Improving Exclusive Breastfeeding by Changing Hospital Practices

Saturday, 7 November 2015

Gwendolen Wheeler, MSN, BSN, RNC-OB, C-EFM
Maternal Child Units, Methodist LeBonheur Healthcare, Germantown, TN, USA
Brittney M. Baird, MSN, RN, RNC-OB, C-EFM
OB Services, Methodist Hospital Germantown Hospital, Germantown, TN, USA
Carla E. Rider, MBA, MSN, RNC-LRN
Women's Service Line, West Florida Healthcare, Pensacola, FL, USA


Hospital practices interfere with successful breastfeeding in the hospital setting.  The Baby Friendly ten steps to successful breastfeeding can improve breastfeeding and provide multiple health benefits for the mother and newborn, yet nurses do not consistently implement these practices.  Through the Maternal-Child Health Nurse Leadership Academy (MCH) sponsored by Sigma Theta Tau International (STTI) and the program sponsor Johnson & Johnson a triad team consisting of Carla Rider, the Faculty Mentor, Brittney Baird, the Leadership Mentor, and Gwendolen Wheeler, the Scholar embarked on an 18-month project. The project allowed the Scholar to facilitate teams to improve exclusive breastmilk feedings at discharge with ongoing mentorship to obtain, practice, and polish leadership skills guided by Kouzes and Posners Leadership Challenge concepts.   

Aim/Goal/Purpose Sentence

The purpose of this presentation is describe a journey to improve exclusive breastfeeding rates by implementing the ten steps of successful breastfeeding and improve patient satisfaction to support optimal maternal child health. 


The objective to improve exclusive breastfeeding in the hospital setting started by educating over 300 nurses on the Baby Friendly ten steps to successful breastfeeding and evidenced-based policy and  guidelines to coach women to exclusively breastfeed and support mothers feeding preference.  Focus groups identified three of the ten steps to strive for improvements. Monthly audits converted to metrics were disseminated to team members who set goals and used PDSA cycles for practice improvements. Audits for step four revealed the number of newborns who had skin-to-skin contact and breastfeed in the first hour of life.  Audits for step seven revealed the number of newborns who had initial newborn assessments and baths at the mother’s bedside reflecting a change in location of the newborn from birth to allow rooming in and allowing the mother and newborn to stay together. Audits for step six revealed the number of newborns discharged from the well-baby setting who had exclusive breastmilk feedings, and based on mother’s desires to breast milk feed, those that accomplished this at discharge and medically indications for not accomplishing this goal.  

The objective to improve the patient experience was measured through the Hospital Consumer Assessment of Healthcare providers and Systems (HCAHPS) score, Press Ganey patient satisfaction survey scores, patient testimonies, and though online patient comments.


The hospital deliveries 4,800 babies a year.  After a 10 month study period, the overall range of breastfeeding rate increased from 50% to 58%.  The ten month top performance month showed 29 more mothers exclusively breastfeed their babies from birth to hospital discharge from the well baby nursery.  During the first hour of life, 139 more mothers and newborns benefited from skin to skin and 220 mother’s breastfed considering her feeding preference.  This reflects a 22% over baseline rate.  To promote rooming-in and allowing the mothers and newborn to stay together, 294 (83%) newborns had the initial nursing assessment at the mother’s bedside and 267 (75%) newborns had the newborn bath at the mother’s bedside.  These results reflect the majority of the initial assessments and baths are now being done as rooming in.  The patient satisfaction scores remained consistently high and patient comments reflected high remarks for the changes in hospital practices supporting their care.


Leadership skills were enhanced by introducing an evidenced-based, quality improvement project using Lewin’s Theory of Change and the Maternal Role Attainment Theory.  Skills were gained in metric measurement, goal setting with teams, and creating outcome graphs. Collaboration and team building with multi-disciplinary team members including more than 300 maternal child nurses, management and administrative leaders, physicians, marketing, and informatics was achieved.  Building high performing teams, enhancing other’s leadership abilities, and increasing employee pride provided patient safety.  Patient-centered care was enhanced by increasing maternal confidence and skills to bond, feed, and comfort the newborn.  In addition, patient centeredness added to the increase in patient satisfaction and accomplishment when caring for their newborn. 

Future hospital goals may be decided on to gain accreditation for a center of excellence in breastfeeding by obtaining the Baby-Friendly Hospital status for successfully implementing the ten steps to successful breastfeeding.  This project will assist the hospital in the process to achieve this goal for improvement.