Administrative OrderAdministrative OrderNo.2007-0026No.2007-0026dated: July 10.2007dated: July 10.2007

Revitalization of the Mother-Baby Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Friendly Hospital Initiative in Health

Facilities with Maternity and Facilities with Maternity and Newborn Care ServicesNewborn Care Services

1992 1992

Rooming-In and Breastfeeding Act Rooming-In and Breastfeeding Act

(RA 7600) Ten Steps to Successful (RA 7600) Ten Steps to Successful Breastfeeding, UNICEF/WHO Global Breastfeeding, UNICEF/WHO Global CriteriaCriteria

1999 1999

The Golden Era of Breastfeeding: DOH The Golden Era of Breastfeeding: DOH certified 1,427 or 83% of targeted certified 1,427 or 83% of targeted

hospitals and lying-in clinicshospitals and lying-in clinics

Historical BackgroundHistorical Background

LEGAL MANDATES

4)4) Philippine Philippine Infant and Young Child Infant and Young Child FeedingFeeding (IYCF) policy as adopted (IYCF) policy as adopted from the WHO/UNICEF 2002 from the WHO/UNICEF 2002 Global Strategy on IYCFGlobal Strategy on IYCF

5)5) PHIC CircularPHIC Circular No. 26 s. 2005 No. 26 s. 2005

6)6) Administrative Order No. 2005-0023 Administrative Order No. 2005-0023 of the DOH, Formula One for Healthof the DOH, Formula One for Health

New Guidelines: New Guidelines:

AO 2007-0026AO 2007-0026Dated July 10, 2007Dated July 10, 2007

Objectives:Objectives:

1.1. transform transform allall health institutions with health institutions with maternity and newborn services …maternity and newborn services …government & private government & private health health facilitiesfacilities….….

2.2. build the critical capacity and build the critical capacity and commitment of health care staff…commitment of health care staff…

3.3. staff establish linkage…staff establish linkage…

What’s new in the AO?What’s new in the AO?

>> Mother-Friendly IndicatorsMother-Friendly Indicators

> Hospital as a Workplace> Hospital as a Workplace

>> Milk CodeMilk Code

> > Process of AccreditationProcess of Accreditation

1.1. Hospital shall incorporate Hospital shall incorporate mother-mother-friendly labor and birthing practicesfriendly labor and birthing practices……

• Clean birthing techniqueClean birthing technique

• Delayed cord clampingDelayed cord clamping

• Placenta removal & disposalPlacenta removal & disposal

• Collaboration/ ReferralCollaboration/ Referral

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Steps to a Mother-Friendly / Steps to a Mother-Friendly / Safe Motherhood InitiativeSafe Motherhood Initiative

2.2. Train staff on essential and Train staff on essential and emergency obstetric and newborn emergency obstetric and newborn care and non-drug methods of pain care and non-drug methods of pain reliefrelief

3.3. Motivate and refer pregnant Motivate and refer pregnant women for STD / HIV/AIDS women for STD / HIV/AIDS screening and voluntary screening and voluntary counseling and treatmentcounseling and treatment

Steps to a Mother-FriendlySteps to a Mother-Friendly Care Care

3.3. Birthing mothers may be offered Birthing mothers may be offered access to a birth companionaccess to a birth companion

4. Birthing mothers may be allowed 4. Birthing mothers may be allowed the freedom to walk and move about the freedom to walk and move about

5. Assume positions not limited to the 5. Assume positions not limited to the lithotomy positionlithotomy position

Steps to a Mother-Friendly CareSteps to a Mother-Friendly Care

6.6. ……avoid avoid unnecessaryunnecessary instrumentation instrumentation that may inhibit breastfeedingthat may inhibit breastfeeding

7.7. Babies bornBabies born by C/S are less likely by C/S are less likely toto • have early skin to skin contacthave early skin to skin contact• more likely to have nursery caremore likely to have nursery care• increasing the risk of cross infection increasing the risk of cross infection • restricting breastfeedingrestricting breastfeeding

Steps to a Mother-Friendly CareSteps to a Mother-Friendly Care

Steps to a Mother-Friendly CareSteps to a Mother-Friendly Care

8.8. Linking the mother and baby to Linking the mother and baby to appropriate community appropriate community breastfeeding breastfeeding support groupsupport group

9.9. Encourage mothers to Encourage mothers to take caretake care of of their premies, NB with defectstheir premies, NB with defects

Hospital as a Workplace

Milk code enforcement Breastfeeding breaks Breastfeeding rooms Breastfeeding storage

facilities Support group Supportive environment

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Mother-Baby Friendly Mother-Baby Friendly Hospital InitativeHospital Initative (MBFHI)(MBFHI)

