Report Publish Date: July 2021

This journal article describes a study of 22 maternity nurses at five Mississippi hospitals. In focus groups, they described their perceptions of how gaining Baby-Friendly designation affected their hospitals and the ups and downs of implementing the Baby-Friendly Hospital Initiative.

Primary Takeaways

The authors found four major themes in the nurses’ experiences:

1.  Change was both psychologically and logistically difficult. Many staff members resisted adopting new practices at their hospitals, and the hospitals had practical challenges, such as moving equipment, customizing medical records, and needing more staff to implement the new approach.
2.  When nurses took leadership roles and helped spearhead the Baby-Friendly Initiative, they felt empowered. Many stood up to resistant doctors and nurses and took ownership over parts of the initiative, for example by creating checklists and tracking sheets and using unit huddles to “keep everybody on the same page.” Many of the nurses felt proud when the initiative succeeded at their hospitals.
3.  Nurses said educating patients was crucial for the initiative’s success. They said including information about the initiative in prenatal education made women more willing to embrace practices Baby-Friendly hospitals encourage, including breastfeeding, skin-to-skin care, rooming-in (rather than having babies stay in the nursery), and pacifier-use restrictions. The nurses said the initiative helped them become more comfortable and better at educating women about how to care for their babies. They also said that general community awareness of what the Baby-Friendly Initiative is and the practices it promotes helped women become more informed about what to expect from their hospital stay after giving birth.
4.  Nurses had concerns about unintended challenges. They worried about the safety of some practices, like babies sleeping in the hospital room with their mothers, and how to deal with patients who didn’t like the new practices. Nurses also had concerns about women feeling shamed if they didn’t want to follow Baby-Friendly guidance, preferring not to room-in or to breastfeed.
    

Overview and Objectives

Launched in 1991, the Baby-Friendly Hospital Initiative is a global program that helps hospitals implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. In 2020, 29% of U.S.women gave birth in the country’s 604 Baby-Friendly hospitals. Mississippi went from zero Baby-Friendly hospitals in 2014 to 20 in 2020. Nurses provide the bulk of leadership for Baby-Friendly implementation at Mississippi hospitals. The authors wanted to know what lessons nurses had learned about the process of becoming a Baby-Friendly hospital. 
 

Hypothesis or Approach 

To form the focus groups, nurses were recruited by contacts at five Baby-Friendly Mississippi hospitals that were part of the Communities and Hospitals Advancing Maternity Practices (CHAMPS) program. The 90-minute focus groups took place in person between late 2019 and early 2020. The authors protected participants’ anonymity. They conducted a thematic analysis, coding transcripts and generating themes and subthemes based on a final list of codes. 

How This Influences Change

“Hospitals seeking Baby-Friendly designation can learn from the challenges and barriers identified in our results to streamline their own processes,” the authors write.