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Baby Friendly Hospital Initiative History

Baby Friendly Hospital Initiative History. 1982: UNICEF Director, James Grant launched initiative known as the child survival revolution, or “GOBI plan” 'G' for growth monitoring 'O' for oral rehydration therapy 'B' for breastfeeding 'I' for immunization. Baby-Friendly Hospital Initiative.

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Baby Friendly Hospital Initiative History

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  1. Baby Friendly Hospital InitiativeHistory • 1982: UNICEF Director, James Grant launched initiative known as the child survival revolution, or “GOBI plan” • 'G' for growth monitoring • 'O' for oral rehydration therapy • 'B' for breastfeeding • 'I' for immunization

  2. Baby-Friendly Hospital Initiative • 1991: WHO/UNICEF • “Ten steps” to successful breastfeeding • Today: 14,500 hospitals in 125 countries • 34 US hospitals

  3. Baby Friendly Hospital:What are the “Ten Steps?” • Write breastfeeding policy. • Train all health care staff. • Inform all pregnant women. • Initiate breastfeeding within an hour of birth. • Show mothers how to breastfeed. • Give infants nothing but breastmilk. • Practice "rooming in." • Encourage breastfeeding on demand. • Give no artificial teats or pacifiers. • Establish breastfeeding support groups.

  4. Effects of“Baby Friendly Initiative” • JAMA 2001 Jan; 285(4):413-420 • Promotion of Breastfeeding Intervention Trial (“PROBIT”) • 30 hospitals, randomized to receive Baby-Friendly training, or to continue their routine practices • 17,000 mother-baby pairs • Followed for 1 year Kramer, JAMA, Jan 2001

  5. “PROBIT” Results Kramer, JAMA, Jan 2001

  6. Baby-Friendly Hospital Initiative: Reduction in Infections and Allergies Kramer, JAMA, Jan 2001

  7. “Maternity Care Practices:Implications for Breastfeeding” DiGirolamo, Grummer-Strawn, and Fein, BIRTH 28:2, 94, June 2001 • Surveyed 1085 women who intended to breastfeed for more than 2 months • Assessed 5 Baby-Friendly practices: • Breastfeeding initiation • Supplements • Rooming-in • Breastfeeding on demand • Pacifiers DiGirolamo, BIRTH, June 2001

  8. Percentage of women who stopped breastfeeding before 6 weeks, by specific hospital practices DiGirolamo, BIRTH, June 2001

  9. Percentage of women who stopped breastfeeding before 6 weeks, by number of Baby-Friendly Hospital Initiative practices they experienced % STOPPED BF Number of Baby-Friendly Practices Reported DiGirolamo, BIRTH, June 2001

  10. “BFHI Improves Breastfeeding Initiation Rates in a US Hospital Setting” • Boston Medical Center • inner-city teaching hospital • 1800 births per year • 15-bed Level III NICU • primarily poor, minority, immigrant families • Implemented Baby-Friendly policies over a 3-year period • Reviewed 200 randomly selected medical records from each of the 3 years Philipp, PEDIATRICS, Sep 2001

  11. BFHI IMPLEMENTATION:EFFECTS ON BREASTFEEDING TRENDS Philipp, PEDIATRICS, Sep 2001

  12. “Effect on Rates of Breastfeeding of Training for the BFHI” • Controlled, non-randomised study • 4 hospitals in southernItaly (group 1) • 4 hospitals in central/northernItaly (group 2) • Implemented Baby-Friendly training • Collected data before and after training Cattaneo, BMJ, Dec 2001

  13. Breastfeeding Rates atDischarge and Three Months Cattaneo, BMJ, Dec 2001

  14. Narcotics during Labor:Effects on Newborns Given IV or IM in Labor: • Decrease alertness • Lower neurobehavioral scores • Inhibit suckling • Delay effective feeding Nissen 1995, Crowell 1994, Matthews 1989, Hodgkinson 1978, and other studies

  15. Studies specific to breastfeeding: Crowell 1994 • 48 healthy term infants • All mothers received local or pudendal anesthetic at delivery • 26 also received analgesia in labor (butorphanol or nalbupine) • Measured time to effective feeding • Effective feeding defined as 3 consecutive IBFAT scores of 10-12

  16. Time To Successful BF By Analgesia And Time Of First Feed To breast within 1 hour To breast after 1 hour No analgesia or given less than 1 hour before birth 6.4 hours (n = 8) 49.7 hours (n = 19) Analgesia given more than 1 hour before birth 50.3 hours (n = 9) 62.5 hours (n = 7) Crowell, J Nurse-Midwifery, 1994

  17. Studies specific to breastfeeding: Riordan 2000 • Studied 129 term infants born vaginally • Scored Infant Breastfeeding Assessment Tool (IBFAT) while in hospital • Measured duration at 6 weeks

  18. Types of Labor Pain Meds in Riordan’s Study: • Epidurals • Bupivacaine with fentanyl • IV Analgesia • 25-50 mg meperidine • 5-10 mg nalbuphine Riordan, JHL Feb 2000

  19. Breastfeeding Score by Labor Medication Group

  20. Any effect on BF duration? • No effect, measured at 6 weeks in Riordan’s study • Halpern (Birth 1999) also reported no effect on duration at 6-8 weeks

