“Baby-Friendly USA”

Anderson Hospital6800 Illinois 162

Maryville, IL 62062

United Way of Greater St. LouisJanuary 5, 2015 – December 31, 2016

Requested: $232,974.28

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Table of Contents

Agency Description 3-4

Community Problem 5-10

Program Summary 11-18

Evaluation Method 17

Funding Request 20-22

Resources 23-24

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Agency Description

Anderson Hospital, established in 1977, is a not for profit hospital focusing on chartering

a healthcare setting and is the leader in providing and promoting quality healthcare in interest

with the communities served. Within Anderson Hospital is a cutting edge health care facility

known as The Pavilion for Women. The women’s pavilion is committed to caring for mothers

and infants by carefully designing the facility to meet the needs of expectant mothers, their

families, and the new babies. Anderson Hospital also has experience with outreach and

implementing community programs directly responding to community needs. Listed below are

some of the programs The Pavilion for Women provides for new mothers and their families.

o Breastfeeding Class – Basic concepts of breastfeeding are covered. The topics may

include, lifestyle changes, pumping, returning to work, and apparel.

o Prepared Childbirth Class – The class is designed for the birth mother and support

person. The class covers anatomy and physiology of labor, pain management

techniques, and birth plans and options.

o Prep School for Dads Class – This class focuses on Dad’s role in newborn development

and care. This class includes interactive session highlighting newborn care such as

bathing, diapering, swaddling, feeing, and comfort strategies.

o Refresher Class – This class is for expectant mothers who have had classes within the

last few years and want to refresh their knowledge.

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o Mom-to-Mom Group – This is a sharing group for new mothers. The mom-to-mom

group is an informal group in which you can find camaraderie, lactation support, and

share concerns and successes related to motherhood.

The Pavilion for Women demonstrates the dedicated compassion for expectant mothers, their

families, and newborn babies by offering several classes, lactation programs, and other gratis

options.

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Community Problem

According to Mary O’Connor M.D and breastfeedingbasics.org the Surgeon General

set a goal for breastfeeding in the United States in 2010. The goal stated that 75% of

women would breastfeed their newborns in the hospital, 50% would breastfeed until six

months of age and 25% of mothers would breastfeed until one year after birth. The Surgeon

General also set a goal that 40% of mothers would exclusively breastfeed their newborns at

three months of age and 17% would exclusively breastfeed their newborns at 6 months of

age. In 2010, it was the first year that the United States had met this goal. In 2010 the

National Immunization Survey also collected data pertaining to breastfeeding. The survey

showed that 25 states have greater than 75% of women breastfeeding at hospital discharge

and 14 states have greater than 50% of infants being breastfed at 6 months of age

(O’Connor, n.d). However, only ten states including Alaska, California, Colorado, Idaho,

Minnesota, Montana, New Hampshire, Oregon, Vermont and Washington have met all five

of the Healthy People 2010 objectives (O’Connor, n.d). The CDC stated that in 2011, only

54.4% of infants received skin-to-skin contact after vaginal birth with their mothers. In 2011,

37.1% of newborns were getting the benefit of rooming-in 23 hours a day with their

mothers (“Breastfeeding Report Card”, 2013, p. 3).

There are many circumstances that lead a new mother to not breastfeed for up to the

recommended minimum of at least the sixth month of life for their newborn infant

(Eidelman & Schanler, 2012). One of the most important factors contributing to this is the

limited resources. One reason that infants are not being breastfed for the adequate amount

of time is due to the amount of mothers and families that choose to have at home births.

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According to the CDC, less than one percent of births occur in the home but that percentage

has been on the rise since 2004 (MacDom, Mathews, & Declercq, n.d. p.3). In 2009, white

non-hispanic women were three to five times more likely to have an at home birth

(MacDom, Mathews, & Declercq, n.d., p.2). For other races, their percentages declined

between 1990 and 2004 but increased again in 2009. There has been a correlation between

home births and women who are 35 years and older, married and had other children

(MacDom, Mathews, & Declercq, n.d.). These women that are giving birth at home may not

have the access to education about the importance of breast feeding for both the mother

and infant. If a mother were to give birth at a hospital, especially a baby-friendly hospital,

they would at least receive some knowledge on the matter.

