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1) Project Background:
The Connecticut Breastfeeding Initiative is funded through the American Recovery and Reinvestment Act, Communities Putting Prevention to Work from the Centers for Disease Control and Prevention. The funds required policy and environmental change initiatives utilizing MAPPS strategies (Media, Access, Point of Decision, Price, and Social Support/Services) with the Baby-Friendly Hospital Initiative listed as an example.
Connecticut has 28 maternity hospitals plus one free-standing birth center. The long-term goal is for all maternity facilities in the state to be designated Baby-Friendly; but, in 2010, only three of the 29 were Baby-Friendly. Baby-Friendly momentum continues to build nationally with a maternity hospital focus on mPinc scores and the revised Joint Commission Perinatal Care Core Measures to report breastfeeding exclusivity rates. Other initiatives that support Baby-Friendly include: American Academy of Pediatrics’ recommendation, United States Breastfeeding Coalition Tool Kit, Healthy People 2020 Goals, Surgeon General’s Call to Action, and Let’s Move! Campaign.
The Connecticut Department of Public Health (DPH) was awarded $141,800 for the project, and contracted with the Connecticut Breastfeeding Coalition (CBC), a long-standing DPH partner with Baby-Friendly expertise. Actual costs exceed this amount with in-kind and financial contributions from both DPH and CBC. The Connecticut Hospital Association also wrote a letter of support and informed maternity hospitals about the project with a newsletter article.
2) Project Activities for Ten Hospitals:
• Deliver 15-hours of training to maternity staff and assist with five additional competency hours (achieves Baby-Friendly Step #2) *
• Provide 40-hours of individualized maternity hospital consultation with Baby-Friendly expert
• Foster bimonthly collaboration and support between the ten maternity hospitals
• Disseminate patient and staff education materials ($750 per hospital)
• Offer financial support for Baby-Friendly USA maternity hospital fees
3) 4-D Pathway to Baby-Friendly Designation:
The 4-D Pathway helps maternity hospitals achieve Baby-Friendly Designation, and there is a fee schedule that corresponds with the Pathway. The ten maternity hospitals were required to pay the $2,000 fee to enter Development; then DPH, with the grant funds, paid for each maternity hospital to enter Dissemination. This strategy demonstrates commitment from hospital administration.
4) Project Achievements to Date:
• Modified a siloed hospital-based program into a statewide public health model
• Created a replicable model for other states and/or counties
• Impacted breastfeeding statewide (43% of births occur at the ten maternity hospitals)
• Focused on underserved, low-income maternity populations (39% of births are public pay at the ten maternity hospitals)
• Helped one hospital achieve Baby-Friendly Designation on November 4, 2011, and moved nine hospitals to Dissemination by project end
• Trained 550+ maternity staff and CBC secured continued education credits for trainees
• Leveraged other federal funding sources such as the WIC Peer Counseling Program
5) Project Evaluation: Results to be disseminated February 2012
• Collect qualitative and quantitative data from the ten maternity hospitals to drive program improvement and identify promising practices for replication
• Conduct a community workshop to discuss lessons learned and ensure sustainability
6) Project Sustainability:
• Strengthened organizational capacity and enhanced existing relationships with maternity hospitals
• Improved breastfeeding knowledge and bedside practices for trained maternity staff
• Developed sustainability plans on how to train new maternity staff in the future
* Three hospitals elected to train their own maternity staff (i.e. train-the-trainer model)
World Health Organization and UNICEF, 1989
Every facility providing maternity services and care for newborn infants should:
1. Have a written breastfeeding policy that is routinely communicated to all health care staff. *
2. Train all health care staff in skills necessary to implement this policy. *
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth. *
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 others 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 teats or pacifiers to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. *
* Indicates the five steps selected for the Connecticut Breastfeeding Initiative (CBI). The project goal is to help ten Connecticut hospitals achieve five of the ten Baby-Friendly steps. Baby-Friendly Designation is typically a multi-year process, so it was realistic to focus on five steps over the two-year project period. Specific steps were selected based on level of importance, difficulty to achieve, and those requiring external technical assistance that would be provided through the initiative. The long-term goal of the project is for the ten hospitals to achieve Baby-Friendly Designation. If so, Connecticut will have almost 50% of its maternity hospitals designated Baby-Friendly.
Connecticut Breastfeeding Initiative Hospitals
Day Kimball Hospital (Putnam)
Griffin Hospital (Derby)
Hospital of Central Connecticut (New Britain)
Lawrence and Memorial Hospital (New London)
St. Francis Hospital and Medical Center (Hartford)
St. Mary’s Hospital (Waterbury)
Windham Community Memorial Hospital (Willimantic)
Yale New Haven Hospital
Current Baby-Friendly Hospitals in Connecticut
+ First of ten CBI hospitals to achieve Baby-Friendly Designation
Four other Connecticut hospitals are independently working towards Baby-Friendly Designation.