BFHI Self-Appraisal Tool Maternity Facilities...© ACM – BFHI Self-Appraisal Tool for Maternity Facilities P a g e | 5 For Hardcopy use please tick or cross the appropriate box

BFHI Self-Appraisal Tool

Maternity Facilities

© ACM – BFHI Self-Appraisal Tool for Maternity Facilities P a g e | 1


Preparing for Assessment and Use of the BFHI Self-Appraisal Tool This self-appraisal tool has been developed for use by maternity facilities, to evaluate how their current practices measure up to the Ten Steps to Successful Breastfeeding and readiness for assessment for Baby Friendly Health Initiative (BFHI) accreditation. It should be used in conjunction with the detailed standards for each step as described in the BFHI Handbook for Maternity Facilities (the handbook).

The facility should appraise its current practices in relation to the BFHI standards in the handbook. The self-appraisal tool permits the facility to make an initial appraisal and review of its practices in support of breastfeeding. Completion of this self-appraisal tool is the first stage of the process, but does not qualify the facility for any award. Analysing the Self-Appraisal Results

If a facility finds that many of its answers to this self-appraisal are “Yes”, this is an indication of good progress towards implementation of the BFHI standards. The facility can also use the self-appraisal to review its strengths and weaknesses, determine any areas that need to be addressed, and decide when it believes it will be ready for assessment (further information about assessment can be found within the handbook). Before assessment, the facility is advised to study the specific standards for each step, as described in the handbook, to learn more details of the global criteria against which they will be assessed.

A facility should develop an action plan if there are many “No” answers on the self-appraisal tool or where 75%1 of babies are not exclusively breastfed or breastmilk fed from birth to discharge. The aim would be to eliminate practices that hinder the initiation of exclusive breastfeeding and to expand those that enhance it.

If this self-appraisal indicates a need for substantial improvements in practice, the facility is encouraged to spend the necessary time adjusting routines, re-educating staff, and establishing new patterns of care. The self-appraisal process should then be repeated.

Once a facility wishes to apply for onsite assessment, the completed self-appraisal tool must be submitted in support of the application.

1 Facilities that are unable to achieve an average 75% exclusive breastfeeding rate over the required period, because

of high-risk clientele, must apply for special consideration before the assessment. Evidence indicating that their exclusive breastfeeding rate would be at least 75% if the calculation excluded babies who were supplemented for documented

Acceptable Medical Reasons must be provided. Request further information from the BFHI Manager about the evidence

to be provided. The assessment cannot proceed without special consideration having being approved.


Materials required for assessment

Before seeking assessment for BFHI accreditation or reaccreditation, the facility must have the following available, as the assessors will need to review these materials:

A copy of the full breastfeeding policy and the abstract/summary.

A copy of any other ‘policies for BFHI’ that meet the requirements of step 1.

This includes any policies, protocols or procedures which may be separate from the breastfeeding policy,

but are required to meet all the criteria stated in step 1.

A copy of the breastfeeding/BFHI education curricula/course outline for each group of

personnel as stated in step 2.

If assessment is for reaccreditation, a copy of the outline and schedule of the breastfeeding/BFHI

continuing education.

An electronic or hard copy of the attendance record for BFHI education for all personnel in groups

1, 2 and 3 including where relevant, evidence showing the number of hours of supervised clinical

experience completed as stated in step 2.

Copies of any clinical pathways which include implementation of BFHI requirements.

Copies of any printed breastfeeding/infant feeding educational material made available to

pregnant women/mothers/families at the facility, including printed information about follow-up and

community resources given to mothers before discharge.

Antenatal Postnatal

Any other handouts or sample bags made available by staff at the facility to mothers/families.

Outline of content of the antenatal breastfeeding education given to mothers in these areas,

where applicable (as stated in step 3):

Antenatal services

Booking-in

Antenatal Education Classes

Receipts and/or records of documentation of purchase of breast-milk substitutes (including

specialised formula) and other supplies needed for artificial feeding.

BFHI data for the most recent 12 months (Jan-Jun & Jul-Dec or Jul-Dec & Jan-Jun) using the BFHI Excel spreadsheet. If more recent data is available, facilities are encouraged to have this data, preferably up to the preceding month, available for assessors to review.


Facility Information

Date completed:

Name of facility:

Address:

Name of CEO/Chief Administrator:

Name of Director of Nursing/Midwifery (with responsibility for maternity services):

Name and position of contact person for BFHI Assessment:

Telephone: Email:

Type of facility: Public Private Public/Private (mixed)

Metro Rural Remote

Other - please specify:

Refer to the definition of facility in the handbook for further information.

