Date of Defense


Date of Graduation




First Advisor

Mary Ann Stark

Second Advisor

Wendy Kershner

Third Advisor

Kimberly Searing


The Baby-Friendly Hospital Initiative is a designation hospitals can achieve that states the facility encourages breastfeeding and mother-baby bonding. The Initiative involves changing over hospital protocols, employee training, and implementing the Ten Steps to Successful Breastfeeding. Although the designation is positive, there have been identified facilitators and barriers that influence the implementation process which can influence whether a hospital will choose to or not to achieve designation. A literature review was performed. Facilitators included: certificate as a marketing tool, project management involvement, the 4-D Pathway, and support. Barriers included: adherence, staffing insufficiencies, provider-level issues, and financial and facility support. Interviews were conducted; both with a baby-friendly hospital and with a non-baby-friendly facility, in order to further explore perceived and real barriers and facilitators of the designation process. The interview with the non-baby-friendly hospital identified facilitators as: already implementing some steps of the Ten Steps to Successful Breastfeeding and had pro-breastfeeding staff. Identified barriers explained by the non-baby-friendly hospital were: financial burden, lack of belief that community was ready for change, communication barriers, and having to designate multiple campuses. The baby-friendly hospital identified facilitators as: right time for change, grant involvement, champion staff, project management involvement, prestige status with designation, the 4-D pathway, and small changes at a time. Barriers identified by the baby-friendly hospital were: fees, getting everyone on board, hard work, keeping personal opinion out of practice, working on all steps at once, and electronic medical record use. Differences between the interviews versus the literature were found as: grants, right circumstance, community, patient persuasion, and electronic medical records. In summary, each facility has individualized perceived facilitators and barriers to implementation but grants and project management are sure to help ease the process. Lack of knowledge, community surroundings, and misperceptions need to be addressed in order to promote hospitals to becoming baby-friendly.

Access Setting

Honors Thesis-Open Access