Barriers and facilitators to implementing the Baby-Friendly hospital initiative in neonatal intensive care units

J Obstet Gynecol Neonatal Nurs. Sep-Oct 2014;43(5):614-24. doi: 10.1111/1552-6909.12479. Epub 2014 Aug 20.


Objective: To explore manager, educator, and clinical leader perceptions of barriers and facilitators to implementing Baby-Friendly practice in the neonatal intensive care unit (NICU).

Design: Qualitative, descriptive design.

Setting: Two university-affiliated level-III NICUs in Canada.

Participants: A purposive sample of 10 medical and nursing managers, nurse educators, lactation consultants, and neonatal nurse practitioners.

Methods: In-depth, semistructured interviews transcribed and analyzed using qualitative content analysis.

Results: Participants valued breastfeeding and family-centered care yet identified numerous contextual barriers to Baby-Friendly care including infant health status, parent/infant separation, staff workloads and work patterns, gaps in staff knowledge and skills, and lack of continuity of breastfeeding support. Facilitators included breastfeeding education, breastfeeding champions, and interprofessional collaboration.

Conclusion: Despite identifying numerous barriers, participants recognized the potential value of expanding the Baby-Friendly Hospital Initiative (BFHI) to the NICU setting. Recommendations include promoting BFHI as a facilitator of family-centered care, interdisciplinary staff education, increasing access to lactation consultants, and establishing a group of NICU champions dedicated to BFHI implementation.

Keywords: BFHI; Baby-Friendly Hospital Initiative; NICU; barriers; breastfeeding; facilitators; implementation; neonatal intensive care unit.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Feeding / methods*
  • Canada
  • Environment
  • Environment Design
  • Family Nursing / organization & administration*
  • Female
  • Health Facility Environment / organization & administration*
  • Hospitals, University
  • Humans
  • Infant Care / organization & administration*
  • Infant Welfare*
  • Infant, Newborn
  • Intensive Care, Neonatal / organization & administration*
  • Interprofessional Relations
  • Interviews as Topic
  • Male
  • Mother-Child Relations
  • Nurse's Role
  • Organizational Policy
  • Patient Care Team / organization & administration*
  • Qualitative Research