Impact of Texas Breastfeeding Learning Collaborative on Obstetric Related Aspects of 10 Steps [24H]

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Our objective is to evaluate the effectiveness of the Texas Breastfeeding Learning Collaborative (TBLC) on performance improvement of maternity care practices supporting breastfeeding most relevant to obstetricians.


Funded by Texas Department of State Health Services and facilitated the National Institute for Children’s Health Quality (NICHQ), TBLC included three 2-day learning sessions, technical support and the use of Plan, Do, Study, Act (PDSA) cycles for learning and performance improvement. Seventy-four Texas hospitals were enrolled in three consecutive cohorts from 2012 to 2017.


Run chart rules revealed favorable shifts from baseline median and/or trends in all Cohorts for prenatal education, breastfeeding support, feeding on cue, skin-to-skin (vaginal and cesarean delivery (CD)), rooming-in, pacifiers and artificial nipple education and referral to community supports at discharge. Prenatal education, skin-to-skin, and rooming-in emerged as process measures with the most opportunity for additional improvement with median performances ranging 52-72% whereas median performance for remaining process measures ranged 77-92%. All Cohorts maintained high median rates of overall breastfeeding (87%, 86%, 84%) and Cohorts A&B had favorable shifts from baseline median for Exclusive Breastfeeding and Supplementation measures.


The Texas Breastfeeding Learning Collaborative changed maternity practices that impacted process and outcome measures despite regional differences in baseline uptake of practices. Obstetricians can influence steps with greatest opportunity for additional improvement at project completion (prenatal education, skin-to-skin, and rooming-in). We encourage obstetricians continued support of these steps and enlist their assistance with future improvement.

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