BabyFriendly Initiative in Manitoba

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Baby-Friendly Initiative in Manitoba

• Manitoba Breastfeeding Co-ordinating
  CommitteeManitoba Health

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An international perspective

• Breastmilk is recognized as the best food for
  babies.
• The World Health Organization (WHO) and the
  United Nations Children Fund (UNICEF) have
  implemented many standards and initiatives to
  help promote breastfeeding worldwide.

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An International Perspective
International Codes and Initiatives and What they
Do

• WHO International Code of Marketing of
  Breast-milk Substitutes
• Innocenti Declaration on the Protection,
  Promotion and Support of Breastfeeding
• The Baby-Friendly Hospital Initiative
• The Seven Point Plan for the Protection,
  Promotion and Support of Breastfeeding

Elimination of free and subsidized supplies of
breastmilk substitutes.
A statement committing both the WHO and UNICEF to
the protection, promotion and support of
breast-feeding, it spells out the benefits of
breastfeeding.
An initiative encouraging maternity-care
providers to help implement breastfeeding locally
and nationally.
Developed by the UK BFI committee to encourage
breastfeeding implementation among health care
professionals.
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Breastmilk...

• provides ideal nutrition for infants and
  contributes to their healthy growth and
  development
• reduces incidence and severity of infectious
  diseases, thereby lowering infant morbidity and
  mortality
• contributes to women's health by reducing the
  risk of breast and ovarian cancer, and by
  increasing the space between pregnancies
• provides social and economic benefits to the
  family and the nation
• provides most women with a sense of satisfaction
  when successfully carried out

As stated in the Innocenti Declaration
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Baby-Friendly Hospital Initiative

• Created in 1991
• Based on the WHO/UNICEF joint statement
  Protecting, Promoting and Supporting
  Breast-feeding The Special Role of Maternity
  Services.
• includes a 10-step process established by
  WHO/UNICEF

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Every facility providing maternity services and
care for newborn infants should
The 10 steps to Successful Breastfeeding

• Have a written breast-feeding 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 breast-feeding.
• Help mothers initiate breast-feeding within a
  half-hour of birth.
• Show mothers how to breast-feed, and how to
  maintain lactation even if they should be
  separated from their infants.

• Give newborn infants no food or drink other than
  breast milk, unless medically indicated.
• Practice rooming-in -- allow mothers and infants
  to remain together -- 24 hours a day.
• Encourage breast-feeding on demand.
• Give no artificial teats or pacifiers (also
  called dummies or soothers) to breast-feeding
  infants.
• Foster the establishment of breast-feeding
  support groups and refer mothers to them on
  discharge from the hospital or clinic.

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Global Status of Baby-Friendly Hospitals in 2000
World wide, over 15, 000 hospitals are
baby-friendly. Most are in developing Countries..
Industrialized Countries

• Sweden 64
• Norway 35
• United Kingdom 29
• United States 25
• Australia 17
• CANADA 1

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Baby-Friendly Hospital Initiative in Canada

• In 1991, Health Canada created the Breastfeeding
  Committee for Canada, comprising experts from
  many different organizations.
• To date, there is only one accredited
  baby-friendly hospital in Canada
  Brome-Missisquoi-Perkins Hospital in Cowansville,
  Quebec

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The Breastfeeding Committee for Canada and the
BFHI

• In Canada, the name Baby-Friendly Hospital
  Initiative has been changed to the
  Baby-Friendly Initiative.
• The BCC is the National Authority for the
  Baby-Friendly Initiative and helps implement it
  nation-wide.

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Breastfeeding Promotion in Manitoba

• The Manitoba Baby-Friendly Co-ordinating
  Committee is the provincial authority for
  implementing the Baby-Friendly Initiative.
• The Manitoba Baby-Friendly Co-ordinating
  Committee is helping Regional Health Authorities
  and hospitals implement the criteria established
  in the 10 Steps.

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Supporting BFI

• The BFI offers many benefits to
• parents, babies and the community
• hospital administration
• The prevalence of breastfeeding reflects the
  importance placed upon it by society.

