The T en S teps of the WHO/UNICEF Baby-Friendly ™ Hospital Initiative

1. The Ten Steps of the WHO/UNICEF Baby-Friendly™ Hospital Initiative Launched in 1991, byUNICEF and the World Health Organization To ensure that all hospitals, maternity facilities and communities become Centers of Breastfeeding Support

2. The Baby Friendly - 10 Steps 1. Have a written breastfeeding policy that is routinely communicated to all health care staff.   2. Train all health care staff in skills necessary to implement this policy.   3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Help mothers initiate breastfeeding within one half-hour of birth.   Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed. 5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants. 

3. The Baby Friendly - 10 Steps 6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.  7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day.   8. Encourage breastfeeding on demand.   9. Give no artificial nipples or pacifiers (soothers) to breastfeeding infants.   10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

4. BFHI 10-Steps based on Research If every baby were exclusively breastfed from Birth for 6 months, an estimated 1.5 million lives world-wide would be saved each year. Babies and Mother’s lives would be enhanced with implementing the 10-Steps because:

5. Immediate postpartum skin-to-skin and breastfeeding supports Mother/Child bonding Breastmilk Alone is the perfect food for Baby’s first 6 months Nutrients, Antibodies, Hormones, Antioxidants, other factors Stimulates immune system – response to diseases & vaccination Protects from diarrhea and acute respiratory infections Sense of empowerment and satisfaction for Mother Decreases blood loss postpartum Delays return to fertility Breastfeeding decreases the risk of breast and ovarian cancer Provides social/economic benefits to the Family The Environment benefits from no-waste breastfeeding BFHI 10-Steps based on Research Why Breastfeed? an abbreviated list

6. Set a Powerful Example for New Mothers and Fathers Give effective, consistent and skilled support to breastfeeding mothers Provide accurate information on the importance of breastfeeding Can instill confidence and empowerment to mothers and fathers to continue breastfeeding WHY The BFHI Initiative? Hospitals, Maternity Units, Birthing Centers

7. Provide information on how medical and labour interventions can affect newborn’s ability to breastfeed and how to compensate when necessary Facilitate breastfeeding as soon as possible after birth Provide continuous skin-to-skin contact for at least the first hour after birth or until after the first breastfeeding before routine procedures such as weighing & measuring some medical tests can be performed while baby skin-to-skin or on the breast Confirm that parents know early feeding readiness cues and respond to them Help mother choose a comfortable position Promoting BFHI How Facilities can Support Exclusive Breastfeeding

8. Facilitate unrestricted breastfeeding 8-12 times per 24 hours Ensure breastfeeding “culture” is sustained Refuse to accept, market, distribute or promote breastmilk substitutes, bottles and artificial nipples Empower women to breastfeed their children exclusively for six months and to continue breastfeeding, with complementary food, into the second year and beyond Some of the 24 Recommendations of the International Lactation Consultant Assn document “Evidence-based guidelines for breastfeeding management during the first fourteen days.” www.guideline.gov Promoting BFHI How Facilities can Support Exclusive Breastfeeding • Correct positioning • Signs of correct latch-on • Signs (in Mother and Infant) of milk transfer • Observe:

9. Baby-Friendly™ designation is an International Standard Baby-Friendly™ maternity services have passed an external assessment according to the Global BFHI Criteria. Is not appropriately applied to other medical services, community activities, workplaces or commercial products. 'breastfeeding-friendly', 'mother-child friendly' or 'pro-breastfeeding' may be used for any other complementary efforts to help mothers to breastfeed. Baby-Friendly™Defined

10. WHO/UNICEF BFHI™ in Canada Breastfeeding Committee for Canada (BCC) is the National Authority for implementing the WHO/UNICEF Baby-Friendly™ Hospital Initiative (BFHI) in Canada

11. Decision: Doesn’t Meet or Meets •  Recognizes need to improvePlan strategies to address weakness areas • May contact Provincial/Territorial Committee for advice • BFHI Pre-Assessment • P/T Committee Reviews (the Approved) Tool and breastfeeding handouts •  Recognizes need to improvePlan actions to improve weak areas • When standards met , submit request to P/T Committee • External Assessment Using BFHI Global Criteria • Breastfeeding Committee for Canada to arrange External Assessment by 2-4 BFHI Assessors (takes 2 – 4 days) •  Submit Action Plan & timetable to meet criteriaA Certificate of Commitment is issued • P/T Committee (or BCC) provides advice up to 4 years • Re-Assessment Every 5 years to Retain Baby-Friendly Criteria   Meets Baby-Friendly Hospital Certificate Awarded By BCC and the P/T Committee WHO/UNICEF BFHI™ in Canada • Self-Appraisal process Form multidisciplinary committee • Complete BFHI Self-Appraisal Tool How a Hospital with a Maternity Facility or a Birthing Center Becomes WHO/UNICEF Baby-Friendly™:

12. How we can contribute Support • World Breastfeeding Week is celebrated every year – in Canada during the first week in October. Join the celebration! • The Breastfeeding Challenge is held in many communities during World Breastfeeding Week. Take the Challenge! http://www.babyfriendly.ca/ Help facilities work towards a BFHI designation • Promote and support implementation of the best practice principles of Baby-Friendly in all hospitals and birthing centres. Created by KairanAthwal and Sylvia teBoekhorst as a student project for the Douglas College Breastfeeding Course for Health Care Providers, Coquitlam BC. Adapted with permission by Sandra Yates, August 3, 2010.

13. References • UNICEF Global Actionwww.unicef.ca • Breastfeeding And The Baby-friendly Initiative http://www.unicef.org/programme/breastfeeding/baby.htm • Canadian Facilities Designated As Baby-friendly http://breastfeedingcanada.ca/html/bfi.html http://www.unicef.org/programme/breastfeeding/assets/statusbfhi.pdf • Annex 1, Evaluating adequacy of Support for breast-feeding in maternity hospitals, wards and clinics, Infant Feeding The Physiological Basis, Supplement to Volume 67, 1989 of the Bulleting of the WHO • Assessment Flowchart. An Overview of the BFI process. (How a Hospital, Maternity Facility, Birthing Center Becomes WHO/UNICEF Baby-Friendly)™ http://breastfeedingcanada.ca/html/bfi.html • The Mother-friendly Childbirth Initiative, 10 questions to Ask, CIMS (Coalition for Improving Maternity Services) http://www.motherfriendly.org/resources/10Q/ • The Breastfeeding Challenge. Quintessence Foundation http://www.babyfriendly.ca/