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Walking with mothers to support and
sustain breastfeeding Lactation
Consultant perspective
Christine Lam
NC (Breastfeeding)
Dept of OampG
QEH
1
285 314 324
378 411
482 50513
568602
611 618642 642
69
739767
792833
855
0
10
20
30
40
50
60
70
80
90
93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12
Hong Kong Breastfeeding Rate
has tripled in the last 2 decades
Source Baby-friendly Hospital Initiative (BFHI) annual survey 2
Breastfeeding Classes A Breastfeeding is Best to baby
B Breastfeeding is good to mom
too
C Breastfeeding Techniques hellip
3
Source FHS DH
771
60
451
341
254
15110
0
10
20
30
40
50
60
70
80
Perc
enta
ge
Ever BF rate
at hospital
discharge
BF (of all
forms) rate
at 1 month
BF (of all
forms) rate
at 2 month
BF (of all
forms) rate
at 4 month
BF (of all
forms) rate
at 6 month
BF (of all
forms) rate
at 9 month
BF (of all
forms) rate
at 12 month
Declined Breastfeeding Rate
With Age (2010)
4
6 58 583 92
124 115135 127
148191
442
513541 553
601635
659696
735
79985
1997 1998 1999 2000 2001 2002 2004 2006 2008 2010 2012
0
10
20
30
40
50
60
70
80
90
Bre
ast
fee
din
g P
erc
en
tag
e (
)
Year
Source regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
Breastfeeding Rates 1997-2012
Breastfeeding on Hospital discharge
Exclusive breastfeeding for 4-6 m
5
Natural = Easy
6
7
Initial difficulty in early partum period
Labour Practice factors bull Parity
bull Delivery mode esp among CS
bull Duration of labor
bull Labor medications
bull Use of formula milk fluids andor teats
bull Medical problems that were perceived as precluding breastfeeding
bull Provider Ambivalence
8
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
285 314 324
378 411
482 50513
568602
611 618642 642
69
739767
792833
855
0
10
20
30
40
50
60
70
80
90
93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12
Hong Kong Breastfeeding Rate
has tripled in the last 2 decades
Source Baby-friendly Hospital Initiative (BFHI) annual survey 2
Breastfeeding Classes A Breastfeeding is Best to baby
B Breastfeeding is good to mom
too
C Breastfeeding Techniques hellip
3
Source FHS DH
771
60
451
341
254
15110
0
10
20
30
40
50
60
70
80
Perc
enta
ge
Ever BF rate
at hospital
discharge
BF (of all
forms) rate
at 1 month
BF (of all
forms) rate
at 2 month
BF (of all
forms) rate
at 4 month
BF (of all
forms) rate
at 6 month
BF (of all
forms) rate
at 9 month
BF (of all
forms) rate
at 12 month
Declined Breastfeeding Rate
With Age (2010)
4
6 58 583 92
124 115135 127
148191
442
513541 553
601635
659696
735
79985
1997 1998 1999 2000 2001 2002 2004 2006 2008 2010 2012
0
10
20
30
40
50
60
70
80
90
Bre
ast
fee
din
g P
erc
en
tag
e (
)
Year
Source regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
Breastfeeding Rates 1997-2012
Breastfeeding on Hospital discharge
Exclusive breastfeeding for 4-6 m
5
Natural = Easy
6
7
Initial difficulty in early partum period
Labour Practice factors bull Parity
bull Delivery mode esp among CS
bull Duration of labor
bull Labor medications
bull Use of formula milk fluids andor teats
bull Medical problems that were perceived as precluding breastfeeding
bull Provider Ambivalence
8
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Breastfeeding Classes A Breastfeeding is Best to baby
B Breastfeeding is good to mom
too
C Breastfeeding Techniques hellip
3
Source FHS DH
771
60
451
341
254
15110
0
10
20
30
40
50
60
70
80
Perc
enta
ge
Ever BF rate
at hospital
discharge
BF (of all
forms) rate
at 1 month
BF (of all
forms) rate
at 2 month
BF (of all
forms) rate
at 4 month
BF (of all
forms) rate
at 6 month
BF (of all
forms) rate
at 9 month
BF (of all
forms) rate
at 12 month
Declined Breastfeeding Rate
With Age (2010)
4
6 58 583 92
124 115135 127
148191
442
513541 553
601635
659696
735
79985
1997 1998 1999 2000 2001 2002 2004 2006 2008 2010 2012
0
10
20
30
40
50
60
70
80
90
Bre
ast
fee
din
g P
erc
en
tag
e (
)
Year
Source regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
Breastfeeding Rates 1997-2012
Breastfeeding on Hospital discharge
Exclusive breastfeeding for 4-6 m
5
Natural = Easy
6
7
Initial difficulty in early partum period
Labour Practice factors bull Parity
bull Delivery mode esp among CS
bull Duration of labor
bull Labor medications
bull Use of formula milk fluids andor teats
