Bailey’s
Golden Start
Breastfeeding
Curriculum for
Nursing Students
 Objective 11:
Best practices
 Objective 12:
Breastfeeding
Report Card,
Healthy People,
Surgeon
General’s Call to
Action
Section 5
Section Five Contents:
 Objectives 11-12
 Topics
Best practices for successful breastfeeding
o The Code
o Ten Steps
 Breastfeeding Report Card
 Healthy People
 Surgeon General’s Call to Action
2
Objective 11
 Discuss Best
Practices, “The
Code” and “The
Ten Steps to
Successful
Breastfeeding”
Image taken by Jennifer
DeJong; Carolyn and Christian,
2008.
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Best Practice Means Promoting
Exclusive Breastfeeding for 6 Months
 The American Academy of Pediatrics
reaffirms its recommendation of exclusive
breastfeeding for about 6 months, followed
by continued breastfeeding as
complementary foods are introduced, with
continuation of breastfeeding for 1 year or
longer as mutually desired by mother and
infant.
4
Best Practice Means Following The
International Code for the Marketing
of Breastmilk Substitutes
The Code recommends:
 No ___________________ of breast-milk
substitutes directly to the public.
 No free _____________ to mothers.
 No promotion of products in
____________________ facilities.
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“The Code”
 No commercial product _________________
to advise mothers.
 No _________ or personal samples to health
workers.
 No words or pictures ________________
artificial feeding, including pictures of
infants on the products.
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“The Code”
 Information to health workers should
be ___________ and factual.
 All information on artificial feeding,
including the labels, should explain the
benefits of breastfeeding, the costs,
and the ____________ associated with
artificial feeding.
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“Experts Agree” Label
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“The Code”
 Unsuitable products, such as
_____________ milk, should not be
promoted for babies.
 All products should be of a high quality
and take into account the
_____________________
9
Best Practice Means Following the
Recommendations of the Baby-Friendly
Hospital Initiative (BFHI)
 In 1991, the WHO/UNICEF cooperatively
launched a worldwide campaign to
improve the care of mothers and babies in
response to feedback from the Convention
on the Rights of the Child; the Declaration
of the World Summit for Children; and the
recommendations of the Innocenti
Declaration -- the Baby Friendly Hospital
Initiative (WHO, 1991).
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The Baby-Friendly 4-D
Pathway
 Since early 2010, to achieve the BF designation,
facilities must register with BFUSA; complete all of
the requirements using the new “4-D Pathway;”
and ultimately demonstrate during an on-site
assessment that they have correctly integrated all
ten steps into their practice. The new 4-D Pathway
maintains all of the high standards of global health
experts but breaks down the process into
manageable steps.
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Studies of the
Impact of the BabyFriendly Hospital
Initiative Abroad
(Macrosystem)





Sweden
China
Nicaragua
Zambia
Switzerland
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The Impact of the
Baby-Friendly Hospital
Initiative in the United
States
 Baby-Friendly Hospitals
(BPHs) in the U.S. have
elevated rates of
breastfeeding initiation
and exclusivity
regardless of
demographic factors
(Merewood et al., 2005).
Image used with permission from William Burleson, Office of
Statewide Health Improvement Initiatives, Minnesota Department
of Health on 2/10/2012.
13
Percent of births at Baby-Friendly
facilities in 2011, by state
14
Why Aren’t There More BabyFriendly Hospitals in the U.S.?
 According to Phillipp et al. (2001):
A major obstacle to the Baby Friendly Initiative
in the United States has been the reliance on
free formula and other formula company
products and gifts that are accepted by many
hospitals. When compliance with The Ten Steps
is achieved, the results are dramatic. The first
Baby-Friendly Hospital in the United States,
Evergreen Hospital in Kirkland, Washington, has
a breastfeeding initiation rate of >90%. (p. 677)
15
An Endemic Problem
Throughout US Health Care
 Bartick et al. (2009) notes, “The
paucity of U.S. Baby-Friendly hospitals
reflects an endemic problem
throughout American health care:
there is a significant gap between
evidence-based recommendations
and actual practice” (p. 794).
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The Ten
Steps
And, some
report difficulty in
following all of
The Ten Steps to
Successful
Breastfeeding,
which are:
Image used with permission from William
Burleson, Office of Statewide Health
Improvement Initiatives, Minnesota
Department of Health on 2/10/2012.
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The Ten Steps to Successful
Breastfeeding
 Have a written breastfeeding _______ that is
routinely communicated to all health care
staff.
 ________ all health care staff in skills
necessary to implement this policy.
 ____________ all pregnant women about the
benefits and management of breastfeeding.
 Help mothers initiate breastfeeding within
____ of birth.
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The Ten Steps to Successful
Breastfeeding
 Show mothers how to breastfeed and how
to maintain lactation, even if they are
separated from their infants.
 Give newborn infants no food or drink other
than breast milk, unless medically indicated.
 Practice "rooming in"— allow mothers and
infants to remain together 24 hours a day.
 Encourage breastfeeding on demand.
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The Ten Steps to Successful
Breastfeeding
 Give no pacifiers or artificial nipples
to breastfeeding infants.
 Foster the establishment of
breastfeeding support groups and
refer mothers to them on discharge
from the hospital or clinic.
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Objective 12
 Describe the
components of
The Breastfeeding
Report Card,
Healthy People
2020 Objectives,
and The 2011
Surgeon
General’s Call to
Action to Support
Breastfeeding
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The Breastfeeding Report Card
 The Breastfeeding Report Card
– http://www.cdc.gov/breastfeeding/dat
a/reportcard.htm
22
Healthy People 2020
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Surgeon General’s CTA
 On January 20, 2011, Surgeon General
Regina M. Benjamin released The Surgeon
General’s Call to Action to Support
Breastfeeding in the Jack Morton
Auditorium at The George Washington
University.
 The Call to Action can be found at:
http://nih.granicus.com/MediaPlayer.php?v
iew_id=7&clip_id=109
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End of:
 Objective 11:
Best practices
 Objective 12:
Breastfeeding Report
Card, Healthy People,
Surgeon General’s Call to
Action
Next:
 Objective13:
Difficulties
 Objective14:
Nursing diagnoses
case studies
 Objective15:
Finding information
on the internet
 Objective16: Role
playing scenarios
Image taken by Jennifer DeJong,
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