Georgia Becomes Baby-Friendly One Hospital at a Time

Posted August 13, 2015 by Cindy Hutter

This is one of a series of posts for National Breastfeeding Month about NICHQ's work to improve breastfeeding-related maternity care practices in hospitals.

Black Mother in the Hospital Receiving Breastfeeding SupportFor DeKalb Medical Center in Decatur, Georgia, becoming designated as Baby-Friendly somehow always got relegated to a “someday list” when there was more time, more resources and fewer competing priorities.

Now, someday is today. DeKalb Medical became the first hospital in Georgia to earn Baby-Friendly accreditation, a status which is reserved for birthing facilities that meet recommended care guidelines for lactating mothers and their babies. Georgia families are grateful.

“We are getting women who live in other areas who end up driving by two other birthing hospitals because they want to come here. They tell us, ‘We heard you are friendly to babies,’” says Jamie Ray, RN, IBCLC, the obstetrical community educator in Women and Infants Service at DeKalb.

DeKalb was one of 89 hospitals across the country to participate in the NICHQ-led national learning collaborative called Best Fed Beginnings. This Center for Disease Control and Prevention-funded initiative helped hospitals improve breastfeeding-related maternity care practices and increased the number of Baby-Friendly hospitals in the U.S. by about 20 percent.

Prior to joining Best Fed Beginnings in 2012, DeKalb had already done away with its nursery to encourage mothers and babies to stay together (a practice known as “rooming-in”)—one of the Ten Steps to Successful Breastfeeding that supports breastfeeding and must be adopted to earn Baby-Friendly status. The hospital also had a basic breastfeeding policy.

“While we did have some of the Ten Steps in place, we quickly learned we were not really doing some of them right,” says Ray.

For example, while hospital staff did a good job helping babies to breastfeed while in the labor and delivery unit, the babies were wrapped in blankets instead of being placed skin-to-skin with their mothers. Evidence shows that this skin-to-skin contact facilitates breastfeeding.

The Best Fed Beginnings learning collaborative taught hospital staff the value of using quality improvement methods to test small changes, track results, tweak and repeat before committing to implementation throughout the system.

“The benefit of the collaborative process is teams, in this case hospitals, can hear from others experiencing similar challenges and learn what worked for them so each team isn’t reinventing the wheel,” says NICHQ’s Senior Director of Perinatal Projects Jennifer Ustianov, MS, BSN, RN, IBCLC. “It’s one of the most effective ways to implement change and do it rapidly.”

DeKalb is certainty an example of rapid change. When the hospital started in the collaborative in 2012, they documented that only 5 percent of vaginal births were followed with skin-to-skin contact between mom and baby. As part of a small test of change, the hospital improvement team, led by Ray, began educating staff about the benefits of skin-to-skin contact and as a result, they began to see their skin-to-skin rates rise.

“After the education, the next month our skin-to-skin numbers were at 24 percent, then 29 percent, then 33 percent,” recalls Ray. “Between December 2012 and January 2013 our skin-to-skin rate rose to 71 percent. It’s all from education.”

The hospital has maintained a skin-to-skin rate above 80 percent since January 2013, with an all-time high of 94 percent in April 2015.

“We’re so grateful for the opportunity to learn from NICHQ. One of the biggest lessons was when pursuing a big change, you have to get the staff involved in the planning and the implementation,” explains Ray. “Staff knew encouraging breastfeeding was the right thing, but didn’t think they had a voice, and you need that in a culture change.”

Two additional hospitals in Georgia have now earned Baby-Friendly designation. Emory University Hospital Midtown became designated in February 2015 and Doctors Hospital in March 2015. These hospitals also participated in the Best Fed Beginning initiative.

Learn more about NICHQ's breastfeeding work at

Read the Best Fed Beginnings final report.


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