Monday, June 15, 2009

Being Baby Friendly


[Pic: Barb and Cassie, used with permission]

On Saturday I attended an update session for assessors and educators in the Baby Friendly Health Initiative (BFHI). I have been involved with BFHI since it was introduced to Australia in the early 1990s, and it was good to focus on the issues of promoting, protecting and supporting breastfeeding in our maternity care system.

The BFHI is an international project that aims to give every baby the best start in life by creating a health care environment where breastfeeding is the norm and practices known to promote the health and well-being of all babies and their mothers are followed.

The BFHI Ten Steps to Successful Breastfeeding are the global standard by which health services are assessed and accredited. A 'Baby Friendly' health service is one where mothers' informed choice of feeding is supported, respected and encouraged.

In Australia, the Australian College of Midwives administers the Baby Friendly Health Initiative.


The BFHI has released a new set of booklets which will be used for health facility (usually hospital) assessments in the future. A few issues that were open to interpretation in the past have been clarified. Acceptable medical reasons for the use of breastmilk substitutes, and Standards for compliance with the World Health Organisation International Code of Marketing of breastmilk substitutes (known as the 'WHO Code' ) are clearly stated. It is likely that some 'Baby Friendly' hospitals will need to improve their policies and practices before their next assessment in order to maintain the award.

Here are a few of *my* highlights taken from the revised BFHI assessment. Please note, this list is not exclusive:
(For the full wording of each Step, click here
Step 1: The facility's breastfeeding policy is supported by clinical protocols which are evidence based.

Step 2: At least 80% of staff who assist mothers with breast feeding are able to describe two issues that should be discussed with a pregnant woman or mother who indicates that she is considering feeding her baby with infant formula.

Step 3: The antenatal education includes the importance of skin to skin contact for all babies (not just those whose mothers plan to breastfeed!) for at least the first hour of life.

Step 4: The facility has procedures which keep mothers and babies together in skin to skin contact for at least an hour after a vaginal or caesarean birth. (medically indicated procedures which vary this policy are stated)

Step 5: Mothers who are not breastfeeding confirm that they have been given individual education about artificial feeding

Step 6: At least 80% of staff who assist with breastfeeding or who provide advice on breastfeeding are able to describe two pieces of information that they will discuss with a pregnant woman or mother who is undecided, but considering feeding her baby with infant formula.

Step 7: All babies stay with their mothers 24-hours a day. Documentation will be expected for any variation from this.

Step 8: Breastfeeding on demand (without restrictions or controls on frequency or length of feeding) is the standard, with emphasis on effective breastfeeding.

Step 9: Mothers can explain why dummy use is discouraged while breastfeeding is being established.

Step 10: The facility reports on how it works with local breastfeeding support groups and services.

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