2. 2
Table of Contents
Agency Description 3-4
Community Problem 5-10
Program Summary 11-18
Evaluation Method 17
Funding Request 20-22
Resources 23-24
3. 3
Agency Description
Anderson Hospital, established in 1977, is a not for profit hospital focusing on chartering
a healthcare setting and is the leader in providing and promoting quality healthcare in interest
with the communities served. Within Anderson Hospital is a cutting edge health care facility
known as The Pavilion for Women. The women’s pavilion is committed to caring for mothers
and infants by carefully designing the facility to meet the needs of expectant mothers, their
families, and the new babies. Anderson Hospital also has experience with outreach and
implementing community programs directly responding to community needs. Listed below are
some of the programs The Pavilion for Women provides for new mothers and their families.
o Breastfeeding Class – Basic concepts of breastfeeding are covered. The topics may
include, lifestyle changes, pumping, returning to work, and apparel.
o Prepared Childbirth Class – The class is designed for the birth mother and support
person. The class covers anatomy and physiology of labor, pain management
techniques, and birth plans and options.
o Prep School for Dads Class – This class focuses on Dad’s role in newborn development
and care. This class includes interactive session highlighting newborn care such as
bathing, diapering, swaddling, feeing, and comfort strategies.
o Refresher Class – This class is for expectant mothers who have had classes within the
last few years and want to refresh their knowledge.
4. 4
o Mom-to-Mom Group – This is a sharing group for new mothers. The mom-to-mom
group is an informal group in which you can find camaraderie, lactation support, and
share concerns and successes related to motherhood.
The Pavilion for Women demonstrates the dedicated compassion for expectant mothers, their
families, and newborn babies by offering several classes, lactation programs, and other gratis
options.
5. 5
Community Problem
According to Mary O’Connor M.D and breastfeedingbasics.org the Surgeon General
set a goal for breastfeeding in the United States in 2010. The goal stated that 75% of
women would breastfeed their newborns in the hospital, 50% would breastfeed until six
months of age and 25% of mothers would breastfeed until one year after birth. The Surgeon
General also set a goal that 40% of mothers would exclusively breastfeed their newborns at
three months of age and 17% would exclusively breastfeed their newborns at 6 months of
age. In 2010, it was the first year that the United States had met this goal. In 2010 the
National Immunization Survey also collected data pertaining to breastfeeding. The survey
showed that 25 states have greater than 75% of women breastfeeding at hospital discharge
and 14 states have greater than 50% of infants being breastfed at 6 months of age
(O’Connor, n.d). However, only ten states including Alaska, California, Colorado, Idaho,
Minnesota, Montana, New Hampshire, Oregon, Vermont and Washington have met all five
of the Healthy People 2010 objectives (O’Connor, n.d). The CDC stated that in 2011, only
54.4% of infants received skin-to-skin contact after vaginal birth with their mothers. In
2011, 37.1% of newborns were getting the benefit of rooming-in 23 hours a day with their
mothers (“Breastfeeding Report Card”, 2013, p. 3).
There are many circumstances that lead a new mother to not breastfeed for up to the
recommended minimum of at least the sixth month of life for their newborn infant
(Eidelman & Schanler, 2012). One of the most important factors contributing to this is the
limited resources. One reason that infants are not being breastfed for the adequate amount
6. 6
of time is due to the amount of mothers and families that choose to have at home births.
According to the CDC, less than one percent of births occur in the home but that percentage
has been on the rise since 2004 (MacDom, Mathews, & Declercq, n.d. p.3). In 2009, white
non-hispanic women were three to five times more likely to have an at home birth
(MacDom, Mathews, & Declercq, n.d., p.2). For other races, their percentages declined
between 1990 and 2004 but increased again in 2009. There has been a correlation between
home births and women who are 35 years and older, married and had other children
(MacDom, Mathews, & Declercq, n.d.). These women that are giving birth at home may not
have the access to education about the importance of breast feeding for both the mother
and infant. If a mother were to give birth at a hospital, especially a baby-friendly hospital,
they would at least receive some knowledge on the matter.