Total bed capacity in the maternity service: _____________

Services provided within the facility (tick all which apply)

Separate Booking-in Service Birth (Labour) Suite area: _______ bed capacity

Antenatal Clinic(s) Birth Centre: _______ bed capacity

Antenatal Classes Special Care and/or NICU: _______ bed capacity

Antenatal Beds: _______ bed capacity Well-Baby Nursery: _______ bed capacity

Postnatal Beds: _______ bed capacity Domiciliary Care

Other areas for mothers and children: _____________________________________ _______ bed capacity

For a facility where services are combined and/or where beds are not designated for a single purpose, provide sufficient information for BFHI to have an understanding of the type of facility and the services offered. This facilitates planning for and reviewing the assessment.

Does the facility hold antenatal clinics at other sites outside the hospital? Yes No

If yes please state or attach when and where:

Total births during the last 12-month period from __________________ to _________________ (dates)

__________ Number of total births

__________ Number by caesarean Caesarean rate _______ %

__________ Number admitted to special care / NICU Special Care rate _______ %

Cultures and languages

What are the main cultural groups served by the facility?

What are the main language(s) used by these groups?

What approximate percentage would each language represent within the total population served by the facility?

Facilities are expected to have translated materials and a breastfeeding policy summary for each language used by at least 10% or more of the women who use the facility’s maternity services.


For Hardcopy use please tick or cross the appropriate box.

For Electronic use, double click on the appropriate box and select “Checked” under Default Value

Step 1 Have a written breastfeeding policy that is routinely communicated to all health care

staff

1.1 Does the facility have written ‘Policies for BFHI’? Yes No

1.2 Does the breastfeeding policy adequately address and enable implementation of each of the Ten Steps to Successful Breastfeeding:

Step 1 Have a written breastfeeding policy that is routinely communicated to all health care staff?

Yes

No

Step 2 Train all health care staff in the skills necessary to implement this policy?

Yes No

Step 3 Inform all pregnant women about the benefits and management of breastfeeding?

Yes No

Step 4 Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed?

Yes No

Step 5 Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants?

Yes No

Step 6 Give newborn infants no food or drink other than breastmilk, unless medically indicated?

Yes No

Step 7 Practise rooming-in - allow mothers and infants to remain together 24 hours a day?

Yes No

Step 8 Encourage breastfeeding on demand? Yes No

Step 9 Give no artificial teats or dummies to breastfeeding infants?

Yes No

Step 10 Foster the establishment of breastfeeding support and refer mothers on discharge from the facility?

Yes No

1.3 Does the facility have policy statements which address support for staff to continue breastfeeding when they return to work?

Yes No


1.4 Does the facility have policy statements which address implementation of the WHO International Code and include the following points:

Adherence by the facility and its staff to the relevant provisions of the WHO International Code and subsequent WHA resolutions?

Yes

No

All promotion of artificial feeding and materials which promote the use of infant formula, feeding bottles and teats is prohibited?

Yes No

The facility is not permitted to receive or distribute free and subsidised (low cost) products within the scope of the WHO International Code?

Yes No

The distribution to parents of take home samples and supplies of infant formula, bottles and teats is not permitted?

Yes No

There are restrictions on access to the facility and staff by representatives from companies in relation to marketing or distributing infant formula products or equipment used for artificial feeding?

Yes No

There is no direct or indirect contact of these representatives with pregnant women or mothers and their families?

Yes No

The facility does not accept free gifts, non-scientific literature, materials or equipment, money, or support for in-service education or events from these companies if there is any association with artificial feeding or potential promotion of brand/product recognition in relation to infant feeding?

Yes No

There is careful scrutiny at the institutional level of any research which involves mothers and babies for potential implications on infant feeding or interference with the full implementation of the policy

Yes No

1.5 Does the facility have policy statements, which address standards of care for the mother who is artificially feeding her baby, and includes the following points:

Relevant personnel have received education to ensure that their knowledge about artificial feeding is current?

Yes

No

Relevant personnel have the skills to teach mothers correct preparation, storage and handling of powdered infant formula?

Yes No

Mothers who are considering artificial feeding are supported to make a fully informed choice, appropriate to their circumstances?

