The UN Millennium Development Goals aimed to reduce poverty and improve health by 2015 through 8 focus areas set globally and locally. Breastfeeding provides health benefits to both mother and baby by reducing infections and diseases. The WHO, UNICEF, and TJC promote exclusive breastfeeding for 6 months. The Baby Friendly Hospital Initiative's 10 steps aim to improve breastfeeding support through policies, education, early skin-to-skin contact and rooming-in practices. Increasing provider buy-in and adjusting practices like rooming-in can help increase breastfeeding exclusivity rates to promote health.

2. UN 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

3. UN Millennium Development
Goals

4. Breastfeeding Overview

5. Breastfeeding Overview
Breastfeeding is “the natural way to feed a newborn”
(Alberta RN, 2014, p.26).
Breastfeeding reduces the incidence of ear, chest, and
urine infections, childhood diabetes, obesity, and GI
infection in babies (Ellis & Surtees, 2011, p. 82).
Breastfeeding reduces maternal risk of breast and ovarian
cancers, heart disease, hypertension, diabetes,
hyperlipidemia, and hip fractures (Ellis & Surtees, 2011, p.
82; Koenig, 2014, p.46).

6. Pathophysiology of
Breastfeeding
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

7. Organizations
Notable organizations that encourage breastfeeding:
The World Health Organization (WHO)
The United Nations Children’s Fund (UNICEF)
The Joint Commission (TJC)

8. The Joint Commission
United States regulatory committee of accreditation
of healthcare organizations, formerly known as
JCACHO
Perinatal Care Measures
Set of regulations related directly to perinatal quality of
care

9. The Joint Commission
Perinatal Care Measures
5 care measures and indicators of quality
PC-01: Elective Delivery
PC-02: Cesarean Sections
PC-03: Antenatal Steroids
PC-04: Healthcare-associated blood stream infections of
the newborn
PC-05: Exclusive breast milk feeding

10. The Joint Commission
PC-O5: Exclusive breast milk feeding
Broken down into two subsets, PC-05 and PC-05a
PC-05 relates to the percentage of babies who were exclusively
breastfed while hospitalized.
Improvements are tracked as an increase in this figure
PC-05a relates to the percentage of babies who were exclusively
breastfed while hospitalized but considers mothers admission
feeding plan
This is a more clear figure of exclusive breastfeeding. Mother’s who
intended to formula feed from admission are excluded from the data

11. Baby Friendly Rap
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
Baby Friendly-USA is the branch responsible for
Baby Friendly organizations in America.

12. Baby Friendly
“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: Commitment
2: Planning
3: Data Collection
4: Designation

13. Baby Friendly’s 10 Steps
1) Breastfeeding policy that is routinely communicated to staff
2) Ensure all health care providers have knowledge and skill to
implement policy
3) Educate women and families of the importance of
breastfeeding
4) 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

14. Baby Friendly’s 10 Steps
5) Assist mothers with lactation needs and teach
methods to maintain supply in the event of
separation (i.e. NICU, surgery, etc)
6) Support exclusive breastfeeding and encourage
for the first 6 months of life. Supplement only when
medically indicated
7) 24 hour rooming in of mother and newborn

15. Baby Friendly’s 10 Steps
8) Encourage infant cue; on demand breastfeeding.
Encourage breastfeeding with complementary foods after
6 months
9) Offer no pacifiers or artificial nipples as they are a
barrier to breastfeeding supported by evidence
10) Provide seamless transition from hospital based
service to community and peer support programs (i.e.
LaLeche League, Baby Café).

16. Baby Friendly
Massachusetts
6 MA hospitals and birthing centers have earned the
designation
Boston Medical Center, Boston
Good Samaritan Medical Center, Brockton
Cambridge Birth Center, Cambridge
Fairview Hospital, Great Barrington
Tobey Hospital, Wareham
Melrose-Wakefield Hospital, Melrose

17. Problem Solving for
Better Health (PSBH)
Steps (Smith, et al., 2011, p. 19
1: Define the problem
2: Prioritize the problem
3: Define a solution
4: Create an action plan
5: Take action

18. Problem Solving for
Better Health (PSBH)
Problem
Breastfeeding exclusivity rates are lower than is ideal
by the sixth month of life.
Question
How can breastfeeding exclusivity rates be increased
to promote breastfeeding to at least the 6th month of life
as WHO, UNICEF and TJC recommend?

