Background: Breastfeeding is a tremendously important public health topic. Breastfeeding is associated with a myriad of health benefits on nearly all levels within the social ecological model (infants, mothers, families, workplaces, communities and societies). Scientific evidence supports that breastfeeding is associated with decreased obesity and other very costly health conditions that occur across the lifespan. The World Health Organization published 10 guidelines that comprise the Baby Friendly Hospital Initiative [BFHI] standards—which identify birthing facility-level elements that are associated with enhanced breastfeeding adoption rates. Methods: The purpose of this study was to determine the extent to which birthing facilities in Atlanta incorporate BFHI elements. Lactation policies among hospitals in the City of Atlanta with maternity wards were solicited, reviewed, and rated by two independent reviewers. Additional observations about environmental supports for breastfeeding were also noted. Results: Four out of 5 eligible hospitals provided their lactation policies for review (80%). Eight of out 10 BFHI elements were present in the 4 hospital policies. One element not present was distribution of reinforcing/educational materials to new mothers—although it was evident in an appendix. Another element that was not clearly stated in one policy was which states that breastfeeding initiation should occur within the first half hour after birth. Observations by reviewers included that ¾ (75%) of study sample were in the midst of drafting new policies. Another note was that ¾ (75%) of study sample was supported by a Centers for Disease Control and Prevention (CDC)/National Initiative for Children’s Healthcare Quality (NICHQ) effort—Best Fed Beginnings. Conclusions: This study is important as it addresses an unexplored question. Establishing such a baseline reveals that while nearly all the BFHI elements are present within the participating City of Atlanta hospitals, the administrative barriers that pursuit of BFHI accreditation poses should be considered. Given the fact that no hospital in Georgia has BFHI accreditation underscores an important new direction for public health researchers’ attention.

The successful transition to motherhood can be associated with the experience of infant feeding, and women’s views of whether that experience has been positive or negative can shape the mothering experience. However, nurses’ engagement with best practice breastfeeding promotion may elicit negative responses from women who are either unsuccessful in their attempts to breastfeed, or do not breastfeed for other reasons. Are nurses adequately prepared or supported to deal with the variety of infant feeding challenges that inevitably arise in perinatal practice settings? For example, Canadian perinatal nurses are expected to conform to WHO-conceived Baby Friendly expectations to disseminate evidence that pertains to the health risks of introducing formula to infants. However, in some circumstances, infant formula is recommended by practitioners in order to provide crucial hydration and/or nourishment, which destabilizes the discourse of risk, and creates confusion for mothers. Questions also arise about the appropriateness of nurses applying WHO guidelines to every woman without first considering intersectional realities which may not align with BF recommendations to breastfeed for six months and beyond. These questions, and others, informed the research question: “What is nurses’ experience of infant feeding support?” Eleven perinatal nurses from across Canada were interviewed. The conversations were interpreted using Gadamerian hermeneutic methodology. Participants described a variety of practices and dilemmas that they associate with infant feeding “support,” highlighting that complex and contradictory forces are at play for nurses involved in infant feeding support as well as the unintended and negative consequences of following BF best practice guidelines. / Graduate / humphriesj@camosun.bc.ca

Syftet med denna studie var att undersöka om en BB-avdelning i Mellansverige uppfyllde UNICEF/WHO´s kriterier för en amningsvänlig vård, samt att jämföra resultaten med tidigare utvärderingar från åren 1996, 1997, 1998 och 2002. Syftet var också att undersöka vad som påverkat mammorna i beslutet att vilja amma. Amningsvänlig vård utgår från ”Tio steg till lyckad amning” och är en global amningsstrategi. Studien genomfördes i form av intervjuer med 40 nyförlösta mammor samt 22 intervjuer med personal. Vidare gjordes observationer på BB-avdelningen samt genomgång av avdelningens skrivna material angående amning, riktat till personal och mammor. Kriterierna för att amningsvänlig vård bedrivs är att, åtta av tio steg i amningsstrategin ska vara uppfyllda. Den undersökta avdelningen uppfyllde fem av de tio stegen. Genomgående i studien framkom att personalen hade goda praktiska amningskunskaper. Mammornas kunskap om hur de upprätthöll amningen var inte tillräckliga. Vidare hade inte mammorna fått tillräcklig kännedom om var de kunde vända sig för att få råd och stöd angående amning efter hemgång. Resultatet var jämförbart med studierna från 1996 och 2002, men en försämring jämfört med studierna 1997 och 1998 då de klarade åtta respektive nio av de tio stegen. Mammorna tillfrågades också om vad som påverkat dem mest i sitt beslut att amma. För förstföderskorna var det rådgivningen de fått på MVC och för omföderskor betydde tidigare erfarenheter mest.

