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Nurses' Perspectives of BFHI

June 2016

AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses, publishes several journals, including Nursing for Women's Health. The June/July 2016 is an issue you might want to pick up! Among the articles within this issue are Intimate Partner Violence, Preventing Newborn Falls, Intergenerational Cycle of Obesity, Zika Virus, Neonatal Resuscitation, and one that I'd like to highlight

Being a Texan, I was so proud to see a fellow Texas hospital, Harris Health System, Ben Taub Hospital in Houston receive their Baby Friendly Designation. Imagine my surprise to see a study they did on the nurses' perspectives of their path to the designation published in this journal!

 Nurses stethoscope

Although the study only contained 10 self-selected participants, there were common themes among each of the nurses interviewed. Being in the Baby-Friendly process myself currently, I can attest to observing the same themes in the nurses I work with. Here are the themes:

1. Resistance: this is a common issue with any change, but especially with such a major, all-encompassing change such as Baby-Friendly. Resistance was found among the staff, the providers, and patients. One quote stood out: "It was suggested that women may be more prepared and hence less resistant if during prenatal care they were successfully educated about breastfeeding and informed on what to expect when they came to the hospital to give birth" (Lundeen et al., 2016).

2. Culture: indicating the culture or paradigm of changing from the old standbys of a separate nursery, immediate weights following delivery, taking the baby away at night so the "mom can rest", and having only nursery nurses or only labor and delivery nurses. The move to the new culture of Baby-Friendly brought out fears and insecurities in staff, providers and patients.

3. Investment in the journey: "Adaptation to practice changes took approximately two years and ... key factors to successful adaptation included having an appealing staff education plan with engaged stakeholder involvement." All the nurses agreed that having a good education led to repetition which then brought about an effective change.

4. Teamwork: Researchers found that "teamwork between transition care nurses and the L&D nurses was an important factor for the successful implementation of the practice changes" (p 284). The first step this hospital took was to move the nursery nurses out to the bedside of laboring patients to care for transitioning newborns. Their job classification was then changed to "transition care nurse" and work began to increase trust in the nurses' skills and new co-workers. The care then moved to a shared model between the transition care nurses and L&D nurses, to work together as a cohesive pair for the mother/baby dyad. "Almost all of the participants explicitly described teamwork, interdisciplinary collaboration, and strong leadership as important factors in transitioning this enormous culture change to standard work" (p 285).

5. Source of pride: Receiving the BFHI designation, one of the first for a nonprofit US hospital, initiated a wave of pride among the entire hospital staff. Those interviewed who had participated in the project task force voiced a sense of accomplishment in "having influence and decision-making ability...a sense of developing something from nothing" (p 285).

This article is very encouraging for those hospital staff who are in the BFHI pathway, since many may feel disheartened and daunted in the setbacks which frequently occur with such a massive change.

From you, I would enjoy hearing your feelings, frustrations, and joys of the BFHI process. Do they mirror these themes? Share here on this forum...you're not alone!


Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA
Professional Development Educator, Step2Education International


Kathy's hospital Christus Santa Rosa Hospital - New Braunfels, successfully received their Baby Friendly Designation in November 2016.



Lundeen, S., Sorensen, S., Bland, M., George, S., and Snyder, B.  (2016).  Nurses' perspectives on the process of attaining baby-friendly designation.  Nursing for Women's Health. 20(3):276-287.

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