By Keri, RN, BScN, IBCLC
Have you heard of the Baby Friendly Initiative? You may not have heard of it here in Ontario - since only TWO acute care hospitals in our province have earned this accreditation. The 2 acute care BFI facilities in Ontario are Toronto East General Hospital and St. Joe's in Hamilton. There are some public health units who have achieved accreditation status as well.
If you haven't heard of it or want to know more, please read on ...
The Baby Friendly Initiative (BFI) was created by the World Health Organization and UNICEF in response to an overwhelming BOTTLE feeding culture that they were seeing globally. They reinstated the importance of breastfeeding back in 1990, and BFI was one of the results. It is an international program and includes 10 steps to successful breastfeeding.
The process to become Baby Friendly is not necessarily an easy task. It takes work, dedication, passion & support from healthcare administrators. It is such a wonderful campaign to promote, protect and support breastfeeding.
There are specific criteria that must be met in each step. Listed below are the steps and after you read through, I will explain a few of them in more detail.
Note these are the Canadian adaptation of the 10 steps, since that's where I live, teach and work.
1) Have a written breastfeeding policy that is routinely communicated to all health care providers and volunteers (makes sense, right? Policy can support clinical practices - which is the care that your provider offers you)
2) Ensure that all healthcare providers have the knowledge and skills necessary to implement the policy.
3) Inform pregnant women about the importance and process of breastfeeding (this is by offering prenatal education, information at prenatal appointments, linking with Public Health and so on)
4) Place babies in uninterrupted skin-to-skin contact with their mothers immediately following birth for at least an hour or until completion of the first feeding or as long as the mother wishes: encourage mothers to recognize when their babies are ready to feed, offering help as needed. (You have every right to ask your care provider to do this - for more info on why skin-to-skin is so great, check out my blog post on skin-to-skin)
5) Assist mothers to breastfeed and maintain lactation should they face any challenges, including separation from their infant. (Makes perfect sense right?)
6) Support mothers to exclusively breastfeed for 6 months, unless supplements are MEDICALLY indicated. (The WHO has specific guidelines on when supplementation is a medical need - even then, there may be alternatives. Ask your healthcare provider if your baby reallllly needs to be supplemented & if it's medically indicated - we cover more information on supplementation in our breastfeeding class - I hope to have a post on this topic in the near future!)
7) Facilitate rooming-in for all mother-infant dyads; mothers and infants room in together (Gone are the days when all the babies are in a the nursery with a big window to look at them through. Moms and babies do best when they are together.
8) Encourage baby-led or cue-based breastfeeding. Encourage sustained breastfeeding beyond 6 months with appropriate introduction of complementary solids. (I always teach parents about the early cues of hunger - and also teach them to let their baby take the lead. Watch the baby, not the clock!)
9) Support mothers to feed & care for their babies without the use of artificial teats or pacifiers (which are dummies or soothers - this is because these can interfere with feeding & can actually change the way a baby sucks. I've seen several occasions where a baby has a bottle in the early days & can't quite figure out how to breastfeed afterwards. I have some tips for that, but it really can make things challenging.)
10) Provide a seamless transition between the services provided by the hospital, community health centres and peer support. Apply principles of Primary Care & Population Health to support the continuum of care & implement strategies that affect the broad determininants that will improve breastfeeding outcomes. (This means that after you leave the hospital, you should be linked with other resources in your community, at community health centres, Public Health, peer support groups, lactation consulting visits or other similar supports. The facility that is Baby Friendly has initiatives and activities within their facility & also collaborates with community partners to ensure this need is met)
Finally, to be Baby Friendly a facility, they must comply with the World Health Organization's International Code of Marketing of Breastmilk Substitutes (this means no free formula, no formula advertising, labelling to state the risks of formula feeding, no freebies from formula companies and so on...) The WHO developed this Code of Marketing back in 1981. As you have probably noticed, not all countries comply with this. Canada does not. Neither does the U.S.
I could write 10 or more posts on the Baby Friendly Initiative based...but before you leave, I just want to highlight a few little tidbits:
Step # 2 is about staff education. Essentially, BFI says that all staff who are directly providing care to new moms & babies must have 18 hours of education related to breastfeeeding & human lactation. That's a tough pill to swallow for maternity units who are already striving to balance budgets. Adding 18 hours of education for an entire floor of nurses is costly. And hospitals (similar to me) have not found that elusive money tree.
Another surprising tidbit about the WHO Code is that to be Baby Friendly you must not accept "freebies" from articial feeding (read: formula) companies. Currently, most hospitals in Ontario are NOT paying for formula. This means easy access to formula for nurses, physicians & patients. That is precisely what the formula companies want to see. (Don't get me wrong, I'm not saying formula is bad - but their advertising and tactics definitely are). Free lunches are rare in healthcare anymore - formula companies offer free lunches, free "education" sessions (with their logo and name all over it), and even offer disposable measuring tapes that we use to measure newborns -- and guess what? LOGOS ALL OVER THOSE TOO. FREE!
This brings us back to the budget. If managers & directors, CNO's, CFO's and CEO's are already trying to balance a tight, strict budget, do you really think they want to start PAYING for formula? For this reason, the process of accreditation may be a challenge.
On that note, there ARE reasons to put this money out, up front. In a study by Bartick (2010), it was discovered that if the United States could comply with recommendations to breastfeed until 6 months exclusively, it would save 13 billion dollars & prevent 911 deaths per year. We can translate that to the Canadian population & we're looking at millions dollars in savings per year. An older study by Ball & Wright (1999) stated that formula fed babies cost the healthcare system between $331-$475 more PER year. I'm going to guess those numbers would be higher now. If you look at how many births are in Ontario (140,000) you're looking at MILLIONS of dollars in savings. SO, to make a long story short - although the BFI is an investment, it's a worthwhile investment for the health of babies and their mothers. (Stay tuned on a future post about the benefits of breastfeeding for both MOM and baby - that's another post for another day!)
The reason that I feel this is so important for families and moms to know about is this:
- You can ASK for these 10 steps to be followed. If your care provider doesn't know about them, you can tell them. The reason for this is, if you ask for these things, you will providing your baby with the best possible start and increasing your chances for successful breastfeeding. That is what the BFI is all about.
- Ask your healthcare facility if they are Baby Friendly. Ask them if they are trying to follow the steps & what they are doing to support them.
- When you fill out your patient satisfaction form at the end of your stay, include that you believe in the BFI.
- We can all be a voice for this process to be a standard of care. Tell your LHIN, write to the Ministry of Health, talk to politicians...
This is GOLD standard & considered best practice ... It is ALL based on evidence information & we know that it works. With breastfeeding getting more attention lately in healthcare systems and in the media, and with breastfeeding being such a vital public health issue - we need to keep BFI in the forefront.
New moms & dads deserve it.
Your baby deserves it too.
Thanks for reading : ) If you have any further questions, feel free to email me.