Hospital breastfeeding policies in the Philadelphia area: a comparison with the ten steps to successful breastfeeding

The purpose of this study was to describe the current status of hospital breastfeeding policies and practices in the southeastern Pennsylvania Delaware Valley and the degree to which the hospitals are implementing the WHO/UNICEF Ten Steps to Successful Breastfeeding.

A descriptive case study design was used to collect data. From 38 hospitals with maternity services in the Philadelphia area, maternal and child health directors, nurse managers, staff nurses, lactation consultants, and childbirth educators were interviewed to determine each hospital's policies and practices, using a questionnaire addressing formal and informal breastfeeding policies. Information from the interviews was used to compare each hospital's policies with the WHO/UNICEF Baby-Friendly Hospital Initiative. A classification system was developed to classify hospitals by level of implementation for each of the Ten Steps.

Most surveyed hospitals were implementing four of the steps and partially implementing the remaining six. Thirty-seven percent of the surveyed hospitals were classified as high implementers and 63 percent as partial implementers of the Ten Steps overall. Key issues that affect implementation of each step were identified through in-depth discussion of several questions.

Areas identified as needing the greatest attention by hospitals were health care professional breastfeeding education, breastfeeding initiation, and support of the breastfeeding mother, particularly in the postdischarge stage.