Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, Provider Training/Education

Intervention Description: Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women's views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated.

Intervention Results: Post intervention there were statistically significant differences in the initiation (p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeeding to 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care.

Conclusion: It is possible to improve outcomes of routine in-patient care within current resources through continuous quality improvement.

Study Design: QE: pretest-posttest

Setting: Large maternity unit in the south of England

Population of Focus: Women on the postnatal ward who were >16 years old, able to speak and read English, and who had not experienced a stillbirth or neonatal death

Data Source: Mother self-report

Sample Size: Pretest (n=751/741)3 Posttest (n=725/725)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, POPULATION-BASED SYSTEMS, COMMUNITY, Community Health Services Policy, Provider Training/Education

Intervention Description: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months.

Intervention Results: The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account.

Conclusion: The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.

Study Design: QE: pretest-posttest time-lagged nonequivalent control group

Setting: 18 Local Health Authorities (LHAs) in 9 regions of Italy

Population of Focus: Women living in the area covered by LHA, with infants > 2000g, who spoke Italian, English, French, or Spanish (or who had a relative who spoke these languages), and without a postpartum condition that required admission to the NICU

Data Source: Mother self-report

Sample Size: Early Intervention Group5 • Enrolled (n=2846) • 12-month follow-up (n=2474) Late Intervention Group • Enrolled (n=2248) • 12-month follow-up (n=1931)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative, Provider Training/Education

Intervention Description: Breastfeeding rates and related hospital practices need improvement in Italy and elsewhere.

Intervention Results: No statistically significant differences in both groups, before and after training, of exclusive breastfeeding at 6 months

Conclusion: Training for at least three days with a course including practical sessions and counselling skills is effective in changing hospital practices, knowledge of health workers, and breastfeeding rates.

Study Design: QE: pretest-posttest time-lagged nonequivalent control group

Setting: 8 hospitals (3 general hospitals and 1 teaching hospital in southern Italy, 3 general hospitals and 1 teaching hospital in central and northern Italy)

Population of Focus: Women with healthy infants > 2000g

Data Source: Mother self-report

Sample Size: Group 1 • Phase 1 (n=529) • Phase 2 (n=515) • Phase 3 (n=516) Group 2 • Phase 1 (n=483) • Phase 2 (n=342) • Phase 3 (n=284)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Lactation Consultant, Telephone Support, Hospital Policies, PROVIDER/PRACTICE, Other (Provider Practice)

Intervention Description: The purpose of this study was to determine whether implementing a program based on a clinical protocol affects breastfeeding rates within a pediatric primary care setting. Increasing breastfeeding rates is an important public health initiative identified by multiple agencies.

Intervention Results: The results of this evaluation were positive for exclusive breastfeeding, with group comparisons showing a statistically significant increase in exclusive breastfeeding rates at all 5 time points.

Conclusion: Our diverse patient population within a pediatric practice had increased initiation rates and exclusive breastfeeding rates after implementation of the ABM's breastfeeding-friendly protocol. Families who receive care in a pediatric primary care setting that has implemented the ABM clinical protocol may have increased rates of exclusive breastfeeding.

Study Design: QE: pretest-posttest

Setting: 2 locations (1 suburban, 1 rural) of a single practice in northern VA

Population of Focus: Women with healthy, singleton births of ≥ 37 GA , who entered the practice within the first week of birth and returned for health maintenance visits at 2, 4, and 6 months

Data Source: Medical record review

Sample Size: Pre-Intervention (n=376) Post-Intervention (n=381)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative,

Intervention Description: Maternity care practices influence breastfeeding outcomes long after women leave the birth setting. We conducted this study to describe, from mothers' perspective, maternity care practices associated with breastfeeding at 3 and 6 months. Six study sites were either designated as Baby-Friendly or were in the process of achieving this designation.

Intervention Results: Our multisite study supports implementing low cost and evidence-based interventions such as immediate and uninterrupted SSC and rooming in to improve breastfeeding exclusivity.

Conclusion: Findings highlight the ongoing need to bridge the gap between hospital discharge and community breastfeeding support, including workplace accommodations.

Study Design: Cross sectional descriptive replication study

Setting: Two large academic medical centers, one in the Northeast and two in the South-central region of the US, and two smaller teaching hospitals and community hospitals in the Northeast and South-central region of the US

Population of Focus: Women who gave birth during the data collection period at each study site

Sample Size: 672 women

Age Range: Women ages 18-48

Intervention Components (click on component to see a list of all articles that use that intervention): Hospital Policies, Social Media,

Intervention Description: The intervention included in-hospital vaccinations for stable preterm infants, vaccination counseling for outpatient follow-up, and online dissemination of vaccine scientific data through social media.

Intervention Results: The study found that the intervention was associated with higher coverage and timeliness of routine immunizations in preterm infants.

