Prevalence of breastfeeding and birth practices during the first wave of the COVID-19 pandemic within the Italian Baby-Friendly Hospital network. What have we learned?

Background: At the beginning of the COVID-19 pandemic, healthcare workers were faced with difficult decisions about maternity care practices. The evidence-based practices recommended by the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) were confirmed by Italian national guidance.Aim: To describe, in a number of facilities that are part of a national Baby-Friendly network, the adherence to some steps of BFHI standards during the COVID-19 emergency.Methods: We conducted a cross-sectional online survey, inviting all hospitals interested in the Initiative, to fill out a semi-structured questionnaire.Results: Out of the 68 participating hospitals, 30.9% were hubs and 69.1% spokes. During May 2020, 61.8% of hospitals had COVID-19 and non-COVID-19 clinical pathways, while 38.8% were only non-COVID-19. None was dedicated exclusively to COVID-19 pathways. The BFHI was effective in guaranteeing ≥80% exclusive breastfeeding, the presence of companion of mother's choice, skin-to-skin and rooming-in. The type of accreditation was associated with the presence of a companion of the mother's choice during labour (p=0.022) and with skin-to-skin (p<0.001). According to the narratives, increased interpersonal distance made interactions with mothers difficult and the absence of a birth companion was reported as a major issue.Discussion and conclusions: The BFHI is a highly-structured, evidence-based care model. Investing in strong collaborative care approaches contributes to hospitals' preparedness.