THE BABY FRIENDLY THE BABY FRIENDLY HOSPITAL INITIATIVEHOSPITAL INITIATIVE

1981:1981: The World Health Organization’s (WHO) The World Health Organization’s (WHO)

International Code of Marketing of International Code of Marketing of Breast-milk SubstitutesBreast-milk Substitutes, adopted by the , adopted by the World Health Assembly, is a World Health Assembly, is a comprehensive set of guidelines, for those comprehensive set of guidelines, for those who work and interact with mothers and who work and interact with mothers and babies, that offers standards for the babies, that offers standards for the appropriate marketing and distribution of appropriate marketing and distribution of commercial competitors to breastfeeding commercial competitors to breastfeeding

(i.e. makers of infant formula)(i.e. makers of infant formula)

1989: 1989: The “Ten Steps to Successful The “Ten Steps to Successful Breastfeeding”Breastfeeding”

A joint WHO/UNICEF statement fromA joint WHO/UNICEF statement from “ “Protecting, Promoting and Supporting Protecting, Promoting and Supporting

Breastfeeding: The Special Role of Breastfeeding: The Special Role of Maternity Services.”Maternity Services.”

1990:1990: World Summit for Children World Summit for Children Statement: Statement:

Empowerment of all women to Empowerment of all women to exclusivelyexclusively breastfeed their children for four to six months breastfeed their children for four to six months and to continue breastfeeding, with and to continue breastfeeding, with complementary food, well into the second year.complementary food, well into the second year.

ExclusiveExclusive breastfeeding for six months is the ‘gold breastfeeding for six months is the ‘gold standard’ for optimal health.standard’ for optimal health.

19911991:: The launch of the BFHIThe launch of the BFHI

The WHO/UNICEF The WHO/UNICEF International Code of International Code of Marketing of Breast-Marketing of Breast-milk Substitutes (and milk Substitutes (and subsequent relevant subsequent relevant World Health Assembly World Health Assembly resolutions)resolutions)

The Ten Steps to The Ten Steps to Successful Successful BreastfeedingBreastfeeding

In New Zealand:In New Zealand:

BFHI launched World Breastfeeding Week 2000 BFHI launched World Breastfeeding Week 2000 (August 1(August 1stst – 7 – 7thth))

First hospitals BFHI accredited 2002 First hospitals BFHI accredited 2002 The Treaty of Waitangi is an integral part of The Treaty of Waitangi is an integral part of

BFHI in Aotearoa New ZealandBFHI in Aotearoa New Zealand Government wanted all maternity facilities to be Government wanted all maternity facilities to be

accredited by the end of 2005!accredited by the end of 2005! By 2012 95% of all facilities in New Zealand are By 2012 95% of all facilities in New Zealand are

BFHI accredittedBFHI accreditted

BFHI:BFHI: A Standard of Care A Standard of Care

Supports the breastfeeding dyadSupports the breastfeeding dyad In New Zealand In New Zealand 95%95% of women give birth of women give birth

intending to breastfeed.intending to breastfeed. Does not mean facilities do not support the Does not mean facilities do not support the

woman who has decided to formula feed woman who has decided to formula feed her baby.her baby.

Basic principles are non-negotiableBasic principles are non-negotiable MinimumMinimum standard of maternity practice standard of maternity practice Random sample of mothers must be Random sample of mothers must be

interviewedinterviewed Random sample of all levels of staffRandom sample of all levels of staff Antenatal and maternity service practice Antenatal and maternity service practice

must be observedmust be observed

In New Zealand to meet the In New Zealand to meet the BFHI standards:BFHI standards:

A facility mustA facility musthave had an exclusive breastfeeding rate have had an exclusive breastfeeding rate of over 75% on discharge, for the past yearof over 75% on discharge, for the past yearGain 100% for Steps 1 and 7Gain 100% for Steps 1 and 7Attain a minimum of 80% for Attain a minimum of 80% for allall other other questions, in all the other standards of the questions, in all the other standards of the assessmentassessment

WHO/UNICEF International Code of WHO/UNICEF International Code of Marketing of Breast-milk SubstitutesMarketing of Breast-milk Substitutes

1.1. No advertising of breastmilk substitutes in the No advertising of breastmilk substitutes in the health care system or to the public health care system or to the public

2.2. No free samples to be given to mothers or No free samples to be given to mothers or pregnant womenpregnant women

3.3. No free or subsidised supplies to hospitalsNo free or subsidised supplies to hospitals

4.4. No contact between company marketing No contact between company marketing personnel and motherspersonnel and mothers

5.5. Materials for mothers should be non-Materials for mothers should be non-promotional and should carry clear and promotional and should carry clear and full information and warnings.full information and warnings.

