Audit on

Baby-Friendly Hospital
Initiative (BFHI)
SUPERVISED BY DR. THAN LWIN

Presented By House Officers O

Presenter H.O Doe Htet Win

DATE 28.12.2016

Introduction

BFHI or BFI is a worldwide programme of WHO and UNICEF

launched in 1991 following the adoption of Innocenti
Declaration on breastfeeding promotion in 1990

Every woman who gives birth has the potential resource of

breast milk for her child. So through the BFHI, empowering
women everywhere to make use of this resource, fulfilling
their right to breastfeed for their own and their childrens
health

For the women who do not breastfeed, BFHI also give

support for feeding options they have chosen with full,
unbiased information, free of commercial pressure and the
Baby Friendly Hospital Initiative
early
continuous contact that promotes good bonding

Aims
1.

2.

3.
4.

Implementation of The Ten Steps to Successful

Breastfeeding; Protecting, Promoting & Supporting
Breastfeeding
Full application of International Code of
Marketing of Breast-milk Substitutes & its
subsequent resolutions
Mother friendly care
HIV & Infant feeding

Baby Friendly Hospital Initiative

Methodology

Study period - 21st November to 21st December

Study group
- Women who gives birth at least once
Study site
- Unit 1, 2, 3 , Central Women Hospital,
Mandalay
Study design- Retrospective Observational Study
Collected data from 60 mothers attending at Maternity
units 1, 2 & 3 of CWH

Baby Friendly Hospital Initiative

Contents

Ante-natal Visit
Vaginal Delivery Vs Caesarean section
Ten Steps to Successful Breastfeeding
Code compliance
Mother-friendly care
HIV & Infant feeding

Baby Friendly Hospital Initiative

Antenatal visit

Antenatal visit should be at least 4 times during

pregnancy (WHO)

1st visit around 16 wks

2nd visit between 24 28 wks
3rd visit at 32 wks
4th visit at 36 wks
Number of Visit

Amount

Percentage (%)

No AN visit

13.33

1-3times

10.00

4 10 times

37

61.67

>10 times

15.00

Baby Friendly Hospital Initiative

Vaginal Delivery Vs Caesarean Section

Number

Percentage (%)

Vaginal Delivery

32

53.33

Caesarean Section

28

46.67

Baby Friendly Hospital Initiative

Ten Steps to Successful

Breastfeeding

Baby Friendly Hospital Initiative

Step 1 : Have a written breastfeeding policy

that is routinely communicated to all health
staf
1.

Policy

Ten steps to successful breastfeeding (not only

listing the steps but also giving appropriate policy
guidance)

Code of Marketing of Breast-milk Substitutes &

regulations the facility and staf need to follow to
comply
Requirement that HIV positive mothers receive
counselling, including information about advantages
and disadvantages of various infant feeding options

2.

Observations that policy is displayed in all

appropriate areas of facility in appropriate language

Covers all topics adequately

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Step 2 : Train all health care staf in skills

necessary to implement this policy
1.

Review of training curriculum

2.

At least 80% of clinical staf members responsible

for the care of pregnant women, mothers and
infants have been given training of at least 20
hours in length

Training curriculum course

Ten steps to Successful Breastfeeding

Code of Marketing of Breast-milk Substitutes

Mother-Friendly care

HIV and Infant feeding (optional)

Support for non-breast feeding mother

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Covers all topics adequately

Step 3 : Inform all pregnant women about

benefits & management of breastfeeding
During AN visit, staf member gave them information
at least two out of three key topics
Importance of immediate skin to skin contact
24-hr rooming in
Risks of giving water, formula or other
supplements in first 6 months if breastfeeding
Answers

Number

Percentage (%)

Yes

42

70

No

18

30

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Step 4 : Place babies in skin to skin contact

with their mothers immediately following birth
for at least an hour.
Encourage mothers to recognize when their
babies are ready to breastfeed and ofer help
with breastfeeding
(Help mother initiate breastfeeding within 30
min)

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Skin to skin contact

Answers

Number

Percentage (%)

Yes

No

60

100

Encourage mothers to recognize when their

babies are ready to breastfeed and ofer help
with breastfeeding
Answers

Number

Percentage (%)

Yes

42

70.00

No

18

30.00

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Step 5 : Show mothers how to breastfeed,

and how to maintain lactation even if they
should be separated from their infants

Staf helped them with breastfeeding within 6 hrs of

delivery
Answers

Number

Percentage (%)

Yes

44

73.33

No

16

26.67

Staf helped them with positioning & attachment

before discharge
Answers

Number

Percentage (%)

Yes

44

73.33

No

16

26.67

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Staf showed or gave them information on how to express

milk by hand
Answers

Number

Percentage (%)

Yes

33

55.00

No

27

45.00

Mothers tried expressing milk themselves and were at

least partially successful
Answers

Number

Percentage (%)

Yes

42

70.00

No

18

30.00

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Step 6 : Give newborn infants no food or drink other than

breastmilk, unless medically indicated
(Exclusive Breastfeeding)
Answers

Number

Percentage (%)

Yes

60

100

No

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Step 7 : Practice rooming-in allow mothers

and infants to remain together (24hrs a day)
unless medically indicated
Answers

Number

Percentage (%)

Yes

60

100

No

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Step 8: Encourage breastfeeding on

demand

Mothers had been told to feed their babies whenever they

seemed hungry
Answers

Number

Percentage (%)

Yes

54

90

No

10

Mothers had been told that their babies should suckle for
as long as they wanted to
Answers

Number

Percentage (%)