Baby- Friendly IndicatorsBaby- Friendly Indicators

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THE TEN STEPS TOTHE TEN STEPS TOSUCCESSFUL SUCCESSFUL BREASTFEEDINGBREASTFEEDING

The Global Criteria to The Global Criteria to Baby Friendly Hospital Baby Friendly Hospital InitiativeInitiative

Written policy which addresses Written policy which addresses the 10 steps the 10 steps Visibly posted in:Visibly posted in:

maternity wardmaternity ward all infant care areas all infant care areas

( well baby / sick baby )( well baby / sick baby ) antenatal care servicesantenatal care services

Language commonly usedLanguage commonly used

Step 1 - Have a written breastfeeding Step 1 - Have a written breastfeeding policy that is routinely communicated to policy that is routinely communicated to all health care staff.all health care staff.

Prohibits…..Prohibits….. promotion of BM substitutes / promotion of BM substitutes /

teats /pacifiersteats /pacifiers distribution of gift packs distribution of gift packs

Mechanism for evaluatingMechanism for evaluating effectiveness of the policyeffectiveness of the policy

We want mothers to give their newborn babies the BEST and the best is mothers’ milk.

In order for us to evaluate if we achieved our goal, please fill up this survey form.

Thank you.

Client Survey on the MBFHI Implementationfor Successful Breastfeeding

Sample only

YesYes NoNo

1. Did you have pre-natal check-up?1. Did you have pre-natal check-up?

If yes, where? _______________If yes, where? _______________

2. Have you listened to lectures in 2. Have you listened to lectures in breastfeeding? breastfeeding?

If no, what is the reason? ___________________If no, what is the reason? ___________________

3. Were you informed on the following?3. Were you informed on the following?

3.1. Advantages of breastfeeding…3.1. Advantages of breastfeeding…

3.2. Correct attachment and positioning…3.2. Correct attachment and positioning…

3.3. Milk expression, collection and storage… 3.3. Milk expression, collection and storage…

3.4. Management to common breast 3.4. Management to common breast problems…problems…

4. Was your baby placed betweeno your breast 4. Was your baby placed betweeno your breast immediately immediately

upon delivery or within 1 hour after birth ? If upon delivery or within 1 hour after birth ? If no, why? ________________________________no, why? ________________________________

4.1. Were you informed on the importance of 4.1. Were you informed on the importance of immediate latching?immediate latching?

YesYes NoNo

5. Were you given information on breastfeeding when you were5. Were you given information on breastfeeding when you were

transferred to your room with your baby?transferred to your room with your baby?

6. Did you need help on your first breastfeeding?6. Did you need help on your first breastfeeding?

7. If yes, why? _________________________________________7. If yes, why? _________________________________________

8. Before hospital discharge, were informed where to go / whom8. Before hospital discharge, were informed where to go / whom

to call if you encounter any problem related to breastfeeding?to call if you encounter any problem related to breastfeeding?

9. Will you recommend breastfeeding?9. Will you recommend breastfeeding?

If no, why ___________________________________________If no, why ___________________________________________

10. What can you recommend / suggest so we could improve our breastfeeding10. What can you recommend / suggest so we could improve our breastfeeding

services for mothers and babies. _______________________________________services for mothers and babies. _______________________________________

Manner of Delivery ______________________ Gravidity ______________Manner of Delivery ______________________ Gravidity ______________

Date / Time Delivered ___________________________________________________Date / Time Delivered ___________________________________________________

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

All staff ( involved with mother and All staff ( involved with mother and baby ) received orientation on BF policybaby ) received orientation on BF policy

Trained on 20 hours w/ 3 hours clinical Trained on 20 hours w/ 3 hours clinical experienceexperience

New employees - orientation & training New employees - orientation & training w/in 6 monthsw/in 6 months

copy of the curricula or course outline – copy of the curricula or course outline – be availablebe available

Training include 10 steps & Training include 10 steps & Milk Code (EO 51)Milk Code (EO 51)

20 hours of training20 hours of training

Training of non-clinical staff Training of non-clinical staff (given their roles) to support (given their roles) to support Importance of breastfeeding (BF)Importance of breastfeeding (BF) Hospital practices that support BFHospital practices that support BF

Step 3 - Inform all pregnant women about Step 3 - Inform all pregnant women about the benefits and management of the benefits and management of breastfeeding.breastfeeding.