6.6. Companies should not give gifts to health Companies should not give gifts to health workersworkers

7.7. No free samples to health workers, No free samples to health workers, except for professional evaluation or except for professional evaluation or research at the institutional levelresearch at the institutional level

8.8. Materials for health workers should Materials for health workers should contain only scientific and factual contain only scientific and factual information.information.

9.9. No pictures of babies or other idealising No pictures of babies or other idealising images on infant formula labels.images on infant formula labels.

10.10. The labels of other products must The labels of other products must provide the information needed for provide the information needed for appropriate use, so as not to discourage appropriate use, so as not to discourage breastfeeding.breastfeeding.

Every facilityEvery facility providing maternity providing maternity services and care for newborn services and care for newborn

infantsinfants should should:: 1.1. Have a written breastfeeding policy that is Have a written breastfeeding policy that is

routinely communicated to all health care staff.routinely communicated to all health care staff. 2.2. Train all health care staff in skills necessary to Train all health care staff in skills necessary to

implement this policy.implement this policy. 3.3. Inform all pregnant women about the benefits Inform all pregnant women about the benefits

and management of breastfeeding.and management of breastfeeding. 4.4. Help mothers initiate breastfeeding within a Help mothers initiate breastfeeding within a

half-hour of birth.half-hour of birth.

5.5. Show mothers how to breastfeed, and Show mothers how to breastfeed, and how to maintain lactation even if they how to maintain lactation even if they should be separated from their infants.should be separated from their infants.

6.6. Give newborn infants no food or drink Give newborn infants no food or drink unless unless medicallymedically indicated. indicated.

7.7. Practise rooming-in – allow mothers and Practise rooming-in – allow mothers and infants to remain together – 24 hours a infants to remain together – 24 hours a day.day.

8.8. Encourage breastfeeding on demand. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also 9. Give no artificial teats or pacifiers (also called dummies or soothers) to called dummies or soothers) to breastfeeding infantsbreastfeeding infants

10. Foster the establishment of 10. Foster the establishment of breastfeeding support groups and refer breastfeeding support groups and refer mothers to them on discharge from the mothers to them on discharge from the hospital or clinic.hospital or clinic.

THINGS TO DO: THINGS TO DO: For ‘the Code’For ‘the Code’ Have a Policy to cover The Code?Have a Policy to cover The Code? Include a policy for formula company Include a policy for formula company

representatives – in keeping with the Code of representatives – in keeping with the Code of Marketing?Marketing?

Include a policy for appropriate management of Include a policy for appropriate management of formula – alternating brands regularly, ensuring formula – alternating brands regularly, ensuring the cost paid for the formula is at least 80% of the cost paid for the formula is at least 80% of the retail price?the retail price?

Ensure formula tins are out of view – no labels Ensure formula tins are out of view – no labels seenseen

Bottles and teats are stored out of viewBottles and teats are stored out of view No references to bottles and teatsNo references to bottles and teats

Is there a policy requesting that women who choose Is there a policy requesting that women who choose to A/F bring in own formulato A/F bring in own formula

Always remember breastfeeding is the normalAlways remember breastfeeding is the normal Toys in toy boxes – yes - they also need to be Code Toys in toy boxes – yes - they also need to be Code

compliantcompliant Books in the units do not contain information which Books in the units do not contain information which

violate the Codeviolate the Code Diaries, lanyards have not been gifted to staffDiaries, lanyards have not been gifted to staff Consent for formula – in appropriate languagesConsent for formula – in appropriate languages Formula purchase records – need to be available – Formula purchase records – need to be available –

showing a decrease in use!showing a decrease in use! Check “gift bags” are Code compliantCheck “gift bags” are Code compliant