Conclusion: Increasing vaccine confidence through web-based interventions could have a positive impact on vaccination acceptance of parents of preterm infants, although timeliness results still delayed. There is a strong need to develop different and effective vaccination strategies to protect this very vulnerable population.

Study Design: The study used a historical cohort design, comparing the interventional 2016-2017 cohort with a preterm cohort from 2013-2014 and a regional pediatric population cohort from 2016-2017.

Setting: The study was conducted in a single NICU in Italy with a specific protocol for vaccination of preterm infants

Population of Focus: The target audience was families of preterm infants.

Sample Size: The study evaluated a cohort of preterm infants born from 2016 to 2017, regularly followed in the outpatient clinic up to 2 years of life.

Age Range: The study focused on preterm infants, but the age range was not specified.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Baby Friendly Hospital Initiative, Quality Improvement/Practice-Wide Intervention, Hospital Policies, Provider Training/Education

Intervention Description: To conduct a national quality improvement initiative between 2011 and 2015. The initiative was entitled Best Fed Beginnings and enrolled 90 hospitals in a nationwide initiative to increase breastfeeding and achieve Baby-Friendly designation.

Intervention Results: Overall breastfeeding increased from 79% to 83% (t = 1.93; P = .057), and exclusive breastfeeding increased from 39% to 61% (t = 9.72; P < .001).

Conclusion: A nationwide initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding.

Study Design: QE: pretest-posttest

Setting: 90 hospitals from 3 geographic regions

Population of Focus: Hospitals with low breastfeeding rates, readiness for change, establishment of a BabyFriendly/breastfeeding steering committee, data about sociodemographic characteristics of population served, geographic location based on regions with low breastfeeding rates and BFHI accreditation, commitment of senior leadership, and experience with quality improvement methods

Data Source: Medical record review

Sample Size: Intervention (N=89) N=hospitals

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational material, HEALTH_CARE_PROVIDER_PRACTICE, Quality Improvement/Practice-Wide Intervention, Hospital Policies, Provider Training/Education,

Intervention Description: The purpose of this system-wide quality improvement project was to create a breastfeeding-friendly pediatric practice. This breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. The policy included: (a) breastfeeding promotion recommendations; (b) provider, nurse, and staff roles; (c) patient education and resources; and (d) breastfeeding-friendly atmosphere guidelines. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized throughout the offices. Lactation support services were publicized via signs and social media postings.

Intervention Results: Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months.

Conclusion: This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.

Study Design: Pre-post intervention

Setting: Multisite rural IL pediatric practice

Population of Focus: Mothers with breastfeeding infants from newborn to 4 months seen for well-child visits at a pediatric practice

Sample Size: 71 infants preintervention and 18 infants postintervention

Age Range: Newborn to infants 4 months old

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative,

Intervention Description: This study examines changes in Baby-Friendly hospital practices, breastfeeding outcomes, and their relationships with Baby-Friendly hospital status among WIC-enrolled children in Los Angeles County.

Intervention Results: In 2017, mothers surveyed were more likely to engage in Baby-Friendly hospital practices compared with 2008. Any and exclusive breastfeeding outcomes at 1 and 3 months significantly increased since 2014, and breastfed infants were more likely to have mothers who participated in Baby-Friendly hospital practices. The more Baby-Friendly hospital practices mothers met, the better the breastfeeding outcomes. However, there is room for improvement in the uptake of Baby-Friendly hospital practices in Baby-Friendly hospitals.

Conclusion: Effort is needed to ensure Baby-Friendly hospitals have support to continuously comply with all steps to maintain Baby-Friendly designation, and non-Baby-Friendly hospitals have support to incorporate these practices into hospital protocols.

Study Design: Triennial cross-sectional survey

Setting: Los Angeles County hospitals

Population of Focus: Infants born in Los Angeles County hospitals, no older than 2 years of age at the time of the survey whose mothers were interviewed

Sample Size: 6,449 infants and their mothers

Age Range: Infants under 2 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative, Provider Training/Education, Expert Support (Provider),

Intervention Description: In 2010, the Hawaii State Department of Health received support from the CDC to launch the Baby-Friendly Hawaii Project to increase the number of Hawaii hospitals that provide maternity care consistent with the Ten Steps to Successful Breastfeeding and increase the rate of women who remain exclusively breastfeeding throughout their hospital stay. The BFHP employed six strategies based on a model developed by the New York City Department of Health and Mental Hygiene: engage hospitals, enlist support, recruit champions, assess hospitals, conduct site visits and trainings, and monitor outcomes. Populations targeted for BFHP were registered nurses, lactation consultants, and other hospital staff, as well as expectant mothers at all 11 Hawaii maternity hospitals during the project period.