There are many consequences, good and bad, when it comes to breastfeeding. Both the
mother and the infant receive benefits from breastfeeding. Not only does the child benefit
from the breastfeeding by receiving complete nutrition and a decrease in illness, but the
mother also has a decrease in ovarian cancer, anemia and osteoporosis ("WHO | Infant and
young child feeding", 2014). Studies show that “breast fed children are less likely to contract
a number of diseases later in life, including juvenile diabetes, multiple sclerosis, heart
disease, and cancer before the age of 15” (“Baby-Friendly USA”, n.d.). By referencing these
existing issues related to mothers choosing formula over breastfeeding and educating and
essentially changing their minds, not only will the health of both mother and baby improve,
but the cost effects of both hospitals and government agencies will be greatly reduced,
7. 7
causing the economy to feel relief.
One of the most prominent problems of new mothers not breastfeeding in relation to
society is the money that is poured into the formula industries. The Special Supplement
Nutrition Program for Women, Infants, and Children is a program that provides participating
mothers and children with free infant formula. A report from the Economic Research
Service has shown that between 57 and 68 percent of all infant formula sold in the United
States is purchased through WIC (“Women, Infants, and Children. Food and Nutrition
Service”, 2014). The net wholesale price of infant formula bought through the WIC program
increases by an average 73 percent after inflation per 26 fluid ounces. Over the course of
one year the WIC program paid about $127 million for infant formula (“WIC. Food and
Nutrition Service”, 2014). During 2011, an average of almost 9 million women, infants, and
children were receiving WIC benefits each month. The WIC program was awarded $6.618
billion by congress in 2012 to accommodate its growing number participants due to the
economic status of the United States (“Nutrition Program Facts Food and Nutrition Service”
2012, p.3). Recent studies done by the U.S. Department of Agriculture states that women
who chose to breastfeed over buying infant formula could save $2,880.00 per year. This
money that is saved could be put back in the community and spent on local goods and
services.
Several promising programs have been introduced to help solve these issues related to
health and the economy, but one has overwhelmingly been the defining difference when it
comes to our specific society and culture. “The U.S. Baby-Friendly Hospital Initiative was
8. 8
launched by the World Health Organization (WHO) and the United Nations Children’s Fund
(UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an
optimal level of care for infant feeding and mother/baby bonding” (“Baby-Friendly USA”,
n.d.). Hospitals that are “baby-friendly” give new mothers the education, skills necessary
and confidence to successfully initiate and continue feeding their newborns by
breastfeeding or feeding formula safely. Compared to non-baby-friendly hospitals, the
initiation rate for breastfeeding was 83.8%, correlated to 69.5% as a national average
(Merewood, Megta, Chamberlain, Philipp, & Bauchner, 2005). The rate of exclusive
breastfeeding during the hospital stay in the Baby-Friendly hospitals was 78.4% compared
to the national mean of 46.3% (Merewood, Megta, Chamberlain, Philipp, & Bauchner,
2005).
Another significant program that has proven results is located in New York City, New
York and was brought about by then Mayor Mike Bloomberg. Under this voluntary program
known as the Latch On NYC Initiative, 27 of the city’s 40 birthing hospitals agreed to place
formula and “swag bags” (name given to bags given out to new parents including formula
and promoting bottle feeding) in a closet away from patients to only be given out upon
request. The initiative also requires a written medical reason for every bottle that is given to
the infant as well as a discussion from medical personnel about the benefits of
breastfeeding (Linge, 2012). While this program works by avoiding giving the new mothers
formula and extending the breastfeeding duration, many mothers felt that they were being
pressured to make the decision to breastfeed, when many new mothers make the decision
9. 9
well before giving birth (Linge, 2012). Unfortunately, this program has no published results
in regard to their breastfeeding rates at this time, but the backlash of the Mayor and his
program have been made very clear since the beginning of the initiative.
