World Breastfeeding Week 1-7 August 2010
Breastfeeding - Just 10 Steps
The Baby-Friendly Way - 10 Steps to Successful Breastfeeding
World Breastfeeding week is celebrated in the first week of August every year and provides an opportunity to reflect on the value of the breastfeeding relationship to the baby, the family and the community. This year the theme is 'Breastfeeding: Just 10 steps - the Baby-Friendly Way' and is an opportunity for us to refocus our attention on and expand the Baby Friendly Hospital Initiative (BFHI). So what is it all about?
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10 Steps to Successful Breastfeeding
- Have a written breastfeeding 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 breastfeeding
- Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed.
- Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants
- Give newborn infants no food or drink other than breastmilk, unless medically indicated
- Practise rooming-in, allow mothers and infants to remain together 24 hours a day
- Encourage breastfeeding on demand
- Give no artificial teats or dummies to breastfeeding infants
- Foster the establishment of breastfeeding support and refer mothers on discharge from the facility.
BFHI is an accreditation scheme that aims to ensure that practices in maternity facilities support mothers to breastfeed. BFHI was developed following the 1990 Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding. The name 'Innocenti' comes from the former orphanage where the WHO/UNICEF policy meeting was held, the Spedale degli Innocenti in Florence. There is a kind of poetry in thinking that a building that used to house abandoned children has now become a by-word for this most important international effort to protect mothers and babies.
What has been happening in the developed world?
It has been 20 years since WHO and UNICEF jointly challenged maternity services from all over the globe to implement the BFHI scheme. The evidence that supports each of the 10 steps has only strengthened to solidify their value as best practice. Over 20,000 maternity services have been certified 'Baby Friendly' around the world.
- In Scotland, babies born in a hospital with the UK Baby Friendly Hospital Initiative were 28% more likely to be exclusively breastfed at 7 days of postnatal age than those born in other maternity units after adjustment for confounding factors. i
- A Swiss study reported that 42% of babies exclusively breastfed for their first 5 months of life were born in Baby Friendly hospitals, compared with 34% for infants born elsewhere. Median breastfeeding duration for infants was longer if the hospital showed good compliance with the Ten Steps (35 weeks vs. 29 weeks for any breastfeeding, 20 weeks vs. 17 weeks for full breastfeeding, and 12 weeks vs. 6 weeks for exclusive breastfeeding. ii
- In Italy, exclusive breastfeeding at discharge increased significantly after 3-day staff training in preparation for BFHI: 23% to 73%, as did the rates of full breastfeeding at 3 months: 40% to 59% and any breastfeeding at 6 months: 41% to 64%. iii
- In Eastern Europe a large study in Belarus observed increased likelihood of breastfeeding at 12 months, increased breastfeeding rates and exclusive breastfeeding rates at 3 and 6 months of life. Improved breastfeeding practices significantly reduced the incidence of gastrointestinal tract infections and atopic eczema during the first year of life. iv
Whilst BFHI has significantly improved breastfeeding practices, there are concerns about recent declines in exclusive breastfeeding which affect the health of mothers and their babies. Inadequate training of health professionals and weakened compliance with the criteria of the 10 steps have been identified as contributing factors. There is a need to revitalise our commitment to implement the BFHI 10 steps without compromise so all babies are fed safely and mothers achieve their breastfeeding goals.
Baby Friendly Health Initiative (BFHI) in Australia
In Australia, the Australian College of Midwives (ACM) is responsible for the administration and accreditation of health facilities as 'Baby Friendly'. They are supported by a committee of representatives from professional associations including: lactation, midwifery, child and family health nurses and the Australian Breastfeeding Association. There are currently 66 Baby Friendly accredited health services across Australia.
It is widely recognised that the implementation of the 10 Steps helps mothers to begin breastfeeding. However, this is not sustained and few babies are fed according to public health guidelines that recommend breastfeeding continue until 2 years or more after the introduction of appropriate solid foods at 6 months.[i] In a response to this challenge, BFHI has extended its Baby Friendly program to include other service providers who support mothers to continue breastfeeding once they leave hospital. Hence, Baby Friendly 'Hospital' Initiative in Australia has been replaced with Baby Friendly 'Health' Initiative to reflect the inclusion of BFHI community and BFHI paediatric. The program recently developed for BFHI Community is a 7-point plan that includes standards to ensure all mothers have access to skilled support to manage infant and child feeding. This program is expected to be implemented in the near future before further expansion can commence on BFHI paediatric standards.
What Can I Do?
- Search
- For further information and a list of Australian accredited facilities by visiting:
- Talk
- to your partner and family about using the 10 steps during the birthing process so they can advocate for you while you are vulnerable
- to your midwife, obstetrician and paediatrician and discuss how you could work together to follow the 10 steps even if you are not birthing in a Baby Friendly facility
- to your friends and colleagues, discuss experiences and explore how using the 10 steps may have affected their breastfeeding relationships
- to your hospital boards, local politicians about what Baby-Friendly means to you.
- Subscribe
Embrace Step 10 by joining ABA or maintaining your subscription so we can continue to provide skilled mother-to-mother support and encouragement to new families. Women will receive the best possible environment for successful breastfeeding when health professionals and trained peer support networks work together. ABA provides a unique service to families in Australia that is not available elsewhere in the world.
- Contribute
iBroadfoot, M, Britten, J, Tappin, D M and MacKenzie, J M, 'The Baby Friendly Hospital Initiative and breast feeding rates in Scotland' in Archives of Disease in Childhood Fetal and Neonatal Edition 2005;90:F114-F116
iiMerten S et al (2005). Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level? Pediatrics 116: e702-e708
iiiCattaneo, A and Buzzetti, R, 'Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative', British Medical Journal 2001;323:1358-62.
ivKramer MS, Chalmers B, Hodnett ED, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001;285:413-420
[i]www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4810.0.55.001Main+Features12001?OpenDocument
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