Check posters complyCheck posters comply

Check pamphlets given out to Check pamphlets given out to mothers are not advertising anything mothers are not advertising anything found under the scope of the Codefound under the scope of the Code

Check A/N references and handouts Check A/N references and handouts are also Code compliantare also Code compliant

The Ten Steps to Successful The Ten Steps to Successful Breastfeeding:Breastfeeding:

HELPFUL ADVICEHELPFUL ADVICE

Step One:Step One: Have a written breastfeeding policy Have a written breastfeeding policy that is routinely communicated to that is routinely communicated to

all health-care staffall health-care staff

100%100% compliance required for this compliance required for this stepstep

Breastfeeding PolicyBreastfeeding Policy

Why have a Policy?Why have a Policy?- Requires a course of action and provides Requires a course of action and provides

guidanceguidance- Helps establish consistent care for Helps establish consistent care for

mothers and babiesmothers and babies- Provides a standard that can be evaluatedProvides a standard that can be evaluated

The Breastfeeding Policy:The Breastfeeding Policy: What should it cover?What should it cover?

At At minimumminimum it must include: it must include:- The 10 Steps to Successful BreastfeedingThe 10 Steps to Successful Breastfeeding- An institutional ban on acceptance of free or An institutional ban on acceptance of free or

low cost supplies of breastmilk substitutes, low cost supplies of breastmilk substitutes, bottles and teatsbottles and teats

- The facility must work in allegiance to the - The facility must work in allegiance to the Treaty of Waitangi to improve outcomes for Treaty of Waitangi to improve outcomes for Maori and non-Maori in their communityMaori and non-Maori in their community

The Policy……………..The Policy……………..

Must be visibleMust be visible Must be in appropriate Must be in appropriate

languages.languages. Should be available on Should be available on

request.request. Recognise it as a wonderful Recognise it as a wonderful

tool for women and staff – tool for women and staff – powerful and empowering!powerful and empowering!

Consultation for the Policy:Consultation for the Policy:

Must be seen – good paper trail essentialMust be seen – good paper trail essential Must be wide consultation process!Must be wide consultation process! Must include consultation with Maori and Must include consultation with Maori and

any culture represented by >5% of any culture represented by >5% of clientele clientele

The Policy……………………The Policy……………………

Sign-off date notedSign-off date noted Displayed in all areasDisplayed in all areas Translated into relevant languagesTranslated into relevant languages Included in the orientation for all new staffIncluded in the orientation for all new staff Other policies should be seen to support Other policies should be seen to support

the policy eg: hypoglycaemiathe policy eg: hypoglycaemia Evaluation tool available to assess Evaluation tool available to assess

effectiveness of policy – audit against the effectiveness of policy – audit against the PolicyPolicy

Step 2:Step 2: Train all health care staff Train all health care staff in skills necessary to implement in skills necessary to implement this policy.this policy.

“ “ If you thinkIf you think

education is expensive,education is expensive,

try ignorance”try ignorance”

EducationEducation Includes NICU staff and any staff that come in Includes NICU staff and any staff that come in

contact with breastfeeding mothers and contact with breastfeeding mothers and babiesbabies

Hours required varyHours required vary Records must be clear and availableRecords must be clear and available Education must be seen to be ongoingEducation must be seen to be ongoing Documentation of all education taught, and Documentation of all education taught, and

their programmes, should be available to viewtheir programmes, should be available to view

Staff employed within the past 6 Staff employed within the past 6 months months mustmust have been orientated to have been orientated to the Breastfeeding Policy and been the Breastfeeding Policy and been placed on the next available placed on the next available breastfeeding education session - but breastfeeding education session - but areare not included not included in the overall in the overall percentage of staff required to meet percentage of staff required to meet this step at the assessment.this step at the assessment.

