The baby friendly hospital initiative : level of implementation in ten New Zealand hospitals : a thesis submitted in partial fulfilment of requirements for the degree of Master of Philosophy in Midwifery at Massey University

Abstract

The potential benefits of breastfeeding are well documented. These include benefits for the infant which may extend into adult life, as well as benefits for the mother, the family, the economy, and the environment. Yet despite this, breastfeeding rates in New Zealand are not improving, and there is evidence of practices in New Zealand hospitals which have a negative influence on breastfeeding. One possible solution to this is to try to improve hospital policies and practices through implementation of the Global Baby Friendly Hospital Initiative (WHO/UNICEF, 1989). The purpose of this study was to ascertain the level of implementation of BFHI related policies and practices in New Zealand hospitals which provide maternity services. A descriptive survey utilizing face to face interviews of groups of 2-6 participants was undertaken in ten hospitals located in the North Island of New Zealand. Respondents included midwifery managers, lactation consultants, midwives, and nurses, familiar with their hospital's breastfeeding policy and practices. An adapted questionnaire and classification system developed by Kovach (1995) classified hospitals within four levels of implementation ranging from high, moderately high, partial, and low. Most of the hospitals were implementing six of the Ten Steps. The majority were not fully implementing Steps 1 and 2, and some hospitals had insufficient knowledge of current practices to be able to demonstrate implementation of Steps 3 and 5. The area identified as needing the greatest attention by hospitals is staff education on breastfeeding. Overall, five hospitals were classified as high implementers and five as moderately high, however no hospital was considered to be fully implementing BFHI. The study identified four main findings: a lack of consistent breastfeeding definitions and insufficient knowledge of exclusive breastfeeding rates; current difficulties in obtaining data, particularly about self-employed Lead Maternity Carer (LMC) practices; a lack of staff knowledge and misperceptions about the BFHI; and a gap between recommended evidence-based practices and reported breastfeeding practices in the surveyed hospitals.