BFCIBFCI

The Seven Point PlanThe Seven Point Plan

Point One: Point One:

Have a written breastfeeding policy Have a written breastfeeding policy that is routinely communicated to all that is routinely communicated to all

staff and volunteersstaff and volunteers

The Policy:The Policy:

What should it cover?What should it cover?

At minimum it should include:At minimum it should include:

- The 7 Point Plan The 7 Point Plan

- Compliance to the International Code of Compliance to the International Code of Marketing of Breast-milk SubstitutesMarketing of Breast-milk Substitutes

- Reflect the guiding principles of the BFCI Reflect the guiding principles of the BFCI Implementation Guide for Health ServicesImplementation Guide for Health Services

Point One: The Policy Point One: The Policy

ConsultationConsultation- Must be shown by documentationMust be shown by documentation- Treaty of Waitangi included/intertwinedTreaty of Waitangi included/intertwined- Extensive consultation evidenced!Extensive consultation evidenced!- Sign-off date notedSign-off date noted- Displayed in all areasDisplayed in all areas- Different languagesDifferent languages- Education about policy for all staff and volunteersEducation about policy for all staff and volunteers- Other policies to support policy eg: Staff employment Other policies to support policy eg: Staff employment

policy.policy.- Measured effectiveness of the policy- Measured effectiveness of the policy

Point 2:Point 2:

Train all providers in the knowledge Train all providers in the knowledge and skills necessary to implement the and skills necessary to implement the breastfeeding policy.breastfeeding policy.

“ “ If you thinkIf you think

education is expensive,education is expensive,

try ignorance”try ignorance”

Areas of knowledgeAreas of knowledge

Guiding principles of Guiding principles of TheThe Seven Point Plan Seven Point Plan Content ofContent of The Seven Point Plan The Seven Point Plan Basic information on breastfeeding support Basic information on breastfeeding support

and managementand management Skill development related to breastfeeding Skill development related to breastfeeding

support and managementsupport and management Attitudes and barriers to breastfeedingAttitudes and barriers to breastfeeding Community resources for breastfeedingCommunity resources for breastfeeding

Staff educated to the level of their roleStaff educated to the level of their role

Policy orientation on commencing workPolicy orientation on commencing work

New staff – education available within New staff – education available within 6months6months

Required Education:Required Education:

Specialist Staff (working with mothers)Specialist Staff (working with mothers)At the time of assessment 80% need to have At the time of assessment 80% need to have

completed the minimum of 21 hours as stipulated completed the minimum of 21 hours as stipulated in the standards for Step Two (in the standards for Step Two (thisthis includes includes information from pregnancy through to complementary information from pregnancy through to complementary foods) foods)

Demonstrates appropriate clinical skillsDemonstrates appropriate clinical skillsContinuing education equates to 4 hours annuallyContinuing education equates to 4 hours annually

Some Groups/individuals may choose to Some Groups/individuals may choose to refer to a Lactation Consultant or other refer to a Lactation Consultant or other breastfeeding advisor. breastfeeding advisor.

They need to show:They need to show:Evidence of referral systemEvidence of referral systemEquates to 2 hours education for each Equates to 2 hours education for each

year of employment (assessed for the year of employment (assessed for the previous 3 years)previous 3 years)

Continuing education equates to 2 Continuing education equates to 2 hours annuallyhours annually

All other staff:All other staff:Equates to one hour for each Equates to one hour for each

year of employment – assessed year of employment – assessed over the previous 3 yearsover the previous 3 years

ongoing education equates to 1 ongoing education equates to 1 hour annuallyhour annually

Point Three:Point Three:

Inform all pregnant women and their Inform all pregnant women and their families about the benefits families about the benefits

and management of and management of

breastfeeding.breastfeeding.

