Lactation History, the Baby-Friendly Hospital Initiative, & the Code Questions and Answers

Lactation History, the Baby-Friendly Hospital Initiative, & the Code Questions and Answers 1977 International consumer boycott In 1977, church groups organized an international consumer boycott against the Nestle corporation for aggressive marketing strategies used to promote its infant formula and formula products 1956 La Leche League In 1956, a group of seven young mothers from Franklin Park, Illinois, USA founded La Leche League International (LLLI). Their goal was to provide breastfeeding help and support to interested women. At the time, as breastfeeding rates were quite low in the United States, this group supporting breastfeeding was controversial. 1981 The Code In 1981, at a meeting of representatives of the World Health Organization, the International Code of Marketing of Breastmilk Substitutes was adopted. 1985 IBLCE "The International Board of Lactation Consultant Examiners (IBLCE) was founded in March 1985 using a $40,000 loan from La Leche League International as start-up funding. IBLCE's founding was in response to the need for standards in the emerging profession of lactation consulting." IBLCE awarded its first credential in 1985. IBLCE is a certification organization for International Board-Certified Lactation Consultants (IBCLCs) with the following mission: - To administer the IBCLC certification exam - To award the credential to those who pass the exam - To protect the public health, safety, and welfare through disciplinary procedures for IBCLCs 1990 Innocenti Declaration The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding was produced and adopted in August, 1990 at a meeting in Florence, Italy. The meeting was held in a historic building, the Spedale degli Innocenti, and thus the name. Four organizations sponsored the meeting: UNICEF, World Health Organization (WHO), United States Agency for International Development (USAID), and the Swedish International Development Authority (SIDA). The Innocenti Declaration was subsequently adopted by the World Health Assembly in 1992. It called for concrete actions for governments to take by 1995. Operational targets included: 1) Appoint a national breastfeeding coordinator and establish a national breastfeeding committee; 2) Ensure that all maternity facilities fully practice the Ten Steps to Successful Breastfeeding; 3) Take action to implement the International Code of Marketing of Breastmilk Substitutes (the Code); and 4) Enact legislation protecting the breastfeeding rights of working women. 1991 Baby-Friendly Hospital Initiative The World Health Organization and UNICEF started the Baby-Friendly Hospital Initiative (BFHI) in 1991. Baby-Friendly is an international designation of breastfeeding excellence awarded to maternity facilities found to 1) be compliant with the Ten Steps to Successful Breastfeeding 2) be compliant with the International Code of Marketing of Breastmilk Substitutes (The Code). 3) Pay fair market value for infant formula and formula products. Each country has a group that runs the program for that country (still following the international guidelines). For example, Baby-Friendly USA is the responsible organization in the United States. 1991 World Alliance for Breastfeeding Action The World Alliance for Breastfeeding Action (WABA) was formed in 1991 to generate public awareness and support for breastfeeding. The 5 core partners that guide and assist WABA to achieve its goals are: 1) Academy of Breastfeeding Medicine (ABM) 2) International Baby Food Action Network (IBFAN) 3) International Lactation Consultants Association (ILCA) 4) La Leche League International (LLLI) 5) Wellstart International. Numerous other organizations support WABA. WABA has conducted numerous campaigns to generate public awareness and support for breastfeeding including coordinating World Breastfeeding Week that is held every year from August 1-August 7. 