Baby-Friendly Initiative in Manitoba

1. Baby-Friendly Initiative in Manitoba Manitoba Breastfeeding Co-ordinating CommitteeManitoba Health

2. An international perspective • Breastmilk is recognized as the best food for babies. • The World Health Organization (WHO) and the United Nations Children Fund (UNICEF) have implemented many standards and initiatives to help promote breastfeeding worldwide.

3. WHO International Code of Marketing of Breast-milk Substitutes; Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding The Baby-Friendly Hospital Initiative The Seven Point Plan for the Protection, Promotion and Support of Breastfeeding An International Perspective International Codes and Initiatives and What they Do: Elimination of free and subsidized supplies of breastmilk substitutes. A statement committing both the WHO and UNICEF to the “protection, promotion and support of breast-feeding,” it spells out the benefits of breastfeeding. An initiative encouraging maternity-care providers to help implement breastfeeding locally and nationally. Developed by the UK BFI committee to encourage breastfeeding implementation among health care professionals.

4. Breastmilk... • provides ideal nutrition for infants and contributes to their healthy growth and development; • reduces incidence and severity of infectious diseases, thereby lowering infant morbidity and mortality; • contributes to women's health by reducing the risk of breast and ovarian cancer, and by increasing the space between pregnancies; • provides social and economic benefits to the family and the nation; • provides most women with a sense of satisfaction when successfully carried out; As stated in the Innocenti Declaration

5. Baby-Friendly Hospital Initiative • Created in 1991 • Based on the WHO/UNICEF joint statement “Protecting, Promoting and Supporting Breast-feeding: The Special Role of Maternity Services.” • includes a 10-step process established by WHO/UNICEF

6. Have a written breast-feeding policy that is routinely communicated to all health care staff. Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about the benefits and management of breast-feeding. Help mothers initiate breast-feeding within a half-hour of birth. Show mothers how to breast-feed, and how to maintain lactation even if they should be separated from their infants. Give newborn infants no food or drink other than breast milk, unless medically indicated. Practice rooming-in -- allow mothers and infants to remain together -- 24 hours a day. Encourage breast-feeding on demand. Give no artificial teats or pacifiers (also called dummies or soothers) to breast-feeding infants. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic. The 10 steps to Successful Breastfeeding Every facility providing maternity services and care for newborn infants should:

7. Global Status of Baby-Friendly Hospitals in 2000 World wide, over 15, 000 hospitals are baby-friendly. Most are in developing Countries.. • Sweden 64 • Norway 35 • United Kingdom 29 • United States 25 • Australia 17 • CANADA 1 Industrialized Countries

8. Baby-Friendly Hospital Initiative in Canada • In 1991, Health Canada created the Breastfeeding Committee for Canada, comprising experts from many different organizations. • To date, there is only one accredited baby-friendly hospital in Canada: Brome-Missisquoi-Perkins Hospital in Cowansville, Quebec

9. The Breastfeeding Committee for Canada and the BFHI • In Canada, the name “Baby-Friendly Hospital Initiative” has been changed to the “Baby-Friendly Initiative.” • The BCC is the National Authority for the Baby-Friendly Initiative and helps implement it nation-wide.

10. Breastfeeding Promotion in Manitoba • The Manitoba Baby-Friendly Co-ordinating Committee is the provincial authority for implementing the Baby-Friendly Initiative. • The Manitoba Baby-Friendly Co-ordinating Committee is helping Regional Health Authorities and hospitals implement the criteria established in the 10 Steps.

11. Supporting BFI The BFI offers many benefits to: • parents, babies and the community • hospital administration “The prevalence of breastfeeding reflects the importance placed upon it by society.”

12. Choosing Breastmilk Parent’s guide to the benefits of breastfeeding

13. Choosing Breastmilk • Breastmilk has been recognized by the World Health Organization as offering “superior nutrition for optimal growth.” • Health Canada has echoed these findings by recommending the use of breastmilk exclusively for the first six months of life. • There are numerous immediate health benefits to breastfeeding.

14. Why Breastfeed? • Provides optimal nutrition and emotional nurturing for the growth of infants. • Contributes to women’s health. • It’s a basic human right, contributing to a woman’s social and economic equality as well as giving the child access to the highest attainable standard of health and nutrition. • Provides positive economic advantages to baby, mother, family and the community. Healthy mothers and babies mean substantial savings in health care costs.

15. Reduces the risk of infant mortality. Reduces infant morbidity from infections such as gastro-intestinal infections and ear infections. Enhances the child’s natural immunity Reduces atopic disease such as eczema and respiratory problems. Reduces the risk of diabetes. Can result in increased intelligence. Reduces the chance of obesity later in life. Helps with digestion. Can result in fewer dental problems later in life such as braces and cavities. Breastfeeding Benefits the Baby

16. Breastfeeding Benefits Mothers • Reduces the risk of breast cancer and ovarian cancer. • Helps reduce post-natal weight-gain by using extra calories. • Helps delay post-natal menstruation. • Reduces the risk of hip fractures in later life. • Rapid uterine involution.

17. Benefits to the Family • Breastfeeding bonds mother and child. • Breastfeeding results in better health, nutrition and well-being. • Portable means of nourishment. • Breastfeeding saves money on formula and medical costs related to illness.

18. Economic Advantages • Breastfeeding saves money in two ways: • On costly formula. • As a preventive measure against infant illness. Data taken from Calgary Health Services, Nutrition Division 1998

19. Environmental Advantages • Reduces the amount of packaging; tin, paper and plastic. • Cuts down on bottles, nipples, disposable liners and feeding equipment.