Antenatal Education should include:Antenatal Education should include: Importance of breastfeeding Importance of breastfeeding Importance of exclusive breastfeeding until 6 monthsImportance of exclusive breastfeeding until 6 months Importance of feeding at the breastImportance of feeding at the breast Health consequences of artificial feedingHealth consequences of artificial feeding Risks and costs of artificial baby milksRisks and costs of artificial baby milks Contraception (compatible with breastfeeding)Contraception (compatible with breastfeeding) The Ten Steps to Successful BreastfeedingThe Ten Steps to Successful Breastfeeding Support in the work place during pregnancy and Support in the work place during pregnancy and

breastfeedingbreastfeeding The challenge of re-lactationThe challenge of re-lactation

The Service must also…….The Service must also…….

Recognize the importance of educating the Recognize the importance of educating the woman who has decided to, or needs to, woman who has decided to, or needs to, feed her baby artificial baby milk.feed her baby artificial baby milk.

Point FourPoint Four

Support mothers to establish and Support mothers to establish and maintain maintain exclusive breastfeedingexclusive breastfeeding to six to six monthsmonths

How?How?

Good antenatal education +Good antenatal education +

Good establishment of breastfeeding +Good establishment of breastfeeding +

Good breastfeeding supportGood breastfeeding support

Examples……Examples……

Antenatally:Antenatally:Realistic breastfeeding expectationsRealistic breastfeeding expectationsPersonal expectationsPersonal expectationsSocial preparationSocial preparationKnowledge of support systems availableKnowledge of support systems available

…………establishmentestablishment

Aware of the importance of exclusivity of feeding at the breast

Knowledge of breastfeeding management Frequent contact for assessment of progress Early identification of any breastfeeding

‘hiccoughs’ Awareness of safe and unsafe sleep practices

……………….support.support Aware of how to access assistance at any Aware of how to access assistance at any

time over the 24 hours of a day if time over the 24 hours of a day if necessary!necessary!

Encouragement to attend peer Encouragement to attend peer breastfeeding groupsbreastfeeding groups

Given appropriate information about Given appropriate information about maintenance of lactation if separation maintenance of lactation if separation necessary necessary

Offered timely advice about contraception, Offered timely advice about contraception, compatible with breastfeedingcompatible with breastfeeding

Mothers Not BreastfeedingMothers Not Breastfeeding

Given individual (including partner/family as Given individual (including partner/family as necessary) support and education covering:necessary) support and education covering:

Safe preparation and handling of formulaSafe preparation and handling of formulaSterilization of equipmentSterilization of equipmentSafe feeding techniquesSafe feeding techniquesDiscussion about co-sleepingDiscussion about co-sleeping

Point FivePoint Five

Encourage sustained breastfeeding Encourage sustained breastfeeding beyond six months, to two years or beyond six months, to two years or more, alongside the introduction of more, alongside the introduction of appropriate, adequate and safe appropriate, adequate and safe complementary foodscomplementary foods

Principles: Principles: Maintain breastfeedingMaintain breastfeeding Practice responsive feedingPractice responsive feeding Prepare, store complementary food safelyPrepare, store complementary food safely Increase amount gradually while Increase amount gradually while

breastfeedingbreastfeeding Ensure consistency of food appropriate to Ensure consistency of food appropriate to

ageage Adapt meal frequency/density to ageAdapt meal frequency/density to age cont’d…….cont’d…….

Cont’d…….. Cont’d……..

Ensure nutrient content of foods meets Ensure nutrient content of foods meets infants needsinfants needs

Use fortified products if neededUse fortified products if needed Adapt feeding during/after illnessAdapt feeding during/after illness Information offered concerning Information offered concerning

breastfeeding in the workplacebreastfeeding in the workplace Information available about contraception Information available about contraception

and co-sleepingand co-sleeping

Sustain breastfeeding until natural weaning Sustain breastfeeding until natural weaning occurs – don’t offer to breastfeed – but don’t occurs – don’t offer to breastfeed – but don’t refuse!refuse!

Point SixPoint Six

Provide a welcoming atmosphere for Provide a welcoming atmosphere for breastfeeding familiesbreastfeeding families

How?How?