There are many consequences, good and bad, when it comes to breastfeeding. Both the

mother and the infant receive benefits from breastfeeding. Not only does the child benefit

from the breastfeeding by receiving complete nutrition and a decrease in illness, but the

mother also has a decrease in ovarian cancer, anemia and osteoporosis ("WHO | Infant and

young child feeding", 2014). Studies show that “breast fed children are less likely to contract

a number of diseases later in life, including juvenile diabetes, multiple sclerosis, heart

disease, and cancer before the age of 15” (“Baby-Friendly USA”, n.d.). By referencing these

existing issues related to mothers choosing formula over breastfeeding and educating and

essentially changing their minds, not only will the health of both mother and baby improve,

but the cost effects of both hospitals and government agencies will be greatly reduced,

causing the economy to feel relief.

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One of the most prominent problems of new mothers not breastfeeding in relation to

society is the money that is poured into the formula industries. The Special Supplement

Nutrition Program for Women, Infants, and Children is a program that provides participating

mothers and children with free infant formula. A report from the Economic Research

Service has shown that between 57 and 68 percent of all infant formula sold in the United

States is purchased through WIC (“Women, Infants, and Children. Food and Nutrition

Service”, 2014). The net wholesale price of infant formula bought through the WIC program

increases by an average 73 percent after inflation per 26 fluid ounces. Over the course of

one year the WIC program paid about $127 million for infant formula (“WIC. Food and

Nutrition Service”, 2014). During 2011, an average of almost 9 million women, infants, and

children were receiving WIC benefits each month. The WIC program was awarded $6.618

billion by congress in 2012 to accommodate its growing number participants due to the

economic status of the United States (“Nutrition Program Facts Food and Nutrition Service”

2012, p.3). Recent studies done by the U.S. Department of Agriculture states that women

who chose to breastfeed over buying infant formula could save $2,880.00 per year. This

money that is saved could be put back in the community and spent on local goods and

services.

Several promising programs have been introduced to help solve these issues related to

health and the economy, but one has overwhelmingly been the defining difference when it

comes to our specific society and culture. “The U.S. Baby-Friendly Hospital Initiative was

launched by the World Health Organization (WHO) and the United Nations Children’s Fund

(UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an

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optimal level of care for infant feeding and mother/baby bonding” (“Baby-Friendly USA”,

n.d.). Hospitals that are “baby-friendly” give new mothers the education, skills necessary

and confidence to successfully initiate and continue feeding their newborns by

breastfeeding or feeding formula safely. Compared to non-baby-friendly hospitals, the

initiation rate for breastfeeding was 83.8%, correlated to 69.5% as a national average

(Merewood, Megta, Chamberlain, Philipp, & Bauchner, 2005). The rate of exclusive

breastfeeding during the hospital stay in the Baby-Friendly hospitals was 78.4% compared

to the national mean of 46.3% (Merewood, Megta, Chamberlain, Philipp, & Bauchner,

2005).

Another significant program that has proven results is located in New York City, New

York and was brought about by then Mayor Mike Bloomberg. Under this voluntary program

known as the Latch On NYC Initiative, 27 of the city’s 40 birthing hospitals agreed to place

formula and “swag bags” (name given to bags given out to new parents including formula

and promoting bottle feeding) in a closet away from patients to only be given out upon

request. The initiative also requires a written medical reason for every bottle that is given to

the infant as well as a discussion from medical personnel about the benefits of

breastfeeding (Linge, 2012). While this program works by avoiding giving the new mothers

formula and extending the breastfeeding duration, many mothers felt that they were being

pressured to make the decision to breastfeed, when many new mothers make the decision

well before giving birth (Linge, 2012). Unfortunately, this program has no published results

in regard to their breastfeeding rates at this time, but the backlash of the Mayor and his

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program have been made very clear since the beginning of the initiative.

