Baby Friendly Initiative and Breastfeeding Success, Annotated Bibliography Example

Introduction

The Baby Friendly Health Initiative (BFHI) has been implemented worldwide to facilitate the breastfeeding patterns during the early period after the infant’s birth. The need for this initiative emerged with the growing awareness of the major decline in the field of breastfeeding rates; the majority of mothers failed to provide their babies with breast milk nutrition immediately after birth, and did not receive adequate conditions for breastfeeding during their stay in hospitals after childbirth. The problem with breastfeeding emerged as a complex organizational issue, since the short period of breastfeeding duration and the beginning of breastfeeding combined with infant formula have become the widespread phenomena in child care.

However, there is an extensive body of research signaling the incomparable benefit of breastfeeding, since it improves child health, and promotes the unity of a mother with her infant. Therefore, both research and practice worldwide have become focused on protecting, promoting, and supporting breastfeeding worldwide. The Baby Friendly Hospital Initiative was specifically designed for the sake of removing organizational barriers to early initiation of breastfeeding, and removing the widespread patterns of providing infants with infant formula in hospitals because of the physical inability to provide mothers with an opportunity to give breast milk to their children. The BFHI recognized low breastfeeding rates as an international, complex, organizational problem; the initiative is supported and overseen by WHO and UNICEF in all countries participating in its implementation. Currently, there are 20,000 healthcare institutions worldwide that are BFHI-accredited. The implementation of BFHI usually occurs according to the “Ten steps to successful breastfeeding” implementation program designed specifically for the BFHI objectives.

Annotated Bibliography

DiGirolamo, A. M., Grummer-Strawn, L. M., & Fein, S. B. (2008). Effect of maternity-care practices on breastfeeding. Pediatrics, 122, S43-S49. DOI: 10.1542/peds.2008-1315e

The authors of the present article conducted an Infant Feeding Practices Study II to explore the effect produced by the six delineated baby-friendly practices and other maternity-care practices as reported by mothers during the period of breastfeeding. The baby-friendly practices chosen for examination were the initiation of breastfeeding within one hour after birth, giving only breast milk, rooming in, breastfeeding on demand, giving no pacifiers, and presence of fostering breastfeeding support groups. The outcomes of the study indicated that only 8.1% of women experienced all baby-friendly practices, the common percentage of experienced practiced equaled 50%, and the overall satisfaction with baby-friendly practices was revealed in mothers’ prolongation of the breastfeeding period for more than 6 weeks.

Moore, T., Gauld, R., & Williams, S. (2007). Implementing baby friendly hospital initiative policy: the case of New Zealand public hospitals. International Breastfeeding Journal, 2(8), 1-8.

The authors initiated a qualitative study based on the assumption about the positive impact of the Baby Friendly Hospital Initiative on the increase of breastfeeding rates. They conducted interviews with six lactation consultants to identify the overarching themes emerging in the discussion of barriers to the implementation of the BFHI at the early stages. The interviews revealed that the hospitals often experience problems due to incongruence of hospital policies with governmental policies, the communication of the policy in different ways, dependence on resources, effect of factors outside the hospital control, complicating organizational factors that affect the possibility of educating staff of the birthing centers, etc. The outcomes of the study also indicate that it is easier to implement the BFHI in smaller hospitals, and the socio-economic status of the community as well as the complexity of presenting cases at the hospitals’ birthing centers play the key role in identification of, and overcoming barriers.

Philipp, B. L., Malone, K. L., Cimo, S., & Merewood, A. (2003). Sustained breastfeeding rates at a US baby-friendly hospital. Pediatrics, 112, e234-e236.

The present study was conducted in the Boston medical Center with the purpose of identifying the persistence of breastfeeding trends after the implementation of the Baby Friendly Hospital Initiative in 1999. The researchers were interested in identifying whether the number of infants receiving any amount of breast milk persisted within two years after the program’s implementation. the statistical data indicated the positive tendency of breastfeeding; the number of infants fed by breast milk exclusively was 34% (1999), 26% (2000), and 25% (2001). The number of infants receiving more breast milk than formula was also persistent. The outcomes of the study show the positive impact of the “Ten Steps to Successful Breastfeeding” program implemented within the framework of the BFHI.

Merewood, A., Mehta, S. D., Chamberlain, L. B., Philipp, B. L., & Bauchner, H. (2005). Breastfeeding rates in US baby-friendly hospitals: Results of a national survey. Pediatrics, 116, 628-634. DOI: 10.1542/peds.2004-1636.

