Ao - Mbfhi. 2ppt

Adm ini stra ti ve Or der No. 20 07-00 26 dat ed: July 10. 2007

Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Facilities with Maternity and Newborn Care Services

Historical Background 1992 Rooming-In and Breastfeeding Act (RA 7600) Ten Steps to Successful Breastfeeding, UNICEF/WHO Global Criteria 1999 The Golden Era of Breastfeeding: DOH certified 1,427 or 83% of targeted hospitals and lying-in clinics

LEGAL MANDATES

Philippine Infant and Young Child Feeding (IYCF) policy as adopted from the WHO/UNICEF 2002 Global Strategy on IYCF 

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PHIC Circular No. 26 s. 2005 Administrative Order No. 2005-0023 of the DOH, Formula One for Health

New Guidelines:

AO 2007-0026 Dated July 10, 2007

Objectives: • transform all health institutions with maternity and newborn services … government & private health facilities…. • build the critical capacity and commitment of health care staff… • staff establish linkage…

What’s new in the AO? > Mother-Friendly Indicators > Hospital as a Workplace > Milk Code > Process of Accreditation

Steps to a Mother-Friendly / Safe Motherhood Initiative

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 Hospital shall incorporate motherfriendly labor and birthing practices… •

Clean birthing technique

• Delayed cord clamping • Placenta removal & disposal • Collaboration/ Referral

Steps to a Mother-Friendly Care

1. Train staff on essential and emergency obstetric and newborn care and non-drug methods of pain relief 3. Motivate and refer pregnant women for STD / HIV/AIDS screening and voluntary counseling and treatment

Steps to a Mother-Friendly Care

3. Birthing mothers may be offered access to a birth companion 4. Birthing mothers may be allowed the freedom to walk and move about 5. Assume positions not limited to the lithotomy position

Steps to a Mother-Friendly Care

 …avoid unnecessary instrumentation that may inhibit breastfeeding  • • • •

Babies born by C/S are less likely to have early skin to skin contact more likely to have nursery care increasing the risk of cross infection restricting breastfeeding

Steps to a Mother-Friendly Care

 Linking the mother and baby to appropriate community breastfeeding support group  Encourage mothers to take care of their premies, NB with defects

Hospital as a Workplace 2/5

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Milk code enforcement Breastfeeding breaks Breastfeeding rooms Breastfeeding storage facilities Support group Supportive environment

Baby- Fri end ly Indi ca tors 3/5

Mother-Baby Friendly Hospital Initative (MBFHI)

Th e Glo bal Cri te ri a to Baby F rien dl y Ho spi ta l Ini tiative

THE TE N STE PS TO SUCC ES SFUL BREA STFEED IN G

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 ward  all infant care areas ( well baby / sick baby )  antenatal care services  Language commonly used

Pr ohibi ts… ..  promotion of BM substitutes / teats /pacifiers  distribution of gift packs Mec hanis m fo r eval uat ing effectiveness of the policy

Sample only

Cli ent Surv ey on t he M BFHI Impl eme nt at ion for Succes sful Bre as tfee di ng We want mothers to give their newborn babies the BEST and the best is mothers’ milk. In order for us to evaluate if we achieved our goal, please fill up this survey form.

Ye s 1. Did you have pre -natal ch eck -up? If yes , wher e? _______________ 2. Have you li st ened to le ct ure s in bre astfee din g? If no, wh at is th e re ason ? ___________________ 3. We re you inform ed on the followin g? 3.1 . Adv antages of br ea stfeedi ng… 3.2 . Corr ect attach me nt and pos it ion ing… 3.3 . Mil k expr es sion, coll ect ion and stora ge… 3.4 . Manage men t to comm on bre ast proble ms… 4. Wa s you r ba by pl aced be twe en o you r brea st im med ia tel y upo n del iv er y or wi th in 1 hou r after birt h ? If no, wh y? ________________________________ 4.1 . Wer e you in form ed on th e impor ta nce of im med ia te latch in g?

No

Yes

No

5. W er e y ou gi ve n inf or mati on on br ea st fe eding when y ou were ans fer red y our b aby ? 6. Dtr id y ou neet dohel p onroom yourwith f ir sty our bre as tf eeding ? 7. I f y es , w hy ? __ ______ ____ ______ ____ ______ ____ ______ ___ 8. B ef or e ho spita l dis cha rge , w er e i nfor med whe re t o go / whom if you e nc ount er eas a nytfe pr eding obl em? r elat ed to 9. to W cill aly l ou r ec omme nd br br eas tfe eding? If no, why __ ______ ____ ______ ____ ______ ____ ______ ____ _ 10 . W ha t c an y ou rec ommend / sugge st so w e c ould impr ov e our bre as tf eeding ser vic es for mothe rs and babies . __ ______ ____ ______ ____ ______ ____ ______ _ Man ner of D eliv er y ______ ____ ______ ____ __ __ ______ ____ __

G rav idit y

Date / T ime Deliv ered __ ______ ____ ______ ____ ______ ____ ______ ____ ______ ___

Step 2 - Train all health care staff in skills necessary to implement this policy. 

