Baby Steps: One Hospital's Quest to Improve Its Breastfeeding Practices


Poster Presentation

Purpose for the Program

Though numerous research studies show the positive effect of the United Nations International Children's Emergency Fund (UNICEF)/World Health Organization (WHO) Baby Friendly Hospital Initiative on breastfeeding rates, only 143 hospitals in the United States have undertaken the necessary steps to become Baby Friendly. In the current economic climate, some hospitals may be concerned about potential costs, including refusing free formula, and others may face cultural or institutional barriers to full implementation.

In 2011, Huntsville Hospital for Women & Children began an initiative to improve its breastfeeding practices. Alabama has the fourth lowest breastfeeding rate in the nation, with less than 60% of infants ever having been breastfed. At Huntsville Hospital, about three-fourths of women intend to breastfeed (similar to the national rate). To support these mothers, hospital leaders decided to advance breastfeeding practices to be in line with the Baby Friendly Hospital Initiative and evidence-based practice.

Proposed Change

Using the Baby-Friendly steps as guidelines, a committee of interested staff and leaders from the postpartum unit planned and implemented a series of interventions focused on breastfeeding.

Implementation, Outcomes, and Evaluation

Staff members were first surveyed about breastfeeding knowledge and education ability. Survey data were used to create a mandatory full-day course for all unit nurses that focused on areas where staff needed further education.

Additional steps undertaken by the unit included replacing the patient discharge bags that display the formula company with bags that contain the hospital logo, increasing lactation consultant hours on the unit, creation of a unit-specific breastfeeding booklet for staff, changing the infants’ intake/output sheet to include breastfeeding education for parents, and to not distribute pacifiers unless specifically requested by parents.

Preliminary data indicated that the breastfeeding course objectives were met and patient satisfaction scores related to breastfeeding assistance were high. Despite the hospital's initial successes, it still faces many challenges in its quest to implement all 10 steps of the Ten Steps to Successful Breastfeeding as outlined by the Baby Friendly Hospitals Initiative. In a state with traditionally low breastfeeding rates, barriers include getting families to room-in with infants, encouraging physicians’ infant assessments and other interventions to be performed in patient rooms, increasing funding for lactation consultants at night and on weekends, looking at ways for mothers who had a cesarean delivery to breastfeed their infants within 1 hour of delivery, and implementing breastfeeding support groups.

Implications for Nursing Practice

Increased staff knowledge, high patient satisfaction scores, and movement toward compliance with the Baby Friendly Hospital's Ten Steps to Successful Breastfeeding are all positive signs of improved breastfeeding practices at Huntsville Hospital. Other hospitals that want to work toward Baby Friendly practices can learn from Huntsville's successes and continued challenges in improving its breastfeeding policies and practices.