Facility staff are required to have prescribed Facility staff are required to have prescribed amounts of education.amounts of education.Specialist Level – 21hrs (and the Specialist Level – 21hrs (and the equivalent to 4hrs annually ongoing)equivalent to 4hrs annually ongoing)Generalist Level – the equivalent to 2hrs Generalist Level – the equivalent to 2hrs for each year of employment – assessed for each year of employment – assessed over the previous three years (and the over the previous three years (and the equivalent to 2hrs annually ongoing)equivalent to 2hrs annually ongoing)Awareness Level – the equivalent to 1hr Awareness Level – the equivalent to 1hr for each year of employment assessed over for each year of employment assessed over the previous three years (and the equivalent the previous three years (and the equivalent to 1hr annually ongoing)to 1hr annually ongoing)

Staff Staff who assistwho assist with breastfeeding: with breastfeeding:

may include midwives, nurses and hospital may include midwives, nurses and hospital aides (in some cases)aides (in some cases)

at least 80% of these staff are required to at least 80% of these staff are required to have had a minimum of 21 hours education have had a minimum of 21 hours education at the time of assessmentat the time of assessment

ongoing education must equate to a ongoing education must equate to a minimum of 4 hours annually minimum of 4 hours annually

stipulated components including stipulated components including ‘Breastfeeding for Maori Women’ and ‘Breastfeeding for Maori Women’ and clinical educationclinical education

Documentation must show:Documentation must show:

For each individual staff member the date of:For each individual staff member the date of:

Commencement of employmentCommencement of employment Orientation to the Breastfeeding Policy at Orientation to the Breastfeeding Policy at

commencement of employment and commencement of employment and whenever the policy is reviewedwhenever the policy is reviewed

Completion of 3 hours (minimum) Completion of 3 hours (minimum) supervised clinical educationsupervised clinical education

Further relevant breastfeeding education Further relevant breastfeeding education sessions (with hours/programmes/sign-on sessions (with hours/programmes/sign-on sheets)sheets)

= total of 21 hours minimum= total of 21 hours minimum breastfeeding breastfeeding

education which indicates an ongoing education which indicates an ongoing education programme is in place.education programme is in place.

Areas of knowledge:Areas of knowledge: Hospital breastfeeding policies and practicesHospital breastfeeding policies and practices The basic components of BFHIThe basic components of BFHI The importance of breastfeedingThe importance of breastfeeding Risks of artificial feedingRisks of artificial feeding Mechanisms of lactation and sucklingMechanisms of lactation and suckling How to help mothers initiate and sustain How to help mothers initiate and sustain

breastfeedingbreastfeeding How to assess a breastfeedHow to assess a breastfeed How to resolve common breastfeeding difficultiesHow to resolve common breastfeeding difficulties

Suggested education methods:Suggested education methods:

Study daysStudy days On-line education On-line education WorksheetsWorksheets Videos/DVD’s with questionnairesVideos/DVD’s with questionnaires Research papers with questionnaireResearch papers with questionnaire Case studies/presentationsCase studies/presentations Discussion periodsDiscussion periods

Generalist Level:Generalist Level:

Documentation which shows the date:Documentation which shows the date: Of employmentOf employment Orientation to the Breastfeeding PolicyOrientation to the Breastfeeding Policy Breastfeeding education received which must Breastfeeding education received which must

include ‘The Ten Steps’ and ‘The Code’include ‘The Ten Steps’ and ‘The Code’ Ongoing educationOngoing education 80% must have completed the above – equating to 80% must have completed the above – equating to

a minimum of 2 hours for each year of employment, a minimum of 2 hours for each year of employment, assessed over the previous three years. Ongoing assessed over the previous three years. Ongoing education equates to a minimum of 2 hours annuallyeducation equates to a minimum of 2 hours annually

Awareness LevelAwareness Level

This could include:This could include: Hospital aidesHospital aides CleanersCleaners PhysiotherapistsPhysiotherapists General theatre staffGeneral theatre staff ReceptionistsReceptionists DietitiansDietitians AnaesthetistsAnaesthetists

Education requirement:Education requirement:These staff are required to have had These staff are required to have had three hours of breastfeeding education over three hours of breastfeeding education over the previous three years or (if employed within thethe previous three years or (if employed within theprevious three years) the equivalent of one previous three years) the equivalent of one hour for each year since employment. hour for each year since employment. This education must include:This education must include:• the Ten Steps to Successful Breastfeedingthe Ten Steps to Successful Breastfeeding• the protection of breastfeeding (the ‘Code’)the protection of breastfeeding (the ‘Code’)

