Implementing Baby-Friendly Practices

Abstract

Breastfeeding is widely viewed as the optimal feeding method for infants among professional nursing and medical organizations. Its health benefits have been comprehensively studied and documented for both infants and mothers. Hospitals and birthing centers can strongly influence the outcomes for mothers who choose to breastfeed by establishing effective breastfeeding behaviors immediately after birth and during the hospital stay. The Baby-Friendly USA initiative outlines 10 steps to successful breastfeeding. Although these steps have been successfully supported in practice, they can be difficult to implement due to a variety of factors, including resistance to change. Specific steps generate more barriers to overcome than others--namely exclusive breastfeeding without supplementation or pacifiers, rooming-in for 23 out of 24 hours, and skin-to-skin contact with a parent immediately after birth and during the hospital stay. Our hospital spent 5 years implementing Baby-Friendly practices to prepare for a successful site visit. In the process, barriers to key Baby-Friendly steps were overcome through creative approaches and strategic education for staff, physicians, and parents. The purpose of this article is to outline specific actions taken that assisted our hospital in its successful journey. Those actions and strategies will hopefully be of value to others in their journey toward designation.

Trends in rooming‐in practices among hospitals in the United States, 2007‐2015

“…28 Efforts to conduct newborn assessments and physician rounds at the bedside, among others, have been documented to increase rooming-in, from a rare occurrence, to occurring among 98% of mother-infant dyads in one hospital. 13 …”

The Baby-Friendly Hospital Initiative in US Hospitals

“…Often the problems center on resistance to change well-established policy and procedures. 18 Since successful breastfeeding touches almost every policy and procedure in perinatal services as well as the physicians, laboratory personnel, pharmacy, and support staff such as housekeeping, a multidisciplinary leadership team is necessary. 19,20 The place to start is to establish a hospital Baby-Friendly Committee with all of the stakeholders present to direct the process and write or update policy and procedures as necessary.…”

“…21 Often adopting all of the Ten Steps is a process that takes hospitals several years to fully implement. 18 Various approaches are found to work, depending on the area of resistance and depending on whether hospital staff have found creative solutions to road blocks. 22 The Massachusetts Baby-Friendly Collaborative developed 4 recommendations based on its experience: (a) manage expectation of patients, family/friends, and staff with prenatal education and anticipatory guidance; (b) restrict access to materials that can undermine breastfeeding (such as infant formula samples, marketing materials, and use of pacifiers); (c) adopt the appropriate perspectives to creatively implement change, including innovations such as "scripts" for staff to use with patients, standardized assessment tools, and management insight to staff roles such as understanding the time constraints of staffing ratios; and (d) combining BFHI efforts with larger forces by tying state, national, and Joint Commission initiatives to hospital policy changes.…”

Demand for Lactation Leads to Flowing Supply of Success: Support Requested from States to Improve Breastfeeding Practices

“…They found that state policies that support breastfeeding were associated with increased breastfeeding initiation rate in the community and that introducing new breastfeeding laws most likely increased the breastfeeding initiation rate among women . Furthermore, studies have shown that governmental and institutional support through policies and initiatives are some of the key factors for achieving a breastfeeding‐friendly environment and improving breastfeeding practices in health facilities . Our research team examined the barriers and facilitators of breastfeeding practices and found that enforcing breastfeeding support policies could facilitate the implementation of the BFHI in US maternity and birthing hospitals.…”