BFHI (Baby-Friendly Hospital Initiative)

1. BFHI (Baby-Friendly Hospital Initiative) A.Mydlilová NARLAC – National Lactation Centre FTN Krč Prague

2. Health 21 in CR

3. BFHI = 10 steps • Implemented in CR in last 20 years • 1992-FTN Krč Prague – 1st Baby-FriendlyHospital in CR • MoHprepares a directive on implementationof 10 stepsintostandardsofhealth care • Guidelines on Baby-FriendlyHospitalsshouldbecomethe part oftheassessmentofthequalityof a hospital (the WHO goal)

4. Step 1. - policy • Written policy based on 10 steps • Health staff should know it and practise

5. Step 2 – train the staff • WHO Training Module (20 hour) • CR – 20 hour course for health workers

6. Step 3 – inform pregnant women • On benefits of BF, physiology, lactation management • Encourage pregnat women to participate at antenatal courses, information on BF should be a part of the course NARLAC Study (2008) • 38 % antenatal courses – no information on BF • 41,8 % mothers not satisfied with the course content • 9 %mothers - information form health profs • Most frequent source of information – internet, magazines, books

7. Sources of information • Books 39 % • Magazines 26 % • internet 15 % • Health profs 9 %

8. Proposals for improvement • Information on BF should be a part of antenatal courses • Methodological guidelines (professional associations): 1. Breast examination 2. Explain consequences of separation (e.g. ICU) 3. Instruct on expressing milk within 6 hours after birth 4. Inform about consequences of using bottles, teats 5. Instruct on techniques of BF, expressing milk, alternative feeding methods • Focus on women with lower education

9. Enable „skin to skin“ contakt as soon as possible „Skin to skin“ contakt important in first 24 hours Prevention of BF problems Inform health profs and public Step 4 – initiate BF within 1 hour

10. Practices to support BF after SC • Early initiation of BF ( within 1 hour) • Choose the appropriate position • Early rooming-in

11. Step 5 – show mothers how to breastfeed • Correct positiong • Correct attachment at the breast Requires practical knowledge and counselling skills, psychological support

12. Step 5 – show mothers how to maintain lactation if separated from their infants • Start expressing milk as soon as possible ( 1. manual expression, 2. pumps) • Train health staff • Health staff provides support to mothers

13. Step 6 – no supplementation • Give newborn infants no food or drink other than breast milk, unless medically indicated, then use alternative methods, no bottles • Stress the importance of colostrum

14. Step 7 – Rooming-in • 24 hours • Inform mothers on its importance • Enables feeding on demand • Mothers learn to recognise fine signals of readiness to breastfeed in the child • RI – newborns cry less, mother sleep more • Crying child – difficult to breastfeed

15. Step 8 – encourage breastfeeding on demand • Do not restrict duration r frequency of BF • Do not encourage a common schedule of BF • Respect individual rhythm and needs of the newborn • Number of breastfeeds should not drop below 8 in 24 hours

16. Step 9 – no bottles or teats • Give no artificial teats or pacifiers (dummies, soothers) to breastfeeding infants • Interferes with suckling techniques • Inform mothers about its importance • Do not promote bottles or pacifiers at the hospital

17. Step 10 – continuing breastfeeding support • WHO encourages continuing support in the community • Lactation counselling after discharge from hospital (lactation centres, lactation counsellors, self-help groups) • Effective help, provides also emotional support

18. WHO Day 5-7 Week 3-4 Week 6 WHO, 2009 CR 48 hours after birth Week 2 Week 6 Month 3 Months 4-5 Directive on Preventive examinations, MoH, 2010 Primary health care (recommended preventive examinations)