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Baby Friendly Hospital Initiative History

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Title: Baby Friendly Hospital Initiative History


1
Baby Friendly Hospital InitiativeHistory
  • 1982 UNICEF Director, James Grant launched
    initiative known as the child survival
    revolution, or GOBI plan
  • 'G' for growth monitoring
  • 'O' for oral rehydration therapy
  • 'B' for breastfeeding
  • 'I' for immunization

2
Baby-Friendly Hospital Initiative
  • 1991 WHO/UNICEF
  • Ten steps to successful breastfeeding
  • Today 14,500 hospitals in 125 countries
  • 34 US hospitals

3
Baby Friendly HospitalWhat are the Ten Steps?
  • Write breastfeeding policy.
  • Train all health care staff.
  • Inform all pregnant women.
  • Initiate breastfeeding within an hour of birth.
  • Show mothers how to breastfeed.
  • Give infants nothing but breastmilk.
  • Practice "rooming in."
  • Encourage breastfeeding on demand.
  • Give no artificial teats or pacifiers.
  • Establish breastfeeding support groups.

4
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6
Effects ofBaby Friendly Initiative
  • JAMA 2001 Jan 285(4)413-420
  • Promotion of Breastfeeding Intervention Trial
    (PROBIT)
  • 30 hospitals, randomized to receive Baby-Friendly
    training, or to continue their routine practices
  • 17,000 mother-baby pairs
  • Followed for 1 year

7
PROBIT Results

8
Baby-Friendly Hospital Initiative Reduction in
Infections and Allergies

9
Maternity Care PracticesImplications for
Breastfeeding
DiGirolamo, Grummer-Strawn, and Fein, BIRTH 282,
94, June 2001
  • Surveyed 1085 women who intended to breastfeed
    for more than 2 months
  • Assessed 5 Baby-Friendly practices
  • Breastfeeding initiation
  • Supplements
  • Rooming-in
  • Breastfeeding on demand
  • Pacifiers

10
Percentage of women who stopped breastfeeding
before 6 weeks, by specific hospital practices
11
Percentage of women who stopped breastfeeding
before 6 weeks, by number of Baby-Friendly
Hospital Initiative practices they experienced
STOPPED BF
Number of Baby-Friendly Practices Reported
12
BFHI Improves Breastfeeding Initiation Rates in
a US Hospital Setting
  • Boston Medical Center
  • inner-city teaching hospital
  • 1800 births per year
  • 15-bed Level III NICU
  • primarily poor, minority, immigrant families
  • Implemented Baby-Friendly policies over a 3-year
    period
  • Reviewed 200 randomly selected medical records
    from each of the 3 years

13
BFHI IMPLEMENTATIONEFFECTS ON BREASTFEEDING
TRENDS
14
Effect on Rates of Breastfeeding of Training for
the BFHI
  • Controlled, non-randomised study
  • 4 hospitals in southern Italy (group 1)
  • 4 hospitals in central/northern Italy (group 2)
  • Implemented Baby-Friendly training
  • Collected data before and after training

15
Breastfeeding Rates at Discharge and Three
Months
16
Narcotics during LaborEffects on Newborns
  • Given IV or IM in Labor
  • Decrease alertness
  • Lower neurobehavioral scores
  • Inhibit suckling
  • Delay effective feeding
  • Nissen 1995, Crowell 1994, Matthews 1989,
    Hodgkinson 1978, and other studies

17
Studies specific to breastfeeding Crowell 1994
  • 48 healthy term infants
  • All mothers received local or pudendal anesthetic
    at delivery
  • 26 also received analgesia in labor (butorphanol
    or nalbupine)
  • Measured time to effective feeding
  • Effective feeding defined as 3 consecutive IBFAT
    scores of 10-12

18
Time To Successful BF By Analgesia And Time Of
First Feed
To breast within 1 hour
To breast after 1 hour
No analgesia or given less than 1 hour before
birth
6.4 hours (n 8)
49.7 hours (n 19)
Analgesia given more than 1 hour before birth
50.3 hours (n 9)
62.5 hours (n 7)
19
Studies specific to breastfeeding Riordan 2000
  • Studied 129 term infants born vaginally
  • Scored Infant Breastfeeding Assessment Tool
    (IBFAT) while in hospital
  • Measured duration at 6 weeks

20
Types of Labor Pain Meds in Riordans Study
  • Epidurals
  • Bupivacaine with fentanyl
  • IV Analgesia
  • 25-50 mg meperidine
  • 5-10 mg nalbuphine

21
Breastfeeding Score by Labor Medication Group
22
Any effect on BF duration?
  • No effect, measured at 6 weeks in Riordans study
  • Halpern (Birth 1999) also reported no effect on
    duration at 6-8 weeks

23
Effect on Lactogenesis
  • Hildebrandt JHL 1999
  • 46 primips and 81 multips
  • Mothers reported time of sensation of milk coming
    in
  • Mean time in entire group was 50 hours
  • Multips 45 hours
  • Primips 59 hours