Out of all the hospitals in the United States, there are only 172 hospitals that use the

baby-friendly hospital initiative. Only 42 out of the 50 states have hospitals that are baby-

friendly (“Baby-Friendly USA, n.d.). This means that there are eight states that do not have

the option to go to a baby-friendly hospital. Some of the recurring findings regarding the

common problems related to either stopping breastfeeding prematurely or never attempt

to feed the infant breast milk from birth, tend to include issues surrounding lack of

education, lack of a support system, red or sore nipples, time constraints of working

mothers, and poor working conditions related to the pumping of breast milk on the job site

(Arora, McJunkin, Wehrer, & Kuhn, 2000, 1-2). In a survey published by the American

Adcademy of Pediatrics, an overwhelming number of new mothers stated that they would

most likely have pursued breastfeeding if they had more information on the topic in

prenatal classes, magazines, books, or television, as well as support from both the father of

the infant as well as other family members (Arora, McJunkin, Wehrer, & Kuhn, 2000). The

correlation between education and higher breastfeeding rates seem high through the

studies. If more mothers had access to education about breastfeeding, more would do so.

These programs both work for the same cause, which is to promote breastfeeding for at

least the first six months after birth. However, the U.S. Baby-Friendly Initiative is the best at

this moment to lead to more and better breastfeeding, which to leads to an improved

environment and economy as a nation.

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Program Summary

This proposal seeks to bring the “Baby-Friendly Hospital Initiative “(BFHI) to Anderson Hospital.

In order to make this change, the hospital must facilitate the “Ten Steps to Successful Breastfeeding.”

After the ten steps are accomplished, the hospital will then become “baby-friendly” and will therefore

become one of the most influential hospitals in the area. By facilitating this change, Anderson Hospital

will produce a higher number of breastfeeding mothers in the St. Louis area, and will therefore create a

healthier population of mothers and babies in the area. Both the mother and the infant receive many

benefits by delivering at a baby-friendly hospital. Mothers will receive education and support pertaining

to proper infant care and nutrition.

The ten steps needed in order for the hospital to be considered baby-friendly include:

1. Have a written breastfeeding policy that is routinely communicated to all health care

staff.

2. Train all health care staff in skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within one hour of birth.

5. Show mothers how to breastfeed and how to maintain lactation, even if they are

separated from their infants.

6. Give infants no food or drink other than breast-milk, unless medically indicated.

7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no pacifiers or artificial nipples to breastfeeding infants.

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10. Foster the establishment of breastfeeding support groups and refer mothers to them on

discharge from the hospital or birth cents.

Once these steps are done then Anderson Hospital will be the area’s only baby-friendly facility giving

mothers an optimal level of care for infant feeding and mother/baby bonding.

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Target Population

The Baby-Friendly Hospital Initiative at Anderson Hospital will attract pregnant women,

mothers, partners and aspiring mothers in the Saint Louis area. In 2012, there were 1,736 live births

at Anderson Hospital (IDPH, 2012). In Madison County there were 3,272 births in 2009 (IDPH 2010).

In St. Louis County there were 12,505 births in 2012. In St. Clair County there were 3,815 births in

2012.

Goals & Objectives

Goal: To make Anderson Hospital a baby-friendly hospital.

Objective 1: By May 1, 2015 Anderson Hospital will have a complete breastfeeding policy that will routinely be communicated to all health care staff.

Objective 2: By August 15, 2015 all health care staff at Anderson Hospital will be trained in the skills necessary to implement this policy.

Objective 3: By December 31, 2015 all breastfeeding support groups will be established.

Objective 4: By January 1, 2016 Anderson hospital will be considered Baby-Friendly and will begin implementation.

Goal 2: To raise the number of new mothers that exclusively breastfeed for the first 6 months of their infants life.

