The Baby-Friendly journey in a US public hospital.

In May of 2007, San Francisco General Hospital & Trauma Center became the first Baby-Friendly certified hospital in San Francisco. This quality improvement program began in 1999 and took 8 years to complete. Challenges to completing this goal included a population that has myriad social issues including non-English-speaking clients, drug abuse, poverty, and homelessness. Further complications included a constantly changing group of perinatal healthcare providers with little-to-no breast-feeding knowledge, hospital practices that did not support rooming-in and skin-to-skin contact, and lack of overall patient breast-feeding education. This article describes the process of implementing The Baby-Friendly Hospital Initiative quality improvement program, achieving certification and subsequent increase in breast-feeding rates. Breast-feeding initiation rates went from 81% in 2002 to 98% in 2010. Exclusivity rates did not change.