Closing the Quality Gap: Promoting Evidence-Based Breastfeeding Care in the Hospital

Abstract

Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. Twenty-four percent of facilities reported regularly giving non-breast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding. Other approaches to improving quality of breastfeeding care include (1) education of hospital decision-makers (eg, through publications, seminars, professional organization statements, benchmark reports to hospitals, and national grassroots campaigns), (2) recognition of excellence, such as through Baby-Friendly hospital designation, (3) oversight by accrediting organizations such as the Joint Commission or state hospital authorities, (4) public reporting of indicators of the quality of breastfeeding care, (5) pay-for-performance incentives, in which Medicaid or other third-party payers provide additional financial compensation to individual hospitals that meet certain quality standards, and (6) regional collaboratives, in which staff from different hospitals work together to learn from each other and meet quality improvement goals at their home institutions. Such efforts, as well as strong central leadership, could affect both initiation and duration of breastfeeding, with substantial, lasting benefits for maternal and child health.

Variation in Formula Supplementation of Breastfed Newborn Infants in New York Hospitals

“…Prenatal breastfeeding education, health care provider and staff training, lactation support, social support, and peer counseling are also related to breastfeeding outcomes. [45][46][47] Research into these exemplar hospitals by using community-based participatory methodology and/or a positive deviance approach might provide insight into important but hitherto undocumented maternal behaviors, family characteristics, staff or community attitudes, and cultural determinants (beyond the recognized hospital policies and practices and socioeconomic, infant, and maternal factors) that are contributing to their better breastfeeding outcomes. 48,49 Recent community-based efforts, sensitive to the cultural determinants and focused on changing social norms, are proving to be successful in improving breastfeeding rates, particularly in disadvantaged communities.…”

Factors Associated With Exclusive Breastfeeding 2 to 4 Weeks Following Discharge From a Large, Urban, Academic Medical Center Striving for Baby-Friendly Designation

“…According to findings in a CDC survey, many U.S. hospital routines undermine mothers who want to breastfeed (CDC, 2008). Giving formula to healthy breastfed infants is a common hospital practice, despite evidence from multiple studies that indicates babies who receive formula in the hospital wean earlier than babies who do not receive formula (Bartick, Stuebe, Shealy, Walker, & Grummer-Strawn, 2009). Hospital practices that have been shown to positively impact breastfeeding outcomes include keeping mothers and babies together, limiting the use of artificial nipples and supplementation with formula, eliminating the distribution of formula gift bags at discharge, and providing breastfeeding education for all staff (Bartick et al, 2009;CDC, 2008 Table 2), which were designed as evidencebased guidelines to promote, protect, and support breastfeeding in a hospital or birthing-center setting (WHO, 1998).…”

“…Giving formula to healthy breastfed infants is a common hospital practice, despite evidence from multiple studies that indicates babies who receive formula in the hospital wean earlier than babies who do not receive formula (Bartick, Stuebe, Shealy, Walker, & Grummer-Strawn, 2009). Hospital practices that have been shown to positively impact breastfeeding outcomes include keeping mothers and babies together, limiting the use of artificial nipples and supplementation with formula, eliminating the distribution of formula gift bags at discharge, and providing breastfeeding education for all staff (Bartick et al, 2009;CDC, 2008 Table 2), which were designed as evidencebased guidelines to promote, protect, and support breastfeeding in a hospital or birthing-center setting (WHO, 1998). Positive breastfeeding outcomes such as increased initiation rates, longer duration, exclusivity, and improved related childhood outcomes have been reported in settings where a number of the Ten Steps to Successful Breastfeeding are in place (DiGirolamo, Grummer-Strawn, & Fein, 2001).…”

“…Although strong evidence supports the Ten Steps to Successful Breastfeeding (hereafter referred to as the "Ten Steps"), hospital compliance in the United States remains a challenge (Bartick et al, 2009). More than 19,000 international hospitals and birthing centers have received the Baby-Friendly designation; however, as of August 3, 2010, only 96 health-care facilities in the United States are recognized as Baby-Friendly (Baby-Friendly USA, 2010).…”

Complementary and alternative therapies: supporting the woman with inadquate milk production

“…Much of the evidence present in the grey literature is entirely anecdotal in nature and describes personal experience rather than taking a scientific approach (Bryson, 2008). Although lactation research is an emerging field , clinical practice has suffered from a lack of evidence-based practice (Bartick, Stuebe, Shealy, Walker, & Grummer-Strawn, 2009). When women approach a primary care provider for information on improving their milk production by using natural remedies, it is challenging to access high quality evidence on which to base recommendations for treatment.…”