Yes No

All mothers who will be leaving the facility using infant formula are given:

o information and instruction on the safe preparation, storage and handling of reconstituted powdered infant formula

Yes

No

o information on the risks to the baby if the preparation and handling instructions are not followed carefully

Yes No

o a demonstration and supervised practice in making up a bottle-feed using powdered infant formula?

Yes No

o information on where to get help with infant feeding after discharge?

Yes No


Instruction is given only to parents who need it; there is no group instruction; it is done privately, away from breastfeeding mothers?

Yes No

Materials on artificial feeding which are shown or given to parents are free from advertising, do not refer to or contain images of an identifiable product, and comply with the WHO International Code?

Yes No

1.6 Does the facility have policy statements, which address mother friendly labour and birthing practices, which includes the following points:

Women are encouraged to have a support person of their choice with them throughout labour and birth?

Yes

No

There is support for practices that can help with comfort and pain relief during labour, without the use of drugs or an epidural?

Yes No

Women are encouraged to move about as they need to during labour, and to assume birthing positions of their choice, unless a restriction is medically indicated?

Yes No

Invasive procedures are not used routinely, unless specifically required for a complication?

Yes No

1.7 Does each policy indicate who the policy relates to and that it is mandatory to adhere to it?

Yes No

1.8 Does the facility have detailed clinical protocols to support the ‘policies for BFHI’?

Yes No

1.9 Are the protocols consistent with BFHI standards, evidence-based, and reflecting contemporary information and practices?

Yes No

1.10 The breastfeeding policy is accessible to mothers and their families on request, and an easily visible summary posted in each area of the facility which potentially serves pregnant women, mothers, infants and/or young children? (See step 1 re facilities where poster display is restricted or not permitted)

Yes

No

1.11 Does the summary address the key points of the full breastfeeding policy? Yes No

1.12 Is the summary available and displayed in each of the language(s) used by 10% or more of the mothers who use the facility’s maternity services?

Yes No

1.13 Are the ‘policies for BFHI’ and clinical protocols readily available so that all personnel who take care of mothers and babies are aware of them and know where they can refer to them?

Yes No

1.14 Is there a mechanism for evaluating the effectiveness of the ‘policies for BFHI’ and clinical protocols and checking them for currency at least every 3 years to ensure current evidence based standards?

Yes No


Step 2 Train all health care staff in the skills necessary to implement this policy

2.1 Have all personnel who have contact with pregnant women, mothers and infants in the care of the facility been allocated to an appropriate group for the purposes of education, based on what they do rather than on their position at the facility?

Yes No

2.2 Have all these personnel received orientation to, and education (relevant to their group) on the ‘policies for BFHI’ and the skills necessary to implement them?

Yes No

2.3 Have all relevant personnel received orientation to, and education on the care of the mother who is artificially feeding her baby?

Yes No

2.4 Have all relevant personnel received orientation to, and education on mother friendly labour and birthing practices?

Yes No

2.5 Are all new personnel, casual, agency/relieving staff, students and others who educate, advise or assist mothers with breastfeeding made aware of the breastfeeding policy and protocols at commencement of their first shift/placement/visit?

Yes No

2.6 Is there a schedule that shows that the required BFHI education is commenced for new personnel within 6 months of their employment in a maternity unit, a paediatric unit or neonatal nursery and completed within 12 months, unless they have received sufficient education elsewhere?

Yes No

2.7 Does the education cover the facility’s ‘policies for BFHI’ and implementation of the Ten Steps to Successful Breastfeeding relevant to their group?

Yes No

2.8 Does the relevant education for groups 1 & 2 include a focus on empowering the mother?

Yes No

2.9 Does the education for groups 1 and 2 cover the Acceptable Medical Reasons for Use of Breastmilk Substitutes?

Yes No

2.10 Does the education for groups 1 and 2 cover the facility’s and health workers’ responsibilities under the WHO International Code and subsequent WHA resolutions?

Yes No

2.11 Does the education for groups 1 & 2 include education on how to provide support to the mother who is artificially feeding her baby?

Yes No

2.12 Does the education for groups 1 & 2 include education covering information on mother friendly labour and birthing practices?

Yes No

2.13 Do the number of hours of education (initial and reassessment) on breastfeeding and lactation management comply with the requirements for each group?

Yes No

2.14 Is a copy of the curricula or course outline (initial and reassessment) for each group available for the assessors to review?

Yes No


2.15 Are personnel well informed (relevant to the different groups) about breastfeeding management, mother-friendly labour and birthing practices and the care of the mother who is artificially feeding her baby?

