BFHI Slides

BABY-FRIENDLY HOSPITAL INITIATIVE
Revised, Updated and Expanded for Integrated Care
“Maternity”, 1963, © 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York
UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2009
Global Strategy for 1/1
Infant and Young Child Feeding

The aim of the Global Strategy is to improve
– through optimal feeding – the nutritional
status, growth and development, health, and
thus the survival of infants and young children.
It supports exclusive breastfeeding for 6 months,
with timely, adequate, safe and appropriate
complementary feeding, while continuing
breastfeeding for two years and beyond.
It also supports maternal nutrition, and social
and community support.
The aim of the 1/2
Baby Friendly Hospital Initiative

To implement
the Ten Steps to Successful Breastfeeding
and
to end the distribution of free and low-cost
supplies of breastmilk substitutes
to health facilities.
1/3
Course Aims
The aim of this course is that
every staff member will confidently
support mothers with early and exclusive
breastfeeding,
and that this facility moves towards
achieving Baby-friendly designation.
3/1
Original illustration by Jenny Corkery

3/2
Infant Feeding Recommendation

for HIV-positive Women
Exclusive breastfeeding is recommended for HIV-
infected mothers for the first six months of life
unless replacement feeding is acceptable,
feasible, affordable, sustainable and safe for
them and their infants before that time.
When replacement feeding is acceptable, feasible,
affordable, sustainable and safe avoidance of all
breastfeeding by HIV-infected mothers is
recommended.
4/1

4/2
The overall aim of the

International Code of Marketing
of Breast-milk Substitutes
is the safe and adequate nutrition
of all infants.
Skin to Skin Contact and 5/1
Early Breastfeeding
©UNICEF C107-2
Skin to Skin Contact and 5/2
Early Breastfeeding
UNICEF/HQ92-0369/ Roger Lemoyne, Thailand

5/3
First Skin to Skin Contact
Dr Nils Bergman, Cape

Town, South Africa
6/1
Parts of the Breast
Adapted from Breastfeeding Counselling: a training course,

WHO/CHD/93.4, UNICEF/NUT/93.2
Helping the Oxytocin Reflex 6/2
Breastfeeding Counselling: a training course,

6/3
What can you see?

Good attachment Poor attachment
6/4
What can you see?

Good attachment Poor attachment
7/1
Breastfeeding Positions
In line

Close
Supported
Facing
BREASTFEED OBSERVATION AID 7/2
Mother's name _______________________________ Date ___________________
Baby's name _________________________________ Baby's age ______________
Signs that breastfeeding is going well: Signs of possible difficulty:
GENERAL
Mother: Mother:
F Mother looks healthy F Mother looks ill or depressed
F Mother relaxed and comfortable F Mother looks tense and uncomfortable
F Signs of bonding between mother and baby F No mother/baby eye contact
Baby: Baby:
F Baby looks healthy F Baby looks sleepy or ill
F Baby calm and relaxed F Baby is restless or crying
F Baby reaches or roots for breast if hungry F Baby does not reach or root
BREASTS
F Breasts look healthy F Breasts look red, swollen, or sore
F No pain or discomfort F Breast or nipple painful
F Breast well supported with fingers away from nipple F Breasts held with fingers on areola
F Nipples protractile F Nipples flat, not protractile
FBABY’S POSITION
F Baby’s head and body in line F Baby’s neck and head twisted to feed
F Baby held close to mother’s body F Baby not held close
F Baby’s whole body supported F Baby supported by head and neck only
F Baby approaches breast, nose to nipple F Baby approaches breast, lower lip/chin to nipple
BABY’S ATTACHMENT
F More areola seen above baby’s top lip F More areola seen below bottom lip
F Baby’s mouth open wide F Baby’s mouth not open wide
F Lower lip turned outwards F Lips pointing forward or turned in
F Baby’s chin touches breast F Baby’s chin not touching breast
SUCKLING
F Slow, deep sucks with pauses F Rapid shallow sucks
F Cheeks round when suckling F Cheeks pulled in when suckling
F Baby releases breast when finished F Mother takes baby off the breast
Mother notices signs of oxytocin reflex F No signs of oxytocin reflex noticed
Notes:
Assess a 7/3
Breastfeed
©UNICEF C107-5
Wide Open 7/4
Mouth
©UNICEF C107-7
Assess a 7/5
Breastfeed
©UNICEF C107-9
Assess a 7/6
Breastfeed
UNICEF/HQ91-0168/ Betty Press, Kenya

8/1
9/1

9/2
Case study
Case study 2 weeks old
Healthy at birth
Discharged Day 2
“Sleeping all the time”

