Improving Maternity Care Practices in New York: Answering the Surgeon General's Call to Action

Abstract

Hospitals providing maternity care influence breastfeeding mothers and infants during the critical, early postnatal period. Despite concerted public health efforts, there are persistent, large variations across New York State (NYS) hospitals in breastfeeding policies, maternity care, and infant feeding practices and in rates of breastfeeding initiation and exclusivity. An initiative addressing this issue is the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative, which was designed and implemented by the NYS Department of Health (NYSDOH). The BQIH Learning Collaborative, adapted from the Institute for Healthcare Improvement Breakthrough Series, embedded evidence-based maternity care best practices in a learning and quality improvement model. The Ten Steps to Successful Breastfeeding served as the backbone for improvement with the aims of increasing the percentages of infants fed any breastmilk and exclusively fed breastmilk while decreasing the percentage of breastfed infants supplemented with formula. Twelve hospitals were selected to participate based on their breastfeeding metrics: 10 of the hospitals were low performing, and two were high performing on these breastfeeding measures. During the 18-month BQIH Learning Collaborative, process improvement occurred for several measures, including breastfeeding within the first hour after birth, breastfeeding mother/infant rooming-in, and receipt of formula samples/discharge bags. NYSDOH plans to spread this Collaborative to all hospitals providing maternity care in NYS. Comprehensive breastfeeding initiatives will continue in NYS in the effort to ensure that all breastfeeding mothers receive optimal support from healthcare providers and hospitals with the goal of making breastfeeding the norm for infant nutrition during the first year of life.

Development of the Breastfeeding Quality Improvement in Hospitals Learning Collaborative in New York State

“…The implementation of the BQIH has been described by Hisgen et al 17 Evaluations of the impact of the BQIH on hospital policies, practices, and breastfeeding metrics are in process. Further studies are needed to determine the impact of the BQIH on breastfeeding exclusivity and duration after the hospital stay and to evaluate the costs and benefits.…”

“…Hospitals were categorized as low-, high-, or medium-performing hospitals based on their breastfeeding metrics. 17 Twenty-three hospitals were categorized as low performing, and five were categorized as high performing. These 28 hospitals were invited to apply to participate; 17 applied, indicating they would attend all Learning Sessions, participate in monthly group and individual calls, and submit data monthly.…”

“…These 28 hospitals were invited to apply to participate; 17 applied, indicating they would attend all Learning Sessions, participate in monthly group and individual calls, and submit data monthly. 17 Each participating hospital was reimbursed up to $5,000 ($1,000 after each of the five Learning Sessions) to partially compensate for staff time and travel expenses.…”

“…17 All 12 hospitals fully participated in all components of the study, submitted all data, and completed the study.…”

Pädiatrische Ernährungsmedizin

“…Inwieweit der Verzicht auf die Vorteile längerer exklusiver Muttermilchernährung durch höhere Morbidität im späteren Leben bezahlt wird, ist nicht gesichert; dass es langfristige Vorteile länger voll gestillter Kinder gibt, ist jedoch dokumentiert [7]. Maßnahmen zur Verlänge-rung der Gesamtstilldauer und Förderung exklusiven Stillens finden in deutschen Geburtskrankenhäusern weit weniger Aufmerksamkeit zum einen als in anderen Ländern [8] und zum anderen als die weiterhin verbreitete Werbung für Muttermilchersatznahrungen [9]. Stillförde-rung ist eine wesentliche Aufgabe pädiatrischer Ernährungsberatung.…”