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All staff ( involved with mother and baby ) received orientation on BF policy Trained on 20 hours w/ 3 hours clinical experience New employees - orientation & training w/in 6 months copy of the curricula or course outline – be available

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Training include 10 steps & Milk Code (EO 51) 20 hours of training Training of non-clinical staff (given their roles) to support  

Importance of breastfeeding (BF) Hospital practices that support BF

Step 3 - Inform all pregnant women about the benefits and management of breastfeeding. 

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Breastfeeding counselling to most pregnant women at antenatal service written antenatal education: 

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importance of exclusive breastfeeding for 6 months benefits of breastfeeding basic breastfeeding management

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

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reflect attendance to BF lecture

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protected from oral & written instruction for artificial feeding

Step 4 - Help mothers initiate breastfeeding within an hour after birth. 

Immediate Skin to skin contact at least for one hour after birth

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immediately after birth for I hr - NVD as soon as mother is responsive - CS

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First Crawl Video

Step 5 - Show mothers how to breastfeed & maintain lactation, even if they should be separated from their infants. 

Offer assistance with breastfeeding within 6 hours of delivery

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show how to express milk

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proper positioning / attachment

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where they could get help

Mother 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. 

Cup feeding is recommended

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Dental Obturator for cleft lip / palate

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Breastmilk storage

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

Step 8 - Encourage Breastfeeding on Demand. 

NO restrictions on frequency or length of breastfeeding

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As often as baby wants

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Advised to breastfeed when babies are hungry

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awaken & feed

Step 9 - Give NO artificial teats or pacifiers (dummies or soothers) to breastfeeding infants. 

Mothers informed on the risk associated with feeding milk / other liquids with teats & bottles and the use of pacifiers

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

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Nursing staff should also be aware of it

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Printed materials available before discharge Encouraged follow up after 2-4 days & in the 2nd week Facility has / allows trained BF mother support counsellors

Compliance to the Philippine Code of Marketing of Breast-milk substitutes 4/5 

The head / director of maternity services reports that: NO employees of manufacturers or distributors of breastmilk substitutes, bottles, teats, pacifiers have direct contact with pregnant women

Compliance to the Philippine Code 

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The hospital does not receive free gifts, non-scientific lectures, materials or equipments, money or support for in-service education…..

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No pregnant women, mothers or their families are given marketing materials, samples, gifts by the facility

Acceptable Medical Reasons for supplementation Exclusive breastfeeding IS TH E NOR M

There is a small number of situations that maybe a 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 ex…infant weak / oral abnormality / separated from mom

2. Infants who may need other nutrition in addition to breastmilk ex…low 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 ex…inborn 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

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mother taking medications antimetabolities / radioactive iodine / some anti-thyroid

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maternal addiction tobacco / alcohol / drug

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HIV infected mothers

HIV and In fant Feeding Have policy to support feeding the HIV positive mother Mother informed on:  Transmission of HIV  Feeding options  Importance of testing & counselling  Maintain confidentiality

UNIC EF/ WHO / UNAID S In fant Feed ing Re commen da tio n for HIVposi ti ve Wo me n

When replacement feeding is acceptable, feasible, affordable, sustainable and safe, (AFASS) avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and should be then discontinued as soon as it is feasible.

Roles and Responsibilities National Management Committee of DOH Chair-Usec for Health Operatios Co-chair-Usec for External Affairs

CHD Assessor’s Team Regional Coordinators Dr. Jose Fabella Memorial Hospital

MB FH I Accr ed it atio n Pr oce ss

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Sel f Ass essme nt of th e h eal th faci li ty CHD Val id ation of submitted self-a sse ssme nt for m Issuance of a Certi fi ca te o f Comm itmen t vali d f or tw o years Re-As ses sment b y the CHD MBFH I As se ssors Team af te r 2 years Iss uance of Pl aque of Acc redita ti on for susta ined imp lementation an d int egration of th e moth er-fri end ly ind icators Ann ual MBFH I Imp leme ntation Rep ort su bmi tte d b y th e hea lth facil ity to th e CHD