Magister Public Health - MPH / Breastfeeding impacts on the health of both the mother and infant and has been noted as being influenced by physiological, physical, socio-economic and environmental factors. The undisputed benefit of exclusive breastfeeding for both the mother and child has led to the global prioritisation of the promotion, protection and support of breastfeeding with the adoption of the Baby Friendly Hospital Initiative (BFHI) strategy. Baby Friendly Hospital (BFH) status is awarded to a maternity unit when they are found to be complying with set criteria Ten Steps to successful Breastfeeding. South Africa has implemented a re-evaluation system for retention of accreditation status, by reassessing accredited facilities every three years. The respective provinces are tasked with monitoring the implementation of BFHI in their public health facilities. Internal monitoring reports, completed by the Western Cape Provincial Department of Health, reflect erosion of key steps between national reassessments. Aim: To describe the experiences, challenges and successes of BFHI implementation in the BFH accredited facilities in the Cape Town geographical health district. Methodology: An explorative qualitative study was conducted. One key informant interview, ten in-depth interviews with champions for BFHI in the maternity facilities and two focus group discussions with frontline staff working at these facilities were used to collect data. The data was analysed using thematic content analysis to identify the main themes related to the successes and challenges experienced with the maintenance of the required practices related to BFHI accreditation. Results: Participants reported that the implementation of the BFHI impacted positively on the health of both mothers and infants. Fewer children were being admitted for common childhood illnesses such as diarrhoea subsequent  to BFHI implementation. Mothers were recovering more quickly after delivery and less complications related to delivery, such as postpartum bleeding, were observed after the implementation of BFHI. BFHI implementation had a positive impact on the attitudes of maternity staff to breastfeeding promotion, protection and support. Subsequent to being awarded BFH status, facilities are tasked with maintaining the implemented practices. Challenges to maintaining the practices included lack of implementation of BFHI practices at clinics, lack of support from facility managers and support staff such as counsellors. The internal assessments implemented as supportive monitoring structures are considered by participants to be a demotivating process and concerns were raised about non nursing staff assessing nursing practices. Conclusion: The potential impact of this strategy on infant and maternal health must be realized by the implementers of BFHI, before the strategized aim is achieved. Co-ordination and support by all role players is vital to the success and elimination of challenges experienced with implementation and maintenance of the BFH strategy. / South Africa

Bakgrund: År 1991 lanserade WHO och UNICEF "Baby Friendly Hospitals Initiative" (BFHI). Motivet var den nedåtgående amningsfrekvensen världen över och de konsekvenser som det medförde till exempel socialt och ekonomiskt. Till grund fanns innocentdeklarationen som bygger på att alla BB avdelningar skall följa "tio steg till lyckad amning. Målet med detta är att främja, stödja och skydda amningen. Forskning visar att amningsfrekvensen har sjunkit de senaste åren i Sverige. Syfte: Syftet var att undersöka nyblivna mödrars upplevelse av stöd i sin förberedelse och uppstart av amning i Kronobergs län och jämföra detta med mödrar vid tre andra kvinnokliniker (Blekinge län, södra Kalmar län och norra Kalmar län). Metod: Undersökningen har en kvantitativ ansats. Enkäter med totalt 35 frågor har delats ut till mödrar vid deras besök för efterkontroll på mödrahälsovården i Kronobergs län. En