Ongoing education: must equate to a minimum ofOngoing education: must equate to a minimum ofone hour annuallyone hour annually

If the first two steps have been well If the first two steps have been well advanced and staff have all had the advanced and staff have all had the education and understand the Policy then education and understand the Policy then the rest of the “Ten Steps” and compliance the rest of the “Ten Steps” and compliance with “The Code” should follow-onwith “The Code” should follow-on

Knowledge will:Knowledge will:

Prevent conflictPrevent conflict Motivate staffMotivate staff

Step Three: ANTENATAL Step Three: ANTENATAL EDUCATIONEDUCATION

Written documentation of content of Written documentation of content of classesclasses

Needs to Cover:Needs to Cover:

- The Breastfeeding Policy- The Breastfeeding Policy

- The importance of - The importance of exclusiveexclusive breastfeeding for 6 monthsbreastfeeding for 6 months

- The importance of breastfeeding- The importance of breastfeeding

- Basic breastfeeding management- Basic breastfeeding management

- Breastfeeding support in the - Breastfeeding support in the communitycommunity

Continued………..Continued……….. Women should have had discussed with them:Women should have had discussed with them: Optimal nutrition for the babyOptimal nutrition for the baby BondingBonding Protection, including the role of colostrumProtection, including the role of colostrum Health advantages to the motherHealth advantages to the mother Positioning and attachmentPositioning and attachment Importance of baby-led feedingImportance of baby-led feeding Importance of ‘rooming-in’, safe and unsafe sleep Importance of ‘rooming-in’, safe and unsafe sleep

practicespractices How to ensure they have enough milkHow to ensure they have enough milk The effect drugs given during labour and birth can The effect drugs given during labour and birth can

have on breastfeedinghave on breastfeeding

Antenatal information:Antenatal information:

Explore the A/N programmeExplore the A/N programme Include all women not just primiparous Include all women not just primiparous

womenwomen Document time when education occurredDocument time when education occurred Ensure the ‘10 steps’ are coveredEnsure the ‘10 steps’ are covered Check the word ‘Check the word ‘exclusiveexclusive’ is used’ is used Ensure women who have had previous Ensure women who have had previous

breastfeeding issues are referred for breastfeeding issues are referred for consultation prior to birth of new babyconsultation prior to birth of new baby

Step Four:Step Four: Help mothers Help mothers initiate breastfeeding within a initiate breastfeeding within a half an hour of birthhalf an hour of birth

New Interpretation:New Interpretation:

Place babies in skin-to-skin contact with Place babies in skin-to-skin contact with their mothers immediately following birth their mothers immediately following birth for at least an hour and encourage for at least an hour and encourage mothers to recognise when their babies mothers to recognise when their babies are ready to breastfeed, offering help if are ready to breastfeed, offering help if necessarynecessary

Early initiation of breastfeeding Early initiation of breastfeeding for the well newbornfor the well newborn

How?How?- Keep mother and baby togetherKeep mother and baby together- Place baby on mothers chestPlace baby on mothers chest- Let baby start suckling when readyLet baby start suckling when ready- Do not hurry or interrupt the processDo not hurry or interrupt the process

Early Initiation:Early Initiation: Skin-to-skin contact– not blanket to skin!Skin-to-skin contact– not blanket to skin! Lead Maternity Carers have had policy Lead Maternity Carers have had policy

consultation – so should complyconsultation – so should comply Assistance with initial breastfeed if Assistance with initial breastfeed if

requiredrequired Skin-to-skin contact can be discontinued Skin-to-skin contact can be discontinued

once baby has latched and suckled once baby has latched and suckled effectively at the breasteffectively at the breast

Step Five:Step Five: Show mothers how to Show mothers how to breastfeed and how to maintain breastfeed and how to maintain lactation, even if they should be lactation, even if they should be separated from their infantsseparated from their infants

Step Five: Show mothers how to Step Five: Show mothers how to breastfeed……breastfeed……

Ensure staff can demonstrate correct Ensure staff can demonstrate correct positioning and latchingpositioning and latching

Mothers must be taught how to hand Mothers must be taught how to hand express express

Mothers must be Mothers must be taughttaught – use words! – use words! Mothers need to know how to store milk Mothers need to know how to store milk

and how often to expressand how often to express

Step Six: Step Six: ONLY BREASTMILK ONLY BREASTMILK UNLESS UNLESS MEDICALLYMEDICALLY INDICATED INDICATED

No promotion of formulaNo promotion of formula- No advertisingNo advertising- No written handoutsNo written handouts- Remember Remember

breastfeeding is the breastfeeding is the norm!norm!