Yes No

2.16 Does the facility maintain electronic or hard copy central records, which can be made available to the assessors, that show the number of hours of education completed (initial and reassessment) by each of the personnel in groups 1, 2 & 3, including, were relevant supervised clinical experience and recognition of prior learning (RPL)?

Yes No


Step 3 Inform all pregnant women about the benefits and management of breastfeeding

If “yes”, to any one of the following three questions, proceed with assessing this step

Does the facility or its satellite centres provide antenatal clinics or services, including inpatient care?

Yes

No

Does the facility or its satellite centres provide antenatal education classes? Yes No

Does the facility have a separate booking-in service? Yes No

3.1 Do booking-in and/or antenatal records indicate whether breastfeeding has been discussed with the pregnant woman?

Yes No

3.2 Are all pregnant women asked about their breastfeeding knowledge and previous experience with baby feeding?

Yes No

3.3 Is a woman who did not breastfeed a previous child or had problems with breastfeeding offered antenatal counselling for breastfeeding?

Yes No

3.4 Is a written description of the minimum content of the antenatal education about mother friendly labour and birthing practices and breastfeeding management available for review?

Yes

No

3.5 Does the antenatal education/discussion with mothers cover the required content listed in step 3?

Yes No

3.6 Is this antenatal information:

available in each language used by 10% or more of the women who use the service ?

Yes

No

written at the appropriate literacy level? Yes No

3.7 Are there supports, resources and materials available for pregnant women from other cultures and/or women who use or understand a language other than English and are these available for review?

Yes No

3.8 Are pregnant women who have attended any of the above services taught about:

the importance of breastfeeding and important aspects of breastfeeding management?

Yes

No

mother friendly labour and birthing practices? Yes No

3.9 Are pregnant women made aware of the breastfeeding and pregnancy support groups, services and/or classes in the local area?

Yes No

3.10 Are pregnant women protected from all types of promotion of artificial feeding and associated products while attending the facility?

Yes

No

3.11 Are all educational materials, handouts and sample bags distributed to antenatal women free of promotion for artificial feeding, infant formula, feeding bottles and teats?

Yes No


Step 4 Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed

4.1 Are babies born per vagina enabled to have immediate skin-to-skin contact on the mother’s chest?

Yes No

4.2 Are babies born by caesarean enabled to have immediate skin-to-skin contact on the mother’s chest in theatre suite (optimum practice), or within 10 minutes of the time they arrive in recovery (minimum practice)?

Yes No

4.3 Is this skin-to-skin contact on the mother’s chest allowed to continue without interruption or separation:

until the baby has had the first breastfeed or for at least an hour if the baby feeds earlier?

Yes

No

for at least an hour after birth if the mother is planning to artificially feed her baby?

Yes

No

4.4 Do staff provide assistance by

keeping the mother and baby together?

Yes

No

ensuring procedures are in place for appropriate vigilance of the infant, including assessment of airway, breathing and colour?

Yes

No

encouraging the mother to recognise and respond to her baby’s innate feeding behaviours and allowing the baby to self-attach?

Yes

No

4.5 When mothers are intending to breastfeed, are their babies allowed to follow the normal sequence of innate feeding behaviours, seek the breast and initiate the first breastfeed when the babies are ready without staff hands-on intervention?

Yes

No

4.6 Are babies allowed to finish the feed when they are ready, without intervention?

Yes No

4.7 Are mothers with babies in special care enabled to hold their babies skin-to-skin (baby’s condition permitting)?

Yes No

4.8 Does the facility use practices and procedures that assist a mother to be more comfortable and in control during labour and birth?

Yes No

4.9 Does the facility use labour and birthing practices and procedures that make it more likely breastfeeding will get off to a good start?

Yes No

4.10 Do staff provide culturally sensitive care in response to the woman’s beliefs, customs or ethnicity?

Yes No


Step 5 Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants

5.1 Do staff offer all mothers ongoing assistance with breastfeeding as required?

Yes No

5.2 Do all relevant staff have the clinical skills needed to assist mothers who are breastfeeding to successfully feed their babies?

Yes No

5.3 Are breastfeeding mothers taught to correctly position and attach their babies for breastfeeding?

Yes No

5.4 Are breastfeeding mothers taught how to recognise if their babies are well attached and breastfeeding effectively?

Yes No

5.5 Are breastfeeding mothers taught how to recognise feeding cues other than crying?

Yes No

5.6 Are breastfeeding mothers taught:

how to stimulate the milk ejection reflex?

