2. United Nations Millennium
Development Goals
• The Millennium Development Goals are a
set of broad benchmarks hoped to have
been realized by 2015. They were adopted
by the United Nations in 2000
– 8 focus areas
– International framework
– Both globally and locally driven
4. Breastfeeding
• While some women acknowledge that
breastfeeding will not work for them and/or
their families, it is illustrated in the
evidence that breast milk is best for
newborns.
5. Breastfeeding
• Health benefits for the newborn such as:
– Passive immunity
– Decreased prevalence of diarrhea, otitis
media, pneumonia, bacteremia, and
meningitis during the first year of life
(Pinto & Schub, 2014, p.1).
– Increased bonding activity and time together
6. Breastfeeding
• Health benefits for the mother such as:
– Increased bonding activity and time together
– Easier postpartum weight loss
– Reduced risk for postpartum depression
– Decreased postpartum bleeding
– Convenience
– Delayed fertility
– Reduced risk for breast and ovarian cancers
later in life
7. Breastfeeding Pathophysiology
• Two main hormones: Prolactin & Oxytocin
– Prolactin
• Anterior Pituitary hormone that causes the breast
to produce milk. Binds to mammary epithelial cell
receptors synthesizing milk proteins. Several
minutes of suckling causes prolactin secretion
– Oxytocin
• Posterior Pituitary hormone that is intermittently
released after suckling stimulation causing “let
down” of milk
8. Baby-Friendly Hospital Initiative
• The Baby Friendly Hospital Initiative
(BFHI) is a joint venture between the WHO
and UNICEF that seeks to promote
exclusive breastfeeding for all mother-
baby dyads who are able to. BFHI seeks
to improve support from healthcare
providers.
• Over 20,000 hospitals designated
worldwide in 156 different countries
9. Baby-Friendly Hospital Initiative
• Baby Friendly-USA is the branch
responsible for Baby Friendly
organizations in America.
• Developed the “Ten Steps To Successful
Breastfeeding” on which the program is
built
10. Baby-Friendly Hospital Initiative
• Baby Friendly” is a distinction earned by
hospitals and birthing centers who choose
to apply
• Baby Friendly designation is a 4 stage
process. Moving through the stages often
takes 2-4 years.
– 1: Discovery
– 2: Development
– 3: Disseminate
– 4: Designation
11. Baby-Friendly Hospital Initiative
• The Ten Steps to Successful
Breastfeeding include:
– Breastfeeding policy that is routinely communicated to
staff
– Ensure all health care providers have knowledge and
skill to implement policy
– Educate women and families of the importance of
breastfeeding
– Encourage and support skin to skin contact for at
least the first hour of life or first feed. Encourage
mothers and offer assistance as needed
12. Baby-Friendly Hospital Initiative
• The Ten Steps to Successful
Breastfeeding include:
– Assist mothers with lactation needs and teach
methods to maintain supply in the event of separation
(i.e. NICU, surgery, etc)
– Support exclusive breastfeeding and encourage for
the first 6 months of life. Supplement only when
medically indicated
– 24 hour rooming in of mother and newborn
13. Baby-Friendly Hospital Initiative
• The Ten Steps to Successful
Breastfeeding include:
– Encourage infant cue; on demand breastfeeding.
Encourage breastfeeding with complementary foods
after 6 months
– Offer no pacifiers or artificial nipples as they are a
barrier to breastfeeding supported by evidence
– Provide seamless transition from hospital based
service to community and peer support programs (i.e.
LaLeche League, Baby Café).
14. Baby-Friendly Hospital Initiative
• Evaluation
– BFHI is producing excellent results worldwide
especially in resource poor nations
– BFUSA is having arguably limited influence
on fairly poor American breastfeeding
statistics
• Encourages and supports quality breastfeeding
support and education
16. Baby-Friendly Hospital Initiative
• The Joint Commission, through its
Perinatal Care Measures, require US
hospitals to report on breastfeeding
statistics and exclusivity statistics.
– This data is directly related to reimbursement
17. Baby-Friendly Hospital Initiative
• If facilities are federally mandated to
improve performance and monitor
statistics, what incentive remains for a
facility to make the financial commitment
buying in to BFUSA?
18. Baby-Friendly Hospital Initiative
• What started, in this country, as a
worthwhile program with mothers and
babies at its core, is becoming a marketing
tool for hospitals to be labeled as “Baby-
Friendly”
19. Breastfeeding Report Card
Exclusive BF at 6 months
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
National Average Massachusetts New Hampshire
2012
2013
2014
20. Breastfeeding Report Card
Percent of births at Baby Friendly Hospitals
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
National Massachusetts New Hampshire
2012
2013
2014
21. References
• Allen, J. A., Longenecker, H. B., Perrine, C. G., & Scanlon, K. S. (2013). Baby-Friendly Hospital Practices and
Birth Costs. Birth: Issues In Perinatal Care, 40(4), 221-226. doi:10.1111/birt.12062
• Centers for Disease Control and Prevention. (2015). Breastfeeding Report Card, United States 2014. Retrieved
online from http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf.
• Centers for Disease Control and Prevention. (2014). Breastfeeding Report Card, United States 2013. Retrieved
online from http://www.cdc.gov/breastfeeding/pdf/2013breastfeedingreportcard.pdf.
• Centers for Disease Control and Prevention. (2013). Breastfeeding Report Card, United States 2012. Retrieved
online from http://www.cdc.gov/breastfeeding/pdf/2012breastfeedingreportcard.pdf.
• Ellis, A., & Surtees, A. (2011). Breastfeeding: implementing the Baby Friendly Initiative. British Journal Of
Healthcare Assistants, 5(2), 82-83.
• Grummer-Strawn, L. M., Shealy, K. R., Perrine, C. G., Macgowan, C., Grossniklaus, D. A., Scanlon, K. S., &
Murphy, P. E. (2013). Maternity Care Practices That Support Breastfeeding: CDC Efforts to Encourage
Quality Improvement. Journal Of Women's Health, 22(2), 107-112. doi:10.1089/jwh.2012.4158
• Harris, M.J. (2010). Evaluating public and community health programs. San Francisco: Jossey-Bass
• Holtz, C. (2013). Global health care: Issues and policies. Boston, MA: Jones and Bartlett.
• Koenig, H. F. (2014). Breastfeeding Education for Healthier Babies. Healthcare Executive, 29(4), 46-49.
• The Baby-Friendly Initiative. (2014). Alberta RN, 70(1), 26-27.
• Weddig, J., Baker, S. S., & Auld, G. (2011). Perspectives of Hospital-Based Nurses on Breastfeeding Initiation
Best Practices. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 40(2), 166-178. doi:
10.1111/j.1552-6909.2011.01232.x
• World Health Organization. (2015). The Ten Steps to Successful Breastfeeding. Retrieved from
https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps.