- Formula is a treatment Formula is a treatment where breastmilk is where breastmilk is unavailableunavailable

In New Zealand we use the words: ‘for sound clinical reasons’

Remember: Remember:

BFHI is all about the BFHI is all about the wellwell baby! baby!

The 20% leeway in this step allows for:The 20% leeway in this step allows for:- Mothers who have decided to formula feedMothers who have decided to formula feed- Babies on the postnatal ward who have Babies on the postnatal ward who have

required formula for a required formula for a sound clinicalsound clinical reasonreason

Sound Clinical Indication:Sound Clinical Indication:

““There are There are rarerare exceptions during which the exceptions during which the infant may require other food or fluids in infant may require other food or fluids in addition to, or in place of, breastmilk. The addition to, or in place of, breastmilk. The feeding programme of these babies should feeding programme of these babies should be determined by qualified health be determined by qualified health professionals on an individual basis.”professionals on an individual basis.”

………….unless clinically indicated.unless clinically indicated

Consent for formula for breastfed babiesConsent for formula for breastfed babies Check sound clinical indicators in your Check sound clinical indicators in your

policy policy How is expressed breastmilk/formula How is expressed breastmilk/formula

given to the baby – the use of bottles and given to the baby – the use of bottles and teats do not support, protect or promote teats do not support, protect or promote breastfeedingbreastfeeding

Step Seven:Step Seven: Practice Rooming-in: Practice Rooming-in: Allow mothers and infants to Allow mothers and infants to remain together 24 hours a dayremain together 24 hours a day

Rooming-inRooming-in

A hospital arrangement where a A hospital arrangement where a mother/baby pair stay together in the mother/baby pair stay together in the same room day and night, allowing same room day and night, allowing unlimited contact between mother and unlimited contact between mother and infantinfant

Why?Why?

Reduces costsReduces costs Requires minimal equipmentRequires minimal equipment Requires no additional personnelRequires no additional personnel Reduces infectionReduces infection Helps establish and maintain Helps establish and maintain

breastfeedingbreastfeeding Facilitates the bonding processFacilitates the bonding process

Mothers should be told:Mothers should be told:

The importance of rooming-in The importance of rooming-in for baby/mother and for baby/mother and breastfeedingbreastfeeding

Baby’s cues for feeding – crying Baby’s cues for feeding – crying is the last cue!!is the last cue!!

More breastfeedsMore breastfeeds Longer breastfeeding durationLonger breastfeeding duration Prevents infectionPrevents infection Safety factorsSafety factors Safe and unsafe sleep practicesSafe and unsafe sleep practices

Remember mothers are asked Remember mothers are asked whether the baby was taken out of the whether the baby was taken out of the room – and who initiated that room – and who initiated that separation!separation!

Check babies are not removed from Check babies are not removed from mothers room at nightmothers room at night

100% compliance is required for this 100% compliance is required for this stepstep

Step Eight:Step Eight: Encourage Encourage breastfeeding on demandbreastfeeding on demand

Breastfeeding “on demand” Breastfeeding “on demand”

= Baby-led or cue-based feeding = Baby-led or cue-based feeding

= Breastfeeding whenever the baby or the = Breastfeeding whenever the baby or the mother wants, with no restrictions on the mother wants, with no restrictions on the length or frequency of feedslength or frequency of feeds

On demand, unrestricted On demand, unrestricted breastfeedingbreastfeeding

Why?Why?• Earlier passage of meconiumEarlier passage of meconium• Lower maximal weight lossLower maximal weight loss• Breastmilk flow established soonerBreastmilk flow established sooner• Larger volume of milk intake on Day 3Larger volume of milk intake on Day 3• Less jaundiceLess jaundice

Recognise the cuesRecognise the cues No timingNo timing Recognise different breast Recognise different breast

capacities!capacities! Different metabolic rates!Different metabolic rates! All women are differentAll women are different All breasts are differentAll breasts are different

