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BABY FRIENDLY HOSPITAL INITIATIVE (BFHI). Goals of baby friendly hospital initiative. To transform hospitals and maternity facilities through implementation of the ten steps
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To transform hospitals and maternity facilities through implementation of the ten steps • To end the practice of distribution of free and low cost supplies of breast milk substitutes to maternity wards and hospitals
Definition: • The Baby Friendly Hospital Initiativewas introduced in 1991 by the World Health Organization/United Nations Children's Fund (WHO/UNICEF) to promote, protect and support breastfeeding in the hospital or birth setting. A key element in this promotion and support is outlined intheir
Ten steps to successful breastfeeding • Have a written breastfeeding policy that is routinely communicated to all health care staff • Train all health care staff in skills necessary to implement this policy • Inform all pregnant women about the benefits and management of breastfeeding • Help mothers initiate breastfeeding within half n hour of birth
Show mothers how to breastfeed and maitainlactation,even if they should be separated fromtheir infants • Give new born infants no food or drink other than breastfeed,unless medically indicated • Practice rooming-in- that is allow mothers and infants to remain together 24 hours aday • Encourage breastfeeding on demand
Give no artificial teats or pacifiers to breastfeed infants • Foster the establishment of breastfeeding support groups and refer mothers on discharge from the hospital or clinic
What our religion says • Islam has known this fact(importance of breastfeeding)for some 1400 years • We have enjoined on man kindness to his parents:inpaindid his mother bear him,and in pain did she gave him birth……….O my Lord!Grant me that I may be grateful for Thy favor • (Holy Quran 46;15)
According to certain witnesses, the Prophet (PBUH)even indicated, in one of his Hadiths “those mothers who can breastfeed their babies and yet do not do so will be called to account”
Step 1 • Have a written breastfeeding policy that is routinely communicated to all health care staff
Why need a policy??? • Requires a course of action and provides guidance • Helps establish consistent care for mothers and babies • Provides a standard that can be evaluated
Policy should includes • At a minimum, it should include: • The 10 steps to successfulbreastfeeding • An institutional ban on acceptance of free or low cost supplies of breast-milk substitutes, bottles, and teats and its distribution tomothers • A framework for assisting HIV positive mothers to make informed infant feeding decisions that meet their individual circumstances and then support for this decision • Other points can be added
It shouldbe: • Written in the most common languages understood by patients andstaff • Available to all staff caring for mothers and babies • Posted or displayed in areas where mothers and babies are caredfor
Step 2. Train all health-care staff in skills necessary to implement this policy.
Areas ofknowledge • Advantages ofbreastfeeding • Risks of artificialfeeding • Mechanisms of lactation andsuckling • How to help mothers initiate and sustain breastfeeding
How to resolve breastfeedingdifficulties • How to assess abreastfeed • Hospital breastfeeding policies and practices • Focus on changing negative attitudes which set upbarriers
Step 3. Inform all pregnantwomen about the benefits of breastfeeding.
It includes • Benefits ofbreastfeeding • Earlyinitiation • Importance of rooming-in (if newconcept) • Importance of feeding ondemand • Importance of exclusivebreastfeeding • How to assure enoughbreastmilk • Risks of artificial feeding and use of bottles and pacifiers (soothers, teats, nipples,etc.)
Step 4. Help mothers initiate breastfeedingwithin a half-hourof birth.
Why early initiation • Increases duration ofbreastfeeding • Allows skin-to-skin contact for warmth and colonization of baby with maternalorganisms • Provides colostrum as the baby’s first immunization • Takes advantage of the first hour ofalertness • Babies learn to suckle moreeffectively • Improved developmentaloutcomes
Keep mother and babytogether • Place baby on mother’schest • Let baby start suckling whenready • Do not hurry or interrupt theprocess • Delay non-urgent medical routines for at least onehour
Step5. Show mothers howto breastfeed and how to maintain lactation, even if they should be separated from theirinfants
Step 6. Give newborn infants no food or drink other than breast milk unless medicallyindicated
Acceptable medical reasons for supplementation orreplacement Infantconditions: • Infants who cannot be BF but can receive BM include those who are very weak, have sucking difficulties or oral abnormalities or are separated from theirmothers. • Infants who may need other nutrition in addition to BM include very low birth weight or preterm infants, infants at risk of hypoglycaemia, or those who are dehydrated or malnourished, when BM alone is not enough. • Infants with galactosemia should not receive BM or the usual BMS. They will need a galactose freeformula. • Infants with phenylketonuria may be BF and receive some phenylalanine freeformula. • • •
Maternalconditions: • BF should stop during therapy if a mother is taking anti-metabolites, radioactive iodine, or some anti-thyroidmedications. Some medications may cause drowsiness or other side effects in infants and should be substituted during BF. BF remains the feeding choice for the majority of infants even with tobacco, alcohol and drug use. If the mother is an intravenous drug user BF is notindicated. Avoidance of all BF by HIV+ mothers is recommended when replacement feeding is acceptable, feasible, affordable, sustainable and safe. Otherwise EBF is recommended during the first months, with BF discontinued when conditionsaremet. Mixed feeding is not recommended. • • •
Maternalconditions (continued): : • If a mother is weak, she may be assisted to position her baby so she canBF. BF is not recommended when a mother has a breast abscess, but BM should be expressed and BF resumed once the breast is drained and antibiotics have commenced. BF can continue on the unaffected breast. Mothers with herpes lesions on their breasts should refrain from BF until active lesions have been resolved. BF is not encouraged for mothers with Human T-cell leukaemia virus, if safe and feasible options are available. BF can be continued when mothers have hepatitis B, TB and mastitis, with appropriate treatmentsundertaken. • • • •
Step 7. Practice rooming-in— allow mothers and infants to remain together— 24 hours aday.
Rooming-in • A hospital arrangement where a mother/baby pair stay in the same room day and night, allowing unlimited contact between mother andinfant
Why rooming-in is important • Reducescosts • Requires minimalequipment • Requires no additionalpersonnel • Reduces infection • Helps establish and maintain breastfeeding • Facilitates the bondingprocess
Breastfeeding ondemand: • Breastfeeding whenever the baby or mother wants, with no restrictions on the length or frequency offeeds
Step 9. Give no artificial teats or pacifiers also called dummies and soothers to breastfeeding infants.
Alternatives to artificialteats • cup • spoon • dropper • Syringe
Step 10.Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital orclinic.
Support caninclude • Early postnatal or cliniccheckup • Home visits • Telephone calls • Communityservices • Outpatient breastfeedingclinics • Peer counsellingprogrammes
Mother supportgroups • Help set up newgroups • Establish working relationships with those already inexistence • Family supportsystem
Definition: The feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container.