Intervention Results: Since 2010, 52 hospital site visits, 58 trainings, and ongoing technical assistance were administered, and more than 750 staff and health professionals from BFHP hospitals were trained. Hawaii’s overall quality composite Maternity Practices in Infant Nutrition and Care score increased from 65 (out of 100) in 2009 to 76 in 2011 and 80 in 2013, and Newborn Screening Data showed an increase in statewide exclusive breastfeeding from 59.7% in 2009 to 77.0% in 2014.

Conclusion: Implementation and findings from the BFHP can inform future planning at the state and federal levels on maternity care practices that can improve breastfeeding.

Study Design: Program evaluation

Setting: Maternity hospitals in Hawaii

Population of Focus: Registered nurses, lactation consultants, and other hospital staff and expectant mothers at all 11 Hawaii maternity hospitals

Sample Size: 750 staff and health professionals

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative,

Intervention Description: To evaluate the impact of transition to Baby-Friendly certification on underserved populations at the University of New Mexico hospital. The journey towards Baby Friendly designation proceeded in four phases. The study team examined inpatient breastfeeding related clinical practices and short-term breastfeeding duration rates among patients of the midwifery service during the transition to Baby Friendly status. The purpose was twofold: (a) to evaluate the impact of BFHI implementation on the short-term duration of both any breastfeeding and exclusive breastfeeding, and (b) to determine the impact of exposure to the inpatient Ten Steps on short-term breastfeeding duration, both individually and cumulatively.

Intervention Results: Implementation of the BFHI and cumulative exposure to the Ten Steps increased short-term duration of any breastfeeding and exclusive breastfeeding at 2-6 weeks postpartum. Exposure to all six of the inpatient Ten Steps increased the odds of any breastfeeding by 34 times and exclusive breastfeeding by 24 times. Exposure to Step 9 (“Give no pacifiers or artificial nipples”) uniquely increased the likelihood of any breastfeeding at 2-6 weeks postpartum by 5.7 times, whereas Step 6 (“Give infants no food or drink other than breastmilk”) increased the rate of exclusive breastfeeding by 4.4 times at 2-6 weeks postpartum.

Conclusion: These findings demonstrate that the Baby Friendly Hospital Initiative can have a positive impact on breastfeeding among underserved populations.

Study Design: Quasi-experimental, retrospective cohort design

Setting: University of New Mexico Hospital

Population of Focus: Mother-baby pairs pre-BFHI and post-BFHI delivering at the hospital

Sample Size: 1004 mother-infant pairs (449 in the pre-BFHI cohort & 555 in the post-BFHI cohort)

Age Range: Mothers age 20-33 and their infants at 2-6 weeks postpartum

Intervention Components (click on component to see a list of all articles that use that intervention): Baby Friendly Hospital Initiative, HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Other Education

Intervention Description: Identify practices associated with breastfeeding maintenance, examine breastfeeding-related hospital practices by hospital designation level (Baby Friendly vs. Gift vs. none), and assess racial disparities in hospital practices and breastfeeding maintenance.

Intervention Results: Breastfeeding in the hospital, infant only receiving breast milk, and breastfeeding within one hour after birth were positively associated and receiving a gift pack with formula was negatively associated with breastfeeding maintenance in both NHW and NHB women. Associations were stronger in NHW compared to NHB mothers.

Conclusion: We identified several practices significantly associated with breastfeeding maintenance. However, racial disparities indicate a need for population-specific supportive practices.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative,

Intervention Description: The environment in which a women gives birth may be an important determinant of breastfeeding initiation. The impact of the Baby-Friendly Hospital Initiative (BFHI) is not well characterized in the southeastern region of the US where significant breastfeeding disparities persist. The study aimed to evaluate the impact of the BFHI on breastfeeding initiation in North Carolina, with special attention to rural areas.

Intervention Results: Birth at a Baby-Friendly hospital was associated with increased odds of breastfeeding initiation, adjusted odds ratio = 1.7, 95% confidence interval [1.65, 1.89]. Model residuals showed significant clustering by county, with some rural areas’ rates systematically overestimated. Whereas presence of a Baby-Friendly hospital in a mother’s community of residence was not associated with increased initiation, birth at a Baby-Friendly hospital was associated with smaller disparities in initiation between rural and urban births.

Conclusion: Birth at a Baby-Friendly hospital is associated with improved breastfeeding initiation and reduced disparities in initiation between rural and urban counties in North Carolina.

Study Design: Secondary data analysis

Setting: Hospitals in North Carolina

Population of Focus: Mothers with North Carolina residence delivering in a hospital

Sample Size: 137,738 women

Age Range: Mothers older than 18 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies

Intervention Description: The purpose of this study was to evaluate the effects on breastfeeding rates of a private-sector early discharge program and a subsequent government mandate guaranteeing 48 hours of hospital coverage.

