Underlying Theory: The CBI’s training and technical assistance program operates on the organizational and policy-levels of the Social Ecological Model. The BFHI is guided by Social Cognitive Theory and addresses maternity staff and mothers’ breastfeeding-related expectations, self-efficacy, and behaviors.
- Education for mothers about breastfeeding during prenatal and intrapartum periods: This is achieved through one-on-one interactions between maternity nursing staff and new or expectant mothers wherein nursing staff teach skills and knowledge about breastfeeding and influence attitudes through the support and information provided. The BFHI includes several steps that seek to educate mothers about breastfeeding, including: Step 3, inform women about benefits of breastfeeding; Step 4, help mothers initiate breastfeeding; and Step 5, show mothers how to breastfeed.
- Maternity care practices in the hospital setting: Such practices promote early breastfeeding initiation immediately following birth, prevent separation of mother and infant, restrict the availability of supplements and pacifiers, provide rooms that accommodate mothers and babies, and ensure follow-up after discharge for breastfeeding mothers. The BFHI strategies promote changes in maternity care practices.
- Professional support for breastfeeding by health professionals: Maternity staff at Baby-Friendly hospitals provide support to breastfeeding mothers in multiple ways, including providing: 1) hands-on lactation support at the bedside; 2) encouragement and education to mothers about giving babies breast milk only, practicing rooming in, encouraging breastfeeding on demand, and avoiding pacifiers and artificial nipples; and 3) breastfeeding education to families.
The evidence summary provided below is based on the evaluation report compiled by Professional Data Analysts. The tables included below are from this same evaluation report.
Methods and data sources:
There were three data sources for the evaluation: (1) A database was maintained to track consultant activities, training attendance and hospitals’ progress on the Ten Steps; (2) Interviews were conducted with representatives from each hospital regarding their experiences implementing the steps, successes, and lessons learned; and (3) A survey was administered to assess maternity staff’s self-reported assessment of changes in knowledge, attitudes, self-efficacy, and behaviors. The retrospective survey asked maternity staff to report on their Baby-Friendly practices prior to training and after receiving the training. Data from 230 maternity staff (out of a total of 583 trained maternity staff) were included in the analysis.
Results: Practice changes at the hospital level and training outcomes for maternity staff are reported in this section.
Hospital Level 4-D Pathway and Practice changes: All 10 hospitals achieved Steps 1, 5, 6, 9 and 10 of the Ten Steps of the Baby-Friendly process, and all were working on achieving the remaining steps. At baseline, one hospital had begun the BFHI journey through the Certificate of Intent process (this process was not associated with any Phases, just completion of the Ten Steps and fair market purchasing of infant formula). The remaining nine hospitals were not yet on the BFHI journey, but entered Discovery (the first Phase of the 4-D Pathway) as part of CBI. At the conclusion of the CBI project, the Certificate of Intent hospital had achieved Baby-Friendly designation. At the end of the project period, one of the remaining nine hospitals was in the Development Phase, seven of the nine were in the Dissemination Phase, and one was in the Designation Phase.
Maternity staff training outcomes:
- Hospitals reported that 583 individuals had been trained in some way (either by the CBI consultant, a person at his/her hospital, or online) and were eligible to complete the maternity staff survey.
- Of those individuals who received training, 230 completed the survey and were included in the analysis.
- These respondents received all 15 lessons through one method or a mix of methods.
The retrospective, one-time survey asked respondents about the extent to which they performed the Baby-Friendly practices before and after the Baby-Friendly training. Practice changes among survey respondents are reported in Figure 1, and confidence levels in Baby-Friendly practices among survey respondents are reported in Figure 2.
Figure 1 below shows the percentage point increase in respondents who strongly agree or agree that they perform the Baby-Friendly practices, as reported after the 15-hour training. The percentages of maternity staff reporting strong agreement or agreement on the practice before and after are reported in parentheses, while the percentage point increase is shown by the bar on the right.
Figure 2 below shows the percentage of trained maternity staff who are reported being somewhat or very confident in their ability to perform the Baby-Friendly practice. As shown in figure 2, at the conclusion of the initiative, nearly all respondents were somewhat or very confident that they could explain the advantages of breastfeeding for mother and baby and educate a mother on the relationship between skin to skin and breastfeeding initiation, and that they understood the role of the hospital lactation consultant.
Figure 1. Percentage point increase in respondents who strongly agree or agree that they performed Baby-Friendly practices before as compared to after the 15-hour training.
Figure 2. Percent of trained maternity staff that are very or somewhat confident in their ability to perform the Baby-Friendly practice.
Hospitals do collect data on breastfeeding initiation and exclusivity; however, these data were not part of the evaluation report that was reviewed.