Healthcare Professionals’ Breastfeeding Attitudes and Hospital Practices During Delivery and in Neonatal Intensive Care Units: Pre and Post Implementing the Baby-Friendly Hospital Initiative

Abstract

Background: The Baby-Friendly Hospital Initiative represents a global effort to support breastfeeding. Commitment to this program has been associated with the longer duration and exclusivity of breastfeeding and improvements in hospital practices. Further, healthcare professionals’ breastfeeding attitudes have been associated with the ability to provide professional support for breastfeeding. Research Aims: To determine healthcare professionals’ breastfeeding attitudes and hospital practices before and after the implementation of the Baby-Friendly Hospital Initiative. Methods: Using a quasi-experimental pretest–posttest study design, healthcare professionals ( N = 131) from the single hospital labor and delivery, maternity care, and neonatal intensive care were recruited before and after the Baby-Friendly Hospital Initiative intervention during 2017 and 2019. Breastfeeding attitudes with the validated Breastfeeding Attitude Questionnaire, breastfeeding-related hospital practices, and background characteristics were collected. Results: The healthcare professionals’ breastfeeding attitude scores increased significantly after the implementation of the Baby-Friendly Hospital Initiative, difference = 0.16, (95% CI [0.13, 0.19]) and became breastfeeding favorable among all professional groups in each study unit. Positive changes in breastfeeding-supportive hospital practices were achieved. The infants had significantly more frequent immediate and uninterrupted skin-to-skin contact with their mothers. The rate of early breastfeeding, as well as the number of exclusively breastfed infants, increased. Conclusions: After the Baby-Friendly Hospital Initiative and Baby-Friendly Hospital Initiative for neonatal wards (Neo-BFHI) interventions were concluded, we found significant improvements in the breastfeeding attitudes of healthcare professionals and in breastfeeding-related care practices. This RCT was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.

Improving breastfeeding support through the implementation of the Baby-Friendly Hospital and Community Initiatives: a scoping review

“…Staff surveys carried out over time need to take account of turnover of staff, therefore longitudinal studies are recommended [ 116 ]. Mäkelä et al [ 152 ] also emphasised the need to study the sustainability of achieved changes in practice, based on a study in Finland, as did a study in the USA [ 153 ]. Shing et al [ 122 ] highlighted the need to consider wider cultural changes about breastfeeding, when conducting longitudinal studies.…”

Maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals: An integrative review

“…In societies where breastfeeding is a norm and the Ten Steps practices are incorporated into the routine care, differences between Baby-Friendly hospitals and non-Baby-Friendly hospitals may be small (Brodribb et al, 2013). On the other hand, a previous study has shown that BFHI implementation is positively associated with healthcare professional's breastfeeding attitudes and breastfeeding support practices in birth hospital (Mäkelä et al, 2021). Based on this, it is likely that mothers in Baby-Friendly hospitals do perceive support that is more adherent to the Ten Steps practices, compared to mothers in non-Baby-Friendly hospitals.…”

Why do we fear bottles and pacifiers?

“…When we discuss the impact of pacifiers and bottles on breastfeeding, the most important outcome is direct breastfeeding, but many studies have also used breastmilk feeding. The BFHI has increased the breastmilk feeding rate 9 in all income settings 10,11 and improved staff attitudes to breastfeeding 12 . However, some studies have also reported downsides to the BFHI, such as increases in hypoglycaemia cases or prolonged hospital stays, although these findings could also have been due changed treatment guidelines 13,14 .…”

“…The BFHI has increased the breastmilk feeding rate 9 in all income settings 10,11 and improved staff attitudes to breastfeeding. 12 However, some studies have also reported downsides to the BFHI, such as increases in hypoglycaemia cases or prolonged hospital stays, although these findings could also have been due changed treatment guidelines. 13,14 It should also be noted that hygiene and clean water resources may be limited globally and may lead to increased risk of infections in neonates and infants if bottles and pacifiers cannot be cleaned adequately.…”