Intervention Results: Rate of breastfeeding increased over time, from 70.1% in the fourth quarter of 1990 to 81.9% in the first quarter of 1998, but there was no change after either intervention

Conclusion: Early postpartum discharge with outpatient breastfeeding support and a home visitor program has no adverse effects on initiation or continuation of breastfeeding.

Study Design: QE: interrupted time series analysis

Setting: Harvard Vanguard Medical Associates (HVMA), which includes 14 health centers in eastern MA

Population of Focus: HVMA/Harvard Pilgrim Health Care (HPHC) mother-infant pairs between Oct 1990-March 1998

Data Source: Harvard Vanguard Medical Associates Automated Medical Records System

Sample Size: Total (n=20,366) N=mother-infant pairs

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Hospital Policies, Baby Friendly Hospital Initiative, HOSPITAL, Policy/Guideline (Hospital)

Intervention Description: The Baby-Friendly Hospital Initiative (BFHI), developed by the World Health Organization (WHO) and United Nations Children's fund, is a global program aimed at promoting, protecting, and supporting breastfeeding. Hospitals in the BFHI community must develop clear policies related to staff training and breastfeeding promotion from pregnancy until hospital discharge following childbirth. The aim of this study was to compare women in non-BFHI-accredited hospitals in a socio-economically homogeneous region of southern Italy (Campania region) with a "baby-friendly hospital," as recognized by UNICEF, in Verbania in the Piedmont region of northern Italy (Castelli Hospital) in terms of 1) breastfeeding in the days following childbirth; 2) the information provided by health personnel before and after childbirth; 3) knowledge about breastfeeding before and during hospitalizations; and 4) participation in antenatal classes.

Intervention Results: In general, both groups showed good basic knowledge about different aspects of breastfeeding. In both regions, about 90% reported that the information received during the antenatal classes simplified the breastfeeding experience.

Conclusion: Our study confirms the importance of systematic promotion of breastfeeding and subsequent delivery of adequate support to maternity departments, in accordance with international guidelines.

Study Design: Evaluation data

Setting: Ten accredited and non-accredited hospitals in the Piedmont region of northern Italy

Population of Focus: Women receiving care at the ten participating hospitals

Sample Size: 786 women (580 in Campania + 206 women in Piedmont)

Age Range: Not reported

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Hospital Policies, Baby Friendly Hospital Initiative, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, this study assessed CHAMPS, which used a Quality Improvement intervention at hospitals, and engaged intensively with local community partners.

Intervention Results: Average hospital breastfeeding initiation rates rose from 56% to 66% (p < 0.05), the proportion of hospitals designated Baby-Friendly or attaining the final stages thereof rose from 15% to 90%, and 80% of Mississippi Special Supplemental Programme for Women, Infants, and Children districts engaged with CHAMPS. CHAMPS also maintains a funded presence in Mississippi, and all designated hospitals have maintained Baby-Friendly status. These findings show that a breastfeeding-focused public health initiative using broad-based strategic programming involving multiple stakeholders and a range of evaluation criteria can be successful.

Conclusion: More breastfeeding promotion and support programmes should assess their wider impact using evidence-based implementation frameworks.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative,

Intervention Description: A recent effort exists to increase the number of Baby-Friendly designated hospitals in Los Angeles County (LAC). At the time that data for this study were collected (August 2014), 16 hospitals had obtained the designation. Sixteen months later (December 2015), another 11 joined the ranks, bringing the total number of Baby-Friendly designated hospitals in LAC to 27. With such a drastically changing scene in birthing hospitals, it is important to document whether there have been corresponding increases in Baby-Friendly hospital practices in LAC and whether being born in a Baby-Friendly designated hospital is associated with improved breastfeeding outcomes in the low-income population in the county.

Intervention Results: The rates of Baby-Friendly hospital practices have improved since 2008. Although no association existed with rates of any breastfeeding, being born in a hospital designated Baby-Friendly or in the process of obtaining this designation was significantly associated with an increased odds of exclusive breastfeeding at 1 and 3 months.

Conclusion: The BFHI may help achieve recommended exclusive breastfeeding rates, especially for low-income populations. Additional strategies are needed to support low-income mothers in LAC with all levels of breastfeeding.

Study Design: Parent reported phone survey

Setting: Los Angeles County hopsitals

Population of Focus: 5,000 WIC families living in Los Angeles County completing the LAC WIC survey

Sample Size: 4,873 infants

Age Range: Infants under 2 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies

Intervention Description: To pilot test a standardized intraoperative and postoperative nursing intervention protocol to minimize maternal-infant separation after Cesarean.

Intervention Results: Compared with the control group, the intervention group experienced earlier first physical contact and feedings and a longer interval until the infant first bath. Differences were found between treatment groups for infant temperatures and respiratory rates. Three infants in the control group experienced suboptimal temperatures. Infants in the intervention group had significantly higher salivary cortisol levels but were within the normal upper level range. No differences were noted in maternal pain, maternal anxiety, or perception of birth experience among treatment groups.