Out of all the hospitals in the United States, there are only 172 hospitals that use the
baby-friendly hospital initiative. Only 42 out of the 50 states have hospitals that are baby-
friendly (“Baby-Friendly USA, n.d.). This means that there are eight states that do not have
the option to go to a baby-friendly hospital. Some of the recurring findings regarding the
common problems related to either stopping breastfeeding prematurely or never attempt
to feed the infant breast milk from birth, tend to include issues surrounding lack of
education, lack of a support system, red or sore nipples, time constraints of working
mothers, and poor working conditions related to the pumping of breast milk on the job site
(Arora, McJunkin, Wehrer, & Kuhn, 2000, 1-2). In a survey published by the American
Adcademy of Pediatrics, an overwhelming number of new mothers stated that they would
most likely have pursued breastfeeding if they had more information on the topic in
prenatal classes, magazines, books, or television, as well as support from both the father of
the infant as well as other family members (Arora, McJunkin, Wehrer, & Kuhn, 2000). The
correlation between education and higher breastfeeding rates seemhigh through the
studies. If more mothers had access to education about breastfeeding, more would do so.
These programs both work for the same cause, which is to promote breastfeeding for at
least the first six months after birth. However, the U.S. Baby-Friendly Initiative is the best at
this moment to lead to more and better breastfeeding, which to leads to an improved
11. 11
Program Summary
Thisproposal seekstobringthe “Baby-FriendlyHospital Initiative“(BFHI) toAndersonHospital.
In orderto make thischange,the hospital mustfacilitate the “TenStepstoSuccessful Breastfeeding.”
Afterthe tenstepsare accomplished,the hospital willthenbecome “baby-friendly”andwill therefore
become one of the most influential hospitalsinthe area.Byfacilitatingthischange,AndersonHospital
will produce ahighernumberof breastfeedingmothersinthe St.Louisarea,and will therefore create a
healthierpopulationof mothersandbabiesinthe area. Both the motherandthe infantreceive many
benefitsbydeliveringata baby-friendlyhospital. Motherswill receive educationandsupportpertaining
to properinfantcare and nutrition.
The ten stepsneededinorderforthe hospital tobe consideredbaby-friendlyinclude:
1. 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 infants no food or drink other than breast-milk, unless medically indicated.
7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
12. 12
10. Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or birth cents.
Once these stepsare done thenAndersonHospital will be the area’sonlybaby-friendlyfacilitygiving
mothersan optimal level of care forinfantfeedingandmother/babybonding.
13. 13
Target Population
The Baby-FriendlyHospital Initiative atAndersonHospital will attractpregnantwomen,
mothers,partnersandaspiringmothersinthe SaintLouisarea.In 2012, there were 1,736 live births
at AndersonHospital (IDPH,2012). In MadisonCountythere were 3,272 birthsin 2009 (IDPH2010).
In St.LouisCountythere were 12,505 birthsin2012. InSt. ClairCountythere were 3,815 birthsin
2012.
Goals & Objectives
Goal: To make AndersonHospital ababy-friendlyhospital.
Objective 1:ByMay 1, 2015 AndersonHospital will have acomplete breastfeedingpolicythatwill
routinelybe communicatedtoall healthcare staff.
Objective 2:ByAugust15, 2015 all healthcare staff at AndersonHospital willbe trainedinthe skills
necessarytoimplementthispolicy.
Objective 3:ByDecember31, 2015 all breastfeedingsupportgroupswill be established.
Objective 4: ByJanuary1, 2016 Andersonhospitalwillbe consideredBaby-Friendlyandwill begin
implementation.
Goal 2: To raise the numberof newmothersthat exclusivelybreastfeedforthe first6 monthsof
theirinfantslife.
14. 14
Objective 1:ByDecember31, 2016, the numberof mothersthatbreastfeedexclusivelyforthe first6
monthsof theirinfantslife,will increase by25% whencomparedto statisticsgatheredbefore
implementationof the Baby-Friendlyinitiative.