jämförelse har därefter gjorts med mödrars svar i norra Kalmar, södra Kalmar och Blekinge län. Resultat: I Kronobergs län ammade 74.4% helt vid efterkontrollen, det fanns en signifikant skillnad mellan de olika klinikerna (p=0.021). Majoriteten av kvinnorna på de olika klinikerna hade en positiv inställning till amning under graviditeten. Större delen av kvinnorna svarade att de hade haft hudkontakt direkt efter förlossningen, men tiden för hudkontakt varierade. I Kronobergs län rapporterade majoriteten av kvinnorna att de hade haft hudkontakt i mindre än 60 min efter förlossningen. Gemensamt för orterna är att de flesta kvinnor svarat att hudkontakten med barnet avslutades när barnet skulle mätas eller vägas (47,2% i Kronobergs län). Det fanns skillnader i amningsstöd från personal mellan de olika klinikerna. I Kronobergs län var det 12.5% av kvinnorna som hade önskat mer hjälp från personalen på BB, medan det i norra Kalmar var 20.8%. Det var nästan 40% av alla barn som hade blivit tillmatade med bröstmjölksersättning på BB och hälften av dessa utan medicinsk indikation. Slutsats: De tio stegen till lyckad amning följs av de fyra klinikerna, men i vissa av stegen finns brister i hur de följs. Hudkontakt bör prioriteras efter förlossning. För att kunna ge kvinnan ett optimalt amningsstöd bör insatser tillsättas på MHV, BB och på BHV. Tillmatningsrutiner på BB bör ses över på alla fyra kliniker. / Background: In 1991, launched the WHO and UNICEF ' Baby Friendly Hospital Initiative " (BFHI). The subject was the downward frequency of breastfeeding worldwide and the consequences that it brought such as socially and economically. The basis was the "innocenti declaration" which is based on that all maternity wards must follow the "ten steps to successful breastfeeding". The goal of this is to promote, support and protect breastfeeding. Research shows that the frequency of breast feeding has fallen in Sweden the last couple of years. Purpose: The aim was to examine expectant mothers' experience of support in their preparation and start-up of breastfeeding in Kronoberg county and compare this with the mothers at three other women's clinics (Blekinge, southern Kalmar county and northern Kalmar). Method: The study has a quantitative approach. Surveys with a total of 35 questions were distributed to mothers during visits to antenatal care for the post in Kronoberg County. A comparison was then made with the mothers answers at north Kalmar, south Kalmar and Blekinge county. Results: In Kronoberg breastfed 74.4% of the mothers completely at the control, there was a significant difference between the clinics (p = 0.021). The majority of women of different clinics had a positive attitude to breastfeeding during pregnancy. Most of the women said they had had skin contact immediately after birth, although the time of skin contact varied. In Kronoberg County reported the majority of women reported that they had had contact with the skin in less than 60 minutes after birth. Common for the clinics is that most women responded that skin contact with the baby ended when the child would be weighed or measured (47.2% in Kronoberg County). There were differences in breastfeeding support from staff between the clinics. In Kronoberg County, it was 12.5% of women who had wanted more help from the staff at the maternity ward, while in northern Kalmar was 20.8%. It was almost 40% of children who had become fed with formula milk in the maternity ward and half of those without a medical indication. Conclusion: The ten steps to successful breastfeeding are followed by the four departments, but in some of the steps are flaws in how they are implemented. Skin contact should be prioritized after childbirth. In order to give the woman an optimal breastfeeding support, efforts should be put on antenatal care, maternity wards and at the child health care. The feeding routines on the maternity ward should be reviewed at all four clinics.

