The Ten Steps of the WHO/UNICEF Baby-Friendly™ Hospital Initiative Launched in 1991, by UNICEF and the World Health Organization To ensure that all hospitals, maternity facilities and communities become Centers of Breastfeeding Support A father watches as his wife breastfeeds their new baby in the maternity ward of the Singburi Hospital, Thailand Fathers are encouraged to learn about the benefits and become active supporters of breastfeeding. Thailand is one of 12 developing countries to take the lead in instituting the "ten steps" of baby-friendly practice in as many hospitals as possible. 

The Baby Friendly - 10 Steps 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 one half-hour of birth.   Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.  Ten steps to successful breastfeeding

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

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:

Why Breastfeed? BFHI 10-Steps based on Research Immediate postpartum breastfeeding helps 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 Health and emotional benefits for Mother Sense of empowerment and satisfaction Decreased blood loss postpartum Delayed return to fertility Decreased risk of breast and ovarian cancer Provides social/economic benefits to the Family Environment Benefits an abbreviated list

Hospital, Maternity Units, Birthing Centers WHY The BFHI Initiative? Hospital, Maternity Units, Birthing Centers Set a Powerful Example for New Mothers (and Fathers) Can provide a “Good Start” to Breastfeeding basics First Influence of the benefits of Breastfeeding Can instill Confidence and Empowerment to Mothers (and Fathers) to continue Breastfeeding

Facilitate breastfeeding as soon as possible after birth Promoting BFHI How Facilities can Support Exclusive Breastfeeding In L&D provide information on how medical intervention and labour interventions can affect newborns ability to breastfeed Facilitate breastfeeding as soon as possible after birth Provide continuous skin-to-skin contact for at least the first 2 hours after birth or until after the first breastfeeding before routine tests – weighing & measuring allow some medical tests to be performed while on the breast Confirm that parents know to respond to early feeding readiness cues Help mother choose a comfortable position

Facilitate unrestricted breastfeeding 8-12 times per 24 hours Promoting BFHI How Facilities can Support Exclusive Breastfeeding Correct positioning (infant) Signs of correct latch-on (infant) Signs (in Mother and Infant) of milk transfer Observe: 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 (educate) women to breastfeed their children exclusively for six months and to continue breastfeeding with complementary food, well 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

Baby-Friendly™ designation is an International Standard Baby-Friendly™ Defined Baby-Friendly™ designation is an International Standard Baby-Friendly™ maternity services have passed 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.

Breastfeeding Committee for Canada (BCC) 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

Decision: Doesn’t Meet or Meets WHO/UNICEF BFHI™ in Canada How a Hospital, Maternity Facility, Birthing Center Becomes WHO/UNICEF Baby-Friendly™: Self-Appraisal process Form multidisciplinary committee Complete BFHI Self-Appraisal Tool Decision: Doesn’t Meet or Meets  Recognizes need to improve Plan 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 improve Plan 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 criteria A Certificate of Commitment is issued P/T Committee (or BCC) provides advice up to 4 years http://www.geocities.com/hotsprings/falls/1136/webdoc30.htm  Meets Baby-Friendly Hospital  Certificate Awarded By BCC and the P/T Committee Re-Assessment Every 5 years  to Retain Baby-Friendly Criteria 

References UNICEF Global Action www.unicef.ca BREASTFEEDING AND THE BABY-FRIENDLY INITIATIVE http://www.unicef.org/programme/breastfeeding/baby.htm CURRENT STATUS OF BABY-FRIENDLY HOSPITAL INITIATIVE List of Baby-Friendly Hospitals 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 BREASTFEEDING COMMITTEE FOR CANADA Breastfeeding Position Statement, How a Hospital, Maternity Facility, Birthing Center Becomes WHO/UNICEF Baby-Friendly™: http://www.geocities.com/hotsprings/falls/1136/webdoc30.htm The Mother-friendly Childbirth Initiative, 10 questions to Ask, CIMS (Coalition for Improving Maternity Services) http://www.motherfriendly.org/resources/10Q/ Take an interactive quiz http://www.unicef.ca/eng/travail/breastFeeding/index.html

Help facilities work towards a BFHI designation How we can contribute Support World Breastfeeding Week is celebrated every year, on the anniversary of the Innocenti Declaration. ( Aug 1- 7 ) UNICEF supports World Breastfeeding Week Help facilities work towards a BFHI designation Canada’s only Baby-Friendly Hospital is Brome-Missisquoi-Perkins Hospital in Cowansville, Quebec. Designated in July 1st, 1999 (as of March 2002) Thank you for listening! Kairan Athwal and Sylvia te Boekhorst