24
Effect of labor pain meds on lactogenesis, contd
  • Multips who delivered vaginally without
    medication had the shortest time to lactogenesis
    (44 hours)
  • 6 hours longer if cesarean section
  • 11 hours longer if primip
  • 13 hours longer if sedative or pain medication
    given during labor

25
Labor AnalgesiaDisturbs Newborn Behavior
  • Ransjo-Arvidson (Birth 2001) studied 28
    mothers-babies
  • Group 1 no analgesia
  • Group 2 pudendal block
  • Group 3 epidural or pethidine or more than one
    type of analgesia

26
In Groups 2 and 3
  • Infants massage-like hand movements were less
    frequent
  • Fewer infants touched the nipple with hands
    before suckling
  • Fewer infants made licking movements and sucked
    the breast
  • Average time to first feeding was more than 150
    minutes (compared to 79 minutes in Group 1)

27
Significance of hand motions
  • Newborns use their hands as well as their mouths
    to stimulate oxytocin after birth

28
Early post-birth events and oxytocin
  • Baby crawls to breast
  • Opens and closes hands
  • Massages the breast
  • Hand movements cause as high an oxytocin rise as
    sucking

29
Skin-to-skin encourages oxytocin release
  • OXYTOCIN
  • Promotes milk
  • Promotes mothering behaviors
  • Alleviates pain

30
Oxytocin in the bloodstream
  • Released with nipple stimulation
  • Released in surges, lasting about 1-2 minutes
  • Contracts muscle cells
  • Causes uterine contractions, causing involution
  • Causes contractions of the muscle cells
    surrounding alveoli and ducts in the breast,
    causing milk let down or milk ejection reflex

31
Second Stage and Early Post-birth Events and
Oxytocin
  • Ferguson's Reflex Physiologic response triggered
    by the fetal presenting part stimulating stretch
    receptors located in the posterior vagina at
    around 1 station. Stimulation causes release of
    oxytocin, naturally augmenting pushing.
  • Mother has another oxytocin surge AFTER babys
    shoulders are delivered

32
Oxytocin effects
  • Opposite of fight or flight response
  • Lowers heart rate
  • Lowers blood pressure
  • Lowers blood cortisol
  • Affects metabolic actions
  • Contracts pyloric sphincter
  • Releases insulin and cholecystokinin

33
Oxytocin in the brain affects social behavior
  • Women who have high levels of oxytocin
  • Produce more milk
  • Breastfeed longer
  • Are more tolerant of repetitious, boring tasks
  • Demonstrate more social behavior better
    listeners
  • Women become more social and retain those traits
    if they continue breastfeeding

34
Oxytocin as Pain-Relief
  • Stimulates endorphins
  • Increases pain threshold

35
Endorphins in Colostrum
  • 2x higher than mothers blood level
  • Elevated endorphins may contribute to
  • postnatal adaptation
  • overcoming stress of labor and birth
  • postnatal development of biologic functions

36
Endorphins in Human Milk
  • Mothers who delivered vaginally had higher levels
    of endorphins in their milk than mothers who had
    elective c-section
  • Preterm mothers had higher levels than term

37
Breastfeeding is analgesic in newborns
  • Pediatrics 2002 Apr109(4)590-3
  • 30 full-term, breastfed infants
  • Intervention group - held and breastfed by their
    mothers during heel lance and blood collection
  • Control group experienced the same test while
    swaddled in their bassinets
  • Crying and grimacing were reduced by 91. Heart
    rate was also substantially reduced by
    breastfeeding

38
The Most Important Factors for Lactogenesis Stage
II
  • Prepared mammary epithelium
  • Progesterone withdrawal
  • Maintained plasma prolactin
  • Removal of milk within an undefined interval
    after birth

39
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40
Days Postpartum
Neville et al, Ped Clin N Am, Feb 2001
41
Milk volume
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43
Importance of nipple stimulation
44
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45
Early initiation of breastfeedingis associated
with
  • Earlier establishment of effective sucking and
    feeding (Righard 1990)
  • Temperature stability (Britton 1980)
  • Higher blood sugar (Hawdon 1992, Yamauchi 1997)
  • Increased stooling, decreased jaundice (Yamauchi
    1990)
  • Longer duration of breastfeeding (DeChateau 1977,
    Salariya 1978, Taylor 1986, Yamauchi 1990)

46
Unrestricted breastfeedingis associated with
  • Less engorgement (Hill 1994)
  • No increase in nipple soreness (DeCarvalho 1984)
  • Less jaundice (DeCarvalho 1983)
  • Stable blood sugar (Hawdon 1992, Yamauchi 1997)
  • Faster onset of mature milk (Salariya 1978,
    Yamauchi 1997)
  • Less weight loss, faster weight gain (DeCarvalho
    1983)

47
Can You?
  • Describe one effect medications given to the
    mother during labor can have on her newborn or on
    breastfeeding
  • Identify the effect of early post-birth
    skin-to-skin contact and breastfeeding on
    maternal hormones and on breastfeeding outcomes
  • Name at least 5 of the 10 Steps to Successful
    Breastfeeding from the Baby Friendly Hospital
    Initiative
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