1994 Academy of Breastfeeding Medicine The Academy of Breastfeeding Medicine (ABM), is a worldwide organization of medical doctors dedicated to the promotion, protection, and support of breastfeeding and human lactation. Formed in 1994, the organization's mission is to unite members of the various medical specialties with this common purpose. ABM pursues three principal goals: 1) Education of healthcare providers and institutions 2) Fostering a global professional community of doctors with diverse specialties committed to the care of women and children 3) Advancement of research and practices that shape public policy in support of breastfeeding 1995 Vatican A working group on breastfeeding, science and society met in 1995 at the Pontifical Academy of Sciences at the Vatican. Subsequent addresses by Catholic pontiffs included: (1) Pope Pius XII encouraged Catholic mothers to nourish their children themselves. Pope John Paul II said that "mothers need time, information, and support" and that "no one can substitute for the mother in this natural activity." Pope Francis encouraged mothers to engage in breastfeeding publicly during church services, including infant baptisms. 2002 Global Strategy for Infant and Young Child Feeding The WHO and UNICEF jointly developed the Global Strategy for Infant and Young Child Feeding. This strategy, among other things, reaffirmed a global commitment to the Code, Baby-Friendly Hospital Initiative, and the Innocenti Declaration. 2016 Lancet series The journal, Lancet, published a breastfeeding series that provided data on breastfeeding and its impact on health and global economic development. Three of the findings: 1) Improving breastfeeding practices could save more than 820,000 lives per year with 87% of the preventable deaths occurring in infants 6 months or younger. 2) The estimated costs associated with not breastfeeding amount to $300 billion per year. (2) 3) Baby-Friendly works. A meta-analysis of studies evaluating the BFHI found that implementation of the BFHI increased exclusive breastfeeding by 49% (95% CI, 33%-68%) and any breastfeeding by 66% (95% CI, 34%-107%). The meta-analysis reviewed 29 studies that found that the BFHI and its elements of hospital support increased breastfeeding in the first hour (relative risk = 1.11; 95% CI, 1.06-1.16), 51 studies that found that it increased exclusive breastfeeding in the first 5 months (relative risk = 1.46; 95% CI, 1.37-1.56), and 47 studies that found that it increased any breastfeeding in the first 6 months (relative risk = 1.40; 95% CI, 1.30-1.52). Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387:491-504. 2022 American Academy of Pediatrics The American Academy of Pediatrics released an update of its "Breastfeeding and the Use of Human Milk." Much of the policy is identical to the 2012 version but, of note, the AAP now aligns with the World Health Organization in recommending that babies be exclusively breastfed until about six months, and continuing until two years or more (instead of one year or more) - if "mutually desired by mothers and their babies". Complementary foods should be introduced in addition to the breastmilk at six months. North American Board of Breastfeeding and Lactation Medicine (NABBLM) "The North American Board of Breastfeeding and Lactation Medicine (NABBLM) was founded by a passionate group of seasoned Breastfeeding and Lactation Medicine Specialists who identify the need to help other physicians practice this specialty by outlining an evidence-based canon of knowledge, scope of practice, and pathway to board certification. NABBLM plans to board-certify physicians who are licensed in the United States and Canada". They are currently getting certified. La Leche League International was formed in 1956 by a group of seven young mothers in Franklin Park, Illinois, USA with a goal of providing support to women interested in breastfeeding. In Spanish, 'leche' means: A) Baby B) Heart C) Milk D) Tongue C) Milk In 1977, church organizations launched an international consumer boycott of this company in protest of its aggressive marketing strategies of infant formula. A) Abbott B) Nestlé C) Danone D) Santander B) Nestlé The organization responsible for administering the International Board-Certified Lactation Consultant (IBCLC) examination is: A) International Lactation Consultant Association (ILCA) B) International Baby Food Action Network (IBFAN) C) World Alliance for Breastfeeding Action (WABA) D) International Board of Lactation Consultant Examiners (IBLCE) D) International Board of Lactation Consultant Examiners (IBLCE) The gold standard for lactation consultant designation is: A) Certified Lactation Counselor (CLC) B) Breastfeeding Peer Counselor C) Doula D) International Board-Certified Lactation Consultant (IBCLC) D) International Board-Certified Lactation Consultant (IBCLC) The Academy of Breastfeeding Medicine (ABM) is a worldwide organization of __________ dedicated to the promotion, protection, and support of breastfeeding. A) Registered nurses B) Medical