Infant Feeding and Institutional Adherence with the Baby-Friendly Initiative: An Assessment through Maternal Experience and Review of Policy and Protocol

Fullerton, Laura Mary and Gustafson, Diana L. (2015) Infant Feeding and Institutional Adherence with the Baby-Friendly Initiative: An Assessment through Maternal Experience and Review of Policy and Protocol. Project Report. Memorial University of Newfoundland, St. John's, Newfoundland. (Submitted)

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Abstract

The World Health Organization and the United Nations International Children’s Emergency Fund recommend exclusive breastfeeding for the first six months of life for optimal infant health and development. Exclusive breastfeeding means feeding an infant with breastmilk and no other liquids, foods, or breastmilk substitutes. Previous research indicates that the benefits of breastfeeding extend beyond infancy and childhood to influence health outcomes throughout the life course. The rates of exclusive breastfeeding in Newfoundland and Labrador for the recommended six-month duration are significantly lower than the national average at 5.8% and 14.4% respectively (Chalmers et al., 2009). The Baby-Friendly Hospital Initiative (BFHI) is a global health promotion initiative committed to improving maternal-infant health by improving rates of exclusive breastfeeding. The initiative and its Ten Steps to Successful Breastfeeding provide guidelines to hospitals and birthing facilities for implementing evidence-informed standards for patient care in pregnancy, childbirth, and the early post-partum period with a goal of improving breastfeeding initiation, duration, and exclusivity. The purpose of this research was to examine hospital adherence with infant feeding guidelines at the Janeway Children’s Hospital/Health Sciences Centre in St. John’s, NL. This interpretative phenomenological study conducted in 2012 included a systematic review of hospital infant feeding policies and protocols and an exploration of maternal healthcare and infant feeding experiences generated from individual and focus group interviews. The study revealed discrepancies between BFI practice guidelines and hospital infant feeding healthcare practices, specifically a lack of full adherence with Steps 3-9 of the BFI, and inconclusive evidence about adherence with Step 10. These findings reveal opportunities for improving breastfeeding initiation, duration and exclusivity. Nine key recommendations are to: 1. Update existing policies: Update Eastern Health infant feeding policies for healthy newborns to align with all Steps and Sub-Steps of the BFI Ten Steps to Successful Breastfeeding. 2. Prioritize regular policy communication among allied health professionals: Ensure health professionals working with mothers in pregnancy, labour/delivery, and postpartum recovery are knowledgeable of hospital policies about breastfeeding. 3. Provide regular and mandatory BFI training for health professionals: Ensure all health professionals providing care to mothers in pregnancy, labour/delivery, and the early post-partum period have completed BFI training, and have the knowledge and skills needed to confidently support the success of mother/infant dyads with breastfeeding. 4. Provide allied health professionals with the organizational and supportive work conditions necessary to implement BFI practice guidelines: Ensure all health professionals working with mothers in pregnancy, labour/delivery, and the early postpartum period are supported (through, for example, appropriate scheduling, patient loads, length of shifts, access to resources) to provide mothers with high-quality and consistent infant feeding information, assistance, and support. 5. Enhance communication between mothers and allied health professionals: Ensure every mother has an opportunity, prior to discharge, to talk with a BFI-trained health professional about the importance and process of breastfeeding, and implications of supplementation, as well as how to recognize infant feeding cues, and signs of effective feeding. Ensure mothers are provided with regular opportunities during their hospital stay to talk with health care providers and ask questions. 6. Prioritize skin-to-skin contact for one full hour or as long as the mother wishes: Ensure skin-to-skin contact immediately after birth for the duration of one hour or as long as the mother wishes. 7. Encourage overnight rooming-in the first night in hospital for all mother-infant dyads: Ensure mothers and infants remain together in the same room overnight. Do not separate mother/infant dyads overnight unless required for medical reasons. 8. Encourage cue-based feeding rather than feeding at timed intervals: Encourage mothers to feed on demand by recognizing and responding to infant feeding cues. Ensure mothers are aware of signs of effective feeding. 9. Provide mothers with access to a certified lactation consultant in hospital: Ensure a certified lactation consultant is available to assist mothers with breastfeeding in hospital 7 days a week.

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