Human Milk Feeding Initiative Enrollment

Name of site*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name*

First Last

Title or position*

Email*

We will use this email address for communication related to the initiative. You will be able to add additional contacts below.

Do you want to add additional contacts?*

Yes
No

Additional contacts

You may enter names and email addresses for up to three additional contacts in the spaces below. If you would like to add others, please send an email to wispqc@perinatalweb.org.

Name

First Last

Email

Do you wish to add another contact?

Yes
No

Name

First Last

Email

Do you wish to add another contact?

Yes
No

Name

First Last

Email

Measure Selection

Use this section to indicate interest in the measures. The measures included in the 2018 initiative are indicated by the asterisk and require a response.

Note that some measures are required based on site setting.

Selection of measures is non-binding.

Measure 1: Prenatal education (Required for community-based obstetric care providers)*

Yes
No
Unsure

100% documented prenatal education on human milk feeding using Criterion 3.4.1 from the Baby Friendly guidelines.

Criterion 3.4.1: A written description of in-house and/or community-based programs and projects the facility has fostered will be available and will cover, at minimum, the importance of breastfeeding, the importance of exclusive breastfeeding for about 6 months, and basic breastfeeding management (e.g., skin-to-skin contact, rooming-in, and risks of supplements while breastfeeding in the first 6 months).

Ref: https://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria

Measure 1: Unsure

Please explain.

Measure 2: Skin-to-skin after delivery*

Yes
No
Unsure

90% of mothers hold healthy term newborns (≥ 37 weeks 0 days gestation) skin-to-skin, uninterrupted, for at least 60 minutes, or until the completion of the first feeding, beginning within one hour of birth for uncomplicated vaginal births and within 2 hours of uncomplicated Cesarean deliveries.

Measure 2: Unsure

Please explain.

Measure 3: Skin-to-skin during procedures

Yes
No
Unsure

90% of mothers hold healthy term newborns (≥ 37 weeks 0 days gestation) skin-to-skin while necessary routine newborn procedures and assessments are done within the first hour after uncomplicated vaginal deliveries.

Measure 3: Unsure

Please explain.

Measure 4: Rooming-in*

Yes
No
Unsure

90% of healthy term newborns (≥ 37 weeks 0 days gestation), regardless of feeding method, remain with their mothers ≥ 23 hours per day.

Measure 4: Unsure

Please explain.

Measure 5: Exclusive human milk feeding during hospitalization*

Yes
No
Unsure

Greater than 70% of healthy term (≥ 37 weeks 0 days gestation) infants receive human milk exclusively through the day of discharge

Measure 5: Unsure

Please explain.

Measure 6: Pumping or manual expression after separation

Yes
No
Unsure

Increase by 5-15 percentage points* the number of women separated from their infants for a medical condition (maternal or neonatal) who pump or manually express milk within 6 hours of separation during maternal hospitalization

*Sites will select the target based on an assessment of their baseline.

Measure 6: Unsure

Please explain.

Measure 7: Mother's milk feeding in the NICU (Required for NICUs)*

Yes
No
Unsure

Increase the use of maternal milk by 10-20%* in infants with birth weights of 1500 grams or less during their 28th day of life in the NICU

*Sites will select the target based on an assessment of their baseline.

Measure 7: Unsure

Please explain.

Measure 7a: Any human milk at discharge from the NICU*

Yes
No
Unsure

Measure 7a: Unsure

Please explain.

Measure 7b: Exclusive human milk feeding at discharge from the NICU*

Yes
No
Unsure

Measure 7b: Unsure

Please explain.

Measure 8: Human milk feeding after discharge (Required for community-based infant/pediatric care providers)*

Yes
No
Unsure

Increase human milk feeding at 3-4 months.

Measure 8: Unsure

Please explain.

Measure 9: Exclusive human milk feeding after discharge*

Yes
No
Unsure

Increase exclusive human milk feeding at 3-4 months.

Measure 9: Unsure

Please explain.

Measure 10: Human milk feeding at discharge (Required for hospitals)*

Yes
No
Unsure

Measure 10: Unsure

Please explain.

Can we list your site on the WisPQC Web site for this initiative?*

Yes
No

One of the strengths of a perinatal collaborative is the opportunity to develop relationships with new stakeholders. WisPQC wants to promote those relationships by listing the sites involved in initiatives on its Web site.

Human Milk Feeding Initiative Enrollment

WisPQC Human Milk Feeding Initiative Enrollment

Additional contacts

Measure Selection