Baby-Friendly Hospital Initiative Practices: Challenges and Strategies

Left to right: deVigne-Jackiewicz, Wight, Fletcher and White.

There has been lots of discussion about Baby-Friendly Hospital Initiative, a global initiative of WHO and UNICEF. How mommy-friendly is the Baby-Friendly Hospital Initiative? Is the breastmilk-only mandate putting babies in danger?

SDCBC’s recent Spring Mini-Seminar focused on this hot topic. Dr. Nancy Wight (MD, FAAP, FABM, IBCLC), Rose deVigne-Jackiewicz (RN, MPH, IBCLC), Ruth Fletcher (BSN, RN, IBCLC) and Nancy White (BSN, RN, IBCLC) talked about the challenges and strategies practicing Baby-Friendly Hospital Initiative.

What most think of when BFHI is mentioned is the famous 10 steps:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff. 
2. Train all health care staff in the skills necessary to implement this policy. 
3. Inform all pregnant women about the benefit and management of breastfeeding. 
4. Help mothers initiative breastfeeding within hour of birth. 
5. Show mothers how to breastfeed and how to maintain lactation. 
6. Give infants no food or drink other than breastmilk, unless medically indicated. 
7. Practice rooming in—allow mothers and infants to remain together 24 hours day. 
8. Encourage breastfeeding on demand. 
9. Give no pacifiers or artificial nipples to breastfeeding infants. 
10. Foster the establishment of breastfeeding support groups. 

However, there are “problems” with the 10 steps, especially when it comes to medically fragile infant. A normal infant should loss no more than 8% of his birth weight by day 4 after birth. Certain conditions would make acceptable medical reasons for the use of breastmilk substitutes. The goals of supplementation is to establish and maintain a mother’s milk supply. Skin-to-skin and putting babies to mothers’ breasts are important even when using supplement. Research shows that through practicing in breastfeeding, mothers are giving an active and meaningful role in the NICU, which can build confidence and enable parents to handle their infants.

Baby-friendly in the NICU is possible, though there are barriers and difficulties. A Neo-Baby Friendly Hospital Initiative for neonatal wards has been established. There are three guiding principals: Staff attitudes toward the mother must focus on the individual mother and her situation. The facility must provide daily centered care. The health care system must ensure continuity of care from pregnancy to after the infants’ discharge. Lack of lactation support and mother-baby separation are some of the main difficulties when practicing baby-friendly in NICU. Parents education, access to pumps and other tools, and Increased lactation support can be the solution.

Even in daily nursing practice, there are challenges of maintaining BFHI. There are sociopolitical barriers such as patient mix. There are organizational barriers such as hospital policies. There are individual barriers. Personal bias and experience, lack of breastfeeding skills and knowledges among new nurses are all issues. We need cultural strategies, family strategies, patient and family education strategies, and staffing strategies to overcome the barriers. Take time to understand mother’s viewpoints and beliefs. Ask family members their opinions about the importance of breastfeeding. Manage expectations, starting with antenatal education. It’s also important to address staff personal bias.

This is an original post for SDCBC by To-wen Tseng.