Target Behavior: Breastfeeding
Intervention Type: Direct Education, PSE Change
Intervention Reach and Adoption
Setting: Health care
Target Audience: Pregnant/Breastfeeding Women
- Multi-disciplinary Task Force Formation: The Task Force provides leadership to guide the facility through changes throughout the organization and assists with fostering knowledge and support of the initiative throughout the facility. The task force is responsible for all aspects of planning, implementation, and evaluation required to comply with the Baby-Friendly Hospital Initiative’s (BFHI) Ten Steps to Successful Breastfeeding.
- Self-Assessment: Facilities are required to complete a Self-Appraisal Survey and Facility Data Sheet in the Discovery Phase to help assess where the facility is in terms of breastfeeding policies and procedures, exclusivity rates, etc. These items are completed when the facility first enters the 4D pathway. The facility continues to monitor practices and collect data while working towards and following Designation. This is done by following a Data Collection Plan that the facility creates in the Development Phase and by utilizing audit tools to insure they are in compliance with the Baby-Friendly Guidelines and Evaluation Criteria.
- Comprehensive Infant feeding Policy: The facility develops a breastfeeding policy that addresses the implementation of the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-Milk Substitutes. The policy is communicated to all healthcare staff and the staff receives the training and education necessary to implement this policy.
- Staff Education: Guidelines from Baby-Friendly USA require that any pediatrician, obstetrician, family practice physician or advanced practice registered nurse that has staff privileges at a Baby-Friendly hospital or birth center receive education on the required topics as indicated in the Guidelines and Evaluation Criteria. The amount and content of the training offered is tailored to the needs of the professionals.
- Education and Support for Mothers: Lactation consultants teach weekly breastfeeding classes, and peer counselors are hired to work with mothers before and after discharge. Peer counselors teach mothers of healthy newborns and neonatal intensive care patients about the benefits of breastfeeding and the importance of skin-to-skin contact between caregiver and infant.
- Paying for Formula: As part of the requirements to achieve Baby-Friendly designation a hospital must follow the International Code of Marketing of Breast-Milk Substitutes. One of the major tenants of “The Code” stipulates the facility cannot accept free formula from formula manufacturers. This includes the formula-company sponsored gift bags that are distributed on postpartum floors in most hospitals. Many United States hospitals find compliance with this step to be the greatest barrier to obtaining Baby-Friendly designation. Paying for formula need not become the rate-limiting step in the process of becoming Baby-Friendly.
Intervention Effect (initiation and exclusivity rates): Breastfeeding initiation rates were compared at BMC before (1995), during (1998), and after (1999) the Baby-Friendly policies were implemented. Breastfeeding initiation was defined as an infant receiving any amount of breast milk while in the hospital after birth. Random medical chart review of 200 records showed that the breastfeeding initiation rates increased from 58% (1995) to 77.5% (1998) to 86.5% (1999). Infants exclusively breastfed, defined as receiving no formula while in the hospital, increased among US born, black mothers in this population from 34% (1995) to 64% (1998) to 74% (1999).
Intervention Effect (sustained initiation rates): Breastfeeding initiation rates were again measured in 2000 and 2001 and compared with initiation rates in 1999 (the year that BMC received Baby-Friendly designation) to determine if the increased rates could be sustained over time. Breastfeeding initiation rates remained high: 87% (1999), 82% (2000), and 87% (2001).
Intervention Effect (duration rates): A random selection of 350 medical records of infants born in 2003 at BMC were reviewed, and of the eligible infants who returned for the six-month follow-up visit, 37.1% were still breastfeeding at six months of age. Among a predominantly low-income, black population, breastfeeding rates at 6 months were comparable to the overall US population.
|Readiness and Capacity – Short Term (ST)||Changes – Medium Term (MT)||Effectiveness and Maintenance – Long Term (LT)||Population Results (R)|
|Sectors of Influence||MT11, MT12||LT19|
Further, facilities enrolled in the 4-D Pathway receive tool kits which consist of an assortment of planning and audit tools.
Baby-Friendly USA, Inc.
125 Wolf Rd., Suite 402
Albany, NY 12205
Phone: (518) 621-7982
Fax: (518) 621-7983