The document discusses Baby-Friendly Hospital Initiative (BFHI) assessment and how BFHI can be included in existing programs. It describes the 10 steps to successful breastfeeding that facilities must demonstrate compliance with to be BFHI designated. These include having a written breastfeeding policy, training staff, informing pregnant women of breastfeeding benefits, helping initiate breastfeeding within 1 hour of birth, teaching breastfeeding maintenance, giving only breastmilk to infants, practicing rooming-in, encouraging unrestricted breastfeeding, and fostering breastfeeding support groups. It also outlines the BFHI assessment process and pathways to designation.

1. Session 15

2. 1. Explain what Baby-friend practices
mean
2. Describe the process of BFHI
assessment
3. Discuss how BFHI can be included in
existing programmes.

4. Have a breastfeeding policy that is
routinely communicated to all health care
staff.

5. Facility will have a written policy on breastfeeding
Nurse Director/Manager will identify health care
professionals with ultimate responsibility for
assuring implementation of breastfeeding policy
Nurse Director/Manager will be able to describe
how staff are made aware of policy and its
content
Staff will be able to identify location of policy and
report having received orientation to policy
The 10 steps and policy regarding restriction of
promotion of breastmilk substitutes will be
prominently displayed about the facility

6. Train all health care staff in the skills
necessary to implement this policy.

7. Facility will have training records for all staff
with daily exposure to nursing moms and
babies as well as records of physician training
Nurse Director/Manager or Training
Coordinator will :
 identify health care professional(s) with ultimate
responsibility for assuring staff training
 provide an outline of the topics covered in training
 describe methods of verifying clinical competency
post training
Training outlines will demonstrate that topics
have been covered and competency verified.

8.  Ten Steps to Successful Breastfeeding tensteps.jbpub.com
(23.4 CEU for RNs & IBCLCs, 10 CME for physicians)
 Lactation for Clinicians
www.umdnj.edu/lactweb/continuing/index.htm (University of
Medicine and Dentistry of New Jersey.-up to
9 CME available)
 Breastfeeding Basics breastfeedingbasics.org
(Case Western Univ-CME currently not available)
 Health E-Learning Australian company providing on-line
CEU for BFHI as well as other breastfeeding topics
http://www.health-e-learning.com/
 Passport to Breastfeeding
http://www.breastfeedingclinic.com/bfdvd/(Canadian - reciprocal
CME through AAFP)
 Physician Lactation Education Collaborative of Washington:
Increasing Breastfeeding Success. Why it matters and what the
research shows (DVD). www.withinreachwa.org $23 for non-WA
residents.
 University of Virginia School of Medicine & Virginia Department of
Health. Breastfeeding Training for Health Professionals. Authors:
n.d. http://www.breastfeedingtraining.org. CME available
 Wellstart International. Lactation Management Self-Study Module
1: http://wellstart.org/Self-Study-Module.pdf

9. Academy of BF Medicine provides protocols,
policy, newsletter, conferences and other
educational events. resources:
www.bfmed.org
AAP and ACOG policy statements
AHRQ review on benefits of BF:
http://ahrq.gov/clinic/tp/brfouttp.htm#report
AHRQ review on the effect of primary care
interventions on BF:
http://www.ahrq.gov/clinic/uspstf/uspsbrfd.ht
m
Articles from Boston Medical Center (authors
Philipp & Merewood on bibliography)

10. Inform all pregnant women about the
benefits and management of
breastfeeding.

11. Written description of the content of prenatal
education will be available and will include
benefits of breastfeeding, importance of exclusive
breastfeeding in the first 6 months, and basic
breastfeeding management
Pregnant women of 36 weeks gestation will
confirm that benefits of breastfeeding have been
presented to them, and will be able to list
benefits of breastfeeding

12. All materials used for prenatal education on
breastfeeding will be free of messages which
promote any infant food or drink other than
human milk and will not bear proprietary product
logos

13. Help mothers initiate breastfeeding within
one hour of birth.

14. Postpartum mothers of vaginal deliveries will
confirm that immediately after birth their baby
was placed skin to skin with them and left there
continuously and uninterrupted until the
completion of the first breastfeeding (or for one
hour if not planning to breastfeed.)
Postpartum mothers of cesarean births will
report that the same continuous skin to skin
care began as soon as they were able to
respond and continued uninterrupted until the
completion of the first breastfeeding (or for one
hour if not planning to breastfeed.)

