AO - MBFHI. 2ppt
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Transcript of AO - MBFHI. 2ppt
Administrative OrderAdministrative OrderNo.2007-0026No.2007-0026dated: July 10.2007dated: July 10.2007
Revitalization of the Mother-Baby Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Friendly Hospital Initiative in Health
Facilities with Maternity and Facilities with Maternity and Newborn Care ServicesNewborn Care Services
1992 1992
Rooming-In and Breastfeeding Act Rooming-In and Breastfeeding Act
(RA 7600) Ten Steps to Successful (RA 7600) Ten Steps to Successful Breastfeeding, UNICEF/WHO Global Breastfeeding, UNICEF/WHO Global CriteriaCriteria
1999 1999
The Golden Era of Breastfeeding: DOH The Golden Era of Breastfeeding: DOH certified 1,427 or 83% of targeted certified 1,427 or 83% of targeted
hospitals and lying-in clinicshospitals and lying-in clinics
Historical BackgroundHistorical Background
LEGAL MANDATES
4)4) Philippine Philippine Infant and Young Child Infant and Young Child FeedingFeeding (IYCF) policy as adopted (IYCF) policy as adopted from the WHO/UNICEF 2002 from the WHO/UNICEF 2002 Global Strategy on IYCFGlobal Strategy on IYCF
5)5) PHIC CircularPHIC Circular No. 26 s. 2005 No. 26 s. 2005
6)6) Administrative Order No. 2005-0023 Administrative Order No. 2005-0023 of the DOH, Formula One for Healthof the DOH, Formula One for Health
New Guidelines: New Guidelines:
AO 2007-0026AO 2007-0026Dated July 10, 2007Dated July 10, 2007
Objectives:Objectives:
1.1. transform transform allall health institutions with health institutions with maternity and newborn services …maternity and newborn services …government & private government & private health health facilitiesfacilities….….
2.2. build the critical capacity and build the critical capacity and commitment of health care staff…commitment of health care staff…
3.3. staff establish linkage…staff establish linkage…
What’s new in the AO?What’s new in the AO?
>> Mother-Friendly IndicatorsMother-Friendly Indicators
> Hospital as a Workplace> Hospital as a Workplace
>> Milk CodeMilk Code
> > Process of AccreditationProcess of Accreditation
1.1. Hospital shall incorporate Hospital shall incorporate mother-mother-friendly labor and birthing practicesfriendly labor and birthing practices……
• Clean birthing techniqueClean birthing technique
• Delayed cord clampingDelayed cord clamping
• Placenta removal & disposalPlacenta removal & disposal
• Collaboration/ ReferralCollaboration/ Referral
1/5
Steps to a Mother-Friendly / Steps to a Mother-Friendly / Safe Motherhood InitiativeSafe Motherhood Initiative
2.2. Train staff on essential and Train staff on essential and emergency obstetric and newborn emergency obstetric and newborn care and non-drug methods of pain care and non-drug methods of pain reliefrelief
3.3. Motivate and refer pregnant Motivate and refer pregnant women for STD / HIV/AIDS women for STD / HIV/AIDS screening and voluntary screening and voluntary counseling and treatmentcounseling and treatment
Steps to a Mother-FriendlySteps to a Mother-Friendly Care Care
3.3. Birthing mothers may be offered Birthing mothers may be offered access to a birth companionaccess to a birth companion
4. Birthing mothers may be allowed 4. Birthing mothers may be allowed the freedom to walk and move about the freedom to walk and move about
5. Assume positions not limited to the 5. Assume positions not limited to the lithotomy positionlithotomy position
Steps to a Mother-Friendly CareSteps to a Mother-Friendly Care
6.6. ……avoid avoid unnecessaryunnecessary instrumentation instrumentation that may inhibit breastfeedingthat may inhibit breastfeeding
7.7. Babies bornBabies born by C/S are less likely by C/S are less likely toto • have early skin to skin contacthave early skin to skin contact• more likely to have nursery caremore likely to have nursery care• increasing the risk of cross infection increasing the risk of cross infection • restricting breastfeedingrestricting breastfeeding
Steps to a Mother-Friendly CareSteps to a Mother-Friendly Care
Steps to a Mother-Friendly CareSteps to a Mother-Friendly Care
8.8. Linking the mother and baby to Linking the mother and baby to appropriate community appropriate community breastfeeding breastfeeding support groupsupport group