Breastfeeding counselling to most Breastfeeding counselling to most pregnant women at antenatal servicepregnant women at antenatal service

written antenatal education:written antenatal education: importance of exclusive breastfeeding forimportance of exclusive breastfeeding for

6 months6 months benefits of breastfeedingbenefits of breastfeeding basic breastfeeding managementbasic breastfeeding management

Antenatal education Antenatal education includes:includes:

Importance of :Importance of : skin to skin contactskin to skin contact early initiationearly initiation rooming in 24 hoursrooming in 24 hours on demand feedingon demand feeding exclusive BF for 6 exclusive BF for 6

monthsmonths risk of artificial risk of artificial

feedingfeeding

reflect attendance reflect attendance to BF lecture to BF lecture

protected from oral protected from oral & written instruction & written instruction for artificial feeding for artificial feeding

Step 4 - Help mothers initiate Step 4 - Help mothers initiate breastfeeding within an hour after birth.breastfeeding within an hour after birth.

Immediate Skin to Immediate Skin to skin contact at skin contact at least for one hour least for one hour after birthafter birth

immediately after immediately after birth for I hr - NVDbirth for I hr - NVD

as soon as mother as soon as mother is responsive - CSis responsive - CS

First Crawl Video

Step 5 - Show mothers how to Step 5 - Show mothers how to breastfeed & maintain lactation, even breastfeed & maintain lactation, even if they should be separated from their if they should be separated from their infants.infants.

Offer assistance with Offer assistance with breastfeeding within 6 hours of breastfeeding within 6 hours of deliverydelivery

show how to express milk show how to express milk

proper positioning / proper positioning / attachmentattachment

where they could get helpwhere they could get help

Mother with Mother with previously previously encountered encountered problem problem should be given should be given special special attention and attention and supportsupport

Step 6 - Give newborn infants no Step 6 - Give newborn infants no food or drink other than breastmilk, food or drink other than breastmilk, unless medically indicated.unless medically indicated.

Cup feedingCup feeding is recommended is recommended

Dental Obturator Dental Obturator for cleft lip / for cleft lip / palatepalate

Breastmilk storageBreastmilk storage

Step 7- Practice rooming in – allow Step 7- Practice rooming in – allow mothers & infants to remain mothers & infants to remain together together – 24 hours a day.– 24 hours a day.

EXCEPTEXCEPT

- for a period of 1 hour for - for a period of 1 hour for hospital procedureshospital procedures

- separation is medically - separation is medically indicatedindicated

Step 8 - Encourage Step 8 - Encourage Breastfeeding Breastfeeding on Demand.on Demand.

NO restrictions on NO restrictions on frequency or frequency or length of length of breastfeedingbreastfeeding

Advised to Advised to breastfeed when breastfeed when babies are hungrybabies are hungry

As often as baby As often as baby wantswants

awaken & feedawaken & feed

Step 9 - Give NO artificial teats or Step 9 - Give NO artificial teats or pacifiers (dummies or soothers) to pacifiers (dummies or soothers) to

breastfeeding infants.breastfeeding infants.

Mothers informed on the risk Mothers informed on the risk associated with feeding milk / associated with feeding milk / other liquids with teats & other liquids with teats & bottlesbottles

and the use of pacifiersand the use of pacifiers

Step 10 - Foster the establishment of Step 10 - Foster the establishment of breastfeeding support groups and refer breastfeeding support groups and refer mothers to them on discharge from the mothers to them on discharge from the

clinic or hospital.clinic or hospital.

Mothers should confirm their plans to Mothers should confirm their plans to BFBF

Staff should describe how / where to Staff should describe how / where to reach the breastfeeding support groupreach the breastfeeding support group

CommunityCommunityHospitalHospital

Nursing staff should also be aware of Nursing staff should also be aware of itit

Printed materials available Printed materials available before discharge before discharge

Encouraged follow up after 2-4 Encouraged follow up after 2-4 days & in the 2days & in the 2ndnd week week

Facility has / allows trained BF Facility has / allows trained BF mother support counsellorsmother support counsellors

Compliance to the Philippine Code of Compliance to the Philippine Code of Marketing of Breast-milk substitutesMarketing of Breast-milk substitutes

The head / director of maternity The head / director of maternity services reports that:services reports that:

NONO employees of employees of manufacturers or manufacturers or distributordistributors s of breastmilk substitutes, of breastmilk substitutes, bottles, bottles, teats, pacifiers have direct teats, pacifiers have direct contactcontact with pregnant women with pregnant women

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Compliance to the Philippine CodeCompliance to the Philippine Code

The hospital The hospital does does not receive not receive

free gifts, free gifts, non-scientific non-scientific

lectures,lectures, materials or materials or

equipments, equipments, money or support money or support

for in-service for in-service education…..education…..

