Policies and Practices in a Cohort of Mississippi Birthing Hospitals During the COVID-19 Pandemic.

Background and Objectives: Guidance around maternity care practices and infant feeding during the COVID-19 pandemic changed over time and was sometimes conflicting. Hospital maternity practices influence breastfeeding, an important preventive strategy against viral illness. Most birthing hospitals in Mississippi are enrolled in CHAMPS, a quality improvement initiative to support breastfeeding and continuously collect maternity care data. The aims of this study were to (1) assess changes to maternity care policies in response to COVID-19, and (2) compare hospital-level breastfeeding, skin-to-skin, and rooming-in rates, at cohort hospitals, before and during the pandemic, overall and stratified by race. Methods: Hospitals responded to a survey on maternity policies in May and September 2020 (Aim 1); hospitals submitted data on breastfeeding and maternity care practices before and during the pandemic (Aim 2). We tested for differences in survey responses using chi-squared statistics and performed an interrupted time series analysis on breastfeeding and maternity care practices data. Results: Twenty-six hospitals responded to the May and September 2020 surveys. Hospitals used different sources to create maternity care policies, and policies differed between institutions. Trends in rates of any and exclusive breastfeeding in the hospital cohort plateaued during the pandemic, in comparison to previous gains, and rates of skin-to-skin and hospital rooming-in decreased. No differences were evident between races. Conclusions: Policies (Aim 1) and practices in the quality improvement cohort hospitals were inconsistent during the COVID-19 pandemic, and changes measured to practices were detrimental (Aim 2). Ongoing monitoring is recommended.

Assessing the impact of a statewide effort to improve breastfeeding rates: A RE-AIM evaluation of CHAMPS in Mississippi.

Communities and Hospitals Advancing Maternity Practices (CHAMPS) is a public health initiative, operating in Mississippi since 2014, to improve maternal and child health practices and reduce racial disparities in breastfeeding. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, this study assessed CHAMPS, which used a Quality Improvement intervention at hospitals, and engaged intensively with local community partners. The study team assessed outcomes through quantitative data (2014-2020) from national sources, Mississippi hospitals, community partners and CHAMPS programme records, and qualitative data from focus groups. With 95% of eligible Mississippi hospitals enrolled into CHAMPS, the programme reached 98% of eligible birthing women in Mississippi, and 65% of breastfeeding peer counsellors in Mississippi's Special Supplemental Nutrition Programme for Women, Infants and Children. Average hospital breastfeeding initiation rates rose from 56% to 66% (p < 0.05), the proportion of hospitals designated Baby-Friendly or attaining the final stages thereof rose from 15% to 90%, and 80% of Mississippi Special Supplemental Programme for Women, Infants, and Children districts engaged with CHAMPS. CHAMPS also maintains a funded presence in Mississippi, and all designated hospitals have maintained Baby-Friendly status. These findings show that a breastfeeding-focused public health initiative using broad-based strategic programming involving multiple stakeholders and a range of evaluation criteria can be successful. More breastfeeding promotion and support programmes should assess their wider impact using evidence-based implementation frameworks.

Mississippi CHAMPS: Decreasing Racial Inequities in Breastfeeding.

Mississippi CHAMPS addressed racial inequities in breastfeeding by implementing community and hospital-based practice changes in accordance with the BFHI and by parallel community work.

Perspectives of Nurses in Mississippi on Implementation of the Baby-Friendly Hospital Initiative.

OBJECTIVE: To describe the experiences and perceptions of Mississippi maternity nurses in hospitals that gained Baby-Friendly designation, including perceived barriers and facilitators to implementation of the Baby-Friendly Hospital Initiative. DESIGN: Descriptive qualitative study using thematic analysis of focus group data. SETTING: Maternity care services of five Baby-Friendly-designated hospitals in Mississippi. PARTICIPANTS: Twenty-two maternity nurses. METHODS: We conducted 90-minute in-person focus groups in which participants described their hospitals' Baby-Friendly experiences. We analyzed focus group transcripts thematically to describe the facilitators and barriers to implementation of the Baby-Friendly initiative. RESULTS: We identified five main themes: The Change Required for BFHI Was Hard, Nurses Felt Empowered by Taking Leadership Roles, Patient Education Was Pivotal to Practice Implementation, Nurses Felt Challenged by Unintended Consequences, and Attitudes Changed From Negative to Positive Over the Course of Adoption. CONCLUSION: Participants from hospitals throughout Mississippi shared similar experiences and cited common facilitators and barriers to achieving Baby-Friendly designation. Participants described the overall process of Baby-Friendly designation as challenging but worthwhile because of the resulting improvements in maternity care, nurses' knowledge, and health outcomes for women and their newborns. Nurses at other hospitals that seek to obtain designation can learn from these experiences to make their own transitions easier.