bull Medical problems that were perceived as precluding breastfeeding
bull Provider Ambivalence
8
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Source FHS DH
771
60
451
341
254
15110
0
10
20
30
40
50
60
70
80
Perc
enta
ge
Ever BF rate
at hospital
discharge
BF (of all
forms) rate
at 1 month
BF (of all
forms) rate
at 2 month
BF (of all
forms) rate
at 4 month
BF (of all
forms) rate
at 6 month
BF (of all
forms) rate
at 9 month
BF (of all
forms) rate
at 12 month
Declined Breastfeeding Rate
With Age (2010)
4
6 58 583 92
124 115135 127
148191
442
513541 553
601635
659696
735
79985
1997 1998 1999 2000 2001 2002 2004 2006 2008 2010 2012
0
10
20
30
40
50
60
70
80
90
Bre
ast
fee
din
g P
erc
en
tag
e (
)
Year
Source regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
Breastfeeding Rates 1997-2012
Breastfeeding on Hospital discharge
Exclusive breastfeeding for 4-6 m
5
Natural = Easy
6
7
Initial difficulty in early partum period
Labour Practice factors bull Parity
bull Delivery mode esp among CS
bull Duration of labor
bull Labor medications
bull Use of formula milk fluids andor teats
bull Medical problems that were perceived as precluding breastfeeding
bull Provider Ambivalence
8
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
6 58 583 92
124 115135 127
148191
442
513541 553
601635
659696
735
79985
1997 1998 1999 2000 2001 2002 2004 2006 2008 2010 2012
0
10
20
30
40
50
60
70
80
90
Bre
ast
fee
din
g P
erc
en
tag
e (
)
Year
Source regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
Breastfeeding Rates 1997-2012
Breastfeeding on Hospital discharge
Exclusive breastfeeding for 4-6 m
5
Natural = Easy
6
7
Initial difficulty in early partum period
Labour Practice factors bull Parity
bull Delivery mode esp among CS
bull Duration of labor
bull Labor medications
bull Use of formula milk fluids andor teats
bull Medical problems that were perceived as precluding breastfeeding
bull Provider Ambivalence
8
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Natural = Easy
6
7
Initial difficulty in early partum period
Labour Practice factors bull Parity
bull Delivery mode esp among CS
bull Duration of labor
bull Labor medications
bull Use of formula milk fluids andor teats
bull Medical problems that were perceived as precluding breastfeeding
bull Provider Ambivalence
8
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
7
Initial difficulty in early partum period
Labour Practice factors bull Parity
bull Delivery mode esp among CS
bull Duration of labor
bull Labor medications
bull Use of formula milk fluids andor teats
bull Medical problems that were perceived as precluding breastfeeding
bull Provider Ambivalence
8
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Initial difficulty in early partum period
Labour Practice factors bull Parity
bull Delivery mode esp among CS
bull Duration of labor
bull Labor medications
bull Use of formula milk fluids andor teats
bull Medical problems that were perceived as precluding breastfeeding
bull Provider Ambivalence
8
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Initial difficulty in early partum period
Maternal reasons
bull Perceived insufficient milk
bull Lack of confidence in feeding
bull Fatigue
bull Back to work
bull Inconvenient
bull Breast problems and Illness
bull Incompatibility with personal needs and life style
Infant reasons
bull Initial separation
bull Breast refusal Infant alertnessresponsiveness
bull Irritability during feeds
9
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Through Mother-Baby-Friendly
Hospital measures
bull Quality improvement
bull Higher standard of care
bull Demonstrate skill practice and knowledge to
support BF
bull Health of babies and mothers
10
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Mothers and Babies receive
bull Correct information and practice
bull Consistent care and advice
bull Consistent skilled help
bull Encourage bonding with support
bull Breastfeeding relationship amp Breastmilk is
treasured
bull Mothersrsquo help and support to their babies is
treasured
11
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Support for healthy breastfeeding
mothers with healthy term babies
Cochrane Database of Systematic Reviews 2012
12
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Conclusion