Yes

No

how to care for their breasts during lactation and what to if their breast become uncomfortably full?

Yes No

supply and demand principles behind maintaining an optimal milk supply?

Yes No

how to maintain lactation if they are separated from their infants?

Yes No

5.7 Are breastfeeding mothers taught how to manually (hand) express their breastmilk?

Yes No

5.8 Are breastfeeding mothers instructed about and provided with written information on how to store and use their expressed breastmilk?

Yes No

5.9 Are breastfeeding mothers made aware of the potential risks associated with using supplements in the first six months?

Yes No

5.10 Are group 2 personnel made aware of whom they can refer mothers for skilled assistance and advice on breastfeeding?

Yes No

5.11 Is a mother who has never breastfed, or who has previously encountered problems with breastfeeding, provided with additional support, assistance and advice from the staff of the facility?

Yes No

5.12 Are mothers who are breastfeeding, or have a breastfed baby/child who has been admitted to any part of the facility, provided with support and assistance that facilitates the continuation of breastfeeding?

Yes No

5.13 Are mothers of babies in special care nurseries supported to initiate lactation as soon as possible but within six hours of birth (unless the mother is severely medically compromised)?

Yes No

5.14 Are mothers of babies in special care nurseries shown how to express their breastmilk and provided with assistance as required?

Yes No


5.15 Are mothers of babies in special care nurseries informed how to establish and maintain lactation by frequent expression of breastmilk?

Yes No

5.16 Are mothers of babies in special care nurseries told and provided with written information on how to store, transport and use their expressed breastmilk?

Yes No

5.17 Is breastfeeding actively promoted and supported in all areas of the facility which might be accessed by mothers and/or babies?

Yes No

5.18 Are mothers who are considering artificial feeding supported to make a fully informed and appropriate decision about infant feeding, which is suitable to their circumstances?

Yes

No

5.19 Are all the relevant staff made aware of the following points:

key safety and hygiene points that should be covered when instructing a mother on reconstitution of a powdered milk formula?

Yes

No

key issues that should be covered when instructing a mother on how to feed her baby with a bottle?

Yes No

5.20 Are mothers/parents who will be leaving the facility using infant formula given a demonstration, supervised practice and information on the safe preparation, storage and handling of reconstituted powdered infant formula, using NHMRC Guidelines?

Yes

No

5.21 Are mothers/parents who will be leaving the facility using infant formula given information on best practice for feeding their babies with a bottle?

Yes No

5.22 Is the instruction on artificial feeding and the supervised practice, given away from mothers who are breastfeeding?

Yes No


Step 6 Give newborn infants no food or drink other than breastmilk, unless medically indicated

6.1 Does the facility’s infant feeding data indicate 75% of babies birthed in the past 12 months have been exclusively breastfed or breastmilk fed from birth to discharge?

Yes No

6.2 Are parents made aware of the importance of exclusive breastfeeding to around 6 months?

Yes No

6.3 Are all relevant personnel instructed on the limited number of Acceptable Medical Reasons for Use of Breastmilk Substitutes for giving food or drink other than breastmilk to breastfeeding babies?

Yes No

6.4 Are the mother/baby’s individual circumstances and alternate management strategies considered before giving a supplement of infant formula to a breastfed baby?

Yes No

6.5 Do breastfed babies receive food or drink other than breastmilk only when there is an acceptable medical reason, or at the mother’s informed request, which is documented at the time?

Yes No

6.6 Does the documentation of supplements include the volume given and the circumstances and reason/s for supplementation?

Yes No

6.7 Does the facility monitor and audit the use of supplements and associated practices and endeavour to reduce their use to the lowest possible level?

Yes No

6.8 If a mother requests her baby be given a supplement of infant formula, are alternate management strategies and the risks of supplementation discussed with her?

Yes No

6.9 Are supplies of infant formula and equipment for artificial feeding stored discretely and not openly on display in maternity and neonatal areas?

Yes No

6.10 Does the facility have adequate space and the necessary equipment for individual instruction on how to prepare infant formula away from breastfeeding mothers?

Yes No

6.11 Does the facility ensure that there are no materials being used, displayed or distributed to parents, which are unsupportive of breastfeeding, or which contradict exclusive breastfeeding for around 6 months, except informational materials given to parents who have chosen to use infant formula to feed their baby?

Yes

No

6.12 Does the facility ensure that there are no educational or promotional materials or literature used, displayed or distributed to parents:

which are produced by a company which markets or distributes products covered by the scope of the WHO International Code?

