BFHI-Baby Friendly Hospital Initiative

ALAKA J MOHAN

Launched by WHO &UNICEF 1991 Introduced in INDIA-1993 To implement practices that

PROTECT PROMOTE breast feedingSUPPORT

Industrialization Change in lifestyle More working women Marketing strategies of baby food

manufacturers

DECLINE IN BREASTFEEDING

launched in 1993 there was resistance at first. Later on there was decline in its

implementation. Revived in 2012.

Situation in india

Babies who are breastfed are generally healthier and achieve optimal growth.

By the implementation of this policy, mothers who lack confidence to breastfeed is encouraged.

In the case of HIV positive mothers,they are helped to take an informed decision on which feeding option is best of her baby

ADVANTAGES OF BFHI

Have a written breast feeding policy that is routinely communicated to all health care staff.

STEP 1

Written breast feeding policy-made available to all staff

Visibly posted in all areas of the health care facility

Displayed in local language

why do you need a policy???????

10 steps of breastfeeding

An institutional ban on breast milk substitutes

A framework for assisting HIV positive mothers in infant feeding.

What should the policy cover?

Train all health care staff in skills necessary to implement this policy

STEP 2

Training should include1.Advantages of breast feeding2.Mechanism of lactation &sucking3.How to help mothers initiate and sustain

breastfeeding4.Positioning attachment5.Risk of artificial feeding

Inform all pregnant women about the benefits and management of breast feeding

STEP 3

Emphasise on importance of exclusive breast feeding, its benefits and technique in the antenatal period itself.

Motivate the mother to breastfeed & allay her doubts.

Help mothers initiate breastfeeding within a half hour of birth.

STEP4

skin to skin contact Vaginal delivery within 30 minCS-within half an hour being able to respond

Why to initiate soon?1.Emotional bonding2.Provides colostrum3.Increase duration of feeding4.Mother will get necessary guidance from

health care professional.

Show mothers how to breastfeed& how to initiate lactation, even if they should be seperated from their infants.

STEP 5

Teach the mothers how to express milk Also teach them about positioning &

attachment

POSITIONING Mother can sit or lie down Her back should be well supported &

shouldn’t lean over baby Position of baby-whole body should be

supported. Baby’s head & body should be in one line Baby’s body turned towards mother(tummy

to tummy) Baby’s nose at level of nipple

TECHNIQUE OF BREAST FEEDING

ATTACHMENT(LATCHING) Baby’s cheek is touched & that initiates

rooting reflex Allow the baby to open mouth widely Latch the baby to breast-nipple and most of

areola must be in baby’s mouth.

Signs of good attachment Baby’s mouth wide open Most of nipple and areola in mouth—only

upper areola is visible Baby’s chin touches the breast Baby’s lowerlip everted

EFFECTIVE SUCKLING Baby sucks slowly & pauses in between to

swallow One can see throat cartilage& muscles

moving Baby’s cheeks are full and not hollow or

retracting.

Inverted nipples Makes latching difficult. Sucking on nipple will make them sore and

excoriated. Treatment –manually nipples are everted

stretched and rolled out several times a day. Plastic syringe used to draw out to correct

problem.

Problems in breast feeding

Sore nipple Occurs in incorrect attachment. Frequent washing with soap and water,

pulling the baby when he is still feeding can cause sore nipple

Treatment-correct positioning & attachment. Apply hind milk Nipple should be aired and allowed to heal

in between feeds

Breast engorgement Milk production increases on 2nd and 3rd day Delay in feeding will cause accumulation of

milk in alveoli Breast becomes swollen hard warm & painful Treatment-early frequent feeds Correct attachment Local warm water packs Breast massage analgesics

Breast abscess Abscess occurs when mastitis,blocked duct

cracked nipple are not treated promptly High grade fever Treatment-analgesics Anitibiotics I&D

NOT ENOUGH MILK Adequacy of breastmilk Baby sleeps-2-3hrs after feed Passing urine 6-8 times in 24hr Gaining weightReason may be no night feedsany illness bottle feeds, maternal stress

insufficient sleep

Can be stored in room temperature for 6-8 hours,in a refrigerator for 24hr and a freezer at -20 degree for 3months

METHOD Wash hands thoroughly Make herself comfortable Gently massage the breast Hold container under the nipple Place her thumb on top of breast atleast

4cm from tip of nipple

EXPRESSED BREAST MILK

Index finger on undersurface Compress and release the tissue To maintain adequate lactation mothers

should express milk atleast 8-10 times in 24 hours

Give newborn infants no food or drink other than breast milk unless medically indicated

STEP 6

Decreased frequency or effectiveness of suckling

Decreased amount of milk removed from breasts

Delayed milk production or reduced milk supply

Some infants have difficulty attaching to breast if formula given by bottle

Impact of routine formula supplementation

Slide 4.6.4

Acceptable medical reasons for supplementation

1.VLBW<1500g infants born before 32 weeks.2.SGA with potentially severe hypoglycaemia3.Infants whose mothers have severe illness4.Infants with inborn errors of metabolism5.Infants with acute water loss6.Mothers taking drugs which is

contraindicated during breast feeding-antimetabolites,antithyroid drugs

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

STEP 7

Benefits of rooming in Cost effective Requires minimal equipment Requires no additional personnel Reduces infection Facilitate bonding establish breast feeding

Encourage breastfeeding on demand

STEP 8

Breastfeed on demand results in1.Earlier passage of meconium.2.Lower maximal weight loss.3.Breastmilk flow is established sooner.4.Larger volume of milk intake.5.Less of jaundice

Give no artificial teats or pacifiers to breastfeeding infants.

STEP 9

It will interfere with suckling & the adjustment of breast milk supply to the baby’s requirement.

Causes diarrhoea.

Foster establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

STEP 10

Breast feeding support groups are often part of community nutrition strategy.

Peer counsellors-women from the community who receive training in breastfeeding support.

They often contact mothers in home. Increases exclusive breastfeeding.