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

2. Health 21 in CR

3. 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)

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

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

6. 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

7. Sources of information
Books %
Magazines %
internet %
Health profs %

8. 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

9. 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

10. Practices to support BF after SC
Early initiation of BF ( within 1 hour)
Choose the appropriate position
Early rooming-in

11. Step 5 – show mothers how to breastfeed
Correct positiong
Correct attachment at the breast
Requires practical knowledge and counselling skills, psychological support

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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