Date of Award
College of Nursing
Doctor of Nursing Practice (DNP)
Objective: Evaluate the effectiveness of the global Baby Friendly Hospital Initiative (BFHI) as an intervention to improve breastfeeding outcomes and to explore factors that are most supportive and predictive of exclusive breastfeeding.
Design: Program evaluation of the BFHI using a retrospective pre and post implementation electronic health record chart review.
Setting: A tertiary level hospital in WA. BFHI designation was achieved in November 2017.
Participants: Patients with a low-risk pregnancy, who gave birth (vaginal or cesarean) to a healthy term infant in Quarter one of 2015 (N=145) and Quarter four of 2018 (N=131).Patient and infant must have been discharged home together.
Methods: Descriptive statistics were generated to retrospectively describe a cohort of patients who gave birth in Quarter one of 2015, before BFHI implementation, and another retrospective cohort of patients who gave birth in Quarter four 2018, after BFHI implementation. Analysis of the differences between the groups were conducted to determine significant differences between the cohorts and explore the potential causative factors between selected BFHI variables and breastfeeding outcomes.
Results: Exclusive breastfeeding rates did not increase from 2015 to 2018 after implementation of the BFHI. The contextual factors of low parity, vaginal birth, and shorter hospital stay were predictive of exclusive breastfeeding at discharge. Exposure to the midwifery model of care during inpatient postpartum recovery and being Caucasian were potentially predictive of exclusive breastfeeding at discharge.
Conclusion: Increased rates of exclusive breastfeeding at discharge were not observed after the implementation of the BFHI at the study site. Variables that were predictive of higher rates of exclusive breastfeeding at discharge were: shorter length of hospital stay post-partum, lower parity, vaginal birth, having a CNM as care provider. Maternal age, race/ethnicity and insurance type did not influence rates of exclusive breastfeeding at discharge in statistically significant ways; however, Caucasian patients were most likely to breastfeed exclusively at discharge.
Martin, Sarah Vivian, "Context Matters: Evaluating the Influence of Patient Demographics and In-Patient Care Parameters on Breastfeeding Outcomes Associated with the Baby Friendly Hospital Initiative" (2021). Doctor of Nursing Practice Projects. 21.