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Barnes-Jewish Hospital Becoming Baby Friendly

Barnes-Jewish Hospital has been selected to participate in Best Fed Beginnings, a first-of-its-kind national effort to significantly improve breast-feeding rates in states where rates are lowest. During the next 18 months, Barnes-Jewish, along with 89 other selected hospitals, will work to earn a Baby-Friendly Hospital designation from Baby-Friendly USA, the accrediting body for the initiative in the United States.

In order to achieve that status, each hospital must verify it has comprehensively implemented the American Academy of Pediatrics-endorsed Ten Steps to Successful Breastfeeding program, as established in the World Health Organization/UNICEF Baby-Friendly Hospital Initiative. The National Initiative for Children’s Healthcare Quality, with support from the Centers for Disease Control and Prevention and Baby-Friendly USA, is leading the Best Fed Beginnings effort to help improve maternity care by increasing the number of U.S. hospitals participating in the Baby-Friendly Initiative.

“The hospitals chosen to participate in Best Fed Beginnings are now on the leading edge of maternity care in the United States and will serve as models for change for other hospitals throughout the country,” says Trish MacEnroe, executive director of Baby-Friendly USA.

Although breast-feeding is one of the most effective preventive health measures for infants and mothers, half of the babies born in the United States are given formula within the first week after birth; by nine months only 31 percent of babies are breast-fed. Best Fed Beginnings seeks to reverse this trend by dramatically increasing the number of U.S. hospitals implementing a proven model for maternity services that better supports a new mother’s choice to breast-feed.

Participating hospitals will use quality improvement methods that follow the Breakthrough Series approach pioneered by the Institute for Healthcare Improvement. Teams will work with each other and with national breast-feeding and quality-improvement experts through in-person learning sessions and subsequent action periods. Regional collaboratives will be established to help participating teams better connect to each other and to local resources.

“This is a fantastic opportunity to improve our Women and Infants Services to better support breast-feeding in the St. Louis community,” says Carol Scott, RN. “We recognize that for women who plan to breast-feed, the hospital experience strongly influences a mother’s ability to start and continue breast-feeding.

We are committed to implementing evidence-based care through the Baby-Friendly designation process. This will ensure that mothers delivering in our hospital who intend to breast-feed are fully supported.”

In 2011, 64.2 percent of new mothers in Missouri report attempting to breast-feed, compared to 70.6 percent of Illinois mothers, according to the Centers for Disease Control and Prevention’s Breast-Feeding Report Card. At Barnes-Jewish, the breast-feeding rate is approximately 49 percent. Breast-feeding rates in impoverished communities and among the African-American population traditionally are low. Barnes-Jewish delivers approximately 3,500 infants a year. Of that number, 64 percent are African-American and about 70 percent are insured through Medicaid.

Research has shown that breast-feeding has multiple health benefits for both infants and mothers. For infants, it decreases the incidence and severity of many infectious diseases, reduces infant mortality and optimally supports neurodevelopment. It also decreases infants’ risk of becoming obese later in childhood. For mothers, breast-feeding decreases the risks of breast and ovarian cancers, diabetes, rheumatoid arthritis and cardiovascular disease.

To learn more about the Best Fed Beginnings initiative, including a list of the participating hospitals, visit bjhne.ws/da.


  1. Maintain a written breast-feeding policy that is routinely communicated to all health care staff
  2. Train all health care staff in the skills necessary to implement this policy
  3. Inform all pregnant women delivering at Barnes-Jewish Hospital about the benefits and management of breast-feeding
  4. Help mothers initiate breast-feeding within one hour of delivery
  5. Demonstrate to mothers how to breast-feed and how to maintain lactation, even if they are separated from their infant
  6. Give infants no food or drink other than breast milk, unless medically indicated
  7. Practice rooming in—allowing mothers and infants to remain together 24 hours a day
  8. Encourage unrestricted breast-feeding
  9. Give no pacifiers or artificial nipples to breast-feeding infants
  10. Foster the establishment of breast-feeding support groups and refer mothers to them upon discharge from the hospital or clinic

* Steps devised by Baby-Friendly USA, with the World Health Organization and the United Nations Children’s Fund


What is Best Fed Beginnings and what is it trying to accomplish?

It is a federal program, supported by the Centers for Disease Control and Prevention and National Institutes for Children’s Health Quality, to help 89 hospitals across the United States implement the steps necessary to achieve Baby-Friendly USA designation. Barnes-Jewish Hospital will become a Baby-Friendly USA institution by September 2014.

Is the program designed to change a mother’s mind about breast-feeding?

Not necessarily. The goal is to ensure that those who already intend to breast-feed and those who are undecided are supported in exclusive breast-feeding during the hospital stay. And it’s never too late to ensure that a mother and her family have the most accurate information about breast-feeding so that they are educated and fully informed when making crucial infant feeding decisions.

What’s the best way to ask families whether they want to breast-feed or bottle feed?

An open-ended question—“What do you know about breast-feeding?— allows mothers and their partners to discuss what they know and provides an opportunity for correcting misinformation.

In a hospital that is focused on patient- and family-centered care, is there room for those who choose to bottle feed?

All families will receive the same high level of culturally sensitive, focused, supportive care. As a Baby-Friendly hospital, we will ensure that all families receive comprehensive information on the benefits of breast-feeding and the risks of formula feeding, documenting each step and choice in the medical record. We will help every parent provide skin-to-skin newborn care, teaching those who choose to formula feed the correct, formula-specific preparation methods while encouraging parent-newborn bonding.

How do we honor cultural differences and still promote what is best for breast-feeding mothers and infants?

With help from the Barnes-Jewish Center for Diversity and Cultural Competence, we will strive to ensure that all patients giving birth at Barnes-Jewish and their families receive complete, evidence-based infant feeding information. Once a family has made an informed decision, we will provide full support while they learn to feed and nurture their infant.

What teaching tools are available to help educate women and families?

Over the next 18 months, the Best Fed Beginnings steering team will develop the processes and tools needed to teach staff members, patients and families, and the community about this new focus in care. Teaching tools and up-to-date educational materials will become part of the standard work we do to support infant feeding.

What is being done to educate mothers and families before they arrive at the hospital?

Baby-Friendly USA-designated hospitals have systems in place to ensure breast-feeding education happens in the prenatal period. We will offer tools to providers and support staff that they can use throughout prenatal care to help promote breast-feeding.

What additional efforts are being made to improve prehospital decision-making and postdischarge education and support?

In addition to collaborating with our prenatal providers and support staff, we will develop relationships with community organizations and organize a Barnes-Jewish Hospital support group.

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