20. Choosing to be Baby-Friendly A guide for Health Administrators

21. The BFI contributes to: • Excellence in family-centred maternity care. • Quality assurance by meeting international standards. • Increased morale and satisfaction of staff and families. • Increased awareness and support of breastfeeding within the community.

22. Benefits to the Hospital • Warmer and calmer emotional environment • Fewer neonatal infections • Less staff time required • Improved hospital image and prestige

23. Breastfeeding is Financially Sound • The health benefits of breastfeeding can cut down on the treatment of child infections. • If 25% more mothers breastfed, cutting down the rate of infection by 25%, a conservative estimate shows the savings could be in excess of $850 000 per year. *based on Ontario figures

24. How Hospitals can Help • Adhere to international guidelines outlined in the International Code of Marketing of Breastmilk Substitutes.

25. International Code of Marketing of Breastmilk Substitutes 1) No advertising of products under the scope of the Code to the public. 2) No free breastmilk samples for mothers. 3) No promotion of products in health care facilities, including the distribution of free or low-cost supplies. 4) No company representatives to advise mothers. 5) No gifts of personal samples to health workers.

26. International Code (continued) 6) No words or pictures idealizing artificial feeding, including pictures of infants on products. 7) Information to health workers should be scientific and factual. 8) All information on artificial feeding, including the labels should explain the benefits of breastfeeding and all costs and hazards associated with artificial feeding. 9) Unsuitable products such as sweetened condensed milk should not be promoted for babies. 10) Products should be of a high quality and take account of the climatic and storage conditions of the country where they are used.

27. What can Hospitals do? • Review existing hospital policy to include Baby Friendly Initiative goals.

28. Example of Hospital Breastfeeding Policy: Brome-Missisquoi-Perkins Hospital Condition 1: Adopt a written breastfeeding policy that is brought to the attention of the treating staff.This policy defines the commitment of the hospital in the promotion, protection and support of breastfeeding. Condition 2: Assure the competence of all the treating personnel to institute this policy. Eighteen hours of instruction in breastfeeding including three (3) hours of clinical practice is envisaged in the orientation of new personnel in the birthing centre. There will also be a continuing education programme to maintain competency. The birthing centre will also furnish the staff with up-to-date information concerning breastfeeding.

29. Condition 3: Inform all pregnant women of the advantages and techniques of breastfeeding.During the prenatal visits to the doctor’s office as well as the monthly visits to the birthing centre, we will offer pertinent information (pamphlets, books,videos, information sessions) on the benefits of breastfeeding. Condition 4: Help the new mother to start nursing her infant within a half hour of the birth. The mother who has just delivered s encouraged to nurse her baby shortly after the birth. The baby is immediately placed on the mother’s abdomen, except if there is a medical contraindication. She is helped to start breastfeeding. In the case of a caesarean, skin to skin contact and breastfeeding will be started as soon as possible. From: BMP Hospital; Breastfeeding Policy, 1998

30. Condition 5: Show mothers how to breastfeed and how to maintain milk production in the event of separation from her baby. The instruction and support given during the hospital stay allows mothers to acquire the knowledge and the necessary ability to nurse their babies, such as positioning and latching into the breast. In special cases where the baby will not take the breast, the mother is encouraged to maintain lactation by pumping her breasts. Condition 6: Do not give any food or drink ot the new-born infant other than mothers milk except if there is a medical indication. In the birthing centre new-borns receive only breastmilk unless there is a medical reason to give a supplement feeding as is stipulated by UNICEF. From: BMP Hospital; Breastfeeding Policy, 1998

31. Condition 7: Leave the baby with its mother 24-hours a day. Mother and baby are not separated during their admission to the birthing centre. The nurse provides care to mother and child in the same private room. Condition 8: Encourage breastfeeding on demand. We encourage demand feeding. The frequency and the duration of nursing are determined by the needs of the infant. Mothers receives support and teaching so that she can recognize the signs of hunger and satiety of her baby. Condition 9: Do not give breastfed infants any artificial milk or pacifier. To facilitate initiation of breastfeeding, we advise the parents to avoid pacifiers and supplements in the first weeks after birth. From: BMP Hospital; Breastfeeding Policy, 1998

32. Condition 10: Encourage formation of breastfeeding support groups and inform mothers of their location. • There is a follow up telephone call 24 hours after discharge with a home visit the following day. Other visits and/or telephone calls will be offered as needed. The line Info-Santé is available 24 hours a day. A list of support groups is given to the mother on discharge. • BMP also adheres to the International Code on the Commercialization of Breastmilk Substitutes. From: BMP Hospital; Breastfeeding Policy, 1998

33. The Need for Education The Study on Attitudes about Breastfeeding offers these tips: • The promotion of breastfeeding depends on changes made to the medical system. • There is a need to create a more realistic expectation about breastfeeding. • Information about breastfeeding needs to be available throughout pregnancies. • Resources must be made available to mothers.

34. Self-AssessmentAre we ready for BFI? • The BCC has issued a Self-Appraisal Tool for the use of hospitals to identify which of their practices coincide with the 10 steps. • The series of yes/no questions can indicate if a hospital is ready to become baby-friendly.

35. How to Get Involved To get more information about breastfeeding, self-assessment and the BFI in Manitoba, call: • La Leche League Canada(204) 257-3509 • Manitoba Health (204 788-6661) • Your Regional Health Authority(204)