doctors C) College professors D) Certified nurse midwives B) Medical doctors The Academy of Breastfeeding Medicine (ABM) has numerous protocols, many in multiple languages, that are available for free. A) True B) False C) False. ABM has numerous protocols but they are not available for free. A) True The World Alliance for Breastfeeding Action (WABA) coordinates World Breastfeeding Week. The dates of World Breastfeeding Week each year are: A) January 1-7 B) February 14-20 C) August 1-7 D) September 1-7 C) August 1-7 The Catholic Church supports breastfeeding. In fact, Pope Francis encouraged mothers to engage in breastfeeding publicly during church services, including infant baptisms. A) True B) False C) The Catholic Church has never made a statement about breastfeeding. A) True A publication in The Lancet stated, "Improving breastfeeding practices could save more than 820,000 lives per year with 87% of the preventable deaths occurring in infants 6 months or younger." A) True B) False A) True The Innocenti Declaration on the ________, ________ and ________ of Breastfeeding was produced and adopted in August, 1990 at a meeting in Florence, Italy. A) Protection, Preservation and Support B) Promotion, Preservation and Support C) Protection, Promotion and Support D) Support, Perseverance and Protection C) Protection, Promotion and Support What does "Baby-Friendly" mean? Baby-Friendly is a designation awarded by the World Health Organization (WHO) and the United Nations International Children's Fund (UNICEF) to maternity facilities that meet international standards supporting and promoting breastfeeding. The Ten Steps to Successful Breastfeeding The framework of the Baby-Friendly Hospital Initiative. Critical management procedures: 1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions. 1b. Have a written infant feeding policy that is routinely communicated to staff and parents. 1c. Establish ongoing monitoring and data-management systems. 2. Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding. Key clinical practices: 3. Discuss the importance and management of breastfeeding with pregnant women and their families. 4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth. 5. Support mothers to initiate and maintain breastfeeding and manage common difficulties. 6. Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated. 7. Enable mothers and their infants to remain together and to practice rooming-in 24 hours a day. 8. Support mothers to recognize and respond to their infants' cues for feeding. 9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers. 10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care. Revisions to the Baby-Friendly Hospital Initiative 2009 - Revision by the WHO Changes included - Expectation that staff will help all mothers with feeding support - both those who are breastfeeding and those who are infant formula feeding. - Revisions to Step 4. The old Step 4 talked about skin-to-skin holding happening within 5 minutes after birth and lasting for 30 minutes. (A lot of things can happen in the Labor and Delivery Suite in the 5 minutes after birth including taking the baby over to the scale, administering eye ointment and Vitamin K, and maybe a quick physical exam by an inpatient clinician. And why 30 minutes?) The new Step 4 says the infant should be placed skin-to-skin with the mother soon (immediately) after birth and remain there without interruption for an hour or more. Staff should assist the mother. If the mother is not breastfeeding, or if breastfeeding is contraindicated, mother should hold her baby skin-to-skin for at least an hour immediately after birth. 2015 - WHO and UNICEF began a process to re-evaluate and tweak the BFHI program as needed. 2017 - WHO guideline "Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services" was published. Changes made to the Ten Steps included: - Compliance with the Code added as Step 1a - Data monitoring added as Step 1c - A competency-based focus for maternity health care staff Does BFHI work? A meta-analysis of studies evaluating the BFHI published in Lancet found that implementation of the BFHI increased exclusive breastfeeding by 49% (95% CI, 33%-68%) and any breastfeeding by 66% (95% CI, 34%-107%). The meta-analysis reviewed 29 studies that found that the BFHI and its elements of hospital support increased breastfeeding in the first hour (relative risk = 1.11; 95% CI, 1.06-1.16), 51 studies that found that it increased exclusive breastfeeding in the first 5 months (relative risk = 1.46; 95% CI, 1.37-1.56), and 47 studies that found that it increased any breastfeeding in the first 6 months (relative risk = 1.40; 95% CI, 1.30-1.52). What impact does breastfeeding in the first hour of life have on the duration of breastfeeding? Research shows that infants who breastfeed in the first hour of life have a better suck and increased breastfeeding duration compared with infants whose first breastfeeding is delayed. What are the nine distinct stages of innate newborn behavior when an infant is placed on the mother's abdomen? 