Yes

No

which picture or refer to a propriety product that is within the scope of the WHO International Code?

Yes No


6.13 Are breastmilk substitutes, including special infant formula and other supplies needed for artificial feeding, purchased by the facility wholesale through a pharmaceutical distributor or government tender or similar contract, or at a retail outlet, or brought in by parents for feeding their own infants?

Yes

No

6.14 The facility and its staff do not accept or distribute to mothers free or subsidised (low cost) samples or supplies of breastmilk substitutes, teats bottles or dummies?

Yes No

6.15 Do all educational materials (including videos/DVDs), handouts and sample bags/gifts conform to the standards stated in step 6?

Yes No

6.16 Have retail outlets within the facility restricted or minimised the promotion and/or sale of materials that are unsupportive of breastfeeding and/or inconsistent with BFHI?

(It is recognised that the influence of the facility may be limited when the retail outlets are not under their direct control.)

Yes No


Step 7 Practice rooming-in – allow mothers and infants to remain together 24 hours a day

7.1 Are babies with their mothers 24 hours per day except when there is a justifiable reason1. that necessitates separation?

Note: for the purposes of this step ‘babies with their mothers’ can include the mother’s partner or support person. 1. Justifiable reasons may include a mother or baby medical reason or a mother whose condition means that she is not able to respond to and/or be responsible for her baby and there is not an alternative carer, such as her partner, who is able to do this. Mother’s request or staff suggestion, without a justifiable reason that necessitates separation, is not acceptable.

Yes No

7.2 Does the facility have suitable provision for direct supervision of babies if they are out of their mothers’ rooms?

Yes No

7.3 Is the time, duration and the reason/circumstances of each separation documented?

Yes No

7.4 Are mother-baby separations uncommon, only when necessary, and fully documented?

Yes No

7.5 Are mothers made aware of why full rooming-in (staying close to their babies 24 hours a day) is important?

Yes No

7.6 Are relevant staff made aware of the circumstances when an exception can be made to mothers and babies rooming in 24 hours per day in the postnatal unit?

Yes No


Step 8 Encourage breastfeeding on demand

8.1 Assuming the baby is feeding effectively, are mothers advised to breastfeed

in response to their baby’s early feeing cues, as often and for as long as the baby wants?

Yes

No

if their breasts become uncomfortable or too full? Yes No

8.2 Are mothers taught to recognise their babies’ early feeding cues before crying?

Yes No

8.3 Are no restrictions placed on breastfeeding, unless frequency or timing of feeds is medically indicated and documented?

Yes No


Step 9 Give no artificial teats or dummies to breastfeeding infants

9.1 Is the use of artificial teats and dummies discouraged by the facility while breastfeeding is being established?

Yes No

9.2 Are artificial teats not used for feeding babies when the mother is breastfeeding or intending to breastfed, unless there is a legitimate clinical indication which has been documented?

Yes No

9.3 When the mother is breastfeeding or planning to breastfeed, and expressed breastmilk or a supplement is given, is the method of feeding other than from the breast documented?

Yes No

9.4 Do the staff members have the necessary skills to assist mothers to use alternate feeding methods, other than teats and bottles, when they are required?

Yes No

9.5 Are dummies not provided by the facility for normal newborn babies? Yes No

9.6 Are pregnant women and mothers made aware of the reasons why dummies are not recommended in the early weeks of breastfeeding?

Yes No


Step10 Foster the establishment of breastfeeding support and refer mothers on discharge

from the facility

10.1 Does the facility have procedures that facilitate ongoing support for breastfeeding and infant feeding when mothers and babies transition from inpatient care to community based care?

Yes No

10.2 Are all the relevant staff made aware of the local breastfeeding and infant feeding support services available to mothers?

Yes No

10.3 Does the facility work with and include the local breastfeeding support groups and services?

Yes No

10.4 Is after-discharge care discussed with mothers and are they provided with written information about both health services and mother support?

Yes No

10.5 Are mothers encouraged to be seen with their babies soon after discharge (preferably 2-4 days after discharge from inpatient care and again in the second week) at the facility or in the community by a skilled appropriate support person who can assess feeding and give any support needed?

Yes No

Documents

BFHI Self-Appraisal Tool Maternity Facilities...© ACM – BFHI Self-Appraisal Tool for Maternity Facilities P a g e | 5 For Hardcopy use please tick or cross the appropriate box