Yes

54

90

No

10

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Step 9 : Give no artificial teats or pacifiers(also

called dummies or soothers) to breastfeeding infants
Answers

Number

Percentage (%)

Yes

60

100

No

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Step 10 : Foster establishment of

breastfeeding support groups and refer
mothers to them on discharge from
hospital or clinic if they had problem with
feeding their babies after returning
home
Answers

Number

Percentage (%)

Yes

24

40

No

36

60

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Code compliance

Mothers have never received leaflets from formula

companies promoting formula feeding or gifts or
samples that include formula, bottles or other related
supplies
Answers

Number

Percentage (%)

Yes

54

90

No

10

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Mother-friendly care

During AN visit, they had been told that they could have companions
during labour and birth and what alternatives there were for
dealing with pain and what was better for mothers and babies

Answers

Number

Percentage (%)

Yes

No

60

100

Mothers were encouraged to walk and move about

during labour or that, if not, there was medical reason
Answers

Number

Percentage (%)

Yes

36

60

No

24

40

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HIV and Infant feeding

During AN visit, mothers had been told about that

why testing and counselling for HIV is
important for pregnant women and HIV positive
mother can pass HIV infection to her baby

Answers

Number

Percentage (%)

Yes

54

90

No

10

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Why Breastfeeding is
important???

WHO recommendation

Exclusive breastfeeding for first 6 months

and then complement breastfeeding for up to 2
years or more
Breastfeeding should begin within one hour of
birth
Breastfeeding should be on demand
Bottles or pacifiers should be avoided

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Advantages (WHO)
1. Benefits for infants (an also Pediatrians)

Contains all the nutrients and antibodies which

protects infants from common childhood illness like
diarrhea and pneumonia (the two primary causes of
child morbidity & mortality worldwide)

2. Benefits for mothers

Exclusive BF is natural method of birth control

(98% protection in the first six months after birth)
Improves uterine involution & prevent PPH
Reduces risks of breast & ovarian cancer, type II DM
and
post partum depression

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3. Long term benefits for children

Adolescents and adults who were breastfed as

babies are less likely to be overweight or
obese
They are less likely to have type II DM and
better in intelligence test

4. HIV and Breastfeeding

Together, breastfeeding and ARVs have the

potential to significantly improve infants
chances of surviving while remaining HIV
uninfected

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Results Summary
Components

Ideal scoring

Results

Step 1

Yes for all items

Yes for all items

Step 2

Yes for all items

Yes for all items

Step 3

70 %

70 %

Step 4

80 % on each item

0% on 1 item & 70% on

1

Step 5

80 % on 3 items & 50 %
on 1

<80% on 3 items&
70% on 1

Step 6

80 %

100 %

Step 7

80 %

100 %

Step 8

80 %

90 %

Step 9

80 %

100 %

Step 10

80 %

50 %

Code compliance

80 %

90 %

Mother-friendly
care

70 % on 1 items & 50 %
on 1

0% on 1item & 60 % on
1

70 % on 1 items & 50 %

90 % on both items
27

HIV
& Infant
Baby Friendly Hospital Initiative

Pitfall Results

1.

Step 4 : Place babies in skin to skin contact with their

mothers immediately following birth for at least an hour.
Encourage mothers to recognize when their babies are
ready to breastfeed and ofer help with breastfeeding
(Help mother initiate breastfeeding within 30 min)

2.

Step 5 : Show mothers how to breastfeed, and how to

maintain lactation even if they should be separated from
their infants

3.

Step 10 : Foster establishment of breastfeeding support

groups and refer mothers to them on discharge from
hospital or clinic if they had problem with feeding their
babies after returning home

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4.

Mother-friendly care

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Borderline Results

Step 3 : Inform all pregnant women about

benefits & management of
breastfeeding

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Suggestions

For step 3,4 & 5

Health Education through Vinyl or Mass media

such as films, animation videos in AN visit
Ensuring all the health care members perform
the BFHI efectively by random checking and
direct checking

For step 10

Breastfeeding support groups should be

encouraged to establish in most regions and
proper referral to them should be done

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(1) Place babies in skin to skin contact

(kangaroo care) with their mothers
immediately following birth for at least an hour
because of its 9 advantages
1.

2.
3.
4.

It helps baby adapt (Thermal regulation)

esp. in preterm babies
It boots babys mental development
It promotes healthy weight
It makes breastfeeding easier

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5.

It helps mother make milk

6.

It reduces Babys Stress & Pain

7.

It helps baby sleep

8.

It promotes bonding with Dad

9.

It prevents mother from postpartum

depression

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Kangaroo care in the first 2 hours after birth

are the most important in terms of easing baby
into the world

After that continued skin-to-skin contact can still be

beneficial esp. for preterms that have low birth
weights and are unable to regulate their own
temperature (Consider it an alternative to an
incubator)

It is recommended that preterms get frequent

kangaroo care for first 20 weeks of life

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How long should Kangaroo

care do???

Do it as long as both baby and parents

enjoy it
When the baby starts fussing and trying to get
of from chest, then it is time to let her do her
own thing

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For Mother Friendly Care (Pain relief)

Relaxing your mind

Focusing on your Breathing (Rhythmic Breathing)
Focusing on something that makes you happy
(such as
an inspirational picture or favorite
object)
Moving Around (Walking, swaying, changing
positions)
Water Therapy (Warm water bath)

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Audit meeting

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We would recommend to re-audit on next 6

month after implementation of BFHI

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Literature Search

BFHI : Revised, Updated and Expanded for Integrated

Care.
Geneva : WHO ; 2009
Fit pregnancy & baby

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