Mother-Baby Friendly

Hospital Initative (MBFHI)

The Global Criteria to

Baby Friendly Hospital
Initiative

THE TEN STEPS TO

SUCCESSFUL BREASTFEEDING

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 wards
all infant care areas
( well baby / sick baby )
antenatal care services
Language / dialect commonly used

Prohibits..
promotion of BM substitutes /
teats /pacifiers
distribution of gift packs
Mechanism for evaluating
effectiveness of the policy

Step 2 - Train all health care staff in

skills necessary to implement this policy.
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

 Training include 10 steps &

International Code
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.

Breastfeeding counselling to most

pregnant women at antenatal service
written antenatal education:
importance of exclusive breastfeeding 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

 reflect attendance to BF
lecture
protected from oral & written
instruction for artificial
feeding

Step 4 - Help mothers initiate

breastfeeding within half hour after birth.
Immediate Skin to skin contact at

least for one hour after birth

immediately after birth for I hr - NVD
as soon as mother is responsive - CS
Helped and encouraged by staff to
recognize baby ready to feed
First Crawl Video

Im hungry Mommy.
Where are you ?

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
show how to express milk
proper positioning / attachment
where they could get help

 Mother with previously encountered

problem should be given special
attention and support

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.
Mothers and infant dyad are
observed in ward for 2
hours
No promotion / display
/ distribution to
mothers, staff, or the
facility
If there are bottled fed
babies, ask the reason
from the mother

Ask staff indication

Is it an Acceptable
Medical Reasons ?
Ask mothers ( NSD &
CS ) if their babies were
fed with food or drink
other than breast milk

Cup feeding is recommended

Dental Obturator for

cleft lip / palate

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

TANDEM BED

Kangaroo Mother Care

Step 8 - Encourage Breastfeeding

on Demand.

NO restrictions on frequency or
length of breastfeeding
Advised to breastfeed when
babies are hungry
As often as baby wants

 awaken & feed

if baby is
sleeping too long
is breast
becomes overfull

Step 9 - Give NO artificial teats or

pacifiers (dummies or soothers) to
breastfeeding infants.
Mothers report that to the best of
their knowledge , infants were NOT
fed using bottles with artificial teats
NOR allowed to suck on pacifier.
Nursing staff reports the same

 Mothers informed on
the risk associated
with feeding milk /
other liquids with
teats & bottles

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
Nursing staff should be aware

 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 International Code of

Marketing of Breast-milk substitutes

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

code

The hospital does not receive free

gifts, non-scientific lectures, materials
or equipments, money or support for
in-service education..
No pregnant women, mothers or their
families are given marketing
materials, samples, gifts by the facility

Mother-friendly care (optional)

Mother-friendly labour & birthing
practices:

With companion for physical

& emotional support

Allowed to walk & move about

Allowed to drink & eat light foods

 Staff / women informed of the birthing

practices
Given advice on the use of non-drug
comfort measures (massage etc)
Not involves invasive procedures as
rupture of the membranes,
episiotomies, induction of labour

Acceptable Medical Reasons

for supplementation
Exclusive breastfeeding IS THE
NORM
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
exinfant weak / oral abnormality /
separated from mom

2. Infants who may need other nutrition in

addition to breastmilk
exlow 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
exinborn 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
mother taking medications
antimetabolities / radioactive iodine /
some anti-thyroid
maternal addiction
tobacco / alcohol / drug
HIV infected mothers

E.O. 51 MILK CODE

National Code of
Marketing of Breastmilk
Substitutes, Breastmilk
Supplements,
and Other Related
Products

Republic Act no. 10028

Expanded Breastfeeding Promotion Act of 2009

Republic Act no 7600

The rooming-in and Breastfeeding Act of 1992