No pregnant No pregnant women, motherswomen, mothers or their or their families families are given are given

marketing marketing materials, materials, samples, samples,

gifts by the gifts by the facility facility

Acceptable Medical Reasons Acceptable Medical Reasons for supplementationfor supplementation

Exclusive breastfeeding IS THE NORM

There is a small number of situations that

maybe a medical indication for

SUPPLEMENTING breastmilk or for NOTSUPPLEMENTING breastmilk or for NOT

USING breastmilk…..USING breastmilk…..

1.1. Infants who cannot be fed at the Infants who cannot be fed at the breast but breast but breastmilk still remains breastmilk still remains the food of the food of choicechoice

ex…infant weak / oral abnormality / ex…infant weak / oral abnormality / separated from mom separated from mom

2. Infants who may need other nutrition 2. Infants who may need other nutrition in in addition to breastmilk addition to breastmilk

ex…low birth weight or preterm < 1500 ex…low birth weight or preterm < 1500 gms or 32 weeks / infants at risk of gms or 32 weeks / infants at risk of hypoglycemia hypoglycemia because because of medical problemof medical problem

Acceptable Medical Reasons Acceptable Medical Reasons for supplementationfor supplementation

3.3. Infants who should not receive Infants who should not receive breastmilk or any other milk including breastmilk or any other milk including the usual BM susbstitutesthe usual BM susbstitutes

ex…inborn errors of metabolism like ex…inborn errors of metabolism like galactosemia / phenylketonuriagalactosemia / phenylketonuria

4. Infants for whom breastmilk is not 4. Infants for whom breastmilk is not availableavailable

ex… mother who died ex… mother who died

no nursing mother availableno nursing mother available

Acceptable Medical Reasons Acceptable Medical Reasons for supplementationfor supplementation

5.5. Maternal conditions that affect Maternal conditions that affect breastfeeding recommendationsbreastfeeding recommendations

mother very weakmother very weak mother taking medicationsmother taking medications

antimetabolities / antimetabolities / radioactive iodine / some radioactive iodine / some anti-thyroidanti-thyroid

maternal addiction maternal addiction tobacco / alcohol / drugtobacco / alcohol / drug

HIV infected mothersHIV infected mothers

Acceptable Medical Reasons for supplementationAcceptable Medical Reasons for supplementation

HIV and Infant FeedingHIV and Infant Feeding

Have policy to support feeding the Have policy to support feeding the HIV positive motherHIV positive mother

Mother informed on:Mother informed on: Transmission of HIV Transmission of HIV Feeding optionsFeeding options Importance of testing & Importance of testing &

counsellingcounselling Maintain confidentialityMaintain confidentiality

UNICEF/ WHO/ UNAIDS UNICEF/ WHO/ UNAIDS Infant Feeding Recommendation for HIV-Infant Feeding Recommendation for HIV-positive Womenpositive Women

When replacement feeding is acceptable, When replacement feeding is acceptable, feasible, affordable, sustainable and safe, feasible, affordable, sustainable and safe, (AFASS) avoidance of all breastfeeding (AFASS) avoidance of all breastfeeding by HIV-infected mothers is recommended. by HIV-infected mothers is recommended.

Otherwise, exclusive breastfeeding is Otherwise, exclusive breastfeeding is recommended during the first months of recommended during the first months of life and should be then discontinued life and should be then discontinued as soon as it is feasible.as soon as it is feasible.

Roles and Responsibilities

National Management Committee of DOHNational Management Committee of DOHChair-Usec for Health OperatiosChair-Usec for Health OperatiosCo-chair-Usec for External AffairsCo-chair-Usec for External Affairs

CHD Assessor’s Team Regional CoordinatorsCHD Assessor’s Team Regional Coordinators

Dr. Jose Fabella Memorial HospitalDr. Jose Fabella Memorial Hospital

Self Assessment of the health facilitySelf Assessment of the health facility

CHD Validation of submitted self-assessment formCHD Validation of submitted self-assessment form

Issuance of a Certificate of Commitment valid for two Issuance of a Certificate of Commitment valid for two yearsyears

Re-Assessment by the CHD MBFHI Assessors Team after 2 Re-Assessment by the CHD MBFHI Assessors Team after 2 yearsyears

Issuance of Plaque of Accreditation for sustained Issuance of Plaque of Accreditation for sustained implementation implementation

and integration of the mother-friendly and integration of the mother-friendly indicatorsindicators

Annual MBFHI Implementation Report submitted by the Annual MBFHI Implementation Report submitted by the health health

facility to the CHDfacility to the CHD

MBFHI Accreditation Process 5/5