15. 15
Activities
Activity Deadline
Gather existing breastfeeding data from
Anderson Hospital (additional information
also gathered in self-appraisal tool)
January 5, 2015
Acquire hospital CEO support letter January 15, 2015
Complete self-appraisal tool February 05, 2015
Form BF committee or task force March 01, 2015
Complete BFHI work plan April 01, 2015
Create breast feeding policy May 01, 2015
Construct staff training plan May 15, 2015
Devise prenatal & postpartum teaching
plans
June 15, 2015
Form data collection plan July 1, 2015
Train Staff August 15, 2015
Collect data September 15, 2015
Implement plan October 31, 2015
Conduct readiness interview November 30, 2015
Participate in onsite assessment December 31, 2015
Gather new data to compare from Anderson
Hospital with data collection plan after
implementation
December 31, 2016
16. 16
GatherExisting Data: We will gatherexistingdatafromhospital questionnairessuchasexitsurveys
whichwill thenbe laterusedincomparingdataaftercompletionof the programto prove the program
was a success. Anderson Hospital will be givenaself-appraisal tool fromBabyFriendlyUSA thatwill
helpwithdatagatheringas well.
Acquire hospital CEO support letter: We will requestaletterof intentfromAndersonHospital CEOand
President,KeithPage expressinghissupportof the Baby-FriendlyHospital Initiative comingtoAnderson
Hospital.Thisletterwillshowthe hospitalsfull supporttothe cause and itsfull cooperationtodedicate
itself tothe 10 stepsto becomingababyfriendlyhospitalaswell astocontinuingthe challengeof
creatinghealthierbabiesandmothers.
Complete self-appraisal tool:Thistool till be completedanduponcompletion,will gatherinformation
aboutAndersonHospital,theirbreastfeedinginitiativeandexclusivityrates.The facilitywill use thisas
theyplanto meetthe TenStepsfor Successful Breastfeedingaswell asincomparisontodata collected
at the endof the program to prove that goal numbertwoof raisingthe amountof motherswhochoose
to breastfeedwasachieved.
Breastfeedingcommittee:A committee will be formedthatincludescertifiedbaby-friendlystaff and
International BoardCertifiedLactationConsultants(IBCLC)willbe formedinordertosuccessfullyguide
AndersonHospital tobaby-friendlystatus.Thisgroupof certifiedstaff will assistpatientsandnew
mothersinbreastfeedingandanyissuesthatmayarise withone onone meetingsaswell asconducting
a supportgroup.
17. 17
BFHI work plan: We will drafta work planthat addressesidentifiedissuesinthe self-appraisaltool that
will leadtopractice change.BabyFriendlyUSA will alsogive modelsof differentactionplansother
hospitalshave usedthathave beensuccessful.
Breastfeedingpolicy:A comprehensivehospital/birthingcenterinfantfeedingpolicywillbe developed
includingacomplete infantfeedingpolicythatexplainsthatbreastfeedingisanorm.Thispolicywill
describe the remainingstepsthatwill be enforcedatthe hospital.
Staff training plan/curriculum:A staff trainingplanwill be createdinorderto ensure the staff hasthe
practical skillsnecessarytoimplementthe policy. The BFHIwill include anonlinedevelopmentphase
tool kitwhichwill include detailsonwhoshouldbe includedinthe trainingandwhatcontent shouldbe
provided.
Prenatal & Postpartum teachingplans: A teachingplanwill be developedforcasesof prenatal and
postpartumwomenatAndersonHospital thatsupportandreinforce the breastfeedingpolicy.These
planswill increase the knowledge surroundingbreastfeedingforbothmotherandinfant,andwill leadto
longerbreastfeedingrates.
Data collectionplan: We will designanddevelopadatacollectiontool.BFHIwill give recommendations
and guidance intheirDevelopmentPhase Tool kitthatwill be provided.Alongwiththiskit,BFUSA will
provide technical assistance afterreviewingthe plan.
Train staff& patienteducation: Staff involvedinthe BFHIthat deal withmaternitycare includinglabor
and deliverynurses,doctors,andall staff that interactwithmotherswill be taughtpractical skillsthat
18. 18
wouldleadtoimprovedbreastfeedingrates.Inthisstage,aneducational programforexpectingwomen
will be developed.
Collectdata: AsdiscussedinBFUSA guidelines,AndersonHospitalwillbe able toimplementaquality
improvementauditof maternitycare practicesanddata will be collectedaftercomplete
implementationbeings.Qualityimprovementactivitieswill be continuedafterimplementationand
before the endof the projectto ensure all standardsare beingmet.