Conclusion: The pilot was valuable in examining intervention feasibility, appropriate outcome measures, and data collection strategies. The standardized intervention protocol shows promise for positively affecting maternal-infant outcomes after Cesarean delivery and merits further testing.

Study Design: RCT

Setting: Acute care community hospital labor/delivery/recovery/ postpartum unit

Population of Focus: Women with a live, singleton fetus with no pre-existing special needs scheduled for a planned, repeat cesarean delivery

Data Source: Observation at birth and medical records at discharge

Sample Size: Intervention (n=25) Control (n=25)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative

Intervention Description: Breastfeeding initiation rates were compared at Boston Medical Center before (1995), during (1998), and after (1999) Baby-Friendly policies were in place.

Intervention Results: Breastfeeding initiation rates increased significantly from 58% in 1995, to 77.5% in 1998, to 86.5% in 1999 (p<.001)

Conclusion: Full implementation of the Ten Steps to Successful Breastfeeding leading to Baby-Friendly designation is an effective strategy to increase breastfeeding initiation rates in the US hospital setting.

Study Design: Time trend analysis

Setting: Boston Medical Center

Population of Focus: Infants admitted to the newborn service at Boston Medical Center for 1995, 1998, and 1999

Data Source: Medical record review

Sample Size: 1995 (n=200) 1998 (n=200) 1999 (n=200)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies

Intervention Description: This study explored whether delaying the newborn's first bath correlates with increased in-hospital breastfeeding rates at our Baby-Friendly, urban safety-net hospital.

Intervention Results: In-hospital exclusive breastfeeding rates increased from 32.7% to 40.2% (p<0.05) after the bath was delayed. Multivariate logistic regression analysis showed that infants born after implementation of delayed bathing had odds of exclusive breastfeeding 39% greater than infants born prior to the intervention (adjusted odds ratio [AOR]=1.39; 95% confidence interval [CI] 1.02, 1.91) and 59% greater odds of near-exclusive breastfeeding (AOR=1.59; 95% CI 1.18, 2.15). The odds of breastfeeding initiation were 166% greater for infants born after the intervention than for infants born before the intervention (AOR=2.66; 95% CI 1.29, 5.46).

Conclusion: In our cohort, a delayed newborn bath was associated with increased likelihood of breastfeeding initiation and with increased in-hospital breastfeeding rates.

Study Design: QE: pretest-posttest

Setting: Boston Medical Center

Population of Focus: Infants admitted to the well infant nursey and eligible for breastfeeding

Data Source: Medical record review

Sample Size: Preintervention (n=348) Postintervention (n=354)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Hospital Policies, Baby Friendly Hospital Initiative,

Intervention Description: The study team examined whether Baby Friendly Hospital accreditation in the past, as indicated by a former BFH designation, had a sustained impact on national breastfeeding rates and duration and that breastfeeding success remains particularly high when BFHs comply closely with monitored BF practices.

Intervention Results: We compared exclusive and any breastfeeding according to BFH designation over the first year of life, using Kaplan-Meyer Survival curves. Logistic regression models were applied to analyse breastfeeding prevalence, and Cox-regression models were used for exclusive (0–6 months) and continued (6–12 months) breastfeeding duration. Average duration of exclusive breastfeeding (13.1 weeks, 95% confidence interval [12.0, 17.4]) and any breastfeeding (32.7 weeks, 95% confidence interval [30.5, 39.2]) were the longest for babies born in currently accredited BFHs. Exclusive breastfeeding was associated with high compliance with monitored BF practices in current BFHs and with the number of BF practices experienced in all hospitals. Continued breastfeeding was significantly longer when babies were born in current BFHs (cessation hazard ratio 0.60, 95% confidence interval [0.42, 0.84]) or in former BFHs (cessation hazard ratio 0.68, 95% confidence interval [0.48, 0.97]).

Conclusion: Overall, the results support continued investment into BFHs, because babies born in current BFHs are breastfed the most and the longest, whereas a former BFH designation shows a sustained effect on continued breastfeeding.

Study Design: Cross-sectional study

Setting: Baby-Friendly hospitals in Switzerland

Population of Focus: Mother-child dyads randomly selected by Swiss Parent Counselors from a list of births registered in the previous 11 months

Sample Size: 1,326 mother-child dyads

Age Range: Infants under 12 months and their mothers

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies

Intervention Description: To examine if initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers increased after a change in hospital policy increased reporting requirements about breastfeeding by new mothers.

Intervention Results: The odds of initiating breastfeeding were greater after implementation of mandatory reporting measures (OR = 2.07; P = 0.0007), yet the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR = 0.94; P = 0.7507). Other variables that had a significant effect on both initiation and exclusive breastfeeding included being non-Hispanic white, other race/ethnicity category, marital status and type of insurance (exclusive breastfeeding only).

