THE BABY FRIENDLY HOSPITAL INITIATIVE

Slides:



Advertisements
Similar presentations
Goals of the Baby-friendly Hospital Initiative
Advertisements

Ten steps to successful breastfeeding Step 1.Have a written breastfeeding policy that is routinely communicated to all health care staff. A JOINT WHO/UNICEF.
Breastfeeding: A WIC Priority
Skilled Birth Attendant and Skilled Birth Attendance
The Ten Steps of the WHO/UNICEF Baby-Friendly™ Hospital Initiative
Baby Friendly Initiative Grey Bruce Health Services
Dr KANUPRIYA CHATURVEDI Dr. S.K. CHATURVEDI
Opportunities to Promote Breastfeeding Preconception Education in school systems Pediatric and adolescent visits Gynecologic visits Breast examinations.
Improving Breastfeeding rates at West Suffolk Hospital
$500 $400 $300 $200 $100 $500 $400 $300 $200 $100 BF in BC $500 $400 $300 $200 $100 $500 $400 $300 $200 $100 $500 $400 $300 $200 $100.
BFHI (Baby-Friendly Hospital Initiative)
BABY FRIENDLY HOSPITAL INITIATIVE
National Breastfeeding Consultative Meeting Legal framework for promoting and protecting breastfeeding in the workplace by: Ms Thulani Ntshani NDOH
Update from West Suffolk Hospital Breast feeding rates and the peer support service Colleen Greenwood West Suffolk Hospital.
Breastfeeding Support and Promotion Joan Younger Meek, MD, FAAP AAP Section on Breastfeeding The American Academy of Pediatrics strongly supports breastfeeding.
Implementing Skin to Skin Contact Routine Practice following Birth By Margaret O’Leary C.M.S. Lactation & Margaret Hynes C.M.S. Lactation.
Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Maternal and Newborn Health Training Package Session 8:
to support breastfeeding mothers
Breastfeeding Week 1-7 August Public education presentation Presented by: add your name 1 Created by Inge Kleinhans, 2013 Public Relations Officer of JuPHASA.
Breast Feeding Information for mentors Gerry Lucas Sue Davis.
 Patti Parsons has no relevant financial and/or non-financial relationships to disclose.
IYCF activities 2014 in Nepal Dr Srijana Basnet Assistant professor, NEBROF member Department of Pediatrics Institute of Medicine.
Golden Start Breastfeeding Initiative Leslie Anderson RN, PHN Laura Pearson RN, PHN.
© 2011 Baby-Friendly USA, Inc. The Baby-Friendly Journey The New 4-D Pathway to Baby-Friendly Designation.
Baby Friendly Hospital Initiative Through Bestfed Beginnings.
Baby Friendly Health Initiative (BFHI) Accreditation
Successful Exclusive Breastfeeding For the First Six Months
Slide 5.1 (HIV) The ten steps to successful breastfeeding for settings where HIV is prevalent: Issues to consider STEP 1:Have a written breastfeeding policy.
Baby-Friendly Hospital Initiative. Quality of Life Families save between $1200 & $1500 in formula alone in the first year Fewer missed days of work.
Maryland’s Commitment to Breastfeeding
DATA COLLECTION – WHAT IS NEEDED FOR BFI DESIGNATION: ARE WE THERE YET? MARINA GREEN RN MSN BREASTFEEDING COMMITTEE FOR CANADA APRIL,
Birth as a Human Rights Issue Ruth Weston Aquabirths, the birth pool specialists.
Presented at the National Breastfeeding Consultative Meeting August 2011 by Lynn Moeng.
Breastfeeding Trends in Hong Kong SAR Presented by Maggie Yu IBCLC Maggie Yu IBCLC La Leche League Hong Kong La Leche League Hong Kong BFHI – Hong Kong.
The Baby Friendly Initiative in Health Services
Breastfeeding.
