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The Baby-Friendly Hospital Initiative.

The Baby-Friendly Hospital Initiative (BFHI) is a world wide program sponsored by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Its goal is to encourage hospitals and birth centers to promote and support breastfeeding. Recognition is given to those organizations that successfully complete a rigorous application and evaluation process. Hospitals and birth centers need to comply with The Ten Steps to Successful Breastfeeding for Hospitals (see sidebar). These ten steps outline critical ways to promote breastfeeding. They assure that:

1. Mothers are given information regarding the importance and benefits of breastfeeding.

2. Health care staff are educated and trained to support breastfeeding mothers and babies.

3. Practices within the facility do not undermine breastfeeding.

4. Support groups are established and available for mothers to attend after leaving the hospital or birth center.

When a facility can demonstrate, through an on-site evaluation, that they are able to implement the Ten Steps, they will be awarded the designation of being a Baby-Friendly institution.

Globally, the BFHI was established to decrease infant morbidity and mortality. Over 16,000 hospitals and birth centers have received the prestigious Baby-Friendly award. In the United States, as of August 2004, only forty-two facilities have achieved the Baby-Friendly status. (see sidebar for current list of U.S. facilities). You can also visit to obtain more information on becoming a Baby-Friendly facility.

It is my hope that the Baby-Friendly Initiative will someday become the "standard of care". This will most likely be due to consumer pressure rather than providers actually believing it is the best way to go. Consumers can and will play a big role in making this happen.

Parents may ask the question: "Are you a Baby-Friendly facility?" and choose where to give birth based on breastfeeding policies. Hospitals and birth centers will not only need to know what that means, they will also need to be serious about achieving the Baby-Friendly Initiative award.

We need to go further than being "fans of breastfeeding". We need to have knowledge and take action prenatally. This means giving mothers and families accurate information to choose a 'feeding method' (whether to breastfeed or not). Mothers and families need to understand the profound benefits of breastfeeding. Clinicians, doulas, childbirth educators, grandparents, partners all need to know specifically how to support the mother and child for successful breastfeeding.

Before labor, families should be aware of how drugs in labor can affect breastfeeding outcomes. Giving birth without medication, as has often been documented, is more possible with the consistent, calm presence of a professional labor support provider.

After giving birth, simple changes in routines can positively affect the mother and baby's beginning. Childbirth educators can encourage families to advocate for themselves and doulas can support families in this. Putting baby to the mother's breast soon after birth does make a difference. It is also okay to delay "routine" procedures such as the bath, Vitamin K. Mother and baby do not need to be separated. Rooming-in also makes a difference.

There should be no artificial baby milk offered. It is not an 'alternative' but a poor fourth choice. The first choice is mother's milk, the second is expressed mother's milk, the third is donated mother's milk and the last choice is artificial baby milk, or formula. There is no need for pacifiers.

While at the hospital or birth center, it is most helpful to limit visitors. Staff and doulas can affirm that mothers and babies should rest and nurse quietly whenever they need to.

Ideally; mothers and babies will get settled at home sooner than later. But early discharge from the hospital or birth center means families need to prepare for postpartum care at home. Doulas should be available to follow-up with this early postpartum care. Families need to have resources readily available, such as contact numbers for lactation consultants, support groups, and early pediatrician appointments.

When choosing a pediatrician, mothers should take care to find a practice that truly supports breastfeeding. If a pediatrician's office has a lactation consultant, that's a great sign that they are taking breastfeeding seriously and want to safeguard moms and babies during this vulnerable time. Parents should interview pediatricians and ask about lactation consultants. Asking the question will raise the issue and hopefully encourage the practice to hire a lactation consultant.

Doulas and childbirth educators can explain these simple but important details to mothers before, during and after birth. Parents can be encouraged to inquire about all this during their prenatal care. Consumers' repeated demands will raise the consciousness of providers. Hospitals do pay attention to 'customer satisfaction'. If enough people ask for these things, there is reason to offer them. It is important to keep sending the message.