  21. Effect on Lactogenesis: • Hildebrandt JHL 1999 • 46 primips and 81 multips • Mothers reported time of sensation of milk coming in • Mean time in entire group was 50 hours • Multips = 45 hours • Primips = 59 hours Hildebrandt, JHL, 1999

  22. Effect of labor pain meds on lactogenesis, cont’d • Multips who delivered vaginally without medication had the shortest time to lactogenesis (44 hours) • 6 hours longer if cesarean section • 11 hours longer if primip • 13 hours longer if sedative or pain medication given during labor Hildebrandt, JHL, 1999

  23. Labor Analgesia…”Disturbs Newborn Behavior” • Ransjo-Arvidson (Birth 2001) studied 28 mothers-babies • Group 1 = no analgesia • Group 2 = pudendal block • Group 3 = epidural or pethidine or more than one type of analgesia Ransjo-Arvidson et al, Birth, 2001

  24. In Groups 2 and 3: • Infant’s massage-like hand movements were less frequent • Fewer infants touched the nipple with hands before suckling • Fewer infants made licking movements and sucked the breast • Average time to first feeding was more than 150 minutes (compared to 79 minutes in Group 1) Ransjo-Arvidson et al, Birth, 2001

  25. Significance of hand motions • Newborns use their hands as well as their mouths to stimulate oxytocin after birth

  26. Early post-birth events and oxytocin • Baby crawls to breast • Opens and closes hands • Massages the breast • Hand movements cause as high an oxytocin rise as sucking

  27. Skin-to-skin encourages oxytocin release • OXYTOCIN: • Promotes milk • Promotes mothering behaviors • Alleviates pain

  28. Oxytocin in the bloodstream • Released with nipple stimulation • Released in surges, lasting about 1-2 minutes • Contracts muscle cells • Causes uterine contractions, causing involution • Causes contractions of the muscle cells surrounding alveoli and ducts in the breast, causing milk “let down” or “milk ejection reflex”

  29. Second Stage and Early Post-birth Events and Oxytocin • Ferguson's Reflex: Physiologic response triggered by the fetal presenting part stimulating stretch receptors located in the posterior vagina at around +1 station. Stimulation causes release of oxytocin, naturally augmenting pushing. • Mother has another oxytocin surge AFTER baby’s shoulders are delivered

  30. Oxytocin effects Opposite of “fight or flight” response: • Lowers heart rate • Lowers blood pressure • Lowers blood cortisol • Affects metabolic actions • Contracts pyloric sphincter • Releases insulin and cholecystokinin

  31. Oxytocin in the brain affects social behavior • Women who have high levels of oxytocin • Produce more milk • Breastfeed longer • Are more tolerant of repetitious, boring tasks • Demonstrate more “social” behavior – better listeners • Women become more social and retain those traits if they continue breastfeeding

  32. Oxytocin as Pain-Relief • Stimulates endorphins • Increases pain threshold

  33. Endorphins in Colostrum • 2x higher than mother’s blood level • Elevated endorphins may contribute to • postnatal adaptation • overcoming stress of labor and birth • postnatal development of biologic functions Journal of Pediatric Gastroenterology and Nutrition Aug 2001

  34. Endorphins in Human Milk • Mothers who delivered vaginally had higher levels of endorphins in their milk than mothers who had elective c-section • Preterm mothers had higher levels than term Zanardo, J Ped Gastroenterol Nutr, Aug 2001

  35. Breastfeeding is analgesic in newborns • Pediatrics 2002 Apr;109(4):590-3 • 30 full-term, breastfed infants • Intervention group - held and breastfed by their mothers during heel lance and blood collection • Control group experienced the same test while swaddled in their bassinets • Crying and grimacing were reduced by 91%. Heart rate was also substantially reduced by breastfeeding

  36. The Most Important Factors for Lactogenesis Stage II: • Prepared mammary epithelium • Progesterone withdrawal • Maintained plasma prolactin • Removal of milk within an undefined interval after birth

  37. Days Postpartum Neville et al, Ped Clin N Am, Feb 2001

  38. Milk volume

  39. Importance of nipple stimulation

  40. Early initiation of breastfeedingis associated with: • Earlier establishment of effective sucking and feeding (Righard 1990) • Temperature stability (Britton 1980) • Higher blood sugar (Hawdon 1992, Yamauchi 1997) • Increased stooling, decreased jaundice (Yamauchi 1990) • Longer duration of breastfeeding (DeChateau 1977, Salariya 1978, Taylor 1986, Yamauchi 1990)

  41. Unrestricted breastfeedingis associated with • Less engorgement (Hill 1994) • No increase in nipple soreness (DeCarvalho 1984) • Less jaundice (DeCarvalho 1983) • Stable blood sugar (Hawdon 1992, Yamauchi 1997) • Faster onset of mature milk (Salariya 1978, Yamauchi 1997) • Less weight loss, faster weight gain (DeCarvalho 1983)

  42. Can You…? • Describe one effect medications given to the mother during labor can have on her newborn or on breastfeeding • Identify the effect of early post-birth skin-to-skin contact and breastfeeding on maternal hormones and on breastfeeding outcomes • Name at least 5 of the 10 Steps to Successful Breastfeeding from the Baby Friendly Hospital Initiative

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