Baby-Friendly Hospital Initiative: An evaluation of a quality certificate within the maternity care context

BACKGROUND: To date, it has never been evaluated whether the way mothers perceive the Baby-Friendly Hospital Initiative (BFHI) matches the theoretical model. Furthermore, literature is not clear about the added value of... [ view full abstract ]

BACKGROUND: To date, it has never been evaluated whether the way mothers perceive the Baby-Friendly Hospital Initiative (BFHI) matches the theoretical model. Furthermore, literature is not clear about the added value of obtaining the official certificate.
AIMS/OBJECTIVES: To examine the association between level of baby-friendly care, perceived by mothers, and the initiation and continuation of breastfeeding.
METHOD: from October 2012 until September 2013 data were collected in seven Flemish maternity units. All mothers who met the inclusion criteria and consented (N=619), completed a questionnaire about perceived care. Breastfeeding mothers were followed up until seven months after birth. The level of baby-friendly care was defined by a factor analysis with principal axis factoring and varimax rotation. This analysis gave insight in how mothers perceived the baby-friendly principles and which factors proved important. Factor scores were used for further analyses. The project was approved by the Ethics Committees of all the participating hospitals.
FINDINGS: 492 mothers (79,5%) started breastfeeding. Seven months later, 24,5% of those mothers was continuing. More antenatal information about breastfeeding doubled the chance to initiate breastfeeding (OR 1,98; 95%CI 1,24-3,16) even after controlling for covariables. None of the baby-friendly principles showed any impact on the long term continuation of the breastfeeding. However, mothers who stopped breastfeeding within three days after birth scored significantly lower (p=.001) for ‘contact with a pacifier or formula feeding’ (mean -1,53) than mothers who continued (mean 0,07). The presence of the official BFHI certificate showed for neither of the two outcomes an effect.
CONCLUSIONS/IMPLICATIONS: ‘Antenatal information’ and ‘contact with a pacifier or formula feeding’ appeared to be the most important factors. According to this study, obtaining the official BFHI certificate did not show an added value on the initiation and continuation of breastfeeding.