Welcome to breastfeed in public areas of Welcome to breastfeed in public areas of the servicethe service

Private space available if requested – clean, Private space available if requested – clean, quiet with a comfortable chairquiet with a comfortable chair

Educate staff about mothers right to Educate staff about mothers right to breastfeedbreastfeed

Notices displayed stating mothers are Notices displayed stating mothers are welcome to breastfeed – posted in welcome to breastfeed – posted in appropriate languages of the service…….appropriate languages of the service…….

Continued……….Continued……….

Culturally appropriate area and informationCulturally appropriate area and information Evidence of consultation with each mother Evidence of consultation with each mother

to ascertain their needs can be seento ascertain their needs can be seen Feedback/suggestions opportunity for Feedback/suggestions opportunity for

mothersmothers ““Code” compliant handouts and information Code” compliant handouts and information

available to take homeavailable to take home

Services which do not work from a site Services which do not work from a site need to meet these requirements need to meet these requirements whenever they deliver the service -whenever they deliver the service -

for example – a Lactation Consultant for example – a Lactation Consultant visiting a woman in her home needs to visiting a woman in her home needs to have an evaluation form (assessment have an evaluation form (assessment of presenting condition) and a feedback of presenting condition) and a feedback form for the motherform for the mother

Point SevenPoint Seven

Promote collaboration among health Promote collaboration among health services and between health services services and between health services and the local communityand the local community

Wow! This is great!!!Wow! This is great!!! Requires involvement of entities outside Requires involvement of entities outside

the service – the service will:the service – the service will:Avail themselves to any opportunity to Avail themselves to any opportunity to

collaborate with otherscollaborate with othersCommunity consultation with PoliciesCommunity consultation with PoliciesHave strong systems in place at the Have strong systems in place at the

interface …. hospitals, LMC’s, Plunket etcinterface …. hospitals, LMC’s, Plunket etcUse written referrals which contain Use written referrals which contain

information about B/f status & B/f issues information about B/f status & B/f issues

Services need to work together…Services need to work together…

To support the breastfeeding dyadTo support the breastfeeding dyad

Share informationShare informationHave discussionsHave discussionsGive feedbackGive feedback

…………this ensures continued supportthis ensures continued support

Breastfeeding Resources….Breastfeeding Resources….

Mother – to – motherMother – to – mother Parent supportParent support Lactation ConsultantsLactation Consultants Breastfeeding ClinicsBreastfeeding Clinics Maori Health AgenciesMaori Health Agencies Pacific Health AgenciesPacific Health Agencies Practice nurses ……………Practice nurses ……………

…….and there’s more …...and there’s more …..

MidwivesMidwives DoctorsDoctors NutritionistsNutritionists PharmacistsPharmacists Dental servicesDental services Health promotersHealth promoters

Antenatally…….Antenatally…….Refer women to voluntary groupsRefer women to voluntary groupsAssist them to set up own informal Assist them to set up own informal

support networks support networks The service can show commitment to The service can show commitment to

the BFCI by…….the BFCI by…….Supporting World Breastfeeding WeekSupporting World Breastfeeding WeekLetters to the editorLetters to the editorSupporting breastfeeding campaignsSupporting breastfeeding campaignsIdentifying and overcoming Identifying and overcoming

breastfeeding barriers within the breastfeeding barriers within the communitycommunity

Working together

References:References:

BFCI Documents for Aotearoa New ZealandBFCI Documents for Aotearoa New Zealand BFHI 2004, Baby-Friendly goals expand to BFHI 2004, Baby-Friendly goals expand to

community and pre-service training. Baby Friendly community and pre-service training. Baby Friendly and beyond - Integrated care for mother and child and beyond - Integrated care for mother and child 2: 1.2: 1.

UNICEF UK Baby Friendly Initiative 2008, The UNICEF UK Baby Friendly Initiative 2008, The seven point plan for sustaining breastfeeding in the seven point plan for sustaining breastfeeding in the community.community.

IYCF Model Chapter for textbooks for Medical IYCF Model Chapter for textbooks for Medical Students,(2009) Session 4 & 5Students,(2009) Session 4 & 5