Important points:

Health care practices CAN have major effect

on breastfeeding (BF)

Poor practices interfere with BF & contribute

to the spread of artificial feeding

Good practices support BF

 25/1

Health care practices

After completing this session participants
will be able to:
list the Ten Steps to Successful Breastfeeding
describe the health care practices summarized
by ‘The Ten Steps to Successful Breastfeeding’
explain why the Baby-friendly Hospital Initiative
(BFHI) is important in areas with a high HIV
prevalence
Important points:

1989, WHO and UNICEF issued a Joint Statement

called

Protecting, Promoting and Supporting

Breastfeeding: The special role of
Maternity Services.

This describes how maternity facilities can

support breastfeeding
 Important points:

The “10 Steps to Successful

Breastfeeding” is the summary of the
main recommendation of the Joint
Statement.

They are the basis for the “Baby

Friendly Hospital Initiative (BFHI)”
launched in1991 by WHO and UNICEF
 25/2

Step one
Have a written breastfeeding policy that
is routinely communicated to all health
staff
Written policy which addresses the 10
steps
Visibly posted in:
maternity ward
all infant care areas
( well baby / sick baby )
antenatal care services
Language / dialect commonly used

Disseminated to all
Should PROHIBIT

promotion of BM substitutes / teats
/pacifiers

distribution of gift packs

Mechanism for evaluating effectiveness of

the policy

2006
 25/3

Step two
Train all health care staff in skills
necessary to implement this policy
2 - Train all health care staff in skills necessary to implement this policy

All staff ( involved with mother and baby )

received orientation on BF policy
Trained on 20 hours w/ 3 hours clinical
experience
includes the 10 steps & EO 51
of non-clinical staff (given their roles) to
support
Step 2 Train all health care staff in skills necessary to implement this policy.

New employees - orientation & training

w/in 6 months

Available copy of the curricula or course

outline
 25/4

Step three
Inform all 25/525/5

pregnant
women about
the benefits and
management of
breastfeeding
3 -Inform all pregnant women about the benefits and management of breastfeeding

Breastfeeding
counseling to
most pregnant
women at
antenatal
service
Step 3 - Inform all pregnant women about the benefits and
management of breastfeeding.

written antenatal education:

importance of exclusive
breastfeeding for 6 months
benefits of breastfeeding
basic breastfeeding
management
(attachment / positioning )
Discuss mother’s questions
(Group / individual
discussion)
 25/6

Step four

Help mothers initiate breastfeeding

within the first hour of birth
25/7
Both naked – skin to skin
Place baby between the breast
At the level of the nipple
Cover mother and baby with the same
blanket
4 - Help mothers initiate breastfeeding within the first hour of birth

Let baby suckle when he

shows that he is ready

Normally alert &

responsive in the first 1-2
hours after birth

Try to delay non urgent

medical routines for at
least an hour
 Step 4 - Help mothers initiate
breastfeeding within an hour after birth.
Q – What medical routines occur in health
facility which could interrupt early contact
between mother and her baby ?

If the 1st feed is delayed for longer than an hour,

BF is LESS likely to be successful.
What about for HIV positive mothers , can
you do skin to skin contact at birth ?

Encourage her to hold and cuddle and

have physical contact with her baby

Help her feel close and affectionate

towards her baby
 25/9

Step five

Show mothers how to breastfeed and how

to maintain lactation, even if they should
be separated from their infants
25/10
 25/12

After caesarian section –usually 4-6 hrs.

Teach breastmilk
expression / collection

To establish and
maintain lactation
 25/13

Step six
Give newborn infants no food or drink other
than breast milk, unless medically indicated
6- Give newborn infants no food or drink other than breast milk, unless medically indicated
25/14

Prelacteal feeds replaces colostrum and baby

is more likely to :

develop infections such

as diarrhea,
intolerance to the protein
in the feed,
makes baby breastfeed
less because he is full
 25/15

Stomach capacity of the

newborn and a 1-year-old child
Newborn stomach capacity 1-year old stomach capacity

10 X
bigger

10 X bigger
Step 6 - Give newborn infants no food or drink other
than breastmilk, unless medically indicated.
 25/16

Step seven

Practice rooming-in: allow mothers and

infants to remain together 24 hours a
day
7 -Practice rooming-in: allow mothers and infants to remain together
24 hours a day

Enables mothers to
respond to the needs
Helps bonding and
breastfeding
Baby cries less
Mothers become
confident about BF
BF continues longer
when she leaves
facility

Bedding - in
Step 7 -Practice rooming-in: allow mothers and infants to remain
together 24 hours a day 25/17

Mothers who are HIV

positive do not need
to be separated from
their babies

General mother to
child contact does not
transmit HIV

Rooming in
 25/18

Step eight

Encourage breastfeeding on demand

 25/19
Step 8 - Encourage breastfeeding on demand
Step 8 -encourage breastfeeding on demand

Q – what does BF on
demand mean ?

Breastfeeding
whenever the baby or
mother wants with no
restrictions on the
length and frequency
of feeds
8 -encourage breastfeeding on demand

Q – What are the advantages of feeding

on demand ?

There is earlier passage of meconium

Baby gains weight faster
Milk “comes in” sooner, larger volume of
milk on day 3
Fewer difficulties like engorgement
Less incidence of jaundice
Even babies in the NICU could be fed
on demand basis
 25/20

Step nine

Give no artificial teats or pacifiers* to

breastfeeding infants

* also called dummies and

soothers
Step 9 -Give no artificial teats or pacifiers* to breastfeeding infants

May carry infection

If hungry baby is
given pacifier, he may
not grow well
Cup feeding is
recommended
 25/22

Step ten

Foster the establishment of

breastfeeding support groups and refer
mothers to them on discharge from
hospital or clinic
10 -Foster the establishment of breastfeeding support groups and
refer mothers to them on discharge from hospital or clinic

25/23
10 -Foster the establishment of breastfeeding support groups and refer
mothers to them on discharge from hospital or clinic

The KEY to best BF practices is continued

day-to-day for the breastfeeding mother
within her home and community

Breastfeeding counselors (YOU) should

visit the mothers after discharge from
health facility and support them to
continue breastfeeding
 25/24

Effect of trained peer counsellors on the

duration of exclusive breastfeeding
80%
70%
70%
60%
50%
Percentage

Exclusively
40% breastfeeding
5 month old
30% infants
20%
10% 6%

0%
Project area Control

Adapted from Haider R, Kabir I, Huttly S and Ashworth A. Training peer counselors to
promote and support exclusive breastfeeding in Bangladesh. J Hum Lact, 2002;18(1):7-12.