1)The birth cry 2) Relaxation (Lasting 2-3 minutes, baby is very quiet and still.) 3) Awakening (At about 3 minutes, head and shoulders move, may open eyes and make small mouthing movements.) 4) Activity (At about 8 minutes, eyes remain open, may look for mother, increased mouthing and sucking, drooling) 5) Resting (Resting may occur at any point.) 6) Crawling (At about 20 minutes, baby begins to approach the breast by leaping, crawling, sliding, and/or pushing. The kicking motion of the feet may help deliver the placenta. Baby continues mouthing and suckling movements although baby is not ready to latch.) 7) Familiarization (At about 45 minutes, baby may lick, touch or massage the breast while looking at the mother.) 8) Suckling (At about 60 minutes, baby self-attaches to the nipple and begins to suck with minimal or no assistance.) 9) Then mother and baby go into a deep sleep. What is Sudden Unexpected Postnatal Collapse? SUPC is a rare but potentially fatal event in otherwise healthy-appearing term newborns. The definition of SUPC includes: - Infant is well at birth (normal 5-minute Apgar and deemed well enough for routine care) - Infant collapses unexpectedly in a state of cardiorespiratory extremis such that resuscitation with positive pressure ventilation (PPV) is required - The collapse occurs within the first 7 days of life - The infant either dies, or goes on to require intensive care, or develops encephalopathy - Other potential medical conditions (like sepsis, cardiac disease) are excluded The incidence of SUPC is estimated to be 2.6 to 38 cases out of 100,000 births. 1/3 of events occur in the first 2 hours of life 1/3 of events occur from 2-24 hours of life 1/3 of events occur from 1-7 days of life Risk factors for Sudden Unexpected Postnatal Collapse Prone position of the baby Lithotomy or supine position of the mother Skin-to-skin contact with poor positioning Unsupervised first breastfeeding attempt Primiparous mother Sleepy or medicated mother Mother left alone in delivery room Maternal obesity Maternal smoking Maternal use of a cell phone Alternative Feeding Methods An alternative feeding method could be feeding by a cup, syringe, spoon, finger, dropper, or SNS (supplemental feeding method - a feeding tube attached to a syringe, with the tip of the tube lying alongside the nipple.) What is "The Code"? The WHO International Code of Marketing of Breast-milk Substitutes or "The Code" is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats (nipples). The Code: - aims to stop the aggressive and inappropriate marketing of breast-milk substitutes. - advocates that babies be breastfed. If babies are not breastfed, for whatever reason, the Code also advocates that they be fed safely on the best available nutritional alternative. Breast-milk substitutes should be available when needed, but not be promoted. The WHO International Code of Marketing of Breast-milk Substitutes 1) No advertising of these products to the public. 2) No free samples to mothers. 3) No promotion of products in healthcare facilities. 4) No company-paid personnel to advise mothers. 5) No gifts or personal samples to health workers. 6) No words or pictures idealizing artificial feeding, including pictures of infants, on the 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 the costs and hazards associated with artificial feeding. 9) Unsuitable products, such as condensed milk, should not be promoted for babies. 