Promoting and Protecting Breastfeeding Hazel Woodcock Infant Feeding Coordinator RFT Obstetrics & Gynaecology.
BFCI The Seven Point Plan. Point One: Have a written breastfeeding policy that is routinely communicated to all staff and volunteers.
The Role of the Midwife in Public Health Julie Foster Senior Lecturer University of Cumbria.
Supporting HIV positive mothers with infant feeding issues Group 4.
International Code of Marketing of Breast-milk Substitutes Abdulwahab Telmesani FRCPC,FAAP Faculty of Medicine and Medical Science Umm Al-Qura University.
1 Breastfeeding Promotion in NICU Z. Mosayebi Neonatologist, Tehran University of Medical Sciences.
Module II: Feeding and HIV Testing for Exposed Infants This module, we will discuss: Unit 1: Infant Feeding Guidelines Unit 2: HIV Testing and Treatment.
Assessing Readiness to Breastfeed in the Prenatal Visit Perinatal Services Coordination Family,Maternal & Child Health Programs Public Health Nancy Hill,
Why Breastfeeding Policies?  International Campaigns –WHO campaign against the extravagant and untrue marketing of breast milk substitutes (WHO Code)
Session 8 Baby Friendly Hospital practices. Where prevention of PTCT and infant feeding decisions can be integrated into MCH services Health education.
B ABY F RIENDLY H OSPITAL I NITIATIVE IN M ONGOLIA Dr.G. Soyolgerel Dr. Sh. Oyukhuu.
First Breastfeeding Attempt within an Hour of Delivery Team Members Pam Allyn Pat Karczewski Maureen Davey.
Ways and means to improve breastfeeding and Complementary feeding in India Dr Ranjana Zade Department Of Community Medicine.
 Breastfeeding Curriculum Megan Mariner MD LATCH NOW.
CPQC-HI MOM (Helping Infants with Mother’s Own Milk) Antenatal Platform Presentation November 10, 2015 Jodi Palmieri BSN, IBCLC St. Vincent’s Medical Center.
Making BFHI a Standard of Care in Health Care will Improve Implementation of 10 Steps in Health Facilities: Tanzanian Hypothesis Presented at IA Conference,
Teddy Nakyanzi - Nutritionist IBFAN Uganda. INTRODUCTION Infant Young Child Feeding has the single greatest potential impact on child survival. Breast.
INCREASING EXCLUSIVE BREASTFEEDING RATES AT BRIDGEPORT HOSPITAL BY DELAYING THE NEWBORN BATH BREAST IS BEST!
World breastfeeding Trends Initiative: regional perspective Percy Chipepera Chief Programme Office: IBFAN Africa Presented at the 9 th IBFAN Africa regional.
CODE IMPLEMENTATION: SHARING EXPERIENCES FROM PORT HARCOURT, NIGERIA Alice Nte Department of Paediatrics University of Port Harcourt Teaching Hospital,
 Ann Dozier, RN, PhD (PI) › Community and Preventive Medicine; University of Rochester  Cindy R. Howard, MD, MPH › Pediatrics; Rochester General Hospital.
Learning and Teaching Breast-Feeding Skills: An Interactive Seminar Scott Hartman Elizabeth H Naumburg Elizabeth Loomis STFM 2014.
NUTRITION DURING LACTATION zzt’07. In-Hospital Breastfeeding Rates (US, 2001) Healthy People 2010 Goal.
Survey Research on MS Obstetricians Who Are Involved in Breastfeeding Education and Support Linda C. McGrath, PhD, IBCLC, LLL Health Educator (CHES) Vincent.
Breastfeeding Promotion in NICU
Relactation & The way s To Increase Breastmilk
Goals of the Baby-friendly Hospital Initiative
Laciana McIntyre Health & Wellness Co-Coordinator
©2013 Baby-Friendly USA, Inc.
Training & Program Delivery Gear Meeting 2 presentation
Legislation & Policy Gear Meeting 2 presentation
Baby-Friendly USA 10 Steps.
Achieving BFHI Accreditation
Presentation transcript:

