Baby Friendly USA 4D Pathway DISCOVERY (July 2012) CEO Letter of Support Application Self Appraisal Tool NICHQ Best Fed Beginnings DEVELOPMENT (Oct 2012) Infant Feeding & Related Policies Staff /Provider Training Curriculum Patient Teaching Plans Data Collection Plan Baby Friendly R Designation July 2015 This the pathway to achieving baby friendly. We are currently in the dissemination phase with the goal of achieving Baby Friendly designation in September 2014. DISSEMINATION (Feb 2013) Staff /Provider Training Collect Data : Chart Audits Patient Interviews QI Plan DESIGNATION (Mar 2014) Implement QI Plan Readiness Interview On Site Assessment (May 2015)

Chart/Patient Interviews Tracking Our Progress Step Where We Start July 2012 April – May 2015 Chart/Patient Interviews Patient Interviews 3. Prenatal Education Breastfeeding discussed Benefits discussed Patient knows 2 health benefits Patient knows 2 of 5 topics 43% 29% 14% 100% 90% 50% 4. Skin to Skin: vaginal birth cesarean birth 38% 40% 5. Mother assisted to: Breastfeed (MBU) Express < 6 hrs ( NICU ) 42% 92% 83% 6. Fed breastmilk only Educated on supplementing Taught safe formula prep & feeding 28% 67% No data 62% 75% 7. Rooming In 93% 8. Feed on Cue No clock times advised 32% 30% 9. No bottle nipple No pacifier Home pacifier + Educated 56% 44% 20% 77% 10. Referred to post d/c breastfeeding support

Step Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 3. Prenatal Ed Brstfd discussed Benefits discussed Mom knows 2 benefits Mom knows 2/5 topics 90% 60% 20% 30% 100% 70% 44% 67% 92% 42% 45% 91% 37% 64% 4. Skin to Skin Vaginal C/Section 78% 71% 83% 100 % 5. Assist to breastfeed W/in 6hrs Shown pos./latch Mom can pos/latch Hand expression Express < 6hrs ( NICU baby) 49% 80% 69% 84% 73% 85% 75% 6. Exclusive Breastfeeding Supplement w/Ed Taught safe formula prep/feeding 3% 40% 50% 0% 61% 54% 7. Rooming In 8. Feed On Cue Hourly intervals 86% 7% 93% 53% 57% 31% 87% 27% 9. No bottle nipples No pacifier Home paci w/Ed 79% 82% 62% 46% 25% 0** 10. Post D/C Help ** 7 out of 12 breastfeeding babies used pacifiers from home, None of these mothers reported receiving education of impact of pacifier on breastfeeding.

Where Do We Stand? March 16, 2015 Past 12 months Step >80% < 80% <80% 1. Policies complete 2.Training 3. Prenatal Ed 12 months  4. Skin to Skin: c/section vaginal  c/sec 11 months 8 months 1 month 4 months 5. Help Breastfeed (MBU) Express < 6 hrs ( NICU) 3 months  7 months 6. Breastmilk only Educate re: supplement 11months 7. Rooming In 6 months 8. Feed on Cue No clock times  10 months 2 months  8 months 9. Avoid artificial nipple Avoid pacifier 10.Source of post d/c support

Meeting & Exceeding our 80% Goal: Patient Interviews STEP5: Assist With Breastfeeding: Medical Separation 2013 2014 2015

Meeting our 80% Goal: Patient Interviews STEP 5: Safe Formula Preparation 2014 2015

Approaching the 80% Goal Patient Interviews STEP4:Skin to Skin: Cesarean Section 2013 2014 2015

Steps with Vulnerabilities Patient Interviews STEP4:Skin to Skin : Vaginal Birth 2013 2014 2015

Steps with Vulnerabilities Patient Interviews STEP5: Assist With Breastfeeding: Stable Dyads 2013 2014 2015

Steps with Vulnerabilities STEP 6: Exclusive Breastfeeding 2013 2014 2015

Steps with Vulnerabilities Patient Interviews STEP 7: Rooming In 2013 2014 2015

Steps with Vulnerabilities Patient Interviews STEP 8: Feed on Cue 2013 2014 2015

Steps with Vulnerabilities Patient Interviews STEP 9: No artificial nipples or pacifiers 2013 2014 2015

Steps with Vulnerabilities Patient Interviews STEP 10: Post Discharge Breastfeeding Support 2013 2014 2015

Opportunities for Improvement… Patient Interviews STEP 3: Prenatal Education 2013 2014 2015