Implementationofthe International Code of Marketingof Breast MilkSubstitutes: AndersonHospital
will determine afairmarketvalue of the supplementsneededforinfantssuchasnipples,pacifiers,
bottlesandotherfeedingresources.Infantformulawill continuetobe providedatmothers’discretion
aftereducationsurroundinginfantnutritionisadministeredormedical issuesregardinginfantfeeding
arise.
ReadinessAssessmentInterview: A 90-minute phone interview will be plannedwithBFUSA toassess
AndersonHospital’sreadinesstoimplementthe program.
Onsite assessment:Whenall of the above are completed,AndersonHospitalwillsendalettertoBFUSA
requestinganonsite assessmenttobe scheduled.Alongwiththe assessment,AndersonHospital will
complete apre-assessmentnarrativealongwiththe mostrecentinfantfeedingpolicy.
19. 19
Evaluation Method
Usingthe data collectiontoolsgiventousbyBFUSA, we will be able toassessAndersonHospital’s
progressionfromJanuary1, 2015 to December31,2016. Everysix monthsdata will be collected.Bythe
program director,programcoordinatorandthe program assistant.Changeswill thenbe made
accordinglytoenhance the programsbenefitsandexceedinitiative expectations.
The two goalsare to make AndersonHospital ababy-friendlyhospital andtoincrease the numberof
motherswhoexclusivelybreastfeedtheirchildrenforthe firstsix months.We askthese fourquestions
to guide thisassessment:
1. Does Anderson Hospital have a complete breastfeeding policy?
2. Are all of Anderson Hospital’s staff trained in the necessary skills to educate mothers on
breastfeeding and mother/baby bonding?
3. Are there breastfeeding support groups for mothers to attend?
4. After checking in with new mothers after six months of birth, are they still exclusively
breastfeeding their infants?
20. 20
Funding Request
A. Salaries and Wages:
The Program Director will be hired to oversee the entire program and spend 100% of
their time (FTE of 1.0) training staff, hiring, and supervising all aspects of the program.
The director has the experience and educational background surrounding these types of
programs and will assist in implementing the project as well as following the budget
accordingly. The salary for this individual will be covered for the two years of the
program until completion in December 2016.
$63,592.00 x1.0 x 2 = $127,184.00
A Program Coordinator will be a currentlyemployednurse onstaff atAndersonHospital
workinginthe laborand deliveryunit. Thispersonwill commit20 hours/week(50% time) (FTE
of .5) to the programand will assisttoaccomplishtaskssuchas developingthe complete
BreastfeedingPolicyandimplementingthe stepsneededtobecome ‘Baby-Friendly.’The salary
for thisindividual will be coveredforthe twoyearsof the programuntil completionin
December2016.
$65,854,00 x 0.5 x 2 = $131,708.00
A Program Assistant will be a part-time assistant (80% time) (FTE .8) will be hired to
assist the Program Coordinator and Director in activities such as clerical and
administrative needs, finances, and coordinating sponsorships from any companies
willing such as Medela and other breastfeeding companies or local Breastfeeding Task
Forces. The salary for this individual will be covered for the two years of the program
until completion in December 2016.
$32,743.00 x 0.8 x 2 = $52,388.80
Total Salaries = $311,280.80
B. Employee Benefits/Payroll Taxes: Total: $10,256.28
Health Insurance cost for full time employees:
Director: $358 x 24 months = $8,592.00
Coordinator: No cost for insurance. Not covered.
Assistant: No cost for insurance. Not covered.
Unemployment:
-$18,492.00 x 3 x .03 = $1,664.28
C. Conferences: Total: $1,000.00
The Program Coordinator will attend continuing education courses surrounding
breastfeeding.
21. 21
-$500.00 x 2 = $1,000.00
D. Rent/Maintain Equipment Total: $100,000.00
Use of a space for supportgroupsand trainingswill be providedbyAndersonHospital.
E. Supplies: Total: $17,340.00
Meeting Supplies: Provide for staff meetings, trainings, support groups etc.
