Mother-Baby Friendly

Hospital Initative (MBFHI)

The Global Criteria to

Baby Friendly Hospital
Initiative
THE TEN STEPS TO
SUCCESSFUL BREASTFEEDING

Step 1 - Have a written breastfeeding

policy that is routinely communicated to
all health care staff.
Written policy which addresses the 10
steps
Visibly posted in:
maternity wards
all infant care areas
( well baby / sick baby )
antenatal care services
Language / dialect commonly used

It should :
Prohibit..
promotion of BM substitutes / teats /
pacifiers
distribution of gift packs
Have a Mechanism for evaluating
effectiveness of the policy

Client Survey on the MBFHI Implementation

for Successful Breastfeeding
We want mothers to give their newborn
babies the BEST and the best is
mothers milk.
In order for us to evaluate if we achieve
our goal, please fill up this survey form.
Thank you.

Yes
1. Did you have pre-natal check-up?
If yes, where? _______________
2. Have you listened to lectures in breastfeeding?
If no, what is the reason? ___________________
3. Were you informed on the following?
3.1. Advantages of breastfeeding
3.2. Correct attachment and positioning
3.3. Milk expression, collection and storage
3.4. Management to common breast problems
4. Was your baby placed betweeno your breast
immediately
upon delivery or within 1 hour after birth ? If no, why?
________________________________
4.1. Were you informed on the importance of immediate
latching?

No

Yes
5. Were you given information on breastfeeding when you were
transferred to your room with your baby?
6. Did you need help on your first breastfeeding?
7. If yes, why? _________________________________________
8. Before hospital discharge, were informed where to go / whom
to call if you encounter any problem related to breastfeeding?
9. Will you recommend breastfeeding?
If no, why ___________________________________________
10. What can you recommend / suggest so we could improve our breastfeeding
services for mothers and babies. _______________________________________
Manner of Delivery ______________________

Gravidity ______________

Date / Time Delivered ___________________________________________________

No

Step 2 - Train all health care staff in

skills necessary to implement this policy.
All staff ( involved with mother and baby )
should have received orientation on the
hospitals BF policy
Trained on 20 hours w/ 3 hours clinical
experience
New employees - orientation & training w/in
6 months
Copy of the course outline used should be
available for inspection

 Training includes the 10 steps &

Philippine Milk Code
20 hours duration using the
UNICEF
WHO 20hrs manual for maternity staff
Training of non-clinical staff (given their
roles) to support breastfeeding
Importance of breastfeeding (BF)
Hospital practices that support BF

Step 3 - Inform all pregnant women about

the benefits and management of
breastfeeding.

Breastfeeding counselling to most

pregnant women at antenatal service
written antenatal education includes:
importance of exclusive breastfeeding for
6 months
benefits of breastfeeding
basic breastfeeding management

Additional antenatal education

Importance of :
skin to skin contact
early initiation
rooming in 24 hours
on demand feeding
exclusive BF for 6 months
risk of artificial feeding

OPD antenatal record should reflect :

attendance to BF lecture
That it Protect clients from oral & written
instruction for artificial feeding

Step 4 - Help mothers initiate

breastfeeding within half hour after birth.
Immediate Skin to skin contact at

least for one hour after birth

immediately after birth for I hr (NSD)
as soon as mother is responsive (CS)
Helped and encouraged by staff to
recognize baby ready to feed
First Crawl Video

 Wait for feeding cues

Ohhhh, Im hungry Mommy.

Where are you ?

Step 5 - Show mothers how to breastfeed

& maintain lactation, even if they should
be separated from their infants.
Offer assistance with breastfeeding
within the first 6 hours after delivery
proper positioning / attachment
Show how to express milk
where they could get help

 Mother with previously encountered

problem should be given special
attention and support

Mothers with previously

encountered problem
should be given special
attention and support

Step 6 - Give newborn infants no food or drink

other than breastmilk, unless medically
indicated.
Mothers and infant dyad are
observed in the ward for
2 hours
There should be No
promotion / display /
distribution to mothers
and staff of products
If there are bottled fed
babies, mother should
know the indication

Staff should know the

indication too.
Is it an Acceptable
Medical Reasons ?
Ask mothers ( NSD &
CS ) if their babies were
fed with food or drink
other than breast milk

Cup Feeding is recommended

Dental Obturator for

cleft lip / palate

Step 7- Practice rooming in allow

mothers & infants to remain together
24 hours a day.
EXCEPT
- for a period of 1
hour for hospital
procedures
- separation is
medically indicated

TANDEM BED

Kangaroo Mother Care

Step 8 - Encourage Breastfeeding

on Demand.

NO restrictions on frequency or
length of breastfeeding
Advised to breastfeed when
babies are hungry
As often as baby wants

AWAKEN & FEED

if baby is
sleeping too long
is breast
becomes overfull

Step 9 - Give NO artificial teats or

pacifiers (dummies or soothers) to
breastfeeding infants.
At NO POINT IN TIME should a
feeding bottle with artificial teats NOR
pacifier be used or seen in the ward
Nursing staff reports the same

 Mothers informed on
the risk associated
with feeding on
artificial milk / other
liquids and using
teats & bottles

Step 10 - Foster the establishment of

breastfeeding support groups and refer
mothers to them on discharge from the clinic
or hospital.

Mothers should confirm their plans to BF

Staff should describe how / where to

reach
the breastfeeding support group
Community
Hospital
Nursing staff should also be aware

 Printed materials available before

discharge
Encouraged follow up after 2 days &
in the 2nd week
Facility has trained BF mother
support counsellors

Compliance to the Philippine Code of

Marketing of Breast-milk substitutes

The head / director of maternity

services can report that:
NO employees of manufacturers or
distributors of breastmilk substitutes,
bottles, teats, pacifiers have direct
contact with pregnant women

code

The hospital does not receive free

gifts, non-scientific lectures, materials
or equipments, money or support for
in-service education..
No pregnant women, mothers or their
families are given marketing
materials, samples, gifts by the facility

Mother-friendly care (optional)

Mother-friendly labour & birthing
practices:

With companion for physical

& emotional support

Allowed to walk & move about

Allowed to drink & eat light foods

 Staff / women informed of the birthing

practices
Given advice on the use of non-drug
comfort measures (massage etc)
Avoids invasive procedures as
rupture of the membranes,
episiotomies, induction of labour

Acceptable Medical Reasons

for supplementation

Exclusive breastfeeding IS THE NORM

There is a small number of situation that
maybe considered as medical indication for

SUPPLEMENTING breastmilk or

for NOT USING breastmilk..

Acceptable Medical Reasons

for supplementation

1. Infants who cannot be fed at the breast but

breastmilk still remains the food of choice
exinfant weak / oral abnormality /
separated from mom

2. Infants who may need other nutrition in

addition to breastmilk
exlow birth weight or preterm < 1500 gms or
32 weeks / infants at risk of hypoglycemia
because of medical problem

Acceptable Medical Reasons

for supplementation

3. Infants who should not receive breastmilk

or any other milk including the usual BM
susbstitutes
exinborn errors of metabolism like galactosemia /
phenylketonuria

4. Infants for whom breastmilk is not available

ex mother who died
no nursing mother available

Acceptable Medical Reasons

for supplementation

5. Maternal conditions that affect

breastfeeding recommendations
mother very weak
mother taking medications
antimetabolities / radioactive iodine /
some anti-thyroid
maternal addiction
tobacco / alcohol / drug
HIV infected mothers

The spirit is looking at the

grave

In Einsteins face youll see

the three graces