The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) both recommend exclusive breastfeeding for the first six months of life. The AAP recommends continued breastfeeding with supplementation of solid foods for at least one year, while the WHO recommends continued breastfeeding with supplementation of solid foods for at least two years. Breastfeeding rates in the United States do not reflect these recommendations, or the breastfeeding goals of Healthy People 2020. Breastfeeding rates are especially low in low-income areas and among WIC recipients. This article details a proposal to implement a new protocol that will implement the WHO and UNICEF Ten Steps to Breastfeeding Success, and seek to earn a Joshua Tree, California hospital Baby-Friendly designation. This hospital serves a low-income population. Baby-Friendly designated hospitals have been shown to practice interventions that result in increased breastfeeding rates. Patient education is an important component to success with exclusive breastfeeding, and must be improved. Continued breastfeeding support is an important area, as well, and patients should have access to community resources and a local lactation consultant. In order for this to be successful, all LDRP staff must be uniformly educated on the benefits of breastfeeding, how to properly support exclusive breastfeeding, and what to teach new mothers. Included in this paper are a new staff breastfeeding protocol, incorporation of organizational change theory, an implementation plan, staff education plans and materials, evaluation tools, and plans to disseminate findings to the community, the stakeholders, and the general nursing population.

The United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) conducted research and found that infants exclusively breast-fed to at least six months of age have significantly better health outcomes (UNICEF, 2015). A problem affecting patient care quality is low exclusive breastfeeding rates. Exclusive breastfeeding rates at six months of age are as low as 38% worldwide (Lake and Chan, 2015). In the United States of America (USA) rates are as low as 21.9%; and in Arizona, 17.2% (Center for Disease Control [CDC], 2012). UNICEF and WHO decided to make a difference in the lives of children by increasing exclusive breastfeeding. They collaborated and created the Baby Friendly Hospital Initiative (BFHI) Ten Steps to Successful Breastfeeding in 1991 (UNICEF, 2015). Those hospitals who successfully implement and pass inspection for the BFHI receive a designation of Baby Friendly. This evidence based designation has led to improved exclusive breastfeeding rates world-wide (Baby-Friendly USA, Incorporated[BFUSA], 2015). Across the USA many hospitals have embraced some of the BFHI steps but few actually obtain the designation and implement all Ten Steps. To obtain full implementation and achievement of the BFHI designation, hospital administration must support the change and cooperate with implementation. This cooperation results in better adherence to the BFHI steps (BFUSA, 2015). Additionally, staff members must understand the importance of the designation and its relationship to implementation of all ten steps. Therefore, education and communication are key components of this project. The goal of this proposed project is to encourage hospital facility stakeholders to strive for the designation. The phases of the proposed project are: assessment of initial understanding; stakeholder education; reassessment of stakeholder understanding; implementation; evaluation; and dissemination of results. A review of evidence demonstrates the effectiveness of the proposed solution. For example, a 2011 review of evidence compares breastfeeding initiation rates and duration in women who gave birth in hospitals with or without the BFHI. Of 990 articles, a total of 26 articles were chosen based upon relevance. From a total of 26 articles, 24 showed a positive relationship to structured program initiation such as BFHI and exclusive breastfeeding rates (Beake, Pellowe, Dykes, Schmied, and Bick, 2011).

The purpose of this study is to identify whether becoming a Baby-Friendly Hospital and implementing Baby-Friendly's Ten Steps to Successful Breastfeeding will affect a mother's initiation and duration of breastfeeding her baby. Scientific evidence supports that breastfeeding is best for the healthy growth and development of babies and is the most normal way for infants to be nourished. The World Health Organization (WHO) recommends exclusive breastfeeding up to 6 months of age. Although 80% of babies start out breastfeeding, only 22% of them are exclusively breastfed for 6 months as recommended (US Department of Health and Human Services, 2015). Research studies show how hospitals practice can make a difference in a mother's success. This paper provides written research that concludes if a hospital is designated Baby-Friendly its breastfeeding rates are higher. It utilizes correlational studies that show hospitals who implement the Baby-Friendly's Ten Steps to Successful Breastfeeding, give their mothers more support with proper information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies (Baby-Friendly USA Inc, 2012). The Self-Efficacy Theory is used to build patient relationships, while increasing a mother's motivation to complete her breastfeeding goal. Rates of initiation and exclusivity will be tracked through chart audits and questionnaires after implementing each step. This project determines that if a hospital is designated Baby-Friendly, the initiation and duration of breastfeeding rates will increase.

This handbook covers current thinking on successful breastfeeding and is the result of the work of a breastfeeding working group set up by the Council of the Royal College of Midwives. Subjects explored include the duration and frequency of feeds, cleanliness, weight gain, postural considerations, ways in which the midwife may help directly and the prevention of mastitis. The variety of appetites in infants is discussed and less common problems such as diabetes, anitcoagulant therapy, mammary surgery, cleft lip and cleft palate are considered.

The Baby Friendly Hospital Initiative is a program designed around the World Health Organization (WHO) and the United Nations Children09́s Fund09́s (UNICEF) Ten Steps for Successful breastfeeding, which was originally published in 1989. These steps give guidance to facilities who wish to increase breastfeeding rates, with the intent of decreasing infant deaths globally, (WHO, 1998). The importance of breastfeeding has been researched and echoed repeatedly throughout the last several years. Although, UNICEF and WHO are traditionally thought of as international governing bodies, it has been well established that first world countries such as the United States can benefit substantially from these practices. The American Academy of Pediatrics (AAP), the authoritative group for pediatricians in the United States, released a position statement in 2012 which concludes that ,0−́given the documented short- and longer-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.0+́ While hospitals can no longer deny they play an important role in the success of breastfeeding, they must also determine how to change a culture that has, for many years, seen breastfeeding as unnecessary. The Baby Friendly Hospital Initiative (BFHI) is based on the Ten Steps for Successful Breastfeeding and provides guidance and incentives for hospitals to get their policies and procedures in alignment with these steps. Implementation of this program is well researched and has shown great success. This paper analyzes this research and lays out plans for the successful implementation of the BFHI. The implementation analysis includes a description of the current state of breastfeeding in the United States, BFHI as a solution, steps to implementation, tools for evaluating the success of BFHI status as well as a plan for dissemination and a review of relevant literature.

Breast milk is important for child nutrition and development. Based on research studies, breast milk provides immune components for the health of the infant and encourages mother-child bonding. Literature has shown the main reason women do not breastfeed is because of inadequate breastfeeding education and support from health professionals or peers. Most nurses in the prenatal and postpartum units have limited knowledge about breastfeeding. The knowledge of the nurses was tested before intervention to gain insight on what the nurses know about breastfeeding and The Baby Friendly Hospital Initiative program. This project aims to improve breastfeeding rates and duration through nursing education. Research evidence supports improved nursing education on breastfeeding as a means of increasing breastfeeding rates. This project proposes breastfeeding education designed for nurses to educate and support mothers for the purpose of increasing breastfeeding rates. In addition, research evidence supports structured education such as The Ten Steps to Successful Breastfeeding to promote breastfeeding. In this light, the proposal suggests the adoption of the Baby Friendly Hospital Initiative program (BFHI) by the hospital to ensure adherence by nurses in their practice. Nurses should familiarize themselves with the problems associated with breastfeeding and the interventions. This is also a one of the main reasons women do not breastfeed and being able to handle these problems will remove some of the obstacles against breastfeeding. Women's' perceptions and cosmetic issues are problems that deserve attention and require nurse's encouragement and support. This project will describe how this will be implemented, the methods by which the outcome will be evaluated and how the results will be shared to stakeholders and larger nursing community.