<p>SAMMANFATTNING</p><p> </p><p>Amningen kan ibland vara svår att komma igång med. En del mammor får det att fungera utmärkt medan andra behöver mera stöd. Baby Friendly Hospital Initiative (BFHI) och ”tio steg till lyckad amning” var tänkt att uppmuntra amningen på BB genom åtgärder som utbildning av barnmorskorna i att stödja mammorna. <strong>Syftet </strong>med denna studie var att beskriva mammors känslor inför amning och deras upplevelse av stöd från personal och pappa under BB-tiden samt att jämföra med en grupp mammor från 1993. <strong>Metoden</strong> var en kvantitativ tvärsnittsstudie. En enkätstudie genomfördes bland mammor på en förlossningsklinik i Sverige. Deltagande mammor var fördelade på 91 mammor 1993 och 16 mammor 2010. För bearbetning av data användes Statistical Package for the Social Science (SPSS). <strong>Resultatet </strong>visade att mammorna upplevde en större känsla av osäkerhet och oro 2010 jämfört med 1993. Av mammorna 2010 kände också majoriteten att amning var något de ”måste lära sig”. Mammorna upplevde papporna som mer stödjande 2010 jämfört med 1993. Initiativet till den första amningen togs 2010 i högre grad av en barnmorska än 1993. År 2010 fick en högre andel av mammorna hjälp av personalen på BB vid amningstillfällena jämfört med 1993. <strong>Konklusionen </strong>är att amningen kunde vara en känslig tid för mammorna och det behövdes stöd. BFHI har haft en positiv effekt på arbetet med att stödja mammorna vid amningen på BB, men det finns fortfarande behov av uppföljning och kontroll av verksamheten. Papporna tar ett större ansvar och är mera stödjande 2010 jämfört med 1993.</p> / <p>ABSTRACT</p><p> </p><p>Sometimes breastfeeding initiating can be hard. Some mothers get a good start others need more support. Baby Friendly Hospital Initiative (BFHI) and “ten steps to successful breastfeeding” were meant to encourage breastfeeding at maternity hospital through measures like education of midwifes in supporting the mothers. The <strong>aim</strong> of this study was to describe mother’s feelings for breastfeeding and their experience of support from nursing staff and fathers during the stay on BB and to compare with a group of mothers from 1993. The <strong>method </strong>was a quantitative cross-sectional study. A survey study was accomplished among mothers in a birth-Clinique in Sweden. Participating mothers was 91 in 1993 and 16 in 2010. Statistical Package for the Social Science (SPSS) was used to processing data. The <strong>result </strong>showed that mothers experienced a greater feeling of uncertainty and anxiety in 2010 compared with 1993. The majority of mothers 2010 also felt that breastfeeding was something they “had to learn”. Mothers experienced that fathers were more supportive in 2010 than 1993. Initiative to the first breastfeeding was in most of the cases in 2010 taken by a midwife and a higher share of the mothers 2010 got help from the nursing staff at breastfeeding time. The <strong>conclusion </strong>is that breastfeeding might be a sensitive period to the mothers and that support was needed. BFHI has had a positive effect on the work in supporting mother’s breastfeed in the maternity hospital, but there are still needs of following-up and controls of the activity. The fathers took in 2010 more responsibility and are more supporting to the mothers compared with 1993.</p>

SAMMANFATTNING   Amningen kan ibland vara svår att komma igång med. En del mammor får det att fungera utmärkt medan andra behöver mera stöd. Baby Friendly Hospital Initiative (BFHI) och ”tio steg till lyckad amning” var tänkt att uppmuntra amningen på BB genom åtgärder som utbildning av barnmorskorna i att stödja mammorna. Syftet med denna studie var att beskriva mammors känslor inför amning och deras upplevelse av stöd från personal och pappa under BB-tiden samt att jämföra med en grupp mammor från 1993. Metoden var en kvantitativ tvärsnittsstudie. En enkätstudie genomfördes bland mammor på en förlossningsklinik i Sverige. Deltagande mammor var fördelade på 91 mammor 1993 och 16 mammor 2010. För bearbetning av data användes Statistical Package for the Social Science (SPSS). Resultatet