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Choosing Breastmilk

• Parents guide to the benefits of breastfeeding

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Choosing Breastmilk

• Breastmilk has been recognized by the World
  Health Organization as offering superior
  nutrition for optimal growth.
• Health Canada has echoed these findings by
  recommending the use of breastmilk exclusively
  for the first six months of life.
• There are numerous immediate health benefits to
  breastfeeding.

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Why Breastfeed?

• Provides optimal nutrition and emotional
  nurturing for the growth of infants.
• Contributes to womens health.
• Its a basic human right, contributing to a
  womans social and economic equality as well as
  giving the child access to the highest attainable
  standard of health and nutrition.
• Provides positive economic advantages to baby,
  mother, family and the community. Healthy
  mothers and babies mean substantial savings in
  health care costs.

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Breastfeeding Benefits the Baby

• Reduces the risk of infant mortality.
• Reduces infant morbidity from infections such as
  gastro-intestinal infections and ear infections.
• Enhances the childs natural immunity
• Reduces atopic disease such as eczema and
  respiratory problems.

• Reduces the risk of diabetes.
• Can result in increased intelligence.
• Reduces the chance of obesity later in life.
• Helps with digestion.
• Can result in fewer dental problems later in life
  such as braces and cavities.

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Breastfeeding Benefits Mothers

• Reduces the risk of breast cancer and ovarian
  cancer.
• Helps reduce post-natal weight-gain by using
  extra calories.
• Helps delay post-natal menstruation.
• Reduces the risk of hip fractures in later life.
• Rapid uterine involution.

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Benefits to the Family

• Breastfeeding bonds mother and child.
• Breastfeeding results in better health, nutrition
  and well-being.
• Portable means of nourishment.
• Breastfeeding saves money on formula and medical
  costs related to illness.

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Economic Advantages

• Breastfeeding saves money in two ways
• On costly formula.
• As a preventive measure against infant illness.

Data taken from Calgary Health Services,
Nutrition Division 1998
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Environmental Advantages

• Reduces the amount of packaging tin, paper and
  plastic.
• Cuts down on bottles, nipples, disposable liners
  and feeding equipment.

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Choosing to be Baby-Friendly

• A guide for Health
• Administrators

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The BFI contributes to

• Excellence in family-centred maternity care.
• Quality assurance by meeting international
  standards.
• Increased morale and satisfaction of staff and
  families.
• Increased awareness and support of breastfeeding
  within the community.

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Benefits to the Hospital

• Warmer and calmer emotional environment
• Fewer neonatal infections
• Less staff time required
• Improved hospital image and prestige

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Breastfeeding is Financially Sound

• The health benefits of breastfeeding can cut down
  on the treatment of child infections.
• If 25 more mothers breastfed, cutting down the
  rate of infection by 25, a conservative estimate
  shows the savings could be in excess of 850 000
  per year.

based on Ontario figures
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How Hospitals can Help

• Adhere to international guidelines outlined in
  the International Code of Marketing of Breastmilk
  Substitutes.

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International Code of Marketing of Breastmilk
Substitutes

• 1) No advertising of products under the scope
  of the Code to the public.
• 2) No free breastmilk samples for mothers.
• 3) No promotion of products in health care
  facilities, including the distribution of free
  or low-cost supplies.
• 4) No company representatives to
  advise mothers.
• 5) No gifts of personal samples to health
  workers.

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International Code (continued)

• 6) No words or pictures idealizing artificial
  feeding, including pictures of infants on
  products.
• 7) Information to health workers should be
  scientific and factual.
• 8) All information on artificial feeding,
  including the labels should explain the benefits
  of breastfeeding and all costs and
  hazards associated with artificial feeding.
• 9) Unsuitable products such as
  sweetened condensed milk should not be promoted
  for babies.
• 10) Products should be of a high quality and take
  account of the climatic and storage conditions
  of the country where they are used.

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What can Hospitals do?

• Review existing hospital policy to include Baby
  Friendly Initiative goals.