Conclusion: Professional support that can be offered to new mothers may have a positive effect on their decision to breastfeed. However, a hospital policy change that increases reporting requirements may not have long-term impact on breastfeeding. Longer term studies and multisite studies are needed.

Study Design: QE: pretest-posttest

Setting: Large hospital with a separate wing for labor and delivery

Population of Focus: Women ≥18 years old at delivery who gave birth between 2013 and 2014

Data Source: Medical record review

Sample Size: Total (n=500)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Hospital Policies,

Intervention Description: The article describes the development and implementation of a standardized evidence-based PPD screening program in the NICU, which includes the use of the Edinburgh Postnatal Depression Scale (EPDS) as the screening tool, clear identification of the maternal depression evaluation and diagnosis plan, and designated private areas in the NICU as an option for maternal PPD screening. The intervention aligns with a discernable strategy of using a multidisciplinary team approach to develop and implement a PPD screening program in the NICU. The article describes a pilot program evaluation of the PPD screening program, which includes PPD screening of eligible consented mothers along with referral and follow-up according to the study protocol criteria. The study analyzes the effectiveness of the PPD screening program in the NICU, but it is not a multicomponent intervention study.

Intervention Results: The study found that NICU mothers are at a higher risk for postpartum depression (PPD) compared to mothers without infants in the NICU. The pilot program evaluation indicated inconsistent PPD screening practices from obstetric providers, strengthening the argument for incorporating maternal PPD screening as a routine process in the NICU. The results of the pilot program evaluation correlated with the literature review, estimating the frequency of PPD among NICU mothers to be over 40 percent . During the pilot program evaluation period, 161 infants were admitted to the NICU, and 45 of the infants admitted reached 30 days of age. The number of eligible mothers was reduced to 39. Out of the 39 eligible mothers, 13 scored 10 or greater on the EPDS, indicating a risk for depression. All 13 mothers scoring 10 or greater on the EPDS were provided with referral references, demonstrating compliance with the study protocol , . The study also highlighted the challenges faced by mothers in obtaining access to PPD diagnostic and follow-up, including limited time, lack of insurance, and future appointments with obstetric providers. The results emphasized the importance of providing support and reinforcement to mothers who had not obtained a follow-up appointment for an evaluation for PPD .

Conclusion: NICU mothers are at a higher risk for PPD compared to mothers without infants in the NICU. When their infant remains admitted to the NICU during PPD screening intervals recommended by the AAP, NICU mothers are not screened at well-child visits as the AAP intends. A multidisciplinary team convened to address the gap between current maternal PPD screening practices in the NICU and the AAP recommendations. The multidisciplinary team agreed that providing a PPD screening program in the NICU was an appropriate step to comply with the AAP screening recommendations. A pilot program evaluated the proposed process of screening for maternal PPD screening in the NICU, providing referral references and following up with mothers when screens indicated a risk for maternal depression. Results of the program evaluation indicated inconsistent PPD screening practices from obstetric providers, which strengthened the argument for incorporating maternal PPD screening as a routine process in the NICU. Findings from this program evaluation correlated with the literature review, estimating the frequency of PPD among NICU mothers is >40 percent. Although our sample was small and the study was limited to a single center, consistent challenges with maternal follow-up indicated that alterations in

Study Design: The study design involved the development and implementation of a pilot program to evaluate the process of maternal postpartum depression (PPD) screening in a single center neonatal intensive care unit (NICU). The pilot program aimed to mimic the PPD screening program developed by the NICU multidisciplinary team and included PPD screening of eligible consented mothers, referral, and follow-up according to the study protocol criteria. The study utilized a convenience sample of mothers of infants admitted to the NICU and involved a multidisciplinary team to discuss the progress of the PPD screening program. The pilot program evaluation protocol was submitted for review and was determined not to be human subject research, but was guided by a doctoral student's program implementation. The study was conducted over a short period of time in a single center NICU using a convenience sample, and the evaluation was limited by the doctoral student's eight-week implementation timeline and some infants' discharge from the NICU during the pilot program

Setting: The study was conducted in a 60-bed Level III neonatal intensive care unit (NICU) at a high-risk perinatology referral center in North Texas. The NICU admits an estimated 700 neonates annually, and the gestational ages of the NICU patients range between 22 and 42 weeks. The average length of stay in the NICU is 27 days. The study utilized a convenience sample of mothers of infants admitted to the NICU

Population of Focus: The target audience of the study is healthcare professionals, particularly those working in neonatal intensive care units (NICUs), who are involved in the care of mothers and infants. The study aimed to evaluate the process of maternal postpartum depression (PPD) screening in the NICU and to assess the effectiveness of a PPD screening program implemented in the NICU. The study findings may be useful for healthcare professionals involved in the care of mothers and infants in NICUs who are interested in implementing or improving PPD screening programs in their practice

