Funded Projects

(FIRST) Impact of Baby Friendly Hospital Initiative in Maryland on Selected WIC Agency Breastfeeding Rates and Maternal Experiences of Breastfeeding Support

Grantee: Johns Hopkins University, The
Principal Investigator: Laura E. Caulfield
Project Number: R40MC30762
Project Date: 04/01/2017

Age group(s)

• Prenatal
• Perinatal/Infancy (0-12 months)

Abstract

In 2012, a call was issued by the Maryland Department of Health and Mental Hygiene (MD DHMH) to all birthing hospitals in Maryland to implement steps similar to "Baby Friendly" practices. This designation "Baby Friendly" requires a significant change in how a hospital delivers maternity care so that it provides evidence-based breastfeeding management and support. Being designated as a Baby Friendly Hospital (BFH) documents that it has implemented the WHO/UNICEF Ten Steps to Successful Breastfeeding. This designation is dependent on a formal audit and includes the establishment of a breastfeeding policy, staff training, changes in maternal and newborn care services to support breastfeeding, and referral to support groups at discharge. MD DHMH efforts to incorporate BFH practices in all its hospitals are aligned with MCHB Performance and Population Domains and the Healthy People 2020 goals for Perinatal and Infant Health to improve breastfeeding practices. During the period that a new mother spends in the hospital, the policies and practices of that hospital are critical to her likelihood of initiating breastfeeding, feeding only breastmilk during the hospital stay, continuing to breastfeed following discharge, and breastfeeding exclusively for 6 months. BFH policies may be particularly important for increasing breastfeeding rates for the vulnerable population served by the Special Supplemental Nutrition Program for Women Infants and Children (WIC). Three hospitals in Maryland are in the process of receiving BFH designation. Each of these hospitals performs all of the deliveries for the WIC participants who receive services from one local WIC agency. Importantly, there are three hospitals which have not started the process of receiving BFH designation and also perform deliveries of WIC participants from one agency. Here we propose to evaluate the impact of BFH implementation on breastfeeding practices among WIC participants in Maryland. The objectives of this study are three-fold: 1) to evaluate the impact of BFH status on breastfeeding practices; 2) to assess maternal perceptions of The 10 Steps of the BFH program; and 3) to qualitatively explore over time the effects of BFH implementation on maternal infant feeding experiences. This study will use a mixed-methods approach to achieve the objectives. We will compare trends in breastfeeding practices prior to BFH implementation with trends following BFH certification, using WIC electronic data and propensity score matching techniques. The impact of BFH status on mothers' experiences with hospital infant feeding practices and postpartum breastfeeding support will be assessed through a brief postpartum telephone survey with WIC participants (1-3 months postpartum) recruited from the six Maryland WIC agencies. Finally, the effects of BFHI implementation on maternal infant feeding experiences will be investigated longitudinally through in-depth interviews at 2 weeks, 3 months, and 6 months postpartum with40 participants who intended to breastfeed and delivered their infants at one of the 6 hospitals. Study results will inform service delivery and policies to address breastfeeding inequities.