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Breaking through the Communications Clutter with “Ten Steps to Successful Breastfeeding”

In an effort to cut through the constant communications clutter – websites, e-newsletters, targeted text messages and mailings, plus a plethora of pregnancy and parenting magazines – that bombards women during pregnancy and during early motherhood, Pennsylvania Hospital is taking a fresh approach to help educate and inform staff and expectant mothers about the process and benefits of successful breast feeding.  10 Step Ribbon Cutting 1

Shown from L to R in theforeground are Daniel Feinberg, MD, chiefmedical officer, Jack Ludmir, MD,chair of Obstetrics and Gynecology; MichaelBuckley, MD, executive director, andMary Del Guidice, RN, MSN, BS, CENP, chief nursing officer, at PennsylvaniaHospital at the ribbon cutting marking the installation of “Ten Steps toSuccessful Breastfeeding.”

“Ten Steps to Successful Breastfeeding” were recently installed along the corridor floors of the Labor and Delivery and Maternity Units at the Hospital, making it literally and figuratively a “low” tech, yet clear and readily accessible public health messaging campaign. 10 Steps StartFunded by a state grant, the graphics create a visually fun pathway of footprints through the units. Each pathway is comprised of ten sets of footprints. Each individual footprint is dedicated to one of the ten steps – in English on the left and Spanish on the right.

The formal Ten Steps as established by the United Nations Children’s Fund (UNICEF) and the World Health Organization Baby-Friendly Hospital Initiative are:


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 newborn infants no food or drink other than breastmilk, unless medically indicated.

7 )

Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day while in the hospital.

8 )

Encourage breastfeeding on demand.

9 )

Give no pacifiers or artificial nipples to breastfeeding infants.


Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

Long known for obstetrical, gynecological and maternity care, Pennsylvania Hospital – the nation’s first hospital, where the most babies are delivered annually in the City of Philadelphia – is already recognized as an exemplary “breastfeeding friendly employer.”  This past summer, the hospital, along with the Hospital of the University of Pennsylvania, was also selected to participate in Best Fed Beginnings a first-of-its-kind national effort to significantly improve breastfeeding rates in US where rates are currently the lowest.

The participating hospitals are working together in a 22-month learning collaborative, using proven quality improvement methods to transform their maternity care services in pursuit of a "Baby-Friendly" designation. This designation will verify that a hospital has comprehensively implemented the American Academy of Pediatrics-endorsed Ten Steps to Successful Breastfeeding. Compared to national averages, breastfeeding rates are higher and disparities in these rates are virtually eliminated in hospitals that achieve the Baby-Friendly status.

“With the installation of Ten Steps, we kicked off our official baby-friendly journey to help significantly improve breastfeeding rates in the Philadelphia region,” said Debi Ferrarello, RN, MS, IBCLC, Director of Family Education. “At Pennsylvania Hospital we understand how a mother’s experience during her stay with us can strongly influence her ability to start and continue breastfeeding. We are committed to implementing evidence-based care through the Baby-Friendly designation process. This way we will ensure that mothers delivering in our hospital who want to breastfeed are fully supported. In the same respect, we’ll also ensure that mothers who are having difficulty or unable to breastfeed are also fully supported.”

There are many reasons to support concerted efforts to have all new mothers attempt, and if possible, sustain breast feeding for at least six months to a year. In addition to all the health benefits for mom and baby, breastfeeding can save time and money in the long run and it’s environmentally friendly. Sadly though, data shows that efforts throughout the state of Pennsylvania to support breastfeeding aren’t so great.

Back in August, the Centers for Disease Control and Prevention (CDC) released their annual Breastfeeding Report Card. The report was a mixed bag of results. Thanks to the efforts by Penn Medicine hospitals and others across the nation, the CDC and UNICEF/WHO, breastfeeding rates are on the rise in the U.S. However, PA lags behind the national average. For example, the report shows that nationally, close to 77 percent of all infants have been breastfed. In PA, it’s only 68 percent. And PA’s breast feeding numbers continue to drop, again below national averages, as infants age. PA also has a bottom-ranking Maternity Practices in Infant Nutrition and Care – or mPINC – score, which assesses overall maternity practices in infant and nutrition care across the nation.

According to research published in the June 2012 issue of the journal Pediatrics, many new mothers have every intention of breastfeeding – as much as 85 percent – plan to do it exclusively. But for various reasons, they can’t. Getting back to all the mass media and communications out there, I’m willing to bet that most women know either because they heard or read about it somewhere, that breastfeeding is beneficial for both mother and infant. So if the primary problem isn’t awareness, what is it? Education and support – or more precisely, the lack of it.

In the Pediatrics study researchers from the CDC’s Division of Nutrition, Physical Activity and Obesity looked into how hospital practices affect new mothers and their ability to achieve their desired personal breastfeeding goals. They found that the main factors affecting new mothers was either hospitals not following one of the Ten Steps for Successful Breastfeeding or hospital staff not helping moms adhere to baby-friendly policies such as maintaining skin-to-skin contact or enabling them to be with their babies 24 hours a day.

“It’s clear we need to focus on setting up our new mothers for success, especially those who want to breastfeed but are having difficulty,” said Ferrarello. “Educating our staff and new moms about the Ten Steps will help us do just that.” 


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