Expansion of the Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding into Neonatal Intensive Care

Abstract

In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.

Critical analyses of the implications of Kangaroo Mother Care on a preterm infant

“…It would be hoped that as more hospitals become Baby Friendly accredited, mothers will benefit beyond this standard of care by receiving anticipatory guidance and tailored support for the breastfeeding obstacles common to their circumstances (Nyqvist et al 2013). …”

Assessing clinicians' knowledge and confidence to perform kangaroo care and positive touch in a tertiary neonatal unit in England using the Neonatal Unit Clinician Assessment Tool (NUCAT)

“…Family centred care (FCC) is a guiding principle in the UNICEF Baby--Friendly Hospital Initiative (BFHI) and aims to ameliorate the trauma experienced by parents by supporting their role in the care of their baby (Nyqvist et al, 2012). Through supporting and educating parents in the practices of kangaroo care (KC) and positive touch (PT) neonatal staff can facilitate parental involvement, enhance the bonding process and minimise parental and infant distress (Hunt, 2008;Cleveland, 2008;Renfrew et al, 2009).…”

Improving Skin To Skin Contact Immediately After Birth and Breastfeeding by Implementing the Ten Steps to Successful Breastfeeding at a Tertiary Community Hospital

“…The Baby-Friendly Hospital Initiative (BFHI) is a global program to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding [8][9][10]. The BFHI assists hospitals in giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feeding formula safely [8].…”

“…The Ten Steps [3,7,[10][11][12][13] for Successful Breastfeeding ( Figure 1) for maternity settings are an evidence-based set of hospital practices, proven to increase breastfeeding rates in healthcare settings and beyond [14]. Skin to skin (STS) has been identified as important for the initiation of breastfeeding.…”