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Objective 1: By December 31, 2016, the number of mothers that breastfeed exclusively for the first 6 months of their infants life, will increase by 25% when compared to statistics gathered before implementation of the Baby-Friendly initiative.

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Activities

Activity Deadline

Gather existing breastfeeding data from Anderson Hospital (additional information also gathered in self-appraisal tool)

January 5, 2015

Acquire hospital CEO support letter January 15, 2015

Complete self-appraisal tool February 05, 2015

Form BF committee or task force March 01, 2015

Complete BFHI work plan April 01, 2015

Create breast feeding policy May 01, 2015

Construct staff training plan May 15, 2015

Devise prenatal & postpartum teaching plans

June 15, 2015

Form data collection plan July 1, 2015

Train Staff August 15, 2015

Collect data September 15, 2015

Implement plan October 31, 2015

Conduct readiness interview November 30, 2015

Participate in onsite assessment December 31, 2015

Gather new data to compare from Anderson Hospital with data collection plan after implementation

December 31, 2016

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Gather Existing Data: We will gather existing data from hospital questionnaires such as exit surveys

which will then be later used in comparing data after completion of the program to prove the program

was a success. Anderson Hospital will be given a self-appraisal tool from Baby Friendly USA that will

help with data gathering as well.

Acquire hospital CEO support letter: We will request a letter of intent from Anderson Hospital CEO and

President, Keith Page expressing his support of the Baby-Friendly Hospital Initiative coming to Anderson

Hospital. This letter will show the hospitals full support to the cause and its full cooperation to dedicate

itself to the 10 steps to becoming a baby friendly hospital as well as to continuing the challenge of

creating healthier babies and mothers.

Complete self-appraisal tool: This tool till be completed and upon completion, will gather information

about Anderson Hospital, their breastfeeding initiative and exclusivity rates. The facility will use this as

they plan to meet the Ten Steps for Successful Breastfeeding as well as in comparison to data collected

at the end of the program to prove that goal number two of raising the amount of mothers who choose

to breastfeed was achieved.

Breastfeeding committee: A committee will be formed that includes certified baby-friendly staff and

International Board Certified Lactation Consultants (IBCLC) will be formed in order to successfully guide

Anderson Hospital to baby-friendly status. This group of certified staff will assist patients and new

mothers in breastfeeding and any issues that may arise with one on one meetings as well as conducting

a support group.

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BFHI work plan: We will draft a work plan that addresses identified issues in the self-appraisal tool that

will lead to practice change. Baby Friendly USA will also give models of different action plans other

hospitals have used that have been successful.

Breastfeeding policy: A comprehensive hospital/birthing center infant feeding policy will be developed

including a complete infant feeding policy that explains that breastfeeding is a norm. This policy will

describe the remaining steps that will be enforced at the hospital.

Staff training plan/curriculum: A staff training plan will be created in order to ensure the staff has the

practical skills necessary to implement the policy. The BFHI will include an online development phase

tool kit which will include details on who should be included in the training and what content should be

provided.

Prenatal & Postpartum teaching plans: A teaching plan will be developed for cases of prenatal and

postpartum women at Anderson Hospital that support and reinforce the breastfeeding policy. These

plans will increase the knowledge surrounding breastfeeding for both mother and infant, and will lead to

longer breastfeeding rates.

Data collection plan: We will design and develop a data collection tool. BFHI will give recommendations

and guidance in their Development Phase Tool kit that will be provided. Along with this kit, BFUSA will

provide technical assistance after reviewing the plan.

Train staff & patient education: Staff involved in the BFHI that deal with maternity care including labor

and delivery nurses, doctors, and all staff that interact with mothers will be taught practical skills that

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would lead to improved breastfeeding rates. In this stage, an educational program for expecting women

will be developed.

Collect data: As discussed in BFUSA guidelines, Anderson Hospital will be able to implement a quality

improvement audit of maternity care practices and data will be collected after complete

implementation beings. Quality improvement activities will be continued after implementation and

before the end of the project to ensure all standards are being met.

