1. First Breastfeeding Attempt within an Hour of Delivery Team Members Pam Allyn Pat Karczewski Maureen Davey

2. À Breastfeeding within an hour of delivery is related to longer continuation of breastfeeding as well as numerous biological and behavior benefits for the mother and the newborn À Baseline data indicates 36% of mothers at LUMC initiate breastfeeding within one hour of delivery Opportunity Statement

3. À To increase the numbers of mothers who attempt their first breastfeeding within an hour of birth from 35% to 60% À To have mothers’ first breastfeeding attempts documented appropriately Goals

4. À No formal standards were set for first breastfeeding attempt occurring in a timely manner À Personnel unaware of research-based evidence promoting first breastfeeding attempt within an hour of delivery À With our cesarean section population, staff has resisted keeping baby long enough in Labor & Delivery to offer opportunity for mother to breastfeed there Problem Identification

5. ¤ WHO and UNICEF developed a strategy - the “Baby Friendly Hospital Initiative” -to improve the worldwide breastfeeding rate. ¤ The “Baby Friendly Hospital Initiative” states that every facility providing maternity services and care for newborn infants should: 1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff 2. Train all health care staff in skills necessary to implement the policy 3. Inform all pregnant women about the benefits and management of breastfeeding 4. Help all mothers initiate breastfeeding within one hour of birth Literature Search

6. 5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants 6. Give newborn infants no food or drink other than breastmilk, unless medically indicated 7. Practice rooming in: allow mothers and infants to remain together 24 hours a day 8. Encourage breastfeeding on demand 9. Give no artificial nipples or pacifiers 10. Foster the establishment of breastfeeding support groups and refer mother to them The “Baby Friendly Hospital Initiative” (continued)

7. À Established standard - set our initial goal to be 60% À Developed breastfeeding pathway for staff accountability À Ongoing education of staff on the breastfeeding pathway and research-based evidence to support timely breastfeeding attempts À Continuation of chart audits to assist in maintaining our goal of 60% Solutions Implemented

8. Confidential Material for Quality Improvement Purposes Chart audit of 30 patients represent each quarter

9. À Quarterly audits reflect improvement from 36% in December 2000 to 63% in March 2003 Data Analysis of Results

10. À Continue random review of charts À Re-inservice staff as required À Look at additional initiative from the “Baby Friendly Hospital Initiative” - “Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants” Next Steps