Abstract
Introduction. Health services and healthcare workers in hospitals that care for mothers and newborns, play an important role in the promotion and support of breastfeeding (BF). Despite all the knowledge regarding the advantages of breastfeeding, there are still numerous obstacles to its diffusion and promotion during the hospital stay for childbirth.Methods. In the year 2003 the Agency for Public Health of Lazio Region implemented a program to promote a regional network of hospitals to be accredited as Baby Friendly Hospitals (BFH)according to the 10 UNICEF/WHO steps . Seventeen hospitals out of 57 participated voluntarily; in these units about 23,000 births take place each year (45% of total births in the region). From September to November 2003, 61 healthcare workers (about four per unit) were trained with a 40-hour course. Throughout 2004, the 61 trainees trained 1,300 healthcare workers (midwives, physicians and nurses) at their units. To monitor the project two types of surveys were carried out, the first using the UNICEF Self Appraisal Tool, and the second, using a questionnaire on how the baby was fed during the hospital stay; both surveys were done in June 2003 and 2004.Results. In total, implementation of the 10 steps went from 38% in 2003 to 58% in 2004. At the baseline the most critical points were for the first step (11% of positive answers), the seventh (24%) and the tenth (21%). After one year, step 1 rose to 41%, step 7 to 41% and step ten to 52%. The percentage of exclusive BF during the hospital stay rose from 35% (2003) to 46% (2004).Conclusions. To our knowledge, this is the first BFH Italian initiative in which a such a large number of maternity units are involved on regional scale. Positive results were reached in BF rates but not as positive as results in the implementation of 10 steps. This demonstrates that the process of implementation of the 10 steps has to be carefully evaluated together with BF rates during hospital stay, at discharge and after.
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