9.9. Encourage mothers to Encourage mothers to take caretake care of of their premies, NB with defectstheir premies, NB with defects
Hospital as a Workplace
Milk code enforcement Breastfeeding breaks Breastfeeding rooms Breastfeeding storage
facilities Support group Supportive environment
2/5
Mother-Baby Friendly Mother-Baby Friendly Hospital InitativeHospital Initative (MBFHI)(MBFHI)
Baby- Friendly IndicatorsBaby- Friendly Indicators
3/5
THE TEN STEPS TOTHE TEN STEPS TOSUCCESSFUL SUCCESSFUL BREASTFEEDINGBREASTFEEDING
The Global Criteria to The Global Criteria to Baby Friendly Hospital Baby Friendly Hospital InitiativeInitiative
Written policy which addresses Written policy which addresses the 10 steps the 10 steps Visibly posted in:Visibly posted in:
maternity wardmaternity ward all infant care areas all infant care areas
( well baby / sick baby )( well baby / sick baby ) antenatal care servicesantenatal care services
Language commonly usedLanguage commonly used
Step 1 - Have a written breastfeeding Step 1 - Have a written breastfeeding policy that is routinely communicated to policy that is routinely communicated to all health care staff.all health care staff.
Prohibits…..Prohibits….. promotion of BM substitutes / promotion of BM substitutes /
teats /pacifiersteats /pacifiers distribution of gift packs distribution of gift packs
Mechanism for evaluatingMechanism for evaluating effectiveness of the policyeffectiveness of the policy
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.
Thank you.
Client Survey on the MBFHI Implementationfor Successful Breastfeeding
Sample only
YesYes NoNo
1. Did you have pre-natal check-up?1. Did you have pre-natal check-up?
If yes, where? _______________If yes, where? _______________
2. Have you listened to lectures in 2. Have you listened to lectures in breastfeeding? breastfeeding?
If no, what is the reason? ___________________If no, what is the reason? ___________________
3. Were you informed on the following?3. Were you informed on the following?
3.1. Advantages of breastfeeding…3.1. Advantages of breastfeeding…
3.2. Correct attachment and positioning…3.2. Correct attachment and positioning…
3.3. Milk expression, collection and storage… 3.3. Milk expression, collection and storage…
3.4. Management to common breast 3.4. Management to common breast problems…problems…
4. Was your baby placed betweeno your breast 4. Was your baby placed betweeno your breast immediately immediately
upon delivery or within 1 hour after birth ? If upon delivery or within 1 hour after birth ? If no, why? ________________________________no, why? ________________________________
4.1. Were you informed on the importance of 4.1. Were you informed on the importance of immediate latching?immediate latching?
YesYes NoNo
5. Were you given information on breastfeeding when you were5. Were you given information on breastfeeding when you were
transferred to your room with your baby?transferred to your room with your baby?
6. Did you need help on your first breastfeeding?6. Did you need help on your first breastfeeding?
7. If yes, why? _________________________________________7. If yes, why? _________________________________________
8. Before hospital discharge, were informed where to go / whom8. Before hospital discharge, were informed where to go / whom
to call if you encounter any problem related to breastfeeding?to call if you encounter any problem related to breastfeeding?
9. Will you recommend breastfeeding?9. Will you recommend breastfeeding?
If no, why ___________________________________________If no, why ___________________________________________
10. What can you recommend / suggest so we could improve our breastfeeding10. What can you recommend / suggest so we could improve our breastfeeding
services for mothers and babies. _______________________________________services for mothers and babies. _______________________________________
Manner of Delivery ______________________ Gravidity ______________Manner of Delivery ______________________ Gravidity ______________
Date / Time Delivered ___________________________________________________Date / Time Delivered ___________________________________________________
Step 2 - Train all health care staff in Step 2 - Train all health care staff in skills necessary to implement this skills necessary to implement this policy.policy.