The authors of the present article attempted to analyze the US-wide available data from hospitals that participate in the BFHI, and hospitals that do not take part in it. The purpose of the comparison was to identify whether the breastfeeding rates and tendencies differ in the BFHI-designated hospitals in comparison with the national, regional, and state rates of breastfeeding. The study sample included 29 Us hospitals that retained the BFHI designation in 2003; the demographic data about infants and their mothers, the breastfeeding rates, and the information on hospitals’ initiation of baby-friendly initiatives were collected in 2003. Upon statistical analysis of these data, the researchers found out that the rate of breastfeeding initiation and the rate if exclusively breast milk feeding of infants during the hospital stay were significantly higher than those for national, regional, and state hospitals were. Analyzing the barriers to implementing the BFHI were discussed in the framework of surveys conducted in the 29 chosen hospitals. The employees of hospitals named steps 2, 6, and 7 as the most difficult ones to be accomplished in the process of adopting the BFHI. One of the reasons for the complications experienced was the financial reimbursement for healthcare executives for the usage of infant formula in feeding infants.

Meyers, D., & Turner-Maffei, C. (2008). Improved breastfeeding success through the Baby-Friendly Hospital Initiative. American Family Physician, 78(2), 180-182.

The authors of the article focused on the crucial role of family physicians in educating pregnant women regarding the value of breastfeeding. They cited the doctors Keister, Roberts, and Werner who assumed the scholarly evidence of BFHI about the viable scope of strategies in promoting, protecting, and supporting breastfeeding. The authors also assumed the importance of providing prenatal breastfeeding education to all families for the sake of providing the full, adequate, and positive information facilitating the choice for breastfeeding. The authors also considered the nonprofit organizations overlooking the operation of BFHI, and analyzed the large-scale trials certifying the positive impact of the initiative on the prevalence of breastfeeding. In addition, the risk factors for breastfeeding are assessed; the prime reason for weaning is seen in the late initiation and administration of formula. The authors concluded their argument by claiming that the prime way of optimizing breastfeeding is to initiate a skin-to-skin contact between a mother and a newborn.

DelliFraine, J., Langabeer II, J., Williams, J. F., Gong, A. K., Delgado, R. I., & Gill, S. L. (2011). Cost comparison of baby friendly and non-baby friendly hospitals in the United States. Pediatrics, 127(4), e989-e994.

The authors explored the incremental costs associated with obtaining the WHO and UNICEF support in terms of initiating the BFHI in a certain healthcare institution concerned with birth and neonatal care. The thesis of the authors was about the evident lack of data about the comparative economic assessment of the true cost differences between neonatal care in baby-friendly and non-baby-friendly hospitals. Therefore, the aim of the researches was to explore the financial costs of becoming a baby-friendly hospital in the USA. The analysis was conducted with the help of data from the 2007 American Hospital Association. The results of the study showed that nursery in addition to labor and delivery costs for baby-friendly sites were from 1.6% to 5% higher than those of non-baby-friendly sites. Therefore, the comparative costs of becoming a baby-friendly hospital were considered insignificant by the researchers. The overall conclusion obtained as a result of the present study focused on the overall benefit for mothers and infants in the initiation of the BFHI, and the comparative benefits of implementing the BFHI that turned out not as costly as it had been previously considered.

Taylor, C., Gribble, K., Sheehan, A., Schmied, V., & Dykes, F. (2011). Staff perceptions and experiences of implementing the baby friendly initiative in neonatal intensive care units in Australia. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 40, 25-34.

The authors composed their article following the objective to explore perceptions, understandings, and experiences of maternity services staff towards WHO/UNICEF-implemented Baby-Friendly Hospital Initiative. The observation was held in four Australian metropolitan focus groups by means of conducting an exploratory study. The overall number of participants equaled 47. The major themes elicited from the interviews and surveys conducted within the framework of the present study included the perceptions of hospital staff about Neonatal Intensive Care Units (NICUs) as different from maternity units, and the perceived difference between the infants in NICUs and maternity wards as the main mitigating factor for BFHI implementation. The respondents also provided the views of the NICU environment as not favorable for the implementation of BFHI due to certain conditions of providing care. Finally, the fact that mothers and infants were separated in NUCUs was considered as a serious barrier to the implementation of the BFHI steps in the NICU practices.

