Baby friendly: a way to accreditation. Part 1

Abstract

In March 2002 the maternity unit at the Calderdale Royal Hospital in Yorkshire became accredited as a ‘Baby friendly hospital’. This article is a personal account of how the Calderdale Royal Hospital improved standards of care for breastfeeding mothers and documents one approach to success. It follows the collaborative process leading to accreditation and includes information regarding the guidelines and literature developed to support and implement the initiative. This is the first of two articles documenting the process, and it focuses on Steps 1 and 2 of the Ten Steps to Successful Breastfeeding programme (UNICEF, 1998).

Barriers, Facilitators, and Recommendations Related to Implementing the Baby-Friendly Initiative (BFI)

“…Reluctance to "push" breastfeeding (concerned about making mothers feel guilty about their personal feeding choices) 16,29,46,58,75,77,81 Traditional beliefs that prioritize maternal rest over infant feeding (eg, belief that a mother is ill immediately postbirth and should not be made to room-in) 60 Staff approach that is flexible, open, and embodied is viewed by patients as more effective than rigid, rules-driven approach to breastfeeding support 81 Reframing language used with new mothers to be more breastfeeding friendly 64 Staff support for and encouragement of BFI policies in the NICU 71 Restricting staff access to pacifiers or formula for supplementation 30,35,46,56 Access to human donor milk/milk banks 57,83 Establish cup feeding of expressed breast milk instead of nipple feeding as standard practice in NICU (with use of formula feeding where indicated) 28 Family support and other resources Lack of family support to breastfeed 73 Family members offer supplements, prelacteal feeds 29 Financial barriers for mothers wishing to obtain breast pumps 69,78 Mothers' involvement with breastfeeding peer support programs (mother-tomother support) 36 …”

“…Lack of administrative support (BFI not an organizational priority) 46,70,77,85 Lack of a designated leader/coordinator for the BFI project 29,59,78 Autocratic, top-down management of the BFI implementation process 46,62,75 Strong administrative/managerial support for the BFI 59,61,63,65,66 Physician leadership and/or active endorsement of the BFI 16,29,47,64,68,84 Coordinated BFI implementation strategy (eg, BFI steering committee or taskforce) with motivated and credible leaders, a shared vision, and engagement of multidisciplinary partners and staff from all levels of the organization 29,35,46,58,[61][62][63][64][65]68,75,[78][79][80]82,84,85 Participatory, decentralized approach to change, with open and ongoing communication throughout the BFI implementation process 55,58,59,61,62,65,80,…”

“…Lack of formal, written breastfeeding policies, or breastfeeding policy not publically available [34][35][36]61,70 Lack of time or experience to draft breastfeeding policies/guidelines 46,61 Inappropriate, outdated, and/or inconsistent breastfeeding policies or practice guidelines 34-36, 44,46 Lack of enforcement of breastfeeding policies 36,46 Formal, written breastfeeding policies and protocols that are visible and consistent with BFI values 28,30,55,64,75,76,83 Clear policies and protocols supporting BFI in high-risk situations (eg, NICU) 78 Hospital consideration of cultural/traditional factors when making changes to breastfeeding policy 29,56 Breastfeeding training…”

“…Lack of a breastfeeding training program for staff or insufficient resources to liberate staff for training 29,30,36,44,46,57,59,65,70,72,79,84 Breastfeeding education is not mandatory, or education time is unpaid 46,85 Poor communication and unclear role responsibilities in NICU regarding breastfeeding education 78 Lack of participation of non-nursing staff in breastfeeding education 35 Availability of breastfeeding training (basic and continuing education) targeting all staff (including managers) 16,36,44,46,56,58,64,73,75,[78][79][80]84 Use of innovative teaching strategies (eg, e-learning, pocket guides to breastfeeding, train-the-trainer methods, videos, dolls) 27,46,55,59,65,76,84 Assessment of staff education needs (eg, via surveys or breastfeeding case reviews) 55,64 Breastfeeding training integrated into mandatory orientation programs 64,74 (continued)…”

“…discouraging staff from handing out formula 56 Removing formula company ads throughout the health care facility and increase visibility of breastfeeding/BFI (posters, leaflets etc) 68,75 Use of ancillary staff to monitor facility for Code violations 84 a Abbreviations: BFI, Baby-Friendly Initiative; NICU, neonatal intensive care unit 29,68,74,82,84 Misconception of which of the Ten Steps apply to NICUs 71,78 Lack of knowledge of community resources 29,36 Access to both formal and informal opportunities for breastfeeding education/skills training (eg, peer learning from more experienced staff, one-to-one teaching from lactation experts, self-learning modules, discussion of breastfeeding policies, attendance at formal training sessions or workshops) 29,30,41,44,[57][58][59]64,66,70,71,75,[78][79][80]82,85 Expansion of staff roles/skills (eg, crosstraining of perinatal staff) to better promote BFI practices 56 Staff attitudes toward the BFI Negative or ambivalent views toward breastfeeding, particularly among senior staff, and medical staff 29,44,59,66,68,74,82,84 Negative or conflicting attitudes toward the BFI as a breastfeeding promotion program (eg, seen as too dogmatic, too inflexible, or too much work) 55,59,…”