All staff ( involved with mother and All staff ( involved with mother and baby ) received orientation on BF policybaby ) received orientation on BF policy
Trained on 20 hours w/ 3 hours clinical Trained on 20 hours w/ 3 hours clinical experienceexperience
New employees - orientation & training New employees - orientation & training w/in 6 monthsw/in 6 months
copy of the curricula or course outline – copy of the curricula or course outline – be availablebe available
Training include 10 steps & Training include 10 steps & Milk Code (EO 51)Milk Code (EO 51)
20 hours of training20 hours of training
Training of non-clinical staff Training of non-clinical staff (given their roles) to support (given their roles) to support Importance of breastfeeding (BF)Importance of breastfeeding (BF) Hospital practices that support BFHospital practices that support BF
Step 3 - Inform all pregnant women about Step 3 - Inform all pregnant women about the benefits and management of the benefits and management of breastfeeding.breastfeeding.
Breastfeeding counselling to most Breastfeeding counselling to most pregnant women at antenatal servicepregnant women at antenatal service
written antenatal education:written antenatal education: importance of exclusive breastfeeding forimportance of exclusive breastfeeding for
6 months6 months benefits of breastfeedingbenefits of breastfeeding basic breastfeeding managementbasic breastfeeding management
Antenatal education Antenatal education includes:includes:
Importance of :Importance of : skin to skin contactskin to skin contact early initiationearly initiation rooming in 24 hoursrooming in 24 hours on demand feedingon demand feeding exclusive BF for 6 exclusive BF for 6
monthsmonths risk of artificial risk of artificial
feedingfeeding
reflect attendance reflect attendance to BF lecture to BF lecture
protected from oral protected from oral & written instruction & written instruction for artificial feeding for artificial feeding
Step 4 - Help mothers initiate Step 4 - Help mothers initiate breastfeeding within an hour after birth.breastfeeding within an hour after birth.
Immediate Skin to Immediate Skin to skin contact at skin contact at least for one hour least for one hour after birthafter birth
immediately after immediately after birth for I hr - NVDbirth for I hr - NVD
as soon as mother as soon as mother is responsive - CSis responsive - CS
First Crawl Video
Step 5 - Show mothers how to Step 5 - Show mothers how to breastfeed & maintain lactation, even breastfeed & maintain lactation, even if they should be separated from their if they should be separated from their infants.infants.
Offer assistance with Offer assistance with breastfeeding within 6 hours of breastfeeding within 6 hours of deliverydelivery
show how to express milk show how to express milk
proper positioning / proper positioning / attachmentattachment
where they could get helpwhere they could get help
Mother with Mother with previously previously encountered encountered problem problem should be given should be given special special attention and attention and supportsupport
Step 6 - Give newborn infants no Step 6 - Give newborn infants no food or drink other than breastmilk, food or drink other than breastmilk, unless medically indicated.unless medically indicated.
Cup feedingCup feeding is recommended is recommended
Dental Obturator Dental Obturator for cleft lip / for cleft lip / palatepalate
Breastmilk storageBreastmilk storage
Step 7- Practice rooming in – allow Step 7- Practice rooming in – allow mothers & infants to remain mothers & infants to remain together together – 24 hours a day.– 24 hours a day.
EXCEPTEXCEPT
- for a period of 1 hour for - for a period of 1 hour for hospital procedureshospital procedures
- separation is medically - separation is medically indicatedindicated
Step 8 - Encourage Step 8 - Encourage Breastfeeding Breastfeeding on Demand.on Demand.
NO restrictions on NO restrictions on frequency or frequency or length of length of breastfeedingbreastfeeding
Advised to Advised to breastfeed when breastfeed when babies are hungrybabies are hungry
As often as baby As often as baby wantswants
awaken & feedawaken & feed
Step 9 - Give NO artificial teats or Step 9 - Give NO artificial teats or pacifiers (dummies or soothers) to pacifiers (dummies or soothers) to
breastfeeding infants.breastfeeding infants.