visade att mammorna upplevde en större känsla av osäkerhet och oro 2010 jämfört med 1993. Av mammorna 2010 kände också majoriteten att amning var något de ”måste lära sig”. Mammorna upplevde papporna som mer stödjande 2010 jämfört med 1993. Initiativet till den första amningen togs 2010 i högre grad av en barnmorska än 1993. År 2010 fick en högre andel av mammorna hjälp av personalen på BB vid amningstillfällena jämfört med 1993. Konklusionen är att amningen kunde vara en känslig tid för mammorna och det behövdes stöd. BFHI har haft en positiv effekt på arbetet med att stödja mammorna vid amningen på BB, men det finns fortfarande behov av uppföljning och kontroll av verksamheten. Papporna tar ett större ansvar och är mera stödjande 2010 jämfört med 1993. / ABSTRACT   Sometimes breastfeeding initiating can be hard. Some mothers get a good start others need more support. Baby Friendly Hospital Initiative (BFHI) and “ten steps to successful breastfeeding” were meant to encourage breastfeeding at maternity hospital through measures like education of midwifes in supporting the mothers. The aim of this study was to describe mother’s feelings for breastfeeding and their experience of support from nursing staff and fathers during the stay on BB and to compare with a group of mothers from 1993. The method was a quantitative cross-sectional study. A survey study was accomplished among mothers in a birth-Clinique in Sweden. Participating mothers was 91 in 1993 and 16 in 2010. Statistical Package for the Social Science (SPSS) was used to processing data. The result showed that mothers experienced a greater feeling of uncertainty and anxiety in 2010 compared with 1993. The majority of mothers 2010 also felt that breastfeeding was something they “had to learn”. Mothers experienced that fathers were more supportive in 2010 than 1993. Initiative to the first breastfeeding was in most of the cases in 2010 taken by a midwife and a higher share of the mothers 2010 got help from the nursing staff at breastfeeding time. The conclusion is that breastfeeding might be a sensitive period to the mothers and that support was needed. BFHI has had a positive effect on the work in supporting mother’s breastfeed in the maternity hospital, but there are still needs of following-up and controls of the activity. The fathers took in 2010 more responsibility and are more supporting to the mothers compared with 1993.

Ample research has been found to suggest that there is no substitute, either nutritionally or emotionally, that can replace the benefits of human milk for human infants. Despite this recognition, the attitude still exists that infant formula is a reasonable alternative. The American Academy of Pediatrics (AAP), World Health Organization (WHO), and United Nation Children's Fund (UNICEF) share policy statements endorsing human milk as the optimal infant nutrition for the first 15 months. Accordingly, WHO and UNICEF launched The Baby-friendly Hospital Initiative established in 1991 to protect, promote, and support breastfeeding. Despite this unilateral support of breastfeeding, nursing and physician educational curriculums do not include lactation education, which limits the knowledge of those who provide care to the mother and newborn dyad. The purpose of this project is to promote staff lactation education and training on the infant feeding practices by encouraging breastfeeding in a hospital setting. This project includes lactation education and hands-on training for staff. A 20-hour didactic lactation education course will meet the requirements to ensure that staff training will assist in supporting patients with the early initiation of breastfeeding. Furthermore, training will include clinical competencies to evaluate the knowledge, practice patterns, and confidence of the staff. Lactation education for providers will be provided through an online course designed to improve their ability to support breastfeeding among their patients. The result of this project will assist hospital leadership to determine specific education and training for staff in increasing exclusive breastfeeding rates among their patient population.

