BFHI (Baby-Friendly Hospital Initiative) A.Mydlilová NARLAC – National Lactation Centre FTN Krč Prague

Health 21 in CR

BFHI = 10 steps Implemented in CR in last 20 years 1992-FTN Krč Prague – 1st Baby-Friendly Hospital in CR MoH prepares a directive on implementation of 10 steps into standards of health care Guidelines on Baby-Friendly Hospitals should become the part of the assessment of the quality of a hospital (the WHO goal)

Step 1. - policy Written policy based on 10 steps Health staff should know it and practise

Step 2 – train the staff WHO Training Module (20 hour) CR – 20 hour course for health workers

Step 3 – inform pregnant women On benefits of BF, physiology, lactation management Encourage pregnat women to participate at antenatal courses, information on BF should be a part of the course NARLAC Study (2008) 38 % antenatal courses – no information on BF 41,8 % mothers not satisfied with the course content 9 %mothers - information form health profs Most frequent source of information – internet, magazines, books

Sources of information Books 39 % Magazines 26 % internet 15 % Health profs 9 %

Proposals for improvement Information on BF should be a part of antenatal courses Methodological guidelines (professional associations): 1. Breast examination 2. Explain consequences of separation (e.g. ICU) 3. Instruct on expressing milk within 6 hours after birth 4. Inform about consequences of using bottles, teats 5. Instruct on techniques of BF, expressing milk, alternative feeding methods Focus on women with lower education

Step 4 – initiate BF within 1 hour Enable „skin to skin“ contakt as soon as possible „Skin to skin“ contakt important in first 24 hours Prevention of BF problems Inform health profs and public

Practices to support BF after SC Early initiation of BF ( within 1 hour) Choose the appropriate position 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 to maintain lactation if separated from their infants Start expressing milk as soon as possible ( 1. manual expression, 2. pumps) Train health staff Health staff provides support to mothers

Step 6 – no supplementation Give newborn infants no food or drink other than breast milk, unless medically indicated, then use alternative methods, no bottles Stress the importance of colostrum

Step 7 – Rooming-in 24 hours Inform mothers on its importance Enables feeding on demand Mothers learn to recognise fine signals of readiness to breastfeed in the child RI – newborns cry less, mother sleep more Crying child – difficult to breastfeed

Step 8 – encourage breastfeeding on demand Do not restrict duration r frequency of BF Do not encourage a common schedule of BF Respect individual rhythm and needs of the newborn Number of breastfeeds should not drop below 8 in 24 hours

Step 9 – no bottles or teats Give no artificial teats or pacifiers (dummies, soothers) to breastfeeding infants Interferes with suckling techniques Inform mothers about its importance Do not promote bottles or pacifiers at the hospital

Step 10 – continuing breastfeeding support WHO encourages continuing support in the community Lactation counselling after discharge from hospital (lactation centres, lactation counsellors, self-help groups) Effective help, provides also emotional support

Primary health care (recommended preventive examinations) WHO Day 5-7 Week 3-4 Week 6 WHO, 2009 CR 48 hours after birth Week 2 Week 6 Month 3 Months 4-5 Directive on Preventive examinations, MoH, 2010