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North Carolina Maternity Center Breastfeeding-Friendly Designation


The North Carolina Maternity Center Breastfeeding-Friendly (NCMCBF) Designation Program encourages hospitals and maternity centers across the state to promote and support breastfeeding. The North Carolina Division of Public Health established a five star recognition system based on the Ten Steps to Successful Breastfeeding as defined by the World Health Organization (WHO) and Baby-Friendly USA (to see the Ten Steps, go to Additional Information section). A hospital or maternity center is awarded one star for every two steps of the Ten Steps to Successful Breastfeeding that it achieves. The North Carolina designation program differs from the Baby-Friendly Hospital Initiative (BFHI) in that:

  • it awards incremental recognition to support continuous quality improvement
  • it does not require site visits
  • it requires no fees

The North Carolina Division of Public Health developed the NCMCBF Designation Program based on findings from the breastfeeding work group of the North Carolina Child Fatality Task Force. Co-chairs of the breastfeeding work group met with the North Carolina Hospital Association (NCHA) to discuss workable solutions to improve breastfeeding support in hospitals and maternity centers. Feedback from the NCHA indicated the BFHI certification was difficult to achieve. The NCHA recommended establishing a program that was voluntary and would not single out any hospitals or maternity centers for not complying.

The breastfeeding work group completed a literature review. The evidence in the literature documented that for every two steps of BFHI implemented, there is improvement in outcomes. No research documented that any one step must precede another. Based on this information, the NCMCBF Designation Program was created to recognize hospitals and maternity centers for achieving any two or more steps of the BFHI. Which steps are achieved or in what order is not relevant.

After a facility receives its initial designation, it can reapply at any time to request the awarding of additional stars. Hospitals and maternity centers must re-apply every three years to maintain their designation in the program. The NCMCBF Designation Program is voluntary and endorsed by the NCHA and the North Carolina Pediatric Society. An expedited application is available for facilities that have already achieved BFHI designation.

Intended population:  The primary audience is hospital administrators and maternity care staff (nurses and lactation consultants); the secondary audience is pregnant and perinatal women at participating hospitals and maternity centers.

Setting: Hospitals and maternity centers that serve pregnant and perinatal women.

Length of time in the field: Since 2010