<p>Breastfeeding impacts on the health of both the mother and infant and has been noted as being influenced by physiological, physical, socio-economic and environmental factors. The undisputed benefit of exclusive breastfeeding for both the mother and child has led to the global prioritisation of the promotion, protection and support of breastfeeding with the adoption of the Baby Friendly Hospital Initiative (BFHI) strategy. Baby Friendly Hospital (BFH) status is awarded to a maternity unit when they are found to be complying with set criteria (&ldquo / Ten Steps to successful Breastfeeding&rdquo / ). South Africa has implemented a re-evaluation system for retention of accreditation status, by reassessing accredited facilities every three years. The respective provinces are tasked with monitoring the implementation of BFHI in their public health facilities. Internal monitoring reports, completed by the Western Cape Provincial Department of Health, reflect erosion of key steps between national reassessments. Aim: To describe the experiences, challenges and successes of BFHI implementation in the BFH accredited facilities in the Cape Town geographical health district. Methodology: An explorative qualitative study was conducted. One key informant interview, ten in-depth interviews with champions for BFHI in the maternity facilities and two focus group discussions with frontline staff working at these facilities were used to collect data. The data was analysed using thematic content analysis to identify the main themes related to the successes and challenges experienced with the maintenance of the required practices related to BFHI accreditation. Results: Participants reported that the implementation of the BFHI impacted positively on the health of both mothers and infants. Fewer children were being admitted for common childhood illnesses such as diarrhoea subsequent&nbsp / to BFHI implementation. Mothers were recovering more quickly after delivery and less complications related to delivery, such as postpartum bleeding, were observed after the implementation of BFHI. BFHI implementation had a positive impact on the attitudes of maternity staff to breastfeeding promotion, protection and support. Subsequent to being awarded BFH status, facilities are tasked with maintaining the implemented practices. Challenges to maintaining the practices included lack of implementation of BFHI practices at clinics, lack of support from facility managers and support staff such as counsellors. The internal assessments implemented as supportive monitoring structures are considered by participants to be a demotivating process and concerns were raised about non nursing staff assessing&nbsp / nursing practices. Conclusion: The potential impact of this strategy on infant and maternal health must be realized by the implementers of BFHI, before the strategized aim is achieved. Co-ordination and support by all role players is vital to the success and elimination of challenges experienced with implementation and maintenance of the BFH strategy.</p>

Bakgrund: Baby Friendly Hospital Initiativ bygger på Tio steg till lyckad amning och lanserades år 1991 i Sverige. Efter detta sågs en ökning av amningsfrekvensen. Nu 20 år efter införandet av Tio steg till lyckad amning sjunker amningsfrekvensen. Studier har visat att amningsutfallet påverkas av hur amningen initieras samt det stöd kvinnan får från vårdpersonal, partner och närstående. Syfte: Syftet med denna studie var att beskriva nyblivna mödrars erfarenheter av förberedelse och initiering av amning. Metod: En enkätstudie med slutna frågor där det fanns möjlighet till egna kommentarer på ett flertal av frågorna. Enkäten delades ut till nyblivna mödrar vid efterkontrollen på kvinnohälsovårdsmottagningen. Det var 98 kvinnor som deltog i studien. Svaren analyserades med statistikprogrammet SPSS version 18. Resultatet beskrivs med deskriptiv statistik och Chi-2 test användes. Resultat: Totalt ammade 64,9 % av kvinnorna helt vid efterkontrollen och 23,7 % ammade delvis. På kvinnohälsovårdsmottagningen hade de flesta kvinnorna diskuterat amning med sin barnmorska. Kvinnorna sökte även information själva på internet, i böcker, tidningar och hos närstående. Förstföderskorna sökte information i större utsträckning än omföderskorna. Drygt hälften av kvinnorna hade upplevt ett tillräckligt stöd från vårdpersonalen kring amningen och majoriteten av kvinnorna uppgav att deras partner var positivt inställd till amning. På BB hade 42,8 % av barnen tillmatats med bröstmjölksersättning och av dessa hade ca hälften fått det på medicinska indikationer och hälften hade fått det utan medicinsk indikation. Majoriteten av barnen använde tröstnapp vid efterkontrollen. Slutsats: Till stor del följs Tio steg till lyckad amning, men på vissa punkter ses brister i följsamheten. Kvinnorna hade önskat mer information och stöd i initieringen av amningen. Nyfödda barn tillmatades med bröstmjölksersättning utan medicinsk indikation och många barn introducerades för tröstnapp inom 2 veckor från födelsen.