What Does It Take to Sustain Baby-Friendly Designation for 25+ Years?

Published On: March 8, 2023|Tags: |

“The 10 Steps were a way to standardize our practice across the unit and across the hospital, because there was basically nothing back then. We were really building it from scratch.”

Sharon Baker, RN

That’s how Sharon Baker, RN, remembers the early days of Baby-Friendly at Northeastern Vermont Regional Hospital (NVRH) in St. Johnsbury, Vermont, which was one of the first facilities in the US designated Baby-Friendly, back in 1999.  Having been re-designated in 2013 and again in 2018, the hospital will soon be able to claim to have sustained its designation for a quarter of a century.

What does it take to achieve this level of commitment and longevity with Baby-Friendly practices?


Baker, who has been a staff nurse at NVRH for over 40 years, since well before the hospital pursued Baby-Friendly designation, says she thinks it’s mostly about doing what’s right for the patient every time.

“We just really want to support women who are breastfeeding. The entire nursing staff has that commitment,” she says. “Baby-Friendly has made us consistent. If I say something to a mother at two o’clock in the morning, I know the nurse following me will say almost exactly the same thing. It decreases the confusion a lot.”


Laura Emery, RN, BSN

Laura Emery, RN, BSN, the current director of the birth center at NVRH, points to the culture as being the key to sustaining Baby-Friendly practices.

“Baby-Friendly has just become a part of our culture here. We practice skin-to-skin and rooming-in and having that uninterrupted ‘Golden Hour,’” Emery says. “Those are our expectations for newborn care and time after birth. That’s the culture of how we do things here and it continues to be the driving force to maintaining Baby-Friendly.”

“We have a process where every new employee, regardless of what department they work in, gets a presentation at orientation where they are told if you walk into a room and see something concerning, you’re empowered to speak up about that,” she says. “Everyone knows we work as a team to support new families.”

It’s that culture, in fact, that drew Emery to NVRH in the first place, nine years ago, from her home an hour away in Westfield, Vermont.

“Being passionate about labor and delivery but also being new to the field, I was really looking for a facility that I felt met my professional goals,” she says. “I actually live much closer to two other facilities. But when I learned about the 10 Steps and knowing the things that are supported through a facility that has a Baby-Friendly culture, I decided to apply there. And that’s why I continue to drive an hour to work every day.”

Supportive Administration

Carol Moore-Whitney, RN, IBCLC

Carol Moore-Whitney, RN, IBCLC, a registered nurse and lactation consultant who also has been at the hospital since before it became Baby-Friendly designated, believes administrative support is one of the most important factors to sustaining Baby-Friendly, especially through periods of high staff turnover.

“We’ve had a strong base and built some resilience,” Moore-Whitney recalls. “A few years ago, we literally had a 70% turnover in a short amount of time. And we had a Baby-Friendly site visit coming up. We weren’t sure we could do it. But the administration and the community said ‘Yes, you can.’ So, we did, and we nailed it. You have to be built for the bumps that are going to happen.”


Moore-Whitney also claims that a straightforward set of key principles offered by Baby-Friendly FUSA in 2018 has helped provide clarity and guidance as the hospital has sustained its Baby-Friendly practices in recent years.

“A few years ago, BFUSA put out a publication that focused on three things: safety first, informed decisions, and caring conversations,” she says. “We follow those three principles in everything we do, and the evidence base from Baby Friendly supports them in terms of policies and recommendations. These principles help us support health equity in an area of the state with deep poverty, high unemployment and poor health outcomes.”

Part of Who We Are

On the other side of the country, EvergreenHealth in Kirkland, Washington, has retained its Baby-Friendly designation for the longest of any facility in the country. A community-owned hospital, EvergreenHealth is widely known for being the first hospital in the nation to be Baby-Friendly designated, way back in 1996.

Donnianne Noble, BSN, RN, IBCLC and Bernie Breslin, DNP, RNC-OB, C-EFM, RNC-NIC are carrying on the tradition created by Baby-Friendly trailblazers, Molly Pessl, RN, BSN, IBCLC, FILCA and Jeanne Tate, MSN, RN, IBCLC.

Donnianne Noble, BSN, RN, IBCLC

“Baby-Friendly is part of who we are,” says Noble. “We even mention it in our telephone ‘hold’ message – ‘Please don’t forget to wear a mask, and did you know that EvergreenHealth is Baby-Friendly?’ Our community and our families have come to expect it. The philosophy and principles are ingrained in our culture and everything that we do to support our patients and families.”

Keeping It Fresh

Noble points out that, as part of EvergreenHealth’s commitment to sustaining the Baby-Friendly designation over a long period of time, they take the time to help staff understand where the ingrained practices actually come from.

“It has become so much a part of our culture that staff sometimes forget that what they’re already doing is Baby-Friendly,” she says. “It would never cross a nurse’s mind now to not put a baby skin-to-skin unless there was a medical reason. That was an interesting development with our most recent re-designation because our staff had stop and say, ‘Yes, I do this process,’ even though it was just the way they normally would do things.”

Committed Staff

Bernie Breslin, DNP, RNC-OB, C-EFM, RNC-NIC

For Breslin, who hails from Ireland and came to EvergreenHealth just in time to lead its most recent re-designation process, the key to Baby-Friendly longevity is the steady commitment of the nursing staff.

“They’re very committed to their processes, and they’re very committed to their community,” she says. “If at any stage anybody suggested we’re not going to continue with Baby-Friendly, I wouldn’t want to be the person to bring that up to the nurses. I can’t even imagine that. They are deeply rooted in this. They own it completely.”

Their commitment was so strong, in fact, that Breslin says the nurses led her through the re-designation process, not the other way around.

“I was very new to the organization and there was so much going on at that time,” she says. “I thought, this was going to be hard for me, that I would need to take my passion out on the floor and share it with the nurses and teach them. But the opposite happened. They were already engaged. They were telling me all of the aspects about Baby-Friendly and how they continue to do it.”

Above everything else, “they’re very, very proud of it,” Breslin says.

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