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What can your birth facility do now?

Your hospital or birthing center can make a commitment to improve infant feeding policies, training and practices by embarking on the 4-D pathway to designation. This journey creates an environment that is supportive of best practices in maternity care and of optimal infant feeding. 

The 4-D pathway is fit for all institutions; large and small hospitals, for profit and not-for-profit hospitals, teaching hospitals, and hospitals at various stages of development in their breastfeeding education and support services, as well as birthing centers.  

Hospitals providing maternity care throughout the US and US Territories may earn designation by successfully completing all 4 phases of the 4-D pathway, implementing the Guidelines and Evaluation Criteria and passing an on-site assessment. The Baby-Friendly Designation process requires verification of policies, curriculum, action plans, quality improvement projects, staff training, and competency verification, as well as a readiness interview and an on-site survey. Upon successful completion of this process, as determined by the onsite assessment, the facility will be granted a license to use the Baby-Friendly certification mark.


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What are the steps in the 4-D pathway?

The 4-D pathway is a tool that hospitals and birthing centers use to measure their progress along the journey that leads to Baby-Friendly designation. To achieve the Baby-Friendly designation, facilities first register with Baby-Friendly USA. They then complete all of the requirements in each of the four phases of the process. Ultimately, the facility demonstrates that they have attained the gold standard of maternity practices during an on-site assessment. At the on-site assessment, the facility must demonstrate to Baby-Friendly USA assessors that they have correctly integrated all of the Ten Steps To Successful Breastfeeding into their maternity practices. The Baby-Friendly USA Guidelines and Evaluation Criteria detail the specific benchmarks against which birthing facilities will be held during their on-site assessment.

To aid facilities in reaching this world-class standard of maternity care, Baby-Friendly USA has created a 4-D pathway for achieving the Baby-Friendly Designation.  This method maintains all of the high standards set by a team of global experts, while breaking the process down into manageable and achievable phases. Following the 4-D pathway will ensure that hospitals and birthing centers implement Baby-Friendly principles in a logical and efficient manner.

The four phases in the 4-D pathway are:

D1: Discovery Phase
Facilities submit a two-part registration form with Baby-Friendly USA and learn about the process for Baby-Friendly designation. 

D2: Development Phase 
Facilities make a commitment to the process and receive a comprehensive set of tools to assist in implementing the Ten Steps to Successful Breastfeeding. Baby-Friendly USA provides technical assistance to the  facility to create a plan for achieving Baby-Friendly guidelines. All plans are reviewed and feedback is provided by Baby-Friendly USA before the facility moves to the next phase. 

D3: Dissemination Phase 
Facilities implement the plans they established during the Development phase. They collect data and measure their results against the Baby-Friendly USA Guidelines and Evaluation Criteria.  Quality improvement activities continue until audit results indicate that all required standards are being met.  

D4: Designation Phase 

Facilities continue their quality improvement program, evaluating their findings against Baby-Friendly USA Guidelines and Evaluation Criteria. The assessment process begins when the facility completes implementation of the Guidelines and Evaluation Criteria and discusses their status with Baby-Friendly USA during a readiness assessment telephone interview. The facility then invites Baby-Friendly USA to send an survey team to their facility to conduct the on-site assessment.  The team visits the facility and conducts a series of interviews, observations and document reviews. Baby-Friendly designation is conferred when the External Review Board reviews the survey tool and confirms that the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast Milk Substitutes have been properly implemented.

i. Dellifrane et al. 2011. Cost Comparison of Baby-Friendly and Non-Baby-Friendly Hospitals in the United States.Pediatrics; 21, epub)]

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