Broadfoot, M., Britten, J., Tappin, D., & MacKenzie (2005). The Baby Friendly Hospital Initiative and breast feeding rates in Scotland. Archives of Disease in Childhood. Fetal and Neonatal Edition, 90, F114-116. doi: 10.1136/adc.2003.041558

The present article aimed at identifying the effect of the baby Friendly Hospital Initiative on the rates of breastfeeding in Scotland, the United Kingdom. The method of research chosen by the researchers was the observational study: the inferences were made on the basis of the annual survey of progress of the WHO/UNICEF initiative regarding awarding hospitals with the status of baby friendly ones. Additional sources of information about breastfeeding tendencies and patterns were the routinely collected breastfeeding rates on the Guthrie Inborn Errors Screening card at the age of 7 days. The results of the study revealed that mothers staying in hospitals that have been awarded a status of baby-friendly from are 28% more likely to be subject to breastfeeding. The overall rates of breastfeeding in the hospitals following the BFHI have been increased at a much faster pace than those in the ordinary hospitals (conclusions were made from 1995-2002 statistics). The overall recommendation produced by the authors on the basis of inferred statistical conclusions is that all maternity units have to stimulate the implementation of the BFHI in their settings for the sake of better health outcomes for mothers and infants.

Abrahams, S. W., & Labbok, M. H. (2009). Exploring the impact of the baby-friendly hospital initiative on trends in exclusive breastfeeding. International Breastfeeding Journal, 4(11), 1-6. doi:10.1186/1746-4358-4-11.

The researchers undertook an international study related to the examination of the impact produced by the implementation of the WHO/UNICEF initiative of initiation of early breastfeeding. They took data on 14 developing countries in which the BFHI program was implemented, and observed the outcomes of the programs within the period of these programs’ activity in those countries. As a result of statistical data analysis, the authors noted the stable upward tendency in the breastfeeding patterns in practically all countries under research. Though there have been no statistically significant differences between the pre-BFHI and the post-BFHI percentages in the majority of countries under the investigation, the association of the BFHI program implementation and the persistent annual increase of the rate of exclusive breastfeeding rates (under two months and under six months) has been documented and statistically proven. The conclusions of the authors concern the overall positive impact of the BFHI program in developing countries; however, the authors noted lack of alignment in data due to the difference in years of BFHI initiation in each separate country. For this reason, they recommended further, more detailed research to be done further on.

Schmied, V., Gribble, K., Sheehan, A., Taylor, C., & Dykes, F. C. (2011). Ten steps or climbing a mountain: A study of Australian health professionals’ perceptions of implementing the baby friendly health initiative to protect, promote, and support breastfeeding. BMC Health Services Research, 11, pp. 1-10. Retrieved from http://www.biomedcentral.com/1472-6963/11/208

The authors focused on analyzing the perceived challenges for the full-scale implementation of the BFHI in the Australian healthcare institutions. Focusing their research on maternity units and neonatal intensive care units in the Area Health Service NSW in Australia, the authors conducted an interpretative qualitative research; they interviewed the total of 132 health professionals to find out their perceptions about the usefulness of BFHI, and the barriers to its implementation. The findings of their thematic analysis suggest that the majority of healthcare professionals (midwives and nurses) agree on the exceptional value of the BFHI program, but have varying beliefs about what is required to attain the BFHI objectives. The authors concluded that there is a major discrepancy between the broad philosophical framework and best practice approach to BFHI, and the applied usage of the ten steps BFHI program as a checklist of its implementation. Therefore, there are complications related to interpreting BFHI, and the need for education and accurate information provision is acknowledged in the article.

Conclusion

As one can see from the present annotated bibliography, there is a clear benefit of the BFHI implemented in hospitals worldwide. The hospitals in which BFHI is implemented, exclusive breastfeeding and a certain amount of breastfeeding rates are undoubtedly higher than the overall national rates of breastfeeding derived from ordinary hospitals. There are certain mother-care practices that have proven efficient within the framework of BFHI implementation; they include early initiation of breastfeeding in one hour after the child’s birth, the ability to room mothers with their infants, no usage of pacifiers, and the presence of breastfeeding support groups.

There are also important organizational issues revealed in the present annotated bibliography; as it comes from the analysis of several articles, there are serious organizational constraints for implementation of BFHI. It is reported that the small size of a hospital facilitates the implementation of BFHI; in addition, staff commitment, provision of appropriate education and accurate information about BFHI aspects is essential for the implementation of the initiative properly and fully. There is also a direct relationship between the socio-economic status of the community in which the hospital is located, the complexity of cases presented to the hospital birthing centers, and the BFHI success.

However, the most significant finding is that the BFHI implementation proves successful in both advanced and developing counties. The rates of breastfeeding are significantly higher in BFHI-accredited hospitals than in ordinary ones, which is shown in longitudinal studies as well. Therefore, there is a current need to explore the opportunities of quicker and more comprehensive BFHI implementation in a larger number of hospitals and birthing centers worldwide.