Implementation of the International Code of Marketing of Breast Milk Substitutes: Anderson Hospital

will determine a fair market value of the supplements needed for infants such as nipples, pacifiers,

bottles and other feeding resources. Infant formula will continue to be provided at mothers’ discretion

after education surrounding infant nutrition is administered or medical issues regarding infant feeding

arise.

Readiness Assessment Interview: A 90-minute phone interview will be planned with BFUSA to assess

Anderson Hospital’s readiness to implement the program.

Onsite assessment: When all of the above are completed, Anderson Hospital will send a letter to BFUSA

requesting an onsite assessment to be scheduled. Along with the assessment, Anderson Hospital will

complete a pre-assessment narrative along with the most recent infant feeding policy.

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Evaluation Method

Using the data collection tools given to us by BFUSA, we will be able to assess Anderson Hospital’s

progression from January 1, 2015 to December 31, 2016. Every six months data will be collected. By the

program director, program coordinator and the program assistant. Changes will then be made

accordingly to enhance the programs benefits and exceed initiative expectations.

The two goals are to make Anderson Hospital a baby-friendly hospital and to increase the number of

mothers who exclusively breastfeed their children for the first six months. We ask these four questions

to guide this assessment:

1. Does Anderson Hospital have a complete breastfeeding policy?

2. Are all of Anderson Hospital’s staff trained in the necessary skills to educate mothers on

breastfeeding and mother/baby bonding?

3. Are there breastfeeding support groups for mothers to attend?

4. After checking in with new mothers after six months of birth, are they still exclusively

breastfeeding their infants?

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Funding Request

A. Salaries and Wages:

The Program Director will be hired to oversee the entire program and spend 100% of their time (FTE of 1.0) training staff, hiring, and supervising all aspects of the program. The director has the experience and educational background surrounding these types of programs and will assist in implementing the project as well as following the budget accordingly. The salary for this individual will be covered for the two years of the program until completion in December 2016.

$63,592.00 x1.0 x 2 = $127,184.00

A Program Coordinator will be a currently employed nurse on staff at Anderson Hospital working in the labor and delivery unit. This person will commit 20 hours/week (50% time) (FTE of .5) to the program and will assist to accomplish tasks such as developing the complete Breastfeeding Policy and implementing the steps needed to become ‘Baby-Friendly.’ The salary for this individual will be covered for the two years of the program until completion in December 2016.

$65,854,00 x 0.5 x 2 = $131,708.00

A Program Assistant will be a part-time assistant (80% time) (FTE .8) will be hired to assist the Program Coordinator and Director in activities such as clerical and administrative needs, finances, and coordinating sponsorships from any companies willing such as Medela and other breastfeeding companies or local Breastfeeding Task Forces. The salary for this individual will be covered for the two years of the program until completion in December 2016.

$32,743.00 x 0.8 x 2 = $52,388.80

Total Salaries = $311,280.80

B. Employee Benefits/Payroll Taxes: Total: $10,256.28

Health Insurance cost for full time employees:Director: $358 x 24 months = $8,592.00Coordinator: No cost for insurance. Not covered.Assistant: No cost for insurance. Not covered.

Unemployment:-$18,492.00 x 3 x .03 = $1,664.28

C. Conferences: Total: $1,000.00

The Program Coordinator will attend continuing education courses surrounding breastfeeding.

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-$500.00 x 2 = $1,000.00

D. Rent/Maintain Equipment Total: $100,000.00Use of a space for support groups and trainings will be provided by Anderson Hospital.

E. Supplies: Total: $17,340.00

Meeting Supplies: Provide for staff meetings, trainings, support groups etc. Pens: $126.00Pencils: $126.00Folders: $128.00Handouts: $400.00

Total: $780.00Office Supplies: Will be used for every work and training

Staples: $50.00File Folders: $75.00Envelopes: $75.00Printer paper: $150.00Ink: $550.00

Total: $900.00Postage: Used for necessities to mail patients and local citizens newsletters and special events

Postage: $360.00Handouts: $100.00Binding: $200.00

Total: $660.00Advertising (printing and publication): Used to market Anderson Hospital and its new program

Newspapers: $3,500.00Billboards: $7,500.00Magazines: $1,500.000Flyers: $1,250.00Handouts: $1,250.00

Total: $15,000Transportation: Any needed transportation will be provided by Anderson Hospital with use of company vehicles.

