Archive | WHO Code/BFHI

JHL’s Newest Podcast: Challenges and Successes: The Baby Friendly Initiative in Norway

The Journal of Human Lactation’s (JHL) newest podcast is now available on their website.  Based upon “Challenges and Successes: The Baby Friendly Initiative in Norway” from the latest issue of JHL, this podcast is an interview by Editor-in-Chief, Anne Merewood, of one of the paper’s authors, Mette Ness Hansen. Hansen is a registered nurse and IBCLC at The Norwegian Resource Centre for Breastfeeding at the Oslo University Hospital and has been involved with the Baby Friendly Hospital Initiative since the early eighties.

Click HERE for the latest podcast.

We asked Hansen to share a bit about how the tide turned in regards to being Baby Friendly in Norway and here is what she had to say:

 When we first began to implement the BFHI back in 1993, we were lucky to be supported by the Norwegian health authorities.

At that time, our maternity ward routines were not particulary Baby-Friendly: 24 hour rooming-in was rare, supplementing with formula and / or sugar water from day one was quite common and breastfeeding knowledge among staff was generally poor.

The general idea was that the best care for the mother after birth, was if she could sleep the whole night after beeing provided with pain killers and sleping pills, while the staff were looking after the baby, giving supplement and pacifiers.

For the staff who were used to taking care of the baby, it was hard to accept that the mother was capable of both feeding and nursing the baby herself. Losing ”control” of the newborn was like loosing their professional identity. Soon we realized that it was necessary to introduce a guiding principle: Caring for the mother, enabling her to care for the baby.

Changing routines is always a challenge and when implementing the BFHI. The most important task was to train the clinical staff members in breastfeeding skills to make them understand the usefulness of the Ten Steps. Today more than 90 % of all babies in Norway are born in a designated Baby-Friendly unit.

The Initiative has been expanded to the NICU’s and since 2005 the Initiative has been adapted to the Community Health Services. Today almost 50% of all mothers with newborn babies are linked to a Maternal and Child Health Center which are designated as, or are in the process of becomming Baby-Friendly.

We have no Baby-Friendly assessment and designation for educational establishments. Most education programs for midwifery and health visitors schools offer education on breastfeeding. The Norwegian Resource Centre for Breastfeeding in co-operation with the College of Health care studies have a program where we educate specialised breastfeeding counsellors on a national level.

Since Febryary 2012, we have been pilot testing an electronic reassessment tool based on WHO’s monitoring tool for BFHI. In October this year, we plan to carry out this reassessment in all Baby-Friendly hospitals and birthing units, and at the same time we are asking for Infant Feeding Records to register the use of supplements.

BFHI is an effective tool in increasing breastfeeding rates and interaction between mother and child. The training of staff is crucial; the more you know about breastfeeding, the more you understand the importance of implementing the Ten Steps.

For subscribers to the journal, you can read the full paper HERE.

Mette Ness Hansen, RN, RM, IBCLC, has been working several years in delivery- and maternity wards. She is now employed in The Norwegian Resource Centre for Breastfeeding, Oslo University Hospital. She has been involved in breastfeeding promotion support since the eighties including initiation and assessment of the WHO/UNICEF “Baby-Friendly Hospital Initiative” (BFHI) and the expansion of BFHI to the neonatal units in Norway. She is a BFHI coordinator, and is also working as a community midwife.

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World Breastfeeding Week: Massachusetts, USA Hospitals Go Bag Free

By Marsha Walker, RN, IBCLC

Massachusetts is now the second state in the US, behind Rhode Island, to have had all of its maternity hospitals eliminate the practice of distributing formula company discharge bags. Ban the Bags is a campaign that began in 2006 to rid hospitals of the practice of distributing formula company discharge bags or other discharge gifts to mothers when leaving the hospital. It was started after efforts in Massachusetts failed to insert regulations regarding such a ban into our hospital perinatal regulations. Ban the Bags, the Massachusetts Breastfeeding Coalition, and the MotherBaby Summit have all encouraged hospitals to eliminate this practice through letter writing, education of hospital management at summits designed just for them, and downright shamed them into doing it in order to get off the list of hospitals we kept who continued engaging in this practice. The list of hospitals who continued to give out these bags was displayed on the MotherBaby Summit website and was placed on a large poster board and displayed annually at the Massachusetts Breastfeeding Coalition’s yearly conference. Ban the Bags answered many e-mails with suggestions, references, and approaches to help individuals get the bags removed from their hospital.

Ban the Bags found that many hospitals did not really care about the effect of formula bags on breastfeeding but responded when told that it was a breech of medical ethics, was in opposition to the hospital’s own mission and vision, and was no different than unethical arrangements with pharmaceutical companies. We encouraged people to contact their hospital Ethics Committee for an opinion on a practice that promoted the use of a potentially hazardous product and how this related to the ethical principles of “first do no harm” and the obligation of health care providers to act in the best interest of their patient. We counseled people to contact the hospital’s Corporate Compliance Department to report how these bags were a conflict of interest, especially since HIPAA defines them as a form of marketing. We recommended that people contact the hospital’s Risk Management Department to inform them that because the hospital had no stock control there was no method to contact patients who had received the bags if there was a recall of the formula. Such a recall occurred in 2006 when one company’s bags were recalled due to the defective packaging of formula inside which resulted in a vitamin C deficiency. Also, the powdered version of formula is not sterile and the hospital could be handing out and liable for a product contaminated with Chronobacter sakazakii. Mothers were never instructed by the hospital in how to safely prepare the powdered formula that they were essentially marketing for formula manufacturers. Eliminating the bags was a fairly easy way to increase the hospital’s score on the mPINC survey.

Ban the Bags advocates toss bag into the original location of the Boston Tea Party!

Hospitals were concerned that they would have to pay for formula, as the formula companies fought hard to prevent the disappearance of this lucrative and inexpensive marketing tactic. We have found that this was not actually true, as manufacturers did not remove their product from the hospital which represented essentially a captive audience. Companies know that well over 95% of mothers continue to use the brand of formula given to their infant in the hospital. Why would a formula company give up this potent marketing advantage? We heard how terrible it would be for poor mothers who could not receive this “gift.” Of course there is only enough formula in the bag for about a week or so worth of feedings, just enough to reduce a mother’s milk supply and accustom the infant to the bottle. Detractors complained that we were “forcing” mothers to breastfeed or removing their choice of infant feeding methods. Mothers decide how they wish to feed their infants well before entering the hospital. Bags have no effect on feeding decisions, they have only one purpose, which is to cause a breastfeeding mother to use formula and create a customer/market where none existed before. We have found that when hospitals remove the bags, they show up in community pediatric and obstetric offices, clinics, and even in ultrasound departments. Make sure to ask that all of these entities cease distributing formula company materials, as this works directly to counteract your efforts in the hospital.

Ban the Bags at www.Banthebags.org has many helpful recommendations on approaching the elimination of this practice. I am happy to help and you can email me at Marshalact@gmail.com.

Marsha Walker is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently a member of the board of directors of the Massachusetts Breastfeeding Coalition, Baby Friendly USA, Best for Babes Foundation, and the US Lactation Consultant Association (USLCA). She is a past president of the International Lactation Consultant Association (ILCA).

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