1. BFCI The Seven Point Plan

2. Point One: Have a written breastfeeding policy that is routinely communicated to all staff and volunteers

3. The Policy:  What should it cover? At minimum it should include: -The 7 Point Plan -Compliance to the International Code of Marketing of Breast-milk Substitutes -Reflect the guiding principles of the BFCI Implementation Guide for Health Services

4. Point One: The Policy  Consultation -Must be shown by documentation -Treaty of Waitangi included/intertwined -Extensive consultation evidenced! -Sign-off date noted -Displayed in all areas -Different languages -Education about policy for all staff and volunteers -Other policies to support policy eg: Staff employment policy. - Measured effectiveness of the policy

5. Point 2:  Train all providers in the knowledge and skills necessary to implement the breastfeeding policy.

6. “ If you think education is expensive, education is expensive, try ignorance” try ignorance”

7. Areas of knowledge  Guiding principles of The Seven Point Plan  Content of The Seven Point Plan  Basic information on breastfeeding support and management  Skill development related to breastfeeding support and management  Attitudes and barriers to breastfeeding  Community resources for breastfeeding

8.  Staff educated to the level of their role  Policy orientation on commencing work  New staff – education available within 6months

9. Required Education:  Specialist Staff (working with mothers) At the time of assessment 80% need to have completed the minimum of 21 hours as stipulated in the standards for Step Two ( this includes information from pregnancy through to complementary foods) At the time of assessment 80% need to have completed the minimum of 21 hours as stipulated in the standards for Step Two ( this includes information from pregnancy through to complementary foods) Demonstrates appropriate clinical skills Demonstrates appropriate clinical skills Continuing education equates to 4 hours annually Continuing education equates to 4 hours annually

10. Some Groups/individuals may choose to refer to a Lactation Consultant or other breastfeeding advisor. They need to show: Evidence of referral system Evidence of referral system Equates to 2 hours education for each year of employment (assessed for the previous 3 years) Equates to 2 hours education for each year of employment (assessed for the previous 3 years) Continuing education equates to 2 hours annually Continuing education equates to 2 hours annually

11.  All other staff: Equates to one hour for each year of employment – assessed over the previous 3 years Equates to one hour for each year of employment – assessed over the previous 3 years ongoing education equates to 1 hour annually ongoing education equates to 1 hour annually

12. Point Three:  Inform all pregnant women and their families about the benefits and management of and management of breastfeeding. breastfeeding.

13. Antenatal Education should include:  Importance of breastfeeding  Importance of exclusive breastfeeding until 6 months  Importance of feeding at the breast  Health consequences of artificial feeding  Risks and costs of artificial baby milks  Contraception (compatible with breastfeeding)  The Ten Steps to Successful Breastfeeding  Support in the work place during pregnancy and breastfeeding  The challenge of re-lactation

14. The Service must also…….  Recognize the importance of educating the woman who has decided to, or needs to, feed her baby artificial baby milk.

15. Point Four  Support mothers to establish and maintain exclusive breastfeeding to six months

16. How?  Good antenatal education +  Good establishment of breastfeeding +  Good breastfeeding support

17. Examples……  Antenatally: Realistic breastfeeding expectations Realistic breastfeeding expectations Personal expectations Personal expectations Social preparation Social preparation Knowledge of support systems available Knowledge of support systems available

18. ……establishment   Aware of the importance of exclusivity of feeding at the breast   Knowledge of breastfeeding management   Frequent contact for assessment of progress   Early identification of any breastfeeding ‘hiccoughs’   Awareness of safe and unsafe sleep practices

19. ……….support  Aware of how to access assistance at any time over the 24 hours of a day if necessary!  Encouragement to attend peer breastfeeding groups  Given appropriate information about maintenance of lactation if separation necessary  Offered timely advice about contraception, compatible with breastfeeding

20. Mothers Not Breastfeeding  Given individual (including partner/family as necessary) support and education covering: Safe preparation and handling of formula Safe preparation and handling of formula Sterilization of equipment Sterilization of equipment Safe feeding techniques Safe feeding techniques Discussion about co-sleeping Discussion about co-sleeping

21. Point Five  Encourage sustained breastfeeding beyond six months, to two years or more, alongside the introduction of appropriate, adequate and safe complementary foods

22. Principles:  Maintain breastfeeding  Practice responsive feeding  Prepare, store complementary food safely  Increase amount gradually while breastfeeding  Ensure consistency of food appropriate to age  Adapt meal frequency/density to age cont’d……. cont’d…….

23. Cont’d…….. Cont’d……..  Ensure nutrient content of foods meets infants needs  Use fortified products if needed  Adapt feeding during/after illness  Information offered concerning breastfeeding in the workplace  Information available about contraception and co-sleeping

24. Sustain breastfeeding until natural weaning occurs – don’t offer to breastfeed – but don’t refuse!

25. Point Six  Provide a welcoming atmosphere for breastfeeding families

26. How?  Welcome to breastfeed in public areas of the service  Private space available if requested – clean, quiet with a comfortable chair  Educate staff about mothers right to breastfeed  Notices displayed stating mothers are welcome to breastfeed – posted in appropriate languages of the service…….

27. Continued……….  Culturally appropriate area and information  Evidence of consultation with each mother to ascertain their needs can be seen  Feedback/suggestions opportunity for mothers  “Code” compliant handouts and information available to take home

28.  Services which do not work from a site need to meet these requirements whenever they deliver the service - for example – a Lactation Consultant visiting a woman in her home needs to have an evaluation form (assessment of presenting condition) and a feedback form for the mother for example – a Lactation Consultant visiting a woman in her home needs to have an evaluation form (assessment of presenting condition) and a feedback form for the mother

29. Point Seven  Promote collaboration among health services and between health services and the local community

30. Wow! This is great!!!  Requires involvement of entities outside the service – the service will: Avail themselves to any opportunity to collaborate with others Avail themselves to any opportunity to collaborate with others Community consultation with Policies Community consultation with Policies Have strong systems in place at the interface …. hospitals, LMC’s, Plunket etc Have strong systems in place at the interface …. hospitals, LMC’s, Plunket etc Use written referrals which contain information about B/f status & B/f issues Use written referrals which contain information about B/f status & B/f issues

31. Services need to work together…  To support the breastfeeding dyad Share information Share information Have discussions Have discussions Give feedback Give feedback ……this ensures continued support

32. Breastfeeding Resources….  Mother – to – mother  Parent support  Lactation Consultants  Breastfeeding Clinics  Maori Health Agencies  Pacific Health Agencies  Practice nurses ……………

33. ….and there’s more …..  Midwives  Doctors  Nutritionists  Pharmacists  Dental services  Health promoters

34.  Antenatally……. Refer women to voluntary groups Refer women to voluntary groups Assist them to set up own informal support networks Assist them to set up own informal support networks  The service can show commitment to the BFCI by……. Supporting World Breastfeeding Week Supporting World Breastfeeding Week Letters to the editor Letters to the editor Supporting breastfeeding campaigns Supporting breastfeeding campaigns Identifying and overcoming breastfeeding barriers within the community Identifying and overcoming breastfeeding barriers within the community

35. Working together

36. References:  BFCI Documents for Aotearoa New Zealand  BFHI 2004, Baby-Friendly goals expand to community and pre-service training. Baby Friendly and beyond - Integrated care for mother and child 2: 1.  UNICEF UK Baby Friendly Initiative 2008, The seven point plan for sustaining breastfeeding in the community.  IYCF Model Chapter for textbooks for Medical Students,(2009) Session 4 & 5