The Effect of Breastfeeding Intervening Program in the Non-Authorized Baby-Friendly Hospital

Background: The program of “baby-friendly hospital” gave fresh impetus to enhance the rate of effectively feeding of mother's milk in Taiwan area. Fifty-two percent babies were born in authorized “baby-friendly hospital”. According to the authorized “baby-friendly hospital” qualifications, there is an almost 100% attending rate in medical centers and regional hospitals, while community hospitals only account for 41.5%. Even though the breastfeeding rate in private obstetrics clinics is only 3.5%, the birth number rate is up to 32.5% of the yearly total birth. The breastfeeding rates at non-authorized “baby-friendly hospitals”, which are classified as community hospital or private obstetrics clinics, can still have a lot of room for improvements.

Purpose:The primary objective of this research is to find out the proper strategies for improving breastfeeding care quality and breastfeeding rate of the postpartum women who were delivered in “non-authorized baby-friendly hospital”, and evaluating its efficacy.

Methods:For reaching the goals, this research was split into 2 steps. In the first step, systematic data collection and focus group research were used to establish standard intervention strategies, cross-sectional study of nurses’ attitudes toward breastfeeding, knowledge and behavioral factors, as well as the opinions and expectations of postpartum women and their family. Samples were divided into two groups, experimental (non-authorized baby-friendly hospital) and control (baby-friendly hospital). Developing the breastfeeding promoting and combined care program was evaluated by comparing the difference between these two study groups. The goal of this clinical breastfeeding promoting and combined care program is to provide a useful reference in increasing the breastfeeding rate for the women who were delivered in “non-authorized baby-friendly hospital”. The second step- the prospective longitudinal research design was adopted, and separated subjects by randomized control and treatment group design to assess the outcomes in four “non-authorized baby-friendly hospital”. The intervening strategies and combined care program is focus on the breastfeeding related job educational training for the nurse who worked in study groups. This effect was measured by the postpartum women’s breastfeeding rate, the breastfeeding related knowledge, attitude, self-efficacy and experience.

Results:First step- The effective sample is 350 into analysis. Breastfeeding rate is 63.4% in hospitalization, 82.4% at first month after birth, 58.5% at fourth month after birth and 49.8% at sixth month after birth. This breastfeeding rate of the women who had delivered baby in “non-authorized baby-friendly hospital” is lower than the government announced rate. The nurses worked in non-authorized “baby-friendly hospital” had lower scores in breastfeeding knowledge and attitude scales. The nurses also had less breastfeeding education in “non-authorized baby-friendly hospital”. Based on this result, improving the nurses’ breastfeeding knowledge and care ability related education program should be a key intervention and consequently increasing the postpartum women’s breastfeeding rate and duration of persistent breastfeeding.    Second step- The efficacy of the breastfeeding intervening strategies and combined care program was then evaluated. The results showed that the score of the breastfeeding related knowledge, attitude, and self-efficacy of the study groups’ nurses were higher than the control groups’, and the postpartum women’s problems in breastfeeding experience had lower of study group than the control group. But the duration of persistent breastfeeding had no difference between the study and control group.

Conclusion: The results of this study might helpful to establish the breastfeeding model in the “non-authorized baby-friendly hospital” (community hospital and private obstetrics clinics). Providing specified suggestions and standardizations, being the references of health policy in the future.