Total: $0.00

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Line Budget Breakdown

Direct ExpensesOne-Time Grant

RequestOther Funding &

In-Kind Contributions

Total Project Expense

Salaries and Wages $204,378.00 $106,908.80 $311,286.80

Employee Benefits/Payroll Taxes

$10,256.28 $0.00 $10,256.28

Consultants & Contract Services

$0.00 $0.00 $0.00

Supplies $1,680.00 $0.00 $1,680.00Telephone $0.00 $15.00 $15.00

Postage and Shipping

$660.00 $0.00 $660.00

Occupancy $0.00 $0.00 $0.00Rent/Maintain

Equipment$0.00 $100,000.00 $100,000.00

Printing and Publications (Advertising)

$15,000.00 $0.00 $15,000.00

Conferences, Meetings

$1,000.00 $0.00 $1,000.00

Insurance $0.00 $0.00 $0.00Local Transportation $0.00 $0.00 $0.00

TOTAL $232,974.28 $206,923.80 $439.898.08

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References

Arora, S., McJunkin, C., Wehrer, J., & Kuhn, P. (2000). Major factors influencing breastfeeding

rates: Mother's perception of father's attitude and milk supply. Pediatrics, 106(67), 1-5.

doi:10.1542/peds.106.5.e67

Baby-Friendly USA. (n.d.). Retrieved February 22, 2014, from

https://www.babyfriendlyusa.org/faqs/importance-of-breastfeeding

Breastfeeding Report Card. (2013, July). Retrieved April 18, 2014, from

http://www.cdc.gov/breastfeeding/pdf/2013breastfeedingreportcard.pdf

Eidelman, A. I., & Schanler, R. J. (2012, March). Breastfeeding and the Use of Human Milk.

Retrieved February 24, 2014, from

https://www2.aap.org/breastfeeding/files/pdf/Breastfeeding2012ExecSum.pdf

Linge, M. K. (2012, July 29). Mayor Bloomberg pushing NYC hospitals to hide baby formula so

more new moms will breast-feed | New York Post. Retrieved February 24, 2014, from

http://nypost.com/2012/07/29/mayor-bloomberg-pushing-nyc-hospitals-to-hide-baby-

formula-so-more-new-moms-will-breast-feed/

MacDom, M. F., Mathews, T. J., & Declercq, E. (n.d.). Home Births in the United States 1990-

2009. Retrieved February 22, 2014, from

http://www.cdc.gov/nchs/data/databriefs/db84.pdf

Merewood, A., Mehta, S. D., Chamberlain, L. B., Philipp, B. L., & Bauchner, H. (2005).

Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey.

Pediatrics, 116, 628-633. doi:10.1542/peds.2004-1636

Nutrition Program Facts Food and Nutrition Service. (2012, December). Retrieved February 24,

2014, from http://www.fns.usda.gov/sites/default/files/WIC-Fact-Sheet.pdf

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O'Conner, M. (n.d.). Breastfeeding Benefits & Barriers: Breastfeeding Statistics in the United

States. Breastfeeding Benefits & Barriers: Breastfeeding Statistics in the United States.

Retrieved April 17, 2014, from

http://www.breastfeedingbasics.org/cgibin/deliver.cgi/content/Introduction/sta_us.ht

WHO | Infant and young child feeding. (2014, February). Retrieved April 19, 2014, from

http://www.who.int/mediacentre/factsheets/fs342/en/

Women, Infants, and Children (WIC) | Food and Nutrition Service. (2014, February 14).

Retrieved from http://www.fns.usda.gov/wic/women-infants-and-children-wic

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