BFHI BFHI (Baby-Friendly (Baby-Friendly

Hospital Initiative) Hospital Initiative)

A.MydlilováA.MydlilováNARLAC – National Lactation NARLAC – National Lactation

CentreCentreFTN Krč PragueFTN Krč Prague

Health 21 in CRHealth 21 in CR

BFHI = 10 stepsBFHI = 10 steps Implemented in CR in last 20 yearsImplemented in CR in last 20 years 1992-FTN Krč Prague – 1st Baby-Friendly 1992-FTN Krč Prague – 1st Baby-Friendly

Hospital in CRHospital in CR

MoH prepares a directive on MoH prepares a directive on implementation of 10 steps into standards implementation of 10 steps into standards of health care of health care

Guidelines on Baby-Friendly Hospitals Guidelines on Baby-Friendly Hospitals should become the part of the assessment should become the part of the assessment of the quality of a hospitalof the quality of a hospital (the WHO goal) (the WHO goal)

Step 1. - policyStep 1. - policy

Written policy based on 10 steps Written policy based on 10 steps Health staff should know it and Health staff should know it and

practise practise

Step 2 – train the staffStep 2 – train the staff

WHO Training Module (20 hour)WHO Training Module (20 hour) CR – 20 hour course for health CR – 20 hour course for health

workersworkers

Step 3 – inform pregnant Step 3 – inform pregnant womenwomen

On benefits of BF, physiology, lactation On benefits of BF, physiology, lactation managementmanagement

Encourage pregnat women to participate at Encourage pregnat women to participate at antenatal courses, information on BF should be antenatal courses, information on BF should be a part of the coursea part of the course

NARLAC Study (2008) NARLAC Study (2008) 38 % antenatal courses – no information on BF38 % antenatal courses – no information on BF 41,8 % mothers not satisfied with the course 41,8 % mothers not satisfied with the course

contentcontent 9 %mothers - information form health profs9 %mothers - information form health profs Most frequent source of information – internet, Most frequent source of information – internet,

magazines, booksmagazines, books

Sources of information Sources of information

Books 39 % Books 39 % Magazines 26 % Magazines 26 % internet 15 % internet 15 % Health profs 9 % Health profs 9 %

Proposals for Proposals for improvementimprovement

Information on BF should be a part of antenatal Information on BF should be a part of antenatal coursescourses

Methodological guidelines (professional Methodological guidelines (professional associations):associations):

1. Breast examination 1. Breast examination 2. Explain consequences of separation (e.g. ICU)2. Explain consequences of separation (e.g. ICU)3. Instruct on expressing milk within 6 hours after 3. Instruct on expressing milk within 6 hours after

birthbirth4. Inform about consequences of using bottles, teats4. Inform about consequences of using bottles, teats5. Instruct on techniques of BF, expressing milk, 5. Instruct on techniques of BF, expressing milk,

alternative feeding methodsalternative feeding methods

Focus on women with lower education Focus on women with lower education

Step 4 – initiate BF Step 4 – initiate BF within 1 hourwithin 1 hour

Enable „skin to Enable „skin to skin“ contaktskin“ contakt as as soon as possiblesoon as possible

„„Skin to skin“ Skin to skin“ contakt contakt important in first important in first 24 hours24 hours

Prevention of BF Prevention of BF problemsproblems

Inform health Inform health profs and public profs and public

Practices to support BF Practices to support BF after SCafter SC

Early initiation of BF ( within 1 Early initiation of BF ( within 1 hour)hour)

Choose the appropriate positionChoose the appropriate position Early rooming-in Early rooming-in

Step 5 – show mothers how to breastfeed

Correct positiong Correct attachment at the breast

Requires practical knowledge and counselling skills, psychological support

Step 5 – show mothers how Step 5 – show mothers how to maintain lactation if to maintain lactation if separated from their separated from their

infantsinfants Start expressing milk as soon as Start expressing milk as soon as possible ( 1. manual possible ( 1. manual expression, 2. pumps)expression, 2. pumps)

Train health staff Train health staff Health staff provides support to Health staff provides support to

mothersmothers

Step 6 – no Step 6 – no supplementationsupplementation

Give newborn infants no food or Give newborn infants no food or drink other than breast milk, drink other than breast milk, unless medically indicated, then unless medically indicated, then use alternative methods, no use alternative methods, no bottlesbottles

Stress the importance of Stress the importance of colostrumcolostrum

Step 7 – Rooming-inStep 7 – Rooming-in 24 hours24 hours Inform mothers on its importanceInform mothers on its importance Enables feeding on demandEnables feeding on demand Mothers learn to recognise fine Mothers learn to recognise fine

signals of readiness to breastfeed in signals of readiness to breastfeed in the childthe child

RI – newborns cry less, mother sleep RI – newborns cry less, mother sleep moremore

Crying child – difficult to Crying child – difficult to

breastfeedbreastfeed

Step 8 – encourage Step 8 – encourage breastfeeding on demandbreastfeeding on demand Do not restrict duration r Do not restrict duration r

frequency of BFfrequency of BF Do not encourage a common Do not encourage a common

schedule of BFschedule of BF Respect individual rhythm and Respect individual rhythm and

needs of the newbornneeds of the newborn

Number of breastfeeds should not Number of breastfeeds should not drop below 8 in 24 hoursdrop below 8 in 24 hours

Step 9 – no bottles or Step 9 – no bottles or teatsteats

Give no artificial teats or pacifiers Give no artificial teats or pacifiers (dummies, soothers) to (dummies, soothers) to breastfeeding infantsbreastfeeding infants

Interferes with suckling Interferes with suckling techniquestechniques

Inform mothers about its Inform mothers about its importanceimportance

Do not promote bottles or Do not promote bottles or pacifiers at the hospitalpacifiers at the hospital

Step 10 – continuing Step 10 – continuing breastfeeding support breastfeeding support

WHO encourages continuing WHO encourages continuing support in the communitysupport in the community

Lactation counselling after Lactation counselling after discharge from hospital discharge from hospital (lactation centres, lactation (lactation centres, lactation counsellors, self-help groups)counsellors, self-help groups)

Effective help, provides also Effective help, provides also emotional supportemotional support

Primary health care Primary health care (recommended (recommended

preventive examinations)preventive examinations)WHO WHO Day 5-7Day 5-7Week 3-4Week 3-4Week 6Week 6

WHO, 2009WHO, 2009

CRCR48 hours after birth48 hours after birthWeek 2Week 2Week 6Week 6Month 3 Month 3 Months 4-5 Months 4-5

Directive on Preventive Directive on Preventive examinations, MoH, examinations, MoH, 20102010