Questions asked at assessment:Questions asked at assessment:

Mothers are asked the cues to feedMothers are asked the cues to feed Ensure baby-led feeding was Ensure baby-led feeding was

recommended!recommended! Know to wake baby if breasts are full Know to wake baby if breasts are full

(or express if this is not appropriate!)(or express if this is not appropriate!) Recognise baby is feeding effectively Recognise baby is feeding effectively

– milk transfer occurring– milk transfer occurring

Step Nine:Step Nine:

Give no artificial teats orGive no artificial teats or

pacifiers (also called dummiespacifiers (also called dummies

or soothers) to breastfeedingor soothers) to breastfeeding

infants.infants.

Reasons include:Reasons include:

These can interfere with the suckling actionThese can interfere with the suckling action

Upsets the needs of the baby Upsets the needs of the baby decreaseddecreased stimulation of the breaststimulation of the breast

Disempowerment of the motherDisempowerment of the mother

No advertisingNo advertising No discussion unless the No discussion unless the

mother has decided to mother has decided to formula feed – then on a formula feed – then on a one-to-one basis onlyone-to-one basis only

The use of pacifiers is The use of pacifiers is detrimental to detrimental to breastfeedingbreastfeeding

Step Ten:Step Ten:

Foster the establishment ofFoster the establishment of

breastfeeding support groupsbreastfeeding support groups

and refer mothers to them onand refer mothers to them on

discharge from the hospital ordischarge from the hospital or

clinic.clinic.

““The key to best breastfeeding The key to best breastfeeding practices is continued day-to-practices is continued day-to-day support for the day support for the breastfeeding mother within breastfeeding mother within her home and community”her home and community”

Very important stepVery important step Discussion and handouts – Discussion and handouts –

find out your local groups.find out your local groups. Culturally appropriateCulturally appropriate Include partners in all Include partners in all

discussions – his/her support discussions – his/her support is paramountis paramount

Significant other and Significant other and mothers mothers veryvery important important

Support can include:Support can include: Early post natal or clinic check-upEarly post natal or clinic check-up Home visitsHome visits Telephone callsTelephone calls Community servicesCommunity services Outpatient breastfeeding clinicsOutpatient breastfeeding clinics Peer counselling programmesPeer counselling programmes Mother support groupsMother support groups Help set up new groupsHelp set up new groups Family support systemFamily support system

BFI and the Treaty of WaitangiBFI and the Treaty of Waitangi Facilities are assessed by a Maori Facilities are assessed by a Maori

assessor to ensure it works in allegiance assessor to ensure it works in allegiance to the Treaty of Waitangi to improve to the Treaty of Waitangi to improve outcomes for Maori and non-Maori in the outcomes for Maori and non-Maori in the community.community.

The Policies, staff education and practices The Policies, staff education and practices and observations need to met the BFHI and observations need to met the BFHI standards.standards.

Standards of care for the non-Standards of care for the non-breastfeeding mother and her babybreastfeeding mother and her baby

Areas to be assessed:Areas to be assessed:The Artificial Feeding PolicyThe Artificial Feeding PolicyStaff educationStaff educationEducation of mothers on an individual basisEducation of mothers on an individual basisPost natal care ensures skin-to-skin contact Post natal care ensures skin-to-skin contact and rooming-inand rooming-in

These mothers are taught how to safely These mothers are taught how to safely prepare and feed their babies and how to prepare and feed their babies and how to clean and sterilise their feeding equipmentclean and sterilise their feeding equipment

These mothers are taught how to manage These mothers are taught how to manage their breasts should they become their breasts should they become uncomfortableuncomfortable

All handouts are Code compliantAll handouts are Code compliant Safe and unsafe sleep practices are Safe and unsafe sleep practices are

discusseddiscussed

References:References:

The BFHI Documents for Aotearoa New The BFHI Documents for Aotearoa New Zealand (2011)Zealand (2011)

““International Code of Marketing of International Code of Marketing of Breastmilk Substitutes and Relevant WHA Breastmilk Substitutes and Relevant WHA resolutions” IBFAN 2006resolutions” IBFAN 2006