Pens: $126.00
Pencils: $126.00
Folders: $128.00
Handouts: $400.00
Total: $780.00
Office Supplies: Will be used for every work and training
Staples: $50.00
File Folders: $75.00
Envelopes: $75.00
Printer paper: $150.00
Ink: $550.00
Total: $900.00
Postage: Used for necessities to mail patients and local citizens newsletters and special
events
Postage: $360.00
Handouts: $100.00
Binding: $200.00
Total: $660.00
Advertising (printing and publication): Used to market Anderson Hospital and its new
program
Newspapers: $3,500.00
Billboards: $7,500.00
Magazines: $1,500.000
Flyers: $1,250.00
Handouts: $1,250.00
Total: $15,000
Transportation: Any needed transportation will be provided by Anderson Hospital with
use of company vehicles.
Total: $0.00
22. 22
Line Budget Breakdown
Direct Expenses
One-Time Grant
Request
Other Funding &
In-Kind
Contributions
Total Project
Expense
Salaries and Wages $204,378.00 $106,908.80 $311,286.80
Employee Benefits/
Payroll Taxes
$10,256.28 $0.00 $10,256.28
Consultants &
Contract Services
$0.00 $0.00 $0.00
Supplies $1,680.00 $0.00 $1,680.00
Telephone $0.00 $15.00 $15.00
Postage and
Shipping
$660.00 $0.00 $660.00
Occupancy $0.00 $0.00 $0.00
Rent/Maintain
Equipment
$0.00 $100,000.00 $100,000.00
Printing and
Publications
(Advertising)
$15,000.00 $0.00 $15,000.00
Conferences,
Meetings
$1,000.00 $0.00 $1,000.00
Insurance $0.00 $0.00 $0.00
Local Transportation $0.00 $0.00 $0.00
TOTAL $232,974.28 $206,923.80 $439.898.08
23. 23
References
Arora, S., McJunkin, C., Wehrer, J., & Kuhn, P. (2000). Major factors influencing breastfeeding
rates: Mother's perception of father's attitude and milk supply. Pediatrics, 106(67), 1-5.
doi:10.1542/peds.106.5.e67
Baby-Friendly USA. (n.d.). Retrieved February 22, 2014, from
https://www.babyfriendlyusa.org/faqs/importance-of-breastfeeding
Breastfeeding Report Card. (2013, July). Retrieved April 18, 2014, from
http://www.cdc.gov/breastfeeding/pdf/2013breastfeedingreportcard.pdf
Eidelman, A. I., & Schanler, R. J. (2012, March). Breastfeeding and the Use of Human Milk.
Retrieved February 24, 2014, from
https://www2.aap.org/breastfeeding/files/pdf/Breastfeeding2012ExecSum.pdf
Linge, M. K. (2012, July 29). Mayor Bloomberg pushing NYC hospitals to hide baby formula so
more new moms will breast-feed | New York Post. Retrieved February 24, 2014, from
http://nypost.com/2012/07/29/mayor-bloomberg-pushing-nyc-hospitals-to-hide-baby-
formula-so-more-new-moms-will-breast-feed/
MacDom, M. F., Mathews, T. J., & Declercq, E. (n.d.). Home Births in the United States 1990-
2009. Retrieved February 22, 2014, from
http://www.cdc.gov/nchs/data/databriefs/db84.pdf
Merewood, A., Mehta, S. D., Chamberlain, L. B., Philipp, B. L., & Bauchner, H. (2005).
Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey.
Pediatrics, 116, 628-633. doi:10.1542/peds.2004-1636
Nutrition Program Facts Food and Nutrition Service. (2012, December). Retrieved February 24,
2014, from http://www.fns.usda.gov/sites/default/files/WIC-Fact-Sheet.pdf
24. 24
O'Conner, M. (n.d.). Breastfeeding Benefits & Barriers: Breastfeeding Statistics in the United
States. Breastfeeding Benefits & Barriers: Breastfeeding Statistics in the United States.
Retrieved April 17, 2014, from
http://www.breastfeedingbasics.org/cgibin/deliver.cgi/content/Introduction/sta_us.ht
WHO | Infant and young child feeding. (2014, February). Retrieved April 19, 2014, from
http://www.who.int/mediacentre/factsheets/fs342/en/
Women, Infants, and Children (WIC) | Food and Nutrition Service. (2014, February 14).
Retrieved from http://www.fns.usda.gov/wic/women-infants-and-children-wic
