The Baby Friendly Hospital Initiative andEssential Newborn Care

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ObjectivesAt the end of this session, you will:Be aware of the relationship between the BFHI and the ENCC in newborn care

Understand how the initiation and establishment of breastfeeding can be achieved by implementing the ten steps to successful breastfeeding. Understand why the ENCC should implemented in a hospital where the BFHI is established practice

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The Ten Steps to Successful Breastfeeding1.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 other than breast milk, 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.

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BFHI Progress: Total number of designated Baby-Friendly Hospitals

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The International Code of Marketing of Breastmilk Substitutes and the BFHIIn a BFHI Maternity facility there must be:

No advertising materials, posters, growth charts, name bands etc, from formula or bottle manufacturers,

No gifts, food, inducements to health workers

No free or low cost breast milk substitutes/formula.

No free products to mothers, pregnant women or their families

No direct contact between employees of formula manufacturers with pregnant women or mothers in the health facility

No demonstrations of making up formula to anyone that does not need them

No use of space, equipment or educational materials sponsored or produced by companies when teaching mothers about infant feeding

Scientific and factual Information given to health workers.

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BABY-FRIENDLY HOSPITAL INITIATIVERevised, Updated and Expanded for Integrated CareMaternity, 1963, 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York

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Revised BFHI Materials 2006BFHI training course - 20 hours including 3 hours clinical practice

Revised interpretation and assessment tools for BFHI 10 steps and Code and support for HIV women.

Two optional components, which are: HIV and infant feedingMother friendly care, which covers labour and delivery practices A section on expansion and integration of BFHI approach into other areas, from other countries, including:Baby friendly communitiesBFHI and Prevention of Mother to Child Transmission (PMTCT) of HIV/AIDSMother-Baby friendly facilities and communitiesBaby-friendly Neonatal Intensive Care and Paediatric UnitsBaby-friendly Physicians Office: Optimising Care for Infants and ChildrenBaby-friendly Complementary Feeding

In 2008 WHO revise Acceptable Medical Reasons for use of breast-milk substituteshttp://www.who.int/child-adolescent-health/publications/pubnutrition.htm

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Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality

Karen M. Edmond, Charles Zandoh, Maria A. Quigley, Seeba Amenga-Etego, SethOwusu-Agyei and Betty R. KirkwoodPediatrics 2006;117;380-386

CONCLUSIONS: Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour. Breastfeeding promotion programs should emphasize early initiation as well as exclusive breastfeeding..

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Step 1Have a written breastfeeding policy that is routinely communicated to all health care staffThe policy has to cover:what is required to implement ALL ten steps

The International Code of Marketing of Breast-milk substitutes and subsequent World Health Assembly (WHA) resolutions

Support for HIV women

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Training for all clinical staff Training of 20 hours including 3 hours of clinical practice

to cover:

The Ten Steps in detail The role of the facility and its staff in upholding the International Code of Marketing and subsequent WHA resolutions.

Feeding the infant who is NOT breastfed.

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STEP 2. Train all health care staff in skills necessary to implement the policy.Effect of breastfeeding training for hospital staff on exclusive breastfeeding rates at hospital dischargeAdapted from: Cattaneo A, Buzzetti R. Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative. BMJ, 2001, 323:1358-1362.

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Inform all pregnant women about the benefits and management of breastfeedingThe benefits of breastfeeding, the importance of early skin-to-skin contact and early initiation of breastfeeding,rooming-in, good positioning and attachment, feeding on demand or baby-led feeding, frequent feeding to help maintain her milk supply

exclusive breastfeeding for the first 6 months, continuing to breastfeed after 6 months when other foods are given.

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STEP 4. Help mothers initiate breastfeeding within a half-hour of birth.This means:

Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour

encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.

Do not part mother and baby until after the first breastfeed.

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Skin-to-skin contact after a caesarian section(epidural)

Breastfeeding can start when the baby is ready if the mother is comfortable.

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Lay the baby on the mothers chest between her breasts and let him self-attach that is what he is biologically programmed to do.

DO NOT ATTACH THE BABY .