Sample Size: The study involved a convenience sample of 30 mothers with infants who remained admitted to the NICU and consented to participate in the postpartum depression (PPD) screening pilot program. Out of the 30 mothers screened, 13 (43.3%) scored 10 or greater on the Edinburgh Postnatal Depression Scale (EPDS), indicating a risk for depression

Age Range: The study included mothers of infants admitted to the neonatal intensive care unit (NICU) who were 18 years of age or older. The maternal population was limited to those who were 18 years of age or older and fluent in English due to the lead investigator's communication capability with the use of a screening tool. NICU caregivers who did not give birth, spoke a language other than English, were less than 30 days from birth, and/or declined study participation were excluded from the study

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Education, Provision of Breastfeeding Item, PROVIDER/PRACTICE, Hospital Policies, Other (Provider Practice), POPULATION-BASED SYSTEMS, COMMUNITY, Other (Communities), Provider Training/Education

Intervention Description: A breastfeeding promotion program conducted on the Navajo reservation.

Intervention Results: Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful.

Conclusion: This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change.

Study Design: QE: pretest-posttest

Setting: Shiprock, NM

Population of Focus: All mothers with infants born at the Shiprock hospital

Data Source: Medical record review

Sample Size: Preintervention (n=988) Postintervention (n=870)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Hospital Policies,

Intervention Description: The intervention was the implementation of an evidence-based standard of care for the detection of PPD that can be implemented with every postpartum patient. The intervention included the use of the Edinburgh Postnatal Depression Scale-10 (EPDS-10) as a reliable and valid screening instrument for PPD. The intervention aligns with a discernable strategy, which is to improve screening practices for PPD in postpartum women. The strategy involved implementing an evidence-based standard of care that included the use of a validated screening tool, staff education, and process changes to ensure that every postpartum patient was screened for PPD. The PDF file describes a quality improvement project that analyzed the implementation of a single intervention, which was the use of the EPDS-10 as a screening tool for PPD. While the project involved multiple components, such as staff education and process changes, the focus of the study was on the implementation of the EPDS-10 and its impact on PPD screening rates.

Intervention Results: The study results indicated significant improvements in screening and referral of postnatal depression within the 8-week period compared to previous practices. Specifically, the implementation of the EPDS-10 led to increased screening rates, with documentation of screening rates ranging from 88% to 99% after the implementation. The study also found a significant increase in the detection and treatment of postpartum depression when a standardized, validated screening tool like the EPDS-10 was implemented. Additionally, the study reported that out of the patients screened, nine patients were detected for further assessment and treatment. The results also showed a significant increase in the percentage of patients screened, from 10.9% to 95.8%, and a significant decrease in the percentage of patients who were not screened, from 89.1% to 4.2%, after the implementation of the EPDS-10. These findings suggest that the implementation of the EPDS-10 positively influenced providers to be more consistent with screening and documentation practices, ultimately leading to improved detection, further assessment, and treatment of postpartum patients

Conclusion: This project established an evidence-based standard of care that can be implemented with every postpartum patient and brought nine women out of the shadows with the hope that they can find the light to recover from PPD.

Study Design: The study design used in the research described in the PDF file is a retrospective-prospective chart audit design. This design involved a formative evaluation of the process of implementation through weekly huddles and individual discussions with clinic staff and licensed clinicians to assess the new screening process and the use of the EPDS-10. Additionally, a retrospective chart audit of the electronic health record (EHR) was performed to determine the number of screenings performed 8 weeks before the implementation, and a prospective chart audit was conducted to determine how many charts had documented screenings during the 8 weeks of the implementation. The study design also involved the analysis of pre- and post-implementation data to evaluate the screening practices and determine if there was a significant difference in screening, detection, and treatment before and after the implementation of the EPDS-10.

Setting: The setting of the study described in the PDF file is a private practice obstetrics and gynecology (OBGYN) office in South Florida. The study focused on implementing the evidence-based standard of care for postpartum depression screening within this clinical setting. The organization consisted of multidisciplinary aggregate stakeholders, including licensed healthcare providers and non-licensed clerical staff, all of whom were involved in the implementation process.

Population of Focus: The target audience of the study described in the PDF file is healthcare providers and staff working in a postpartum ambulatory clinic, specifically in the obstetrics and gynecology (OBGYN) setting. The study aimed to improve the detection and treatment of postpartum depression (PPD) in women by implementing an evidence-based standard of care for PPD screening that can be implemented with every postpartum patient. The study also aimed to enhance the knowledge and competency of healthcare providers and staff in PPD screening, assessment, diagnosis, and treatment referrals.

