The Baby-Friendly Journey in a US Public Hospital

Abstract

In May of 2007, San Francisco General Hospital & Trauma Center became the first Baby-Friendly certified hospital in San Francisco. This quality improvement program began in 1999 and took 8 years to complete. Challenges to completing this goal included a population that has myriad social issues including non-English-speaking clients, drug abuse, poverty, and homelessness. Further complications included a constantly changing group of perinatal healthcare providers with little-to-no breast-feeding knowledge, hospital practices that did not support rooming-in and skin-to-skin contact, and lack of overall patient breast-feeding education. This article describes the process of implementing The Baby-Friendly Hospital Initiative quality improvement program, achieving certification and subsequent increase in breast-feeding rates. Breast-feeding initiation rates went from 81% in 2002 to 98% in 2010. Exclusivity rates did not change.

The Impact in the United States of the Baby-Friendly Hospital Initiative on Early Infant Health and Breastfeeding Outcomes

“…[18][19][20][21][22][23] However, documentation is fragmentary regarding the impact of the BFHI on early infant health outcomes and breastfeeding outcomes in the United States. 1,[24][25][26][27] While studies suggest that Baby-Friendly practices increase breastfeeding initiation and exclusivity rates, there is a lack of reconciliation on breastfeeding duration rates and causal mechanisms related to the BFHI's success. 22,26,27 Additionally, evidencedbased guidelines for early infant health outcomes such as neonatal weight loss, hypoglycemia, hyperbilirubinemia, and hypothermia with respect to Baby-Friendly practices are inadequate.…”

“…1,[24][25][26][27] While studies suggest that Baby-Friendly practices increase breastfeeding initiation and exclusivity rates, there is a lack of reconciliation on breastfeeding duration rates and causal mechanisms related to the BFHI's success. 22,26,27 Additionally, evidencedbased guidelines for early infant health outcomes such as neonatal weight loss, hypoglycemia, hyperbilirubinemia, and hypothermia with respect to Baby-Friendly practices are inadequate. 24,28,29 This is especially pertinent for late preterm infants (34-36 weeks) who are vulnerable to dehydration and rehospitalization due to feeding difficulties related to prematurity.…”

“…34,35 Staff education and training, as well as adequate time and staffing resources to properly implement the ''Ten Steps'' are interpersonal provider level considerations. 26,30,36 Organizational hospital factors involve establishing a written hospital policy to support breastfeeding mothers, consistent organizational implementation of the ''Ten Steps,'' and provision of structural, social, and health provider support throughout all stages of pregnancy. 26,30,36,37 Finally, policy/systems factors include the availability of breastfeeding information, and standardized breastfeeding definitions, charting, and tracking mechanisms.…”

“…26,30,36 Organizational hospital factors involve establishing a written hospital policy to support breastfeeding mothers, consistent organizational implementation of the ''Ten Steps,'' and provision of structural, social, and health provider support throughout all stages of pregnancy. 26,30,36,37 Finally, policy/systems factors include the availability of breastfeeding information, and standardized breastfeeding definitions, charting, and tracking mechanisms. 26,27,30,37,38 Baby-Friendly Practices Defined Baby-Friendly USA is responsible for the initiative's implementation in the United States.…”

Can kangaroo care help newborns with neonatal abstinence syndrome? Case report

“…[12] Another study reported that substance abusing mothers participating in 30 minutes of KC at birth as part of Baby Friendly requirements reported satisfaction with KC at birth and in the first 3 postpartum days. [13] Thus, the purposes of the two case studies reported here were to document clinical experience using KC in newborns with NAS to determine how holding impacted severity of NAS by documenting changes in Modified Neonatal Abstinence scores and how mothers felt about KC. We wanted to observe how long the mother spontaneously offered KC because mothers who are smokers might not be able to tolerate an hour or more of KC and because mothers on drug maintenance programs may be reluctant to visit or hold their newborns skin-to-skin as previous research has shown.…”