19. Problem Solving for
Better Health (PSBH)
One factor that potentially inhibits establishing strong
breastfeeding self-efficacy is nursing and other
provider buy in
Buy in of the problem includes attitude adjustments and
resistance to change
Rooming in

20. Problem Solving for
Better Health (PSBH)
Rooming in is the practice of allowing mother and
infant dyads and family to remain together and not
routinely separated.
L&D: STS care at delivery and for the recovery period.
Routine activities performed while STS (APGARs,
meds, vitals). Encourage feeding when infant shows
cues. Encourage the Breast Crawl
Breast Crawl Video

21. Problem Solving for
Better Health (PSBH)
Rooming in should be continued upon transfer to the
Postpartum unit if a transfer occurs
PP: Routine care such as baths, vitals, and meds
should be done at the bedside and with education
and/or return demonstration by family.
Problem: Nursing workflow prefers these activities in
the nursery to cluster care of all newborns. Here is our
need for adjustment to change of a workflow

22. Problem Solving for
Better Health (PSBH)
Some parents, when offered the opportunity for
nursery care instead of rooming in, jump at the
chance.
Delayed infant feeding cue recognition
Discourages feeding on demand
May result in delayed/impaired attachment and predict
breastfeeding problems and early supplementation or
formula feeding

23. Problem Solving for
Better Health (PSBH)
What will be the most successful method of changing
rooming in culture of our nurseries?

24. Problem Solving for
Better Health (PSBH)
Nursery
Staffing of a wellborn nursery should be limited to necessity.
Hyperbilirubinemia: those newborns requiring ultraviolet light treatment
Circumcision and recovery
No boarder babies
Rooming in
Staff nurses should be educated and commit to rooming in
Routine care activities will be clustered and will include education and active
participation

25. Problem Solving for
Better Health (PSBH)
Get involved!!!
Massachusetts Breastfeeding Coalition
Baby Café
AWHONN
Health Policy

26. Problem Solving for
Better Health (PSBH)
Evaluation- Family
As part of ongoing patient satisfaction surveys, rooming in will be a line
item reviewed with the patient, regardless if exclusively breastfeeding at
discharge or formula feeding
Evaluation- Staff
Education around rooming in and its evidence based benefits will be
reinforced regularly (staff meetings, email signatures, etc.)
After a culture and workflow change, management and other
stakeholders will routinely discuss opportunities for improvement(s).

28. 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
Baby-Friendly USA, Inc. (2012). Retrieved from
https://www.babyfriendlyusa.org/
Ellis, A., & Surtees, A. (2011). Breastfeeding:
implementing the Baby Friendly Initiative. British
Journal Of Healthcare Assistants, 5(2), 82-83

29. References
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
Holtz, C. (2013). Global health care: Issues and policies. Boston, MA:
Jones and Bartlett.
Joint Commission. (2015). Specifications Manual for Joint
Commission National Quality Measures (v2015A1). Oakbrook
Terrace, Illinois. Retrieved from
https://manual.jointcommission.org/releases/TJC2015A1/MIF0170.ht
ml.

30. References
Koenig, H. F. (2014). Breastfeeding Education for Healthier
Babies. Healthcare Executive, 29(4), 46-49.
Otsuka, K., Taguri, M., Dennis, C., Wakutani, K., Awano,
M., Yamaguchi, T., & Jimba, M. (2014). Effectiveness of
a Breastfeeding Self-efficacy Intervention: Do Hospital
Practices Make a Difference?. Maternal & Child Health
Journal, 18(1), 296-306. doi:10.1007/ s10995-013-
1265-2
Pinto, S., & Schub, T. (2014). Breastfeeding: Interventions to
Promote Initiation and Extend Duration of Breastfeeding.
Cinahl Information Systems.

31. References
Samuel, T. M., Thomas, T., Bhat, S., & Kurpad, A. V.
(2012). Are infants born in baby- friendly hospitals
being exclusively breastfed until 6 months of age?.
European Journal Of Clinical Nutrition, 66(4), 459-
465. doi:10.1038/ejcn. 2011.179
St. Fleur, R., & McKeever, J. (2014). The Role of the
Nurse-Physician Leadership Dyad in
Implementing the Baby-Friendly Hospital Initiative.
Nursing For Women's Health, 18(3), 231-235.
doi:10.1111/1751-486X.12124

32. References
The Baby-Friendly Initiative. (2014). Alberta RN,
70(1), 26-27.
Wedding, 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