“Refusing” the breast

3 stools in week
UNICEF/HQ91-0168/ Betty Press, Kenya

12% under birth weight
Bottle with honey and
water twice yesterday
10/1
Kangaroo
Mother Care
Dr Nils Bergman,
South Africa
Cape Town,
Kangaroo 10/2
Mother
Care
Dr Nils Bergman, Cape Town, South Africa
10/3
Positioning a
preterm
infant
UNICEF/HQ93-0287/ Roger Lemoyne, China

10/4
Twins Grow
Well on
Breastmilk
UNICEF/HQ92-0260/ Lauren Goodsmith, Mauritania

DANCER Hand 10/5
Position
©UNICEF C107-21
Chin Support 10/6
Kay Hoover and Barbara Wilson-Clay, from The Breastfeeding Atlas

11/1
Hand
Expression
©UNICEF 910164F
Cup Feeding
UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course

2009
11/2
Promoting breastfeeding in health facilities:

A short course for administrators and policy makers WHO/NUT/96.3, Wellstart International
11/3
Supplementer
Dr Ruskhana Haider, Dhaka, Bangladesh

12/1
Size and Shape
There are many

different shapes and
sizes of breast and
nipple.
Babies can breastfeed
from almost all of them.
12/2
Full Breast
UNICEF C-107-19
12/3
Engorged Breast
© UNICEF C-10-25
12/4
Mastitis
©UNICEF C107-39
12/5
Sore Nipple
©UNICEF C107-31
12/6
Sore
Nipple
©UNICEF C107-32
12/7
Syringe method for inverted nipples

12/8
Candida on the nipple
©UNICEF C107-34
12/9
Candida on the nipple
©UNICEF C107- 33
Tongue-tie 12/10
©UNICEF C107-35
13/1
Lactational Amenorrhea Method (LAM)

Ask the mother or advise her to ask herself these three questions:
YES
1. Have your menses returned? When the answer to ANY
NO one of these questions
becomes YES
2. Are you giving supplements or The mother’s chance of
are there long periods without YES pregnancy is increased.
breastfeeding either day or night?
NO For continued protection,
and to achieve child
3. Is your baby more than six YES spacing, a complementary
months old? family planning method
NO needs to be used, and
There is only a 1-2% chance of breastfeeding continue.
pregnancy at this time. Institute for Reproductive Health, Georgetown, Washington, DC
13/2
UNICEF/WHO/UNAIDS
Infant Feeding Recommendation for
HIV-positive Women
Exclusive breastfeeding is recommended for HIV-
infected mothers for the first six months of life
unless replacement feeding is acceptable,
feasible, affordable, sustainable and safe for
them and their infants before that time.
When replacement feeding is acceptable, feasible,
affordable, sustainable and safe avoidance of all
breastfeeding by HIV-infected mothers is
recommended.
14/1

15/1
Course Aims
The aim of this course is that
every staff member will confidently support
mothers to succeed
with early and exclusive breastfeeding,
and that this facility moves towards
achieving Baby-Friendly designation.
15/2
Developing a Plan:
Step One
Where are we
now?
Developing a Plan: 15/3
Step Two
Where do we
want to be?
15/4
Developing a Plan:
Step Three
How will
we get
there?
15/5
Developing a Plan:
Step Four
How will we know if

we are there?
15/6
Developing a Plan:
Step Five
How will we sustain it?

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BABY-FRIENDLY HOSPITAL INITIATIVE

Revised, Updated and Expanded for Integrated Care

Infant and Young Child Feeding

Baby Friendly Hospital Initiative

Original illustration by Jenny Corkery

Infant Feeding Recommendation

Original illustration by Jenny Corkery

The overall aim of the

UNICEF/HQ92-0369/ Roger Lemoyne, Thailand

First Skin to Skin Contact

Dr Nils Bergman, Cape

Parts of the Breast

Adapted from Breastfeeding Counselling: a training course,

Breastfeeding Counselling: a training course,

What can you see?

Breastfeeding Counselling: a training course,

Breastfeeding Counselling: a training course,

Breastfeeding Counselling: a training course,

UNICEF/HQ91-0168/ Betty Press, Kenya

Original illustration by Jenny Corkery

“Sleeping all the time”

Breastfeeding Counselling: a training course,

UNICEF/HQ91-0168/ Betty Press, Kenya

UNICEF/HQ93-0287/ Roger Lemoyne, China

UNICEF/HQ92-0260/ Lauren Goodsmith, Mauritania

Kay Hoover and Barbara Wilson-Clay, from The Breastfeeding Atlas

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course

Promoting breastfeeding in health facilities:

Dr Ruskhana Haider, Dhaka, Bangladesh

Size and Shape

There are many

Breastfeeding Counselling: a training course,

Syringe method for inverted nipples

Breastfeeding Counselling: a training course,

Candida on the nipple

Candida on the nipple

Lactational Amenorrhea Method (LAM)

Original illustration by Jenny Corkery

How will we know if

How will we sustain it?

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