Session 15

1. Explain what Baby-friend practices mean

2. Describe the process of BFHI assessment

3. Discuss how BFHI can be included in existing programmes.

Have a breastfeeding policy that is routinely communicated to all health care staff.

Facility will have a written policy on breastfeedingNurse Director/Manager will identify health care

professionals with ultimate responsibility for assuring implementation of breastfeeding policy

Nurse Director/Manager will be able to describe how staff are made aware of policy and its content

Staff will be able to identify location of policy and report having received orientation to policy

The 10 steps and policy regarding restriction of promotion of breastmilk substitutes will be prominently displayed about the facility

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

Facility will have training records for all staff with daily exposure to nursing moms and babies as well as records of physician training

Nurse Director/Manager or Training Coordinator will : identify health care professional(s) with ultimate

responsibility for assuring staff training provide an outline of the topics covered in training describe methods of verifying clinical competency

post trainingTraining outlines will demonstrate that topics

have been covered and competency verified.

Ten Steps to Successful Breastfeeding tensteps.jbpub.com (23.4 CEU for RNs & IBCLCs, 10 CME for physicians)

Lactation for Clinicians www.umdnj.edu/lactweb/continuing/index.htm (University of Medicine and Dentistry of New Jersey.-up to 9 CME available)

Breastfeeding Basics breastfeedingbasics.org (Case Western Univ-CME currently not available)

Health E-Learning Australian company providing on-line CEU for BFHI as well as other breastfeeding topics http://www.health-e-learning.com/

Passport to Breastfeeding http://www.breastfeedingclinic.com/bfdvd/(Canadian - reciprocal CME through AAFP)

Physician Lactation Education Collaborative of Washington: Increasing Breastfeeding Success. Why it matters and what the research shows (DVD). www.withinreachwa.org $23 for non-WA residents.

University of Virginia School of Medicine & Virginia Department of Health. Breastfeeding Training for Health Professionals. Authors: n.d. http://www.breastfeedingtraining.org. CME available

Wellstart International. Lactation Management Self-Study Module 1: http://wellstart.org/Self-Study-Module.pdf

Academy of BF Medicine provides protocols, policy, newsletter, conferences and other educational events. resources: www.bfmed.org

AAP and ACOG policy statementsAHRQ review on benefits of BF:

http://ahrq.gov/clinic/tp/brfouttp.htm#reportAHRQ review on the effect of primary care

interventions on BF: http://www.ahrq.gov/clinic/uspstf/uspsbrfd.htm

Articles from Boston Medical Center (authors Philipp & Merewood on bibliography)

Inform all pregnant women about the benefits and management of breastfeeding.

Written description of the content of prenatal education will be available and will include benefits of breastfeeding, importance of exclusive breastfeeding in the first 6 months, and basic breastfeeding management

Pregnant women of 36 weeks gestation will confirm that benefits of breastfeeding have been presented to them, and will be able to list benefits of breastfeeding

All materials used for prenatal education on breastfeeding will be free of messages which promote any infant food or drink other than human milk and will not bear proprietary product logos

Help mothers initiate breastfeeding within one hour of birth.

Postpartum mothers of vaginal deliveries will confirm that immediately after birth their baby was placed skin to skin with them and left there continuously and uninterrupted until the completion of the first breastfeeding (or for one hour if not planning to breastfeed.)

Postpartum mothers of cesarean births will report that the same continuous skin to skin care began as soon as they were able to respond and continued uninterrupted until the completion of the first breastfeeding (or for one hour if not planning to breastfeed.)

Postpartum mothers of vaginal deliveries will confirm that immediately after birth their baby was placed skin to skin with them and left there continuously and uninterrupted until the completion of the first breastfeeding (or for one hour if not planning to breastfeed).

Postpartum mothers of cesarean births will report that the same continuous skin to skin care began as soon as they were able to respond and continued uninterrupted until the completion of the first breastfeeding (or for one hour if not planning to breastfeed).

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

Postpartum mothers will: report that nursing staff offered further

assistance with breastfeeding within six hours of delivery.

be able to demonstrate correct positioning and attachment.

report that they were shown and/or given information regarding how to express their milk.

Mothers with babies in special care will: report that they have been offered help to

initiate and maintain lactation by frequent expression of breastmilk.

Staff will :report that they teach mothers positioning and

attachment.report that they teach or give information about

expression of breastmilk.demonstrate correct teaching of positioning and

attachment.describe an acceptable technique for breastmilk

expression as taught to mothers.

Give newborn (breastfed) infants no food or drink other than breastmilk, unless medically indicated.

[The requirement to purchase formula is a sub-step of Step 6.]

infants with severe dysmaturityinfants of very low birth weightinfants with inborn errors of metabolisminfants with acute water lossinfants whose mothers are severely illinfants whose mothers require a

medication that is contraindicated

Mothers will:report that their babies have been exclusively

breastfed, unless acceptable medical reasons apply

OR report that staff have explored reasons for and possible negative consequences of supplementation elected by mother for non-medical reasons.

Staff will:report that mothers are routinely encouraged to

exclusively breastfeed.

Materials given to breastfeeding mothers and displayed in facility are free of messages (including product logos and names) which promote infant food or drink other than breastmilk.

Nursing Director/Manager will show evidence that the facility purchases breastmilk substitutes, nipples and pacifiers at fair market prices.

Practice rooming-in - allow mothers and infants to remain together twenty-four hours a day.

Mothers will:room-in with their babiesreport that their babies have stayed in their room

day and night except for periods of up to one hour daily for hospital procedures

Staff will report that:rooming-in is encouraged as the norm any request by mother for not rooming-in is

explored and education about the advantages of rooming-in is given

Encourage unrestricted breastfeeding.

Mothers will report that: they have been advised to feed their babies on

cueno restrictions have been placed on how often or

how long to breastfeed

Staff will report that:mothers are taught to feed on cueno restrictions are placed on frequency or length

of feeds

Give no pacifiers or artificial nipples to breastfeeding infants.

Mothers will report that:their babies have not been given nipples or

pacifiersOR that staff have offered education regarding

possible disadvantages of mother’s decision to use pacifiers or bottles

Staff will report that:breastfed babies are not routinely given bottles

or pacifiersthe use of pacifiers is discouraged

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birthing center.

The facility will report that: it has taken action to foster the establishment of

breastfeeding support groups in the communityMothers will report that:staff have offered resources for on-going support.Staff will report that:mothers are always referred to on-going support

resources.

The Pathway to Baby-Friendly™ Designation

Hospital Breastfeeding

Policy

ReadinessInterview

ImplementQI PlanCollect Data

Train Staff

Data Collection

Plan

Prenatal/PostpartumTeaching Plans

Staff TrainingCurriculum

On-SiteAssessment

Start

DDiscoveryiscovery

DDevelopmentevelopment

DDisseminationissemination DDesignationesignation

BF Committee Or Task Force

BFHIWork Plan

Register withBaby-Friendly USA

Obtain CEO Support Letter

Complete SelfAppraisal Tool

Baby-FriendlyDesignation

Baby-Friendly USA, Inc. 2010For more information go to www.babyfriendlyusa.org

Bridge to Development Phase-

Registry of IntentAward

Bridge to Designation Phase

DisseminationCertificate of Completion

Bridge to Dissemination

Phase-Development-Certificate of Completion