By Linda Deys, IBCLC: 

The road to Baby Friendly Health Initiative (BFHI) accreditation has been a long one for two hospitals in the Illawarra Shoalhaven Local Health District (ISLHD). Shoalhaven District Memorial Hospital (SDMH) and Milton-Ulladulla Hospital (MUH) are the health district’s regional and rural hospital providers on Yuin country, along the beautiful south coast of NSW. ISLHD midwives first broached the endeavour as far back as 2007, when BFHI was first recommended by NSW Health.  This early working group set up the original policies and education practices that have been progressed and developed to their current use. In 2013, staff at SDMH again began to work towards accreditation, even having a BFHI assessor from another LHD come and do a mock assessment. Policies were updated and education continued but with timing and management changes, it wasn’t meant to be.

In 2017, I (Linda Deys IBCLC) commenced a newly created ISLHD position as Clinical Midwife Consultant, Lactation Support. Implementing BFHI across the whole of the district was a goal that was now more achievable with district leadership support and someone to lead the charge. A business case was proposed in 2019 to develop a Clinical Midwife Specialist/Lactation Consultant position for inpatient maternity wards, and in early 2020, SDMH supported, created and filled this position with Nicole Voegt (IBCLC).  A multidisciplinary ISLHD Breastfeeding Reference Group was established in February 2020 with the goals of protecting, promoting and supporting breastfeeding across the district, sharing of resources and knowledge, and supporting the establishment and maintenance of BFHI. We really felt like we were moving forward as a team.

Staff education became the main focus, including using the ‘Keeping Abreast’ study day design, started in 2007. We now run four full day education sessions across the district each year. In line with NSW Health, all policies are written with a district wide focus and we were encouraged by the update to the Ministry of Health Breastfeeding Policy Directive – Breastfeeding in NSW – Promotion, Protection and Support, PD2018_034.  Changes to the BFHI booklet, in particular the education requirements for Group 1 staff reinvigorated our teams – we could see the light at the end of the tunnel!

It became apparent that accrediting the three hospitals with maternity services in the district was not achievable in one assessment. Strong leadership and management support in the southern hub created the right environment for BFHI preparation to progress. In particular this maternity service team, as a whole, saw BFHI as more than a recognition of our knowledge and policies, but as a part of our woman-centred care. We wanted to improve the infant feeding experience of all women who were cared for in our service. Our aim was to give women what they needed to make an informed feeding choice and support them to meet their goals. In 2021 the decision was made to delay BFHI assessment goals at our larger, metropolitan hospital and focus on SDMH and MUH.

All women attending maternity care in Milton and Shoalhaven hospitals are in an all-risk MAPS (Maternity Antenatal Postnatal Service) model of care. MUH has no inpatient or birthing service so women birth at SDMH unless referred to a higher level of care at the metropolitan hospital or a tertiary facility. Like all birthing services we have had increasing caesarean section and induction rates, higher maternal morbidity and acuity, and in the last few years a pandemic added to the mix! We had been able to achieve a total 94% skin-to-skin rate for all births, including 86% at caesarean sections in the 12 months preceding our first assessment. Around 94% of women initiate breastfeeding, with 85% exclusively breastfeeding to discharge.

Finally in 2022 we felt ready to apply for our first ‘cluster’ assessment and the dates were set for June 2022! After the initial nerves and fear, we reminded ourselves we were ready! Outcomes and positive feedback from the women confirmed our decision. Six weeks before the actual assessment we were again fortunate enough to have a practice run with an experienced BFHI assessor. I would highly recommend this if you have the opportunity – it evened out some of the nerves of staff and highlighted some areas to tweak, and the lovely comments from the women interviewed on this much smaller scale were very positive and reassuring.

Despite all of the trepidation and an enormous amount of preparation of documents and data we felt the actual assessment process was supportive and constructive, and reassured us that we were doing what we had aimed for. Due to Covid this was a remote assessment so everything was loaded onto a SharePoint provided by ACM BFHI, including photos and a video showing what our two services looked like. We decided not to give up our day jobs and move into cinematography but the end product was able to meet the purpose. We were feeling proud of where we work and what we do and I think this came across. Staff interviews were able to be scheduled to fit into a teams format but all staff were aware they could be called upon to interview if anything clinical caused an unavailability. We thought we had enough women who had provided consent to be interviewed (via phone) but over the three days we did need to seek more. This was a learning point for us, and for those of you planning assessments, get way more women than you think will be needed!

We were very excited to be successful with our assessment and are now accredited for BFHI until 2025. Some points to consider for those working towards assessment or reassessment –

• Have women at the centre of your motivation to be BFHI accredited – the assessment should just be a confirmation that you are providing the right care for women coming through your service – they are your litmus paper.
• Be collaborative with the multidisciplinary team – everyone has a role and educational needs specific to their area and speciality.
• Be prepared – include anything that shows off what you do and provide it in your documentation; have all staff ready for interview (which means all of them are better practitioners with more knowledge to support breastfeeding); consent twice as many women for interview than you think you will need.

Thank you to ACM BFHI for all of their support and guidance, to all of the staff at SDMH and MUH, and to the women we are lucky enough to care for as they meet their babies and learn to feed them.