10) All products should be of high quality and take account of the climate and storage conditions of the country where they are used. World Health Assembly (WHA) The company that every so often revises The Code. The International Baby Food Action Network (IBFAN) The International Baby Food Action Network (IBFAN) monitors marketing practices of the infant formula companies and which countries are taking actions to implement the Code. The World Health Organization (WHO) recommends: The World Health Organization (WHO) recommends: Initiating breastfeeding within 1 hour of birth Exclusive breastfeeding during the first 6 months of life Continuing breastfeeding until 2 years or beyond, along with nutritionally adequate and safe complementary foods from the age of 6 months The International Code of Marketing of Breast Milk Substitutes is a set of recommendations to regulate the marketing of...? The International Code of Marketing of Breast Milk Substitutes is a set of recommendations to regulate the marketing of: Breast-milk substitutes Feeding bottles and teats (a teat is a nipple) The Code (does/does not) not apply to breast pumps, storage bags and pacifiers. DOES NOT! Pacifiers The Code does not apply to pacifiers. However, Step 9 of the Baby-Friendly Ten Steps to Successful Breastfeeding discourages pacifier use for healthy term infants in the maternity hospital setting. The American Academy of Pediatrics Statement of Breastfeeding and the Use of Human Milk recommends holding on pacifiers until breastfeeding is established, at around 3 weeks of life. Which statement about the Baby-Friendly Hospital Initiative is true? A) It is only for hospitals in the United States. B) It is only for hospitals in the European Union. C) It is only for hospitals accredited by the Joint Commission. D) It is an international designation from the WHO and UNICEF so it is available worldwide. D) It is an international designation from the WHO and UNICEF so it is available worldwide. For an uncomplicated vaginal birth, Step 4 of the Ten Steps to Successful Breastfeeding recommends: A) Immediate and uninterrupted skin-to-skin contact for the first 30 minutes B) Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth C) Beginning skin-to-skin contact once the baby has been weighed, examined, and had pictures taken D) Initiating skin-to-skin contact once the baby has been weighed and examined B) Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth Step 4 of the Ten Steps to Successful Breastfeeding recommends skin-to-skin contact after birth for: A) Only infants of mothers who wish to breastfeed B) Only infants of mothers who wish to formula feed C) All infants regardless of mother's feeding choice D) Only the infants of the mothers who ask for skin-to-skin holding C) All infants regardless of mother's feeding choice Skin-to-skin contact after birth is important because it: A) Promotes bonding B) Helps breastfeeding C) Stabilizes the infant's sugar (glucose) level D) Regulates the infant's vital signs including heart rate, respiratory rate and temperature E) All of the above E) All of the above The Ten Steps, the framework of the Baby-Friendly Hospital Initiative, include: A) Train all staff, hospital-wide, with 10 hours of lactation education B) Encourage feeding on cue for all infants regardless of feeding method C) No availability of infant formula for any infants D) Directions are given to new parents on the brand of bottle to buy B) Encourage feeding on cue for all infants regardless of feeding method A standard of care in a Baby-Friendly designated hospital is: A) All staff are competent in teaching hand expression B) Discharge bags given to the hospital by the formula sales representative for free may be given out to parents at discharge as long as the can of formula is removed C) Mother and baby room-in 24 hours a day D) Parents need to bring in their own infant formula C) Mother and baby room-in 24 hours a day Research demonstrates that Baby-Friendly increases breastfeeding rates. A) True B) False C) No research has been conducted on the issue A) True What does SUPC stand for? Sudden Unexpected Postnatal Collapse When does SUPC occur? A) 1/3 in first 2 hours, 1/3 in first 24 hours, 1/3 in first 7 days B) 1/3 in first 2 hours, 2/3 in first 24 hours C) 2/3 in first 2 hours, 1/3 in first 24 hours D) 2/3 in first 2 hours, 1/3 in first 7 days A) 1/3 in first 2 hours, 1/3 in first 24 hours, 1/3 in first 7 days All are risk factors for Sudden Unexpected Post Natal Collapse except: A) Skin-to-skin contact with poor positioning B) Maternal use of cell phone C) Paternal obesity D) Mother left alone in delivery room C) Paternal obesity Fill in the blanks. The World Health Organization recommends: Initiating breastfeeding within ______ of birth Exclusive breastfeeding during the first ________ of life, With continued breastfeeding until ________ or beyond, along with nutritionally adequate and safe complementary foods from the age of six months. 1 hour 6 months 2 years