• Development of feeding protocols for infants; including breastfeeding policies, supplementation guidelines for breastfed infants, and limiting bottle and pacifier use
• Standardizing infant feeding assessment at delivery and on the post-partum unit
• Analyzing and minimizing the impact of NICU routines on breastfeeding babies
• Encouragement of skin-to-skin time at delivery and less routine suctioning for healthy newborns
• Standardized education for all nursing and medical staff in the hospital and clinic- this was the most challenging for an academic center, and we have trained over 600 staff!
• Simplifying formula options in the hospital and minimizing waste and loss of products (we went from 31 products down to 10)

• Paying for all formula and infant feeding supplies (this is much easier if the usage is down)
• Ten step posters in English and Spanish were placed in all mother-baby areas of the hospital
• Hospital newsletters, email lists, nurse managers, physicians, hospital administrators were all informed about the goal of becoming Baby Friendly
• Constant attention to the process and positive support for the needed changes

Changes such as described above are often slow, but can be very rewarding when you step back and look at where you came from. We all need to do whatever we can to minimize the impact of our hospital habits and routines on healthy breastfeeding mothers and babies!