15. Postpartum mothers of vaginal deliveries will
confirm that immediately after birth their baby
was placed skin to skin with them and left there
continuously and uninterrupted until the
completion of the first breastfeeding (or for one
hour if not planning to breastfeed).
Postpartum mothers of cesarean births will report
that the same continuous skin to skin care began
as soon as they were able to respond and
continued uninterrupted until the completion of
the first breastfeeding (or for one hour if not
planning to breastfeed).

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

17. Postpartum mothers will:
report that nursing staff offered further
assistance with breastfeeding within six hours of
delivery.
be able to demonstrate correct positioning and
attachment.
report that they were shown and/or given
information regarding how to express their milk.
Mothers with babies in special care will:
 report that they have been offered help to
initiate and maintain lactation by frequent
expression of breastmilk.

18. Staff will :
report that they teach mothers positioning and
attachment.
report that they teach or give information about
expression of breastmilk.
demonstrate correct teaching of positioning and
attachment.
describe an acceptable technique for breastmilk
expression as taught to mothers.

19. Give newborn (breastfed) infants no food
or drink other than breastmilk, unless
medically indicated.
[The requirement to purchase formula is a
sub-step of Step 6.]

20. infants with severe dysmaturity
infants of very low birth weight
infants with inborn errors of metabolism
infants with acute water loss
infants whose mothers are severely ill
infants whose mothers require a
medication that is contraindicated

21. Mothers will:
report that their babies have been exclusively
breastfed, unless acceptable medical reasons
apply
OR report that staff have explored reasons for
and possible negative consequences of
supplementation elected by mother for non-
medical reasons.
Staff will:
report that mothers are routinely encouraged to
exclusively breastfeed.

22. Materials given to breastfeeding mothers and
displayed in facility are free of messages
(including product logos and names) which
promote infant food or drink other than
breastmilk.
Nursing Director/Manager will show evidence that
the facility purchases breastmilk substitutes,
nipples and pacifiers at fair market prices.

23. Practice rooming-in - allow mothers and
infants to remain together twenty-four
hours a day.

24. Mothers will:
room-in with their babies
report that their babies have stayed in their room
day and night except for periods of up to one
hour daily for hospital procedures
Staff will report that:
rooming-in is encouraged as the norm
any request by mother for not rooming-in is
explored and education about the advantages of
rooming-in is given

25. Encourage unrestricted breastfeeding.

26. Mothers will report that:
they have been advised to feed their babies on
cue
no restrictions have been placed on how often or
how long to breastfeed
Staff will report that:
mothers are taught to feed on cue
no restrictions are placed on frequency or length
of feeds

27. Give no pacifiers or artificial nipples to
breastfeeding infants.

28. Mothers will report that:
their babies have not been given nipples or
pacifiers
OR that staff have offered education regarding
possible disadvantages of mother’s decision to
use pacifiers or bottles
Staff will report that:
breastfed babies are not routinely given bottles
or pacifiers
the use of pacifiers is discouraged

29. Foster the establishment of breastfeeding
support groups and refer mothers to them
on discharge from the hospital or birthing
center.

30. The facility will report that:
it has taken action to foster the establishment of
breastfeeding support groups in the community
Mothers will report that:
staff have offered resources for on-going support.
Staff will report that:
mothers are always referred to on-going support
resources.

31. The Pathway to
Baby-Friendly™ Designation
Hospital
Breastfeeding
Policy
Readiness
Interview
Implement
QI Plan
Collect Data
Train Staff
Data
Collection
Plan
Prenatal/Postpartum
Teaching Plans
Staff Training
Curriculum
On-Site
Assessment
Start
DDiscoveryiscovery
DDevelopmentevelopment
DDisseminationissemination DDesignationesignation
BF Committee
Or Task Force
BFHI
Work Plan
Register with
Baby-Friendly USA
Obtain CEO
Support Letter
Complete Self
Appraisal Tool
Baby-Friendly
Designation
© Baby-Friendly USA, Inc. 2010For more information go to www.babyfriendlyusa.org
Bridge to
Development Phase-
Registry of Intent
Award
Bridge to
Designation Phase
Dissemination
Certificate of Completion
Bridge to
Dissemination
Phase-
Development-
Certificate of
Completion