bull Support is likely to be more effective in settings with high initiation rates so efforts to increase the uptake of breastfeeding should be in place
bull Support may be offered either by professional or trained peer supporters or a combination of both
bull Strategies mainly on face-to-face support are more likely to succeed
---------------
bull Support that is only offered reactively in which women are expected to initiate the contact is not so effective
bull Women should be offered ongoing visits on a scheduled basis so they can predict that support will be available
bull Support should be tailored to the needs of the setting and the population group
13
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Skilled Help amp Advice
In its 2003 Global Strategy for Infant and Young Child Feeding the WHO states that
bull Virtually all mothers can breastfeed provided they have accurate information and support hellip should also have access to skilled practical help from eg trained health workers hellip lay counsellors and certified lactation consultantshellip
bull help to build mothersrsquo confidence improve feeding technique and resolve breastfeeding problems
14
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
International Board of Lactation
Consultant Examiners (IBCLE)
bull The most trusted source for certifying practitioners in lactation and breastfeeding care
bull Certifies individuals who meet these standards
Scope of Practice
bull To protect the public by promoting that all IBCLC provide safe competent and evidence-based care
15
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Exam Blue Print
1 Anatomy
2 Physiology and endocrinology
3 Nutrition and Biochemistry
4 Immunology and infectious disease
5 Pathology
6 Pharmacology and toxicology
7 Psychology sociology and anthropology
8 Growth parameters and developmental milestones
9 Interpretation of research
10 Ethical and legal issues
11 Breastfeeding equipment and technology
12 Techniques
13 Public Health
90 Hours Breastfeeding Education + Hours
Clinical Experience
16
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
International Board Certified
Lactation Consultant (IBCLC)
Professions that meet the regulations and standards for practice established by a governmental authority
ndash Dentist
ndash Dietician
ndash Midwife
ndash Nurse
ndash Occupational Therapist
ndash Pharmacist
ndash Physical Therapist or Physiotherapist
ndash Physician or Medical Doctor
ndash Speech Pathologist or Therapist
17
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Effectiveness of IBCLC
bull IBCLCs assisted women in anticipating managing and overcoming these barriers
bull hellipunderscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding
bull hellipthe success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement guidance and support
Teich AS Barnett J Bonuck K (2014)
Memmott MM Bonuck KA (2006) 18
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Sharing
bull There are more mothers breastfeed and they can breastfeed longer
bull Understand women babies and lactation
bull Both for normal preterm amp sick babies
bull Care for their families
bull Human art and science parenting
bull Network and communication
bull Share information
19
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
What mothers need to know
20
bull Benefits of breastfeeding
ndash Commitment to BF
bull Technique
ndash To avoid problems in initial breastfeeding
bull How to assess breastfeeding
ndash Know that baby has adequate intake
bull What else
ndash Life style adjustment
ndash Understanding baby behaviour wide range of diversity
ndash Parenting possibility
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Adjustment of life style after childbirth
family relationship
21
bull I donrsquot know feeding on cues are like
that I donrsquot know when to feed
bull My family esp my husband and
mother are sorting out all the
methods for how to wean night
feeding The most common method
is feeding the baby with formula at
night
bull My family will show their unhappy if I
show refusing them to feed my baby
They want to participate in infant
feeding So I pump the milk out for
them
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Overview of Interventions
Individual Level
bull Education and professional support
to increase knowledge skill and
self-efficacy
Interpersonal Level
