Interstate Collaborative of the Ten Steps

Background: Implementation of and adherence to The Ten Steps to Successful Breastfeeding is known to increase breastfeeding rates to at least one year of life, on even the country-level. Unfortunately, hospitals across the United States have been extremely slow to implement these practices. The Breastfeeding-Friendly Healthcare project exists to develop a better understanding of what works to support implementation and sustained adherence in North Carolina hospitals. This project is unique in supporting implementation of the Ten Steps in hospitals that serve low-wealth populations and that did not necessarily intend to seek Baby-friendly status.

Methods: Throughout this four-year initiative, barriers and facilitators to quality improvement in breastfeeding support have been assessed annually, using a multiple case study, mixed-methods approach. Data were collected from all hospitals at baseline, midterm (after the intervention with the first group), and after intervention with both groups. Data collected included breastfeeding and exclusive breastfeeding rates, health worker KAP, key informant interview, and two methods to assess achievement of the steps.

Results: Hospitals participating in the Breastfeeding-Friendly Healthcare project have seen significant increases in breastfeeding initiation and exclusivity rates. Barriers and facilitators were identified, and addressed using various strategies and immediate analysis to assess cost-effectiveness, user-friendliness (staff comfort level) and feasibility. This intensive cycle of assessment, implementation and re-assessment resulted in an evidence-based set of practices shown to result in increased adherence to the Ten Steps to Successful Breastfeeding (packaged as a toolkit).

Discussion: This session will highlight the key components of the resulting toolkit, preparing participants to support increased implementation of the Ten Steps in hospitals around the world.