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North Carolina Maternity Center Breastfeeding-Friendly Designation


Summary: How the Designation Program works

Hospitals and maternity centers download an application from the North Carolina Maternity Center Breastfeeding-Friendly (NCMCBF) Designation Program page of the Nutrition Services Branch website (www.nutritionnc.com). The application is submitted with supporting documentation demonstrating compliance with the requirements for each step in the application.

Using assessment criteria in the review tool, the NCMCBF Designation Program committee members review submitted applications. The assessment criteria and review tool is based on the BFHI self-appraisal tool, survey questions from the Centers for Disease Control and Prevention (CDC) Maternity Practices in Infant Nutrition and Care (mPINC) Survey, and on previous pilot work done through the Carolina Global Breastfeeding Institute (CGBI). Review committee members utilize the assessment criteria and review tool to determine the award level for NCMCBF Designation Program applicants.

Hospitals and maternity centers are awarded up to five stars based on the number of the Ten Steps they have achieved. Hospitals and maternity centers that receive a designation are provided a packet including a certificate of designation, logos to use in promotion of the designation, and a sample press release. These hospitals and maternity centers also receive recognition on the North Carolina Division of Public Health, Nutrition Services Branch website.

Below is an outline of steps to follow when planning a designation program 

Planning and Preparing

  • Convene meetings of state-level public health leaders to assess breastfeeding rates and policies in the state and to set priorities for action.
  • Engage stakeholders, including hospitals and maternity centers, to solicit feedback about identified barriers and keys to success in implementing breastfeeding-friendly policies at the facility level.
  • Consider the hospitals’ and maternity centers’ needs when designing and implementing the program.
  • Create or adapt standards, designation levels, a program application, and logo for the program, based on state or regional needs and the organizational capacity of the implementing group (in this case, the North Carolina Division of Public Health).
  • Develop and implement a selection process for designation. The NCMCBF Designation Program assessment tool is based on the BFHI self-appraisal tool, CDC mPINC Survey questions, and previous pilot work from CGBI.
  • Create packet of materials to be provided to hospitals and maternity centers that are awarded designation.
  • Allocate time for the State Breastfeeding Coordinator or other knowledgeable staff person to oversee the program.

Soliciting and Reviewing Applications

  • Post the application and detailed application instructions on the sponsoring agency’s website.
  • Publicize the program throughout the state using press releases and direct communication with hospitals and maternity centers.
  • Use a standardized review process to award designations based on the hospitals’ or maternity centers’ applications and supporting evidence.
  • Provide a designation packet to all hospitals and maternity centers awarded designation including: a letter stating the designation level awarded by the review team; a certificate of designation; a CD with logos for the level of designation; instructions for use of the logos; and a sample press release.
  • Provide public recognition of all hospitals and maternity centers awarded designation on the sponsoring agency’s website.

Training and Technical Assistance

  • Provide support and technical assistance for hospitals and maternity centers completing the application process.
  • Contact each applicant via phone and/or email after the review.  The follow-up contact provides an opportunity to gather additional information the review committee determined is needed to award a designation and to provide guidance on how the hospital or maternity center can improve a subsequent application. The NCMCBF Designation Program developers estimate a minimum of three technical assistance contacts are needed per application.

Keys to Success

  • Obtain buy-in from stakeholders. The breastfeeding workgroup sought buy-in from the North Carolina Hospital Association, North Carolina Pediatric Society, and the North Carolina Child Fatality Task Force.
  • Create the program to be voluntary versus mandatory.
  • Provide post-review technical assistance calls to designated hospitals and maternity centers to build momentum for future submissions.
  • Limit site visits or onsite technical assistance to reduce staffing costs. This measure allows the program to be administered by an existing staff position with a very small % FTE (full time equivalent) allocated to the NCMCBF Designation Program.
  • Designate dedicated staff hours for technical assistance calls and follow-up.