bull Peer support
bull Professional support and
encouragement
bull Supportive home environment
Organizational Level
bull Hospital and Maternity Care
Practices
bull Workplace Support
Macro-level
bullMedia and Social Marketing
bullNational Policies
bull Maternity Leave
bull Implementation of WHO code
bull BFHI
22
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Further Support of BF in HK
Hospital Community
Breastfeeding policies Written guidelines for both healthy and sick
Unrestricted on parents presence
Skin-to-skin contact
Systematic breastfeeding training for staff
No detrimental practice to BF
Lactation consultant support and monitor throughout should NOT
be a expensive service for general public
More trained staff among different specialties amp collaboration 23
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Strategies
A Broaden the scope of training
ndash Professional training
bull Medical Curriculum at least 7-8 hours for
their roles
bull Nurses
ndash At present most institutes have about 2
hours only
bull Dietitian
ndash Specialty
bull Family medicine
bull Paediatricians
24
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Strategies
B Collaboration with Peer Counsellors
ndash Parenting style mothering art
ndash New understanding of parenting through
breastfeeding
C Social Support
ndash Acceptance of BF
ndash Facilities
ndash Work mother support
25
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Train Help difficult situation
Listen to mothers and Support them
Baby with
tracheostomy Breast Abscess with
drainage only
Inverted Nipples
Needs more trained staff and partnership to support mothers as long as breastfeeding continued
With mothers and babies we can work in a CREATIVE way for them
26
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Support Successful Breastfeeding
Breastfeeding more higher exclusivity and longer
27
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
References 1 Baby-friendly Hospital Initiative (BFHI) annual survey in Hong Kong by BFHI Hong Kong Association
2 Regular reports from all maternity units in public and private hospitals in Hong Kong amp BF Survey FHSDH
3 Annual Survey on Breastfeeding (2013) Hospital Authority Breastfeeding Promotion Subcommittee
4 Mannel R Mannel RS 2006 Staffing for Hospital Lactation Programs Recommendations From a Tertiary Care Teaching Hospital J Hum Lact 22 409
5 Teich AS Barnett J Bonuck K (2014)Womens perceptions of breastfeeding barriers in early postpartum period a qualitative analysis nested in two randomized controlled trials Breastfeeding Medicine 9(1)9-15 2014 Jan-Feb
6 Wonjar D (2004) Maternal perceptions of early breastfeeding experiences and breastfeeding outcomes at 6 weeks Clinical Effectiveness in Nursing Volume 8 2004 93ndash100
7 Mastrup R Bojesen SN Kronborg H Hallstrom I (2012) Breastfeeding support in neonatal intensive care a national survey Journal of Human Lactation 28(3)370-9 2012 Aug
8 Sisk PM Lovelady CA Dillard RG Gruber KH (2006) Lactation Counseling for Mothers of Very Low BirthWeight Infants Effect on Maternal Anxiety and Infant Intake of Human Milk Pediatrics11767
9 Gross SM Resnik AK Nanda JP Cross-Barnet C Augustyn M Kelly L Paige DM (2011) Early postpartum a critical period in setting the path for breastfeeding succes Breastfeeding Medicine 6(6)407-12 Dec
10 Memmott MM Bonuck KA(2006) Motherrsquos reactions to a skill-based breastfeeding promotion intervention Maternal amp Child Nutrition 2(1)40-50 Jan
11 Witt AM Smith S Mason MJ Flocke SA (2012) Integrating routine lactation consultant support into a pediatric practiceBreastfeeding Medicine 7(1)38-42Feb
12 Dyson L McCormick FM Renfrew MJ (2009) Interventions for promoting the initiation of breastfeedingCochrane Database of Systematic Reviews 4
13 Renfrew MJ McCormick FM Wade A Quinn B Dowswell T (2012)Support for healthy breastfeeding mothers with healthy term babies Cochrane Database of Systematic Reviews 5
28
Thanks
29
Thanks
29
![THE COGNITIVE AND NEURODEVELOPMENTAL ...733729/...benefits and management of breastfeeding, [4] help mothers to initiate breastfeeding within 30 minutes after birth, [5] tell mothers](https://img.dokumen.tips/doc/110x75/5f3737e37da8af2d0f3edb9d/the-cognitive-and-neurodevelopmental-733729-benefits-and-management-of-breastfeeding.jpg)