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Effect of delivery room practices on early breastfeeding

Adapted from: Righard L, Alade O. Effect of delivery room routines on success of first breastfeed .Lancet, 1990, 336:1105-1107.63% P

Step 4: Temperatures of infants after birth kept either skin-to-skin with mother or in a cotAdapted from: Christensson K et al. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. Acta Paediatr, 1992, 81:490.Slide

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STEP 5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infantsAll mothers are taught hand expression (or given leaflet and referral for help).All breastfeeding mothers are taught positioning and attachment.

All mothers who have decided not to breastfeeding are:Informed about risks and management of various feeding options and helped to decide what is suitable in their circumstancesTaught to prepare feeds of their choice and asked to demonstrate what they have learned.

Mothers of babies in special care units are:Helped within 6 hours of their babys birth to initiate lactation, stimulate milk flow and express by hand.told to breastfeed or express at least 6-8 times, from the day of birth, in 24 hours to maintain their milksupply.Given information on risks and benefits of various feeding options and how to care for their breasts if they are not planning to breastfeed.

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Effect of the maternity ward system on the lactation success of low-income urban Mexican women Slide From: Perez-Escamilla R, Segura-Millan S, Pollitt E, Dewey KG. Effect of the maternity ward system on the lactation success of low-income urban Mexican women. Early Hum Dev., 1992, 31 (1): 25-40.NUR, nursery, n-17RI, rooming-in, n=15RIBFG, rooming-in with breastfeeding guidance, n=22NUR significantly different from RI (p

Step 5: Effect of proper attachment on duration of breastfeedingAdapted from: Righard L, Alade O. (1992) Sucking technique and its effect on success of breastfeeding. Birth 19(4):185-189.Slide

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STEP 6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.Supplements/replacement feeds are given to babies only:If medically indicated

If mothers have made a fully informed choice after counselling on various options and the risks and benefits of each.

Reasons for supplements are documented

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STEP 7. Practice rooming-in - allow mothers and infants to remain together 24 hours a day

All mothers and babies room-in together, including at night.

Separation occurs only for justifiable reason, which is documented.

Helps mother to recognise her babys feeding cues

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Step 7: Effect of rooming-in on frequency of breastfeeding per 24 hoursAdapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-in/not rooming-in and breastfeeding variables. Acta Paediatr Scand, 1990, 79:1019.Slide

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STEP 8. Encourage breastfeeding on demand

Mothers are taught how to recognize the signs that their babies are hungry and that they are satisfied.

No restrictions are placed on the frequency or duration of breastfeeding.

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Step 8: Breastfeeding frequency in the first 24 hours after birth and incidence of jaundice on day 6From: Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics, 1990, 86(2):171-175.Slide

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STEP 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

Babies are not fed using bottles and teats, pacifiers or dummies.

Mothers are taught about the risks of using feeding bottles

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Step 9: Proportion of infants breastfed up to 6 months of age according to frequency of pacifier use at 1 monthNon-users vs part-time users: P

Step 10

Foster the establishment of breastfeeding SUPPORT GROUPS and refer mothers to them on discharge from the hospital or clinic

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HIV and Infant Feeding: optional componentTopics to be covered in HIV CourseBasic facts on the risks of HIV transmission during pregnancy, labour, delivery and breastfeeding and its preventionImportance of testing and counseling for HIVLocal availability of feeding optionsFacilities/provision for counseling HIV positive women on advantages and disadvantages of different feeding options; assisting them in formula feedingHow to assist HIV positive mothers who have decided to breastfeed; including how to transition to replacement feeds at the appropriate timeDangers of mixed feedingHow to minimize the likelihood that a mother, whose status is unknown or HIV negative, will be influenced to replacement feed

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MotherFriendly: optional componentEncourage women to have a birthing companion. Encourage women to walk and move about during labour; to give birth in positions they choose. Allow women light foods and drink during labour.Reduce use of invasive procedures such as rupture of membranes, episiotomies, acceleration or induction of labour, caesarean sections or instrumental deliveries, unless specifically required for a complication. Encourage women to consider the use of non-drug methods of pain reliefReduces length of labour.

Reduces length of labour, reduce pain

Reduces need for intravenous fluids

Reduces infectons

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