state of Texas is exclusively breastfed after birth. Texas also has several counties with the highest rates of sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID) in the United States. Hospitals are key to improving these outcomes by providing education and care that follows best practices.
Currently, the care families get can look different depending on the hospital. There are notable disparities in breastfeeding and safe infant sleep practices that persist across hospital settings and communities, especially among underserved populations. Our goal is to help support hospitals in removing systemwide processes and structural barriers to improve infant nutrition and care. We want families to get high-quality breastfeeding and safe infant sleep support, no matter the hospital.
3. What drew you personally to LASSO-TX?
Breastfeeding isn’t always natural or easy. Some moms and babies need extra support, and neonatal intensive care unit (NICU) nurses are called on every day to provide that help. When I first started as a NICU nurse, before becoming a nurse practitioner, I didn’t have any children of my own. That made it challenging to support moms who were learning to breastfeed. I called on my colleagues and friends who had nursed and watched lactation consultants with fascination.
We have some phenomenal lactation consultants across the state who are truly skilled at connecting with moms in ways that are unique to their craft. Later, once I became a mother myself, I was fortunate to achieve the breastfeeding goals I set for myself and my children, which deepened my understanding of how meaningful — and how hard — breastfeeding can be.
Many people think breastfeeding is a natural, automatic process: Just bring the baby close to the mom and they’ll know what to do. While that’s true for some babies, it isn’t for all. Some babies need extra help. Some moms need extra help. That’s where support makes a real difference.
Being part of LASSO-TX is an incredible opportunity to support hospitals in advancing care so they can better serve families and communities across the state. For me, it speaks to what about my work touches my heart: helping a mother form and nurture her unique bond with her baby. It’s unlike any other bond that exists because you’re giving your baby something created just for them exactly the right way every time.
I’m excited to support LASSO-TX and help expand breastfeeding and safe infant sleep supports across Texas.
4. How will you know if LASSO-TX is successful?
Success, to me, means hospitals have the resources to continue this work and build on their progress even after the initiative ends. The goal is for hospitals to develop the ability to effectively test, scale, and implement changes to achieve patient care objectives they set for themselves. We hope to lay a strong foundation by equipping hospital teams with the culture, education, and tools needed to keep moving forward.
It's not just about improving outcomes, though that’s important. We also want to give our partners quality improvement tools they can carry for LASSO-TX and any future projects. If we can do that, I believe we’ve succeeded.
Gillian Gonzaba, NNP-BC, is Co-Chair of the Texas Collaborative for Healthy Mothers and Babies (TCHMB) Neonatal Committee and a member of the TCHMB Executive Committee.