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Brome-Missisquoi-Perkins Hospital
Example of Hospital Breastfeeding Policy
Condition 1 Adopt a written breastfeeding
policy that is brought to the attention of the
treating staff. This policy defines the
commitment of the hospital in the promotion,
protection and support of breastfeeding. Conditi
on 2 Assure the competence of all the treating
personnel to institute this policy. Eighteen
hours of instruction in breastfeeding including
three (3) hours of clinical practice is
envisaged in the orientation of new personnel in
the birthing centre. There will also be a
continuing education programme to maintain
competency. The birthing centre will also
furnish the staff with up-to-date information
concerning breastfeeding.
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Condition 3 Inform all pregnant women of the
advantages and techniques of breastfeeding. Durin
g the prenatal visits to the doctors office as
well as the monthly visits to the birthing
centre, we will offer pertinent information
(pamphlets, books,videos, information sessions)
on the benefits of breastfeeding. Condition 4
Help the new mother to start nursing her infant
within a half hour of the birth. The mother who
has just delivered s encouraged to nurse her baby
shortly after the birth. The baby is
immediately placed on the mothers abdomen,
except if there is a medical contraindication.
She is helped to start breastfeeding. In the
case of a caesarean, skin to skin contact and
breastfeeding will be started as soon as
possible.
From BMP Hospital Breastfeeding Policy, 1998
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Condition 5 Show mothers how to breastfeed and
how to maintain milk production in the event of
separation from her baby. The instruction and
support given during the hospital stay allows
mothers to acquire the knowledge and the
necessary ability to nurse their babies, such as
positioning and latching into the breast. In
special cases where the baby will not take the
breast, the mother is encouraged to maintain
lactation by pumping her breasts. Condition 6
Do not give any food or drink ot the new-born
infant other than mothers milk except if there is
a medical indication. In the birthing centre
new-borns receive only breastmilk unless there is
a medical reason to give a supplement feeding as
is stipulated by UNICEF.
From BMP Hospital Breastfeeding Policy, 1998
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Condition 7 Leave the baby with its mother
24-hours a day. Mother and baby are not
separated during their admission to the birthing
centre. The nurse provides care to mother and
child in the same private room. Condition 8
Encourage breastfeeding on demand. We encourage
demand feeding. The frequency and the duration
of nursing are determined by the needs of the
infant. Mothers receives support and teaching
so that she can recognize the signs of hunger and
satiety of her baby. Condition 9 Do not give
breastfed infants any artificial milk or
pacifier. To facilitate initiation of
breastfeeding, we advise the parents to avoid
pacifiers and supplements in the first weeks
after birth.
From BMP Hospital Breastfeeding Policy, 1998
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• Condition 10 Encourage formation of
  breastfeeding support groups and inform mothers
  of their location.
• There is a follow up telephone call 24 hours
  after discharge with a home visit the following
  day. Other visits and/or telephone calls will be
  offered as needed. The line Info-Santé is
  available 24 hours a day. A list of support
  groups is given to the mother on discharge.
• BMP also adheres to the International Code on the
  Commercialization of Breastmilk Substitutes.

From BMP Hospital Breastfeeding Policy, 1998
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The Need for Education
The Study on Attitudes about Breastfeeding offers
these tips

• The promotion of breastfeeding depends on changes
  made to the medical system.
• There is a need to create a more realistic
  expectation about breastfeeding.
• Information about breastfeeding needs to be
  available throughout pregnancies.
• Resources must be made available to mothers.

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Self-AssessmentAre we ready for BFI?

• The BCC has issued a Self-Appraisal Tool for the
  use of hospitals to identify which of their
  practices coincide with the 10 steps.
• The series of yes/no questions can indicate if a
  hospital is ready to become baby-friendly.

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How to Get Involved
To get more information about breastfeeding,
self-assessment and the BFI in Manitoba, call

• La Leche League Canada(204) 257-3509
• Manitoba Health (204 788-6661)
• Your Regional Health Authority(204)