Maternity Facilities

The core purpose of the BFHI is to ensure that mothers and newborn infants receive timely and appropriate care before and during their stay in a facility providing maternity and newborn services, to enable the establishment of optimal feeding of newborn infants, thereby promoting their lifetime health and development. Given the proven importance of breastfeeding, the BFHI protects, promotes and supports breastfeeding. At the same time, it also aims to enable appropriate optimal care and feeding of newborn infants who are not (yet or fully) breastfed, or not (yet) able to do so.


Families must receive quality and unbiased information about infant feeding. Facilities providing maternity and newborn services have a responsibility to promote breastfeeding, but they must also respect the mother’s preferences and provide her with the information required to make an informed decision about the best feeding option for her and her baby in her particular circumstances. The facility has an obligation to support mothers to successfully feed their newborn infants in the manner they choose.

The 2018 revised version of the Ten Steps to Successful Breastfeeding are separated into Critical Management Procedures, which provide an enabling environment for sustainable implementation within a facility, and Key Clinical Practices, which delineate the care that each mother and baby should receive. The Key Clinical Practices are evidence-based interventions to support mothers to successfully establish breastfeeding.

The Critical Management procedures are designed to ensure that the necessary policies, guidelines and processes are in place to allow health-care providers to implement the Baby Friendly standards effectively. The following step from the 10 Steps needs to be met in order to successfully complete the critical management procedures:

 

  • Step 1a: Have a Written Infant Feeding Policy that is Routinely Communicated to Staff and Parents
  • Step 1b: Comply Fully with the International Code of Marketing of Breastmilk Substitutes and Relevant World Health Assembly Resolutions
  • Step 1c: Establish Ongoing Monitoring and Data-Management Systems
  • Step 2: Ensure that Staff have Sufficient Knowledge, Competence and Skills to Support Breastfeeding

 

The Key Clinical Practices are designed to confirm that the policies and procedures have been implemented, and that the staff have been educated appropriately and are providing a high standard of care for pregnant women, mothers and babies. Evidence will be gathered during interviews with mothers to determine if the Baby Friendly standards are being implemented effectively. The following steps need to be met in order to successfully complete the key clinical practices:

  • Step 3: Discuss the Importance and Management of Breastfeeding with Pregnant Women and their Families

  • Step 4: Facilitate Immediate and Uninterrupted Skin-to-Skin Contact and Support Mothers to Recognise when their Babies are Ready to Breastfeed, Offering Help if Needed

  • Step 5: Support Mothers to Initiate and Maintain Breastfeeding and Manage Common Difficulties

  • Step 6: Do Not Provide Breastfed Newborns Any Food or Fluids Other than Breastmilk, Unless Medically Indicated

  • Step 7: Enable Mothers and their Infants to Remain Together and to Practise Rooming-in 24 Hours a Day.

  • Step 8: Support Mothers to Recognise and Respond to their Infants’ Cues for Feeding

  • Step 9: Counsel Mothers on the Use and Risks of Feeding Bottles, Teats and Pacifiers.

  • Step 10: Coordinate Discharge so that Parents and their Infants Have Timely Access to Ongoing Support and Care

Once facilities are assessed and successfully pass all 10 Steps they will receive the prestigious Baby Friendly Accreditation recognising excellence in the care of mothers, babies and their families.


Initial accreditation typically lasts for three years. Although no formal assessment will take place during this time, facilities must continue to collect infant feeding statistics and audit their implementation of the standards. Facilities will submit their bi- annual data to the Baby Friendly Health Initiative team as evidence that the standards are being maintained along with their Annual Interim Report.

 

If during the assessment a facility does not quite meet all the standards for each of the 10 Steps, a copy of the assessment report and scoring booklet will be provided to the facility with a letter detailing the recommendations and the expected time frame for implementation to achieve accreditation. Once the due date for the recommendations is reached, a partial reassessment will occur, either by document review and/or by return visit to the facility. Only the criteria not achieved previously will be assessed during the partial reassessment.

Re-assessment will take place every 3 years to ensure that all the standards from each of the 10 Steps are being maintained and to explore how the service is building on the good work it has already done.

Preparations for re-accreditation are the same process as for initial accreditation. Ensuring that a three-year action plan for BFHI requirements is developed and implemented on a rolling schedule will mean less stress and work in the lead up to re-accreditation.

Re-assessment will consist of interviews with mothers, staff and managers to establish how the standards are being maintained. Internal audit results and outcomes such as breastfeeding initiation, continuation, exclusive breastfeeding and supplementation rates (where applicable) will be reviewed.

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