THE BABY FRIENDLY HOSPITAL INITIATIVE

1981: The World Health Organization’s (WHO) International Code of Marketing of Breast-milk Substitutes, adopted by the World Health Assembly, is a comprehensive set of guidelines, for those who work and interact with mothers and babies, that offers standards for the appropriate marketing and distribution of commercial competitors to breastfeeding (i.e. makers of infant formula)

1989: The “Ten Steps to Successful Breastfeeding” A joint WHO/UNICEF statement from “Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services.” The Ten Steps were adopted in 1989

1990: World Summit for Children Statement: Empowerment of all women to exclusively breastfeed their children for four to six months and to continue breastfeeding, with complementary food, well into the second year. Exclusive breastfeeding for six months is the ‘gold standard’ for optimal health.

1991: The launch of the BFHI The WHO/UNICEF International Code of Marketing of Breast-milk Substitutes (and subsequent relevant World Health Assembly resolutions) The Ten Steps to Successful Breastfeeding

In New Zealand: BFHI launched World Breastfeeding Week 2000 (August 1st – 7th) First hospitals BFHI accredited 2002 The Treaty of Waitangi is an integral part of BFHI in Aotearoa New Zealand Government wanted all maternity facilities to be accredited by the end of 2005! By 2012 95% of all facilities in New Zealand are BFHI accreditted

BFHI: A Standard of Care Supports the breastfeeding dyad In New Zealand 95% of women give birth intending to breastfeed. Does not mean facilities do not support the woman who has decided to formula feed her baby. 95% initiate breastfeeding – data extrapolated from breastfeeding statistics received from BFHI assessments of over 90% of facilities in New Zealand (2010)

Basic principles are non-negotiable Minimum standard of maternity practice Random sample of mothers must be interviewed Random sample of all levels of staff Antenatal and maternity service practice must be observed

In New Zealand to meet the BFHI standards: A facility must have had an exclusive breastfeeding rate of over 75% on discharge, for the past year Gain 100% for Steps 1 and 7 Attain a minimum of 80% for all other questions, in all the other standards of the assessment

WHO/UNICEF International Code of Marketing of Breast-milk Substitutes No advertising of breastmilk substitutes in the health care system or to the public No free samples to be given to mothers or pregnant women No free or subsidised supplies to hospitals No contact between company marketing personnel and mothers The Main Points of The Code

Materials for mothers should be non-promotional and should carry clear and full information and warnings. Companies should not give gifts to health workers No free samples to health workers, except for professional evaluation or research at the institutional level

Materials for health workers should contain only scientific and factual information. No pictures of babies or other idealising images on infant formula labels. The labels of other products must provide the information needed for appropriate use, so as not to discourage breastfeeding.

Every facility providing maternity services and care for newborn infants should: 1. Have a written breastfeeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Help mothers initiate breastfeeding within a half-hour of birth.

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants. 6. Give newborn infants no food or drink unless medically indicated. 7. Practise rooming-in – allow mothers and infants to remain together – 24 hours a day. 8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

THINGS TO DO: For ‘the Code’ Have a Policy to cover The Code? Include a policy for formula company representatives – in keeping with the Code of Marketing? Include a policy for appropriate management of formula – alternating brands regularly, ensuring the cost paid for the formula is at least 80% of the retail price? Ensure formula tins are out of view – no labels seen Bottles and teats are stored out of view No references to bottles and teats

Always remember breastfeeding is the normal Is there a policy requesting that women who choose to A/F bring in own formula Always remember breastfeeding is the normal Toys in toy boxes – yes - they also need to be Code compliant Books in the units do not contain information which violate the Code Diaries, lanyards have not been gifted to staff Consent for formula – in appropriate languages Formula purchase records – need to be available – showing a decrease in use! Check “gift bags” are Code compliant Can request mothers bring their own formula – the one they intend to continue using – however this cannot be enforced if mother refuses

Check A/N references and handouts are also Code compliant Check posters comply Check pamphlets given out to mothers are not advertising anything found under the scope of the Code Check A/N references and handouts are also Code compliant The scope of the “Code applies to the marketing, and practices related thereto, of the following products: breastmilk substitutes, including infant formula; other milk products, foods and beverages, including bottle-fed complementary foods, when marketed or otherwise to be suitable, with or without modification, for use as a partial or total replacement of breastmilk; feeding bottles and teats. It also applies to their quality and availability and to information concerning their use.” International Code of Marketing of Breastmilk Substitutes and Relevant WHA resolutions IBFAN 2006

The Ten Steps to Successful Breastfeeding: HELPFUL ADVICE

Step One: Have a written breastfeeding policy that is routinely communicated to all health-care staff 100% compliance required for this step

Breastfeeding Policy Why have a Policy? Requires a course of action and provides guidance Helps establish consistent care for mothers and babies Provides a standard that can be evaluated

The Breastfeeding Policy: What should it cover? At minimum it must include: The 10 Steps to Successful Breastfeeding An institutional ban on acceptance of free or low cost supplies of breastmilk substitutes, bottles and teats - The facility must work in allegiance to the Treaty of Waitangi to improve outcomes for Maori and non-Maori in their community

The Policy…………….. Must be visible Must be in appropriate languages. Should be available on request. Recognise it as a wonderful tool for women and staff – powerful and empowering!

Consultation for the Policy: Must be seen – good paper trail essential Must be wide consultation process! Must include consultation with Maori and any culture represented by >5% of clientele

The Policy…………………… Sign-off date noted Displayed in all areas Translated into relevant languages Included in the orientation for all new staff Other policies should be seen to support the policy eg: hypoglycaemia Evaluation tool available to assess effectiveness of policy – audit against the Policy

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

“ If you think education is expensive, try ignorance”

Education Includes NICU staff and any staff that come in contact with breastfeeding mothers and babies Hours required vary Records must be clear and available Education must be seen to be ongoing Documentation of all education taught, and their programmes, should be available to view

Staff employed within the past 6 months must have been orientated to the Breastfeeding Policy and been placed on the next available breastfeeding education session - but are not included in the overall percentage of staff required to meet this step at the assessment.