Sample Size: The PDF file does not explicitly mention the number of participants involved in the study. However, it provides specific data related to the screening and treatment of patients before and after the implementation of the Edinburgh Postnatal Depression Scale-10 (EPDS-10). It mentions that out of the 55 patients who were seen before the implementation of the EPDS-10, 6 patients (10.9%) had documentation in the electronic health record (EHR) that a postpartum depression screening was performed. Additionally, it states that out of the 48 postpartum patients seen after the implementation, 46 were screened with the EPDS-10. While the exact number of participants is not explicitly provided, the study does present specific data on the outcomes of the intervention.

Age Range: The PDF file does not specify the age range of the participants involved in the study. The focus of the study is on the implementation of the Edinburgh Postnatal Depression Scale-10 (EPDS-10) as a screening tool for postpartum depression in women. Therefore, the age range of the participants is not explicitly mentioned in the provided content.

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Hospital Policies,

Intervention Description: The intervention was the implementation of an evidence-based standard of care for the detection of PPD that can be implemented with every postpartum patient. The intervention included the use of the Edinburgh Postnatal Depression Scale-10 (EPDS-10) as a reliable and valid screening instrument for PPD. The intervention aligns with a discernable strategy, which is to improve screening practices for PPD in postpartum women. The strategy involved implementing an evidence-based standard of care that included the use of a validated screening tool, staff education, and process changes to ensure that every postpartum patient was screened for PPD. The PDF file describes a quality improvement project that analyzed the implementation of a single intervention, which was the use of the EPDS-10 as a screening tool for PPD. While the project involved multiple components, such as staff education and process changes, the focus of the study was on the implementation of the EPDS-10 and its impact on PPD screening rates.

Intervention Results: The study results indicated significant improvements in screening and referral of postnatal depression within the 8-week period compared to previous practices. Specifically, the implementation of the EPDS-10 led to increased screening rates, with documentation of screening rates ranging from 88% to 99% after the implementation. The study also found a significant increase in the detection and treatment of postpartum depression when a standardized, validated screening tool like the EPDS-10 was implemented. Additionally, the study reported that out of the patients screened, nine patients were detected for further assessment and treatment. The results also showed a significant increase in the percentage of patients screened, from 10.9% to 95.8%, and a significant decrease in the percentage of patients who were not screened, from 89.1% to 4.2%, after the implementation of the EPDS-10. These findings suggest that the implementation of the EPDS-10 positively influenced providers to be more consistent with screening and documentation practices, ultimately leading to improved detection, further assessment, and treatment of postpartum patients

Conclusion: This project established an evidence-based standard of care that can be implemented with every postpartum patient and brought nine women out of the shadows with the hope that they can find the light to recover from PPD.

Study Design: The study design used in the research described in the PDF file is a retrospective-prospective chart audit design. This design involved a formative evaluation of the process of implementation through weekly huddles and individual discussions with clinic staff and licensed clinicians to assess the new screening process and the use of the EPDS-10. Additionally, a retrospective chart audit of the electronic health record (EHR) was performed to determine the number of screenings performed 8 weeks before the implementation, and a prospective chart audit was conducted to determine how many charts had documented screenings during the 8 weeks of the implementation. The study design also involved the analysis of pre- and post-implementation data to evaluate the screening practices and determine if there was a significant difference in screening, detection, and treatment before and after the implementation of the EPDS-10.

Setting: The setting of the study described in the PDF file is a private practice obstetrics and gynecology (OBGYN) office in South Florida. The study focused on implementing the evidence-based standard of care for postpartum depression screening within this clinical setting. The organization consisted of multidisciplinary aggregate stakeholders, including licensed healthcare providers and non-licensed clerical staff, all of whom were involved in the implementation process.

Population of Focus: The target audience of the study described in the PDF file is healthcare providers and staff working in a postpartum ambulatory clinic, specifically in the obstetrics and gynecology (OBGYN) setting. The study aimed to improve the detection and treatment of postpartum depression (PPD) in women by implementing an evidence-based standard of care for PPD screening that can be implemented with every postpartum patient. The study also aimed to enhance the knowledge and competency of healthcare providers and staff in PPD screening, assessment, diagnosis, and treatment referrals.

Sample Size: The PDF file does not explicitly mention the number of participants involved in the study. However, it provides specific data related to the screening and treatment of patients before and after the implementation of the Edinburgh Postnatal Depression Scale-10 (EPDS-10). It mentions that out of the 55 patients who were seen before the implementation of the EPDS-10, 6 patients (10.9%) had documentation in the electronic health record (EHR) that a postpartum depression screening was performed. Additionally, it states that out of the 48 postpartum patients seen after the implementation, 46 were screened with the EPDS-10. While the exact number of participants is not explicitly provided, the study does present specific data on the outcomes of the intervention.

Age Range: The PDF file does not specify the age range of the participants involved in the study. The focus of the study is on the implementation of the Edinburgh Postnatal Depression Scale-10 (EPDS-10) as a screening tool for postpartum depression in women. Therefore, the age range of the participants is not explicitly mentioned in the provided content.