High 5
for Mom and Baby

The Crucial Role of Hospitals

Birth facility policies and practices significantly impact whether a woman chooses to start breastfeeding and how long she continues to breastfeed. This is supported by abundant evidence and reflected in the inclusion of maternity care to support breastfeeding in our national health priorities and quality measures for hospitals. Healthy People 2020 includes objectives specifically related to maternity practices that support breastfeeding and the Joint Commission--the organization that accredits and certifies U.S. hospitals--added exclusive breast milk feeding in the hospital as a new quality of care measure in 2010.

Clearly, maternity care can either help or hinder both initiation and duration of breastfeeding.  The U.S. Surgeon General’s 2011 Call to Action to Support Breastfeeding cited hospital policies and practices as a leading barrier to successful breastfeeding. Inappropriate routines and provision of care, fragmented care, and inadequate hospital facilities for women who are breastfeeding were mentioned in the report.  One study cited in the report indicated that maternity practices related to breastfeeding are often not evidence based and frequently interfere with breastfeeding.   

Evidence based policies and practices, in combination, are shown to support breastfeeding initiation and duration.  The Ten Steps to Successful Breastfeeding of the Baby Friendly Hospital Initiative (www.babyfriendlyusa.org) are widely recognized as the gold standard for maternity practices.

As more and more hospitals obtain the Baby-Friendly designation, more and more families are meeting public health goals for births that occur in facilities meeting standards of care. In 2007, only 2.9% of births in the United States occurred in a Baby-Friendly designated hospital. Today, in 2018 this number has skyrocketed to more than 25% of births in more than 500 facilities. In the state of Kansas, this number has greatly risen also, from no designated facilities in 2013 to 6 hospitals that are Baby-Friendly designated in 2018, accounting for 46% of births in the state.

A Colorado study found that five of these maternity care practices significantly increase breastfeeding duration and may offer an effective path to more incremental adoption of evidence based maternity care practices.  In her forward to the report, Getting It Right After Delivery:  Five Hospital Practices That Support Breastfeeding,  Dr. Marianne Neifert wrote that each practice has a significant positive impact on breastfeeding continuation, but women who experience all five supportive hospital practices have the longest duration of breastfeeding. These five practices are at the core of the High 5 for Mom & Baby program.

The Maternity Practices in Infant Nutrition and Care (mPINC) survey (see www.cdc.gov/breastfeeding/data/mpinc/results.htm)  administered by the CDC, provides some insight into current hospital practices in Kansas. The most recent report—2015—gives Kansas maternity practices related to healthy newborn feeding and care an overall composite quality practice score of 76 out of 100 and ranks Kansas as 36th among the states.  Kansas strengths, according to the report, are Labor and Delivery Care; Feeding of Breastfed Infants; and Contact Between Mother and Infant.  Improvements recommended relate to Staff Training, Hospital Discharge Cart, and Structural & Organizational Aspects of Care Delivery.  Looking specifically at indicators related to the recommendations of the High 5 for Mom and Baby program, there is also room for changing practices to better support mothers and babies to be able to breastfeed. 

High 5 mPINC Indicator Percent of Kansas Facilities with Ideal Response
1. Assure immediate and sustained skin-to-skin contact between mother and baby after birth  Initial breastfeeding opportunity is within one hour 79% (2011: 51%)
2. Give newborn infants no food or drink other than breast-milk, unless medically indicated Supplemental feedings to breastfeeding infants are rare 52% (2011: 29%)
3. Practice "rooming in" – allow mothers and infants to remain together 24 hours a day Mother-infant pairs are not separated during the hospital stay 59% (2011: 39%)
4. Give no pacifiers or artificial nipples to breastfeeding infants Staff rarely provide pacifiers to breastfeeding infants 44% (2011: 19%)
5. Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge Staff provide appropriate discharge planning (referrals & other multi-modal support) 44% (2011: 25%)



The role of hospitals in
breastfeeding success

The importance of breastfeeding

Current breastfeeding rates
in Kansas

The High 5 practices

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