Facility staff are required to have prescribed amounts of education. Specialist Level – 21hrs (and the equivalent to 4hrs annually ongoing) Generalist Level – the equivalent to 2hrs for each year of employment – assessed over the previous three years (and the equivalent to 2hrs annually ongoing) Awareness Level – the equivalent to 1hr for each year of employment assessed over the previous three years (and the equivalent to 1hr annually ongoing) Breastfeeding

Staff who assist with breastfeeding: may include midwives, nurses and hospital aides (in some cases) at least 80% of these staff are required to have had a minimum of 21 hours education at the time of assessment ongoing education must equate to a minimum of 4 hours annually stipulated components including ‘Breastfeeding for Maori Women’ and clinical education

Documentation must show: For each individual staff member the date of: Commencement of employment Orientation to the Breastfeeding Policy at commencement of employment and whenever the policy is reviewed

Completion of 3 hours (minimum) supervised clinical education Further relevant breastfeeding education sessions (with hours/programmes/sign-on sheets) = total of 21 hours minimum breastfeeding education which indicates an ongoing education programme is in place.

Areas of knowledge: Hospital breastfeeding policies and practices The basic components of BFHI The importance of breastfeeding Risks of artificial feeding Mechanisms of lactation and suckling How to help mothers initiate and sustain breastfeeding How to assess a breastfeed How to resolve common breastfeeding difficulties

Suggested education methods: Study days On-line education Worksheets Videos/DVD’s with questionnaires Research papers with questionnaire Case studies/presentations Discussion periods

Generalist Level: Documentation which shows the date: Of employment Orientation to the Breastfeeding Policy Breastfeeding education received which must include ‘The Ten Steps’ and ‘The Code’ Ongoing education 80% must have completed the above – equating to a minimum of 2 hours for each year of employment, assessed over the previous three years. Ongoing education equates to a minimum of 2 hours annually

Awareness Level This could include: Hospital aides Cleaners Physiotherapists General theatre staff Receptionists Dietitians Anaesthetists

Education requirement: These staff are required to have had three hours of breastfeeding education over the previous three years or (if employed within the previous three years) the equivalent of one hour for each year since employment. This education must include: the Ten Steps to Successful Breastfeeding the protection of breastfeeding (the ‘Code’) Ongoing education: must equate to a minimum of one hour annually

If the first two steps have been well advanced and staff have all had the education and understand the Policy then the rest of the “Ten Steps” and compliance with “The Code” should follow-on

Knowledge will: Prevent conflict Motivate staff

Step Three: ANTENATAL EDUCATION Written documentation of content of classes Needs to Cover: - The Breastfeeding Policy - The importance of exclusive breastfeeding for 6 months - The importance of breastfeeding - Basic breastfeeding management - Breastfeeding support in the community The Breastfeeding Policy is a powerful tool – if mothers are aware of the care which should be afforded to them. Breastfeeding as opposed to expressed breastmilk given in a bottle.

Continued……….. Women should have had discussed with them: Optimal nutrition for the baby Bonding Protection, including the role of colostrum Health advantages to the mother Positioning and attachment Importance of baby-led feeding Importance of ‘rooming-in’, safe and unsafe sleep practices How to ensure they have enough milk The effect drugs given during labour and birth can have on breastfeeding

Antenatal information: Explore the A/N programme Include all women not just primiparous women Document time when education occurred Ensure the ‘10 steps’ are covered Check the word ‘exclusive’ is used Ensure women who have had previous breastfeeding issues are referred for consultation prior to birth of new baby

Step Four: Help mothers initiate breastfeeding within a half an hour of birth

New Interpretation: 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 necessary

Early initiation of breastfeeding for the well newborn How? Keep mother and baby together Place baby on mothers chest Let baby start suckling when ready Do not hurry or interrupt the process

Early Initiation: Skin-to-skin contact– not blanket to skin! Lead Maternity Carers have had policy consultation – so should comply Assistance with initial breastfeed if required Skin-to-skin contact can be discontinued once baby has latched and suckled effectively at the breast

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

Step Five: Show mothers how to breastfeed…… Ensure staff can demonstrate correct positioning and latching Mothers must be taught how to hand express Mothers must be taught – use words! Mothers need to know how to store milk and how often to express Some people feel these things are not all required to be shown to a new mother – but if the woman gets home and has issues with breastfeeding (and her LMC is unavailable) at least she will have the skills to hand express (and store her milk) thereby preventing the risk of formula use and decreasing lactation. A BFHI accredited facility must show it is protecting breastfeeding (exclusive breastfeeding) – therefore this information is essential to be relayed!