In the fall of 2002 the hospital where I work set up a multidisciplinary task force to get the process underway. We have written a Letter of Intent to become a Baby-Friendly Hospital & Birth Center. Currently we are tackling the Ten Steps, and hope to have a site visit sometime in 2005.

One of the most exciting, as well as crucial, parts of this effort is that the passion and work is carried by many individuals and groups within the hospital and birth center. I am the only lactation consultant, but our task force consists of doulas, nurses, nutritionists, doctors, midwives, support staff, and community members. We each bring our unique interests and beliefs together to strengthen the goal of ensuring that mothers and babies get the best beginning possible by breastfeeding with confidence and ongoing support.

The Ten Steps to Successful Breastfeeding

The BFHI promotes, protects, and supports breastfeeding through The Ten Steps to Successful Breastfeeding for Hospitals, as outlined by UNICEF/WHO. The steps for the United States are:

1. Maintain 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 hour of birth.

5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

6. Give infants no food or drink other than breastmilk, unless medically indicated.

7. Practice 'rooming-in'-allow mothers and infants to remain together 24 hours a day.

8. Encourage unrestricted breastfeeding.

9. Give no pacifiers or artificial nipples to breastfeeding infants.

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

42 US Baby-Friendly Hospitals and birth centers as of August 2004

Alice Peck Day Memorial Hospital, Lebanon New Hampshire

Aurora Lakeland Medical Center, Elkhorn, Wisconsin

Blount Memorial Hospital, Maryville, Tennessee

Boston Medical Center, Boston, Massachusetts

Cape Canaveral Hospital, Cocoa Beach, Florida

Community Hospital of Anaconda, Anaconda, Montana

Community Hospital of the Monterey Peninsula, Monterey, California

Elmbrook Memorial Hospital, Brookfield, Wisconsin

Evergreen Hospital Medical Center, Kirkland, Washington

GoletaValley Cottage Hospital, Santa Barbara, California

Hartford Hospital, Hartford, Connecticut

Inland Midwife Services,The Birth Center, Redlands, California

Kaiser Permanente Medical Center, Honolulu, Hawaii

Kaiser Permanente Medical Center, Hayward, California

Kaiser Sunnyside Medical Center, Clackamas, Oregon

Kootenai Medical Center, Coeur d'Alene, Idaho

Lisa Ross Birth & Women's Center, Knoxville, Tennessee

Mercy Hospital Anderson, Cincinnati, Ohio

Mercy Hospital Fairfield, Fairfield, Ohio

Mercy Franciscan Hospital Mt. Airy, Cincinnati, Ohio

Methodist Hospital, Indianapolis, Indiana

Methodist Hospital, Omaha, Nebraska

Miles Memorial Hospital, Damariscotta, Maine

Morton Plant Hospital, Clearwater, Florida

Newport Hospital, Newport, Rhode Island

Northeastern Vermont Regional Hospital, St. Johnsbury, Vermont

Okanogan-Douglas District Hospital, Brewster, Washington

Peace-Health Nurse Midwifery Birth Center, Eugene, Oregon

Providence Medford Medical Center, Medford, Oregon

Reading Birth & Women's Center, Reading, Pennsylvania

Rochester General Hospital, Rochester, New York

Scripps Memorial Hospital Encinitas, Encinitas, California

St. Elizabeth Medical Center, Edgewood, Kentucky

St. John's Hospital, Springfield, Illinois

St. Mary Medical Center, WallaWalla, Washington

South County Hospital, Wakefield, Rhode Island

Tacoma General Hospital, Tacoma, Washington

Three Rivers Community Hospital, Grants Pass, Oregon

Ventura County medical Center, Ventura, California

Weed Army Community Hospital, Fort Irwin, California

Women's Health & Birth Center, Santa Rosa, California

Women's Wellness & Maternity Center, Madisonville, Tennessee

Kate Reist is a nurse-midwife and Lactation Consultant with the Cambridge Health Alliance. She lives with her family in Cambridge, Massachusetts.
COPYRIGHT 2004 Association of Labor Assistants & Childbirth Educators
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Title Annotation:Breastfeeding
Author:Reist, Kate
Publication:Special Delivery
Date:Dec 22, 2004
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