Step Six: ONLY BREASTMILK UNLESS MEDICALLY INDICATED In New Zealand we use the words: ‘for sound clinical reasons’ No promotion of formula No advertising No written handouts Remember breastfeeding is the norm! Formula is a treatment where breastmilk is unavailable

Remember: BFHI is all about the well baby! The 20% leeway in this step allows for: Mothers who have decided to formula feed Babies on the postnatal ward who have required formula for a sound clinical reason

Sound Clinical Indication: “There are rare exceptions during which the infant may require other food or fluids in addition to, or in place of, breastmilk. The feeding programme of these babies should be determined by qualified health professionals on an individual basis.”

…….unless clinically indicated Consent for formula for breastfed babies Check sound clinical indicators in your policy How is expressed breastmilk/formula given to the baby – the use of bottles and teats do not support, protect or promote breastfeeding

Step Seven: Practice Rooming-in: Allow mothers and infants to remain together 24 hours a day

Rooming-in A hospital arrangement where a mother/baby pair stay together in the same room day and night, allowing unlimited contact between mother and infant

Why? Reduces costs Requires minimal equipment Requires no additional personnel Reduces infection Helps establish and maintain breastfeeding Facilitates the bonding process

Mothers should be told: The importance of rooming-in for baby/mother and breastfeeding Baby’s cues for feeding – crying is the last cue!! More breastfeeds Longer breastfeeding duration Prevents infection Safety factors Safe and unsafe sleep practices

Check babies are not removed from mothers room at night Remember mothers are asked whether the baby was taken out of the room – and who initiated that separation! Check babies are not removed from mothers room at night 100% compliance is required for this step Babies may be separated from their mother for periods of up to an hour for a sound clinical reason; if separation is requested the mother must have requested it. If otherwise initiated the baby needs to be held during the separation (by staff or family member) for the time it is away from its mother.

Step Eight: Encourage breastfeeding on demand

Breastfeeding “on demand” = Baby-led or cue-based feeding = Breastfeeding whenever the baby or the mother wants, with no restrictions on the length or frequency of feeds

On demand, unrestricted breastfeeding Why? Earlier passage of meconium Lower maximal weight loss Breastmilk flow established sooner Larger volume of milk intake on Day 3 Less jaundice

Recognise the cues No timing Recognise different breast capacities! Different metabolic rates! All women are different All breasts are different

Questions asked at assessment: Mothers are asked the cues to feed Ensure baby-led feeding was recommended! Know to wake baby if breasts are full (or express if this is not appropriate!) Recognise baby is feeding effectively – milk transfer occurring

Step Nine: Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

Reasons include: These can interfere with the suckling action Upsets the needs of the baby  decreased stimulation of the breast Disempowerment of the mother

No advertising No discussion unless the mother has decided to formula feed – then on a one-to-one basis only The use of pacifiers is detrimental to breastfeeding

Step Ten: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

“The key to best breastfeeding practices is continued day-to-day support for the breastfeeding mother within her home and community”

Very important step Discussion and handouts – find out your local groups. Culturally appropriate Include partners in all discussions – his/her support is paramount Significant other and mothers very important

Support can include: Early post natal or clinic check-up Home visits Telephone calls Community services Outpatient breastfeeding clinics Peer counselling programmes Mother support groups Help set up new groups Family support system

BFI and the Treaty of Waitangi Facilities are assessed by a Maori assessor to ensure it works in allegiance to the Treaty of Waitangi to improve outcomes for Maori and non-Maori in the community. The Policies, staff education and practices and observations need to met the BFHI standards.

Standards of care for the non-breastfeeding mother and her baby Areas to be assessed: The Artificial Feeding Policy Staff education Education of mothers on an individual basis Post natal care ensures skin-to-skin contact and rooming-in

These mothers are taught how to safely prepare and feed their babies and how to clean and sterilise their feeding equipment These mothers are taught how to manage their breasts should they become uncomfortable All handouts are Code compliant Safe and unsafe sleep practices are discussed

References: The BFHI Documents for Aotearoa New Zealand (2011) “International Code of Marketing of Breastmilk Substitutes and Relevant WHA resolutions” IBFAN 2006