Mothers informed on the risk Mothers informed on the risk associated with feeding milk / associated with feeding milk / other liquids with teats & other liquids with teats & bottlesbottles
and the use of pacifiersand the use of pacifiers
Step 10 - Foster the establishment of Step 10 - Foster the establishment of breastfeeding support groups and refer breastfeeding support groups and refer mothers to them on discharge from the mothers to them on discharge from the
clinic or hospital.clinic or hospital.
Mothers should confirm their plans to Mothers should confirm their plans to BFBF
Staff should describe how / where to Staff should describe how / where to reach the breastfeeding support groupreach the breastfeeding support group
CommunityCommunityHospitalHospital
Nursing staff should also be aware of Nursing staff should also be aware of itit
Printed materials available Printed materials available before discharge before discharge
Encouraged follow up after 2-4 Encouraged follow up after 2-4 days & in the 2days & in the 2ndnd week week
Facility has / allows trained BF Facility has / allows trained BF mother support counsellorsmother support counsellors
Compliance to the Philippine Code of Compliance to the Philippine Code of Marketing of Breast-milk substitutesMarketing of Breast-milk substitutes
The head / director of maternity The head / director of maternity services reports that:services reports that:
NONO employees of employees of manufacturers or manufacturers or distributordistributors s of breastmilk substitutes, of breastmilk substitutes, bottles, bottles, teats, pacifiers have direct teats, pacifiers have direct contactcontact with pregnant women with pregnant women
4/5
Compliance to the Philippine CodeCompliance to the Philippine Code
The hospital The hospital does does not receive not receive
free gifts, free gifts, non-scientific non-scientific
lectures,lectures, materials or materials or
equipments, equipments, money or support money or support
for in-service for in-service education…..education…..
No pregnant No pregnant women, motherswomen, mothers or their or their families families are given are given
marketing marketing materials, materials, samples, samples,
gifts by the gifts by the facility facility
Acceptable Medical Reasons Acceptable Medical Reasons for supplementationfor supplementation
Exclusive breastfeeding IS THE NORM
There is a small number of situations that
maybe a medical indication for
SUPPLEMENTING breastmilk or for NOTSUPPLEMENTING breastmilk or for NOT
USING breastmilk…..USING breastmilk…..
1.1. Infants who cannot be fed at the Infants who cannot be fed at the breast but breast but breastmilk still remains breastmilk still remains the food of the food of choicechoice
ex…infant weak / oral abnormality / ex…infant weak / oral abnormality / separated from mom separated from mom
2. Infants who may need other nutrition 2. Infants who may need other nutrition in in addition to breastmilk addition to breastmilk
ex…low birth weight or preterm < 1500 ex…low birth weight or preterm < 1500 gms or 32 weeks / infants at risk of gms or 32 weeks / infants at risk of hypoglycemia hypoglycemia because because of medical problemof medical problem
Acceptable Medical Reasons Acceptable Medical Reasons for supplementationfor supplementation
3.3. Infants who should not receive Infants who should not receive breastmilk or any other milk including breastmilk or any other milk including the usual BM susbstitutesthe usual BM susbstitutes
ex…inborn errors of metabolism like ex…inborn errors of metabolism like galactosemia / phenylketonuriagalactosemia / phenylketonuria
4. Infants for whom breastmilk is not 4. Infants for whom breastmilk is not availableavailable
ex… mother who died ex… mother who died
no nursing mother availableno nursing mother available
Acceptable Medical Reasons Acceptable Medical Reasons for supplementationfor supplementation
5.5. Maternal conditions that affect Maternal conditions that affect breastfeeding recommendationsbreastfeeding recommendations
mother very weakmother very weak mother taking medicationsmother taking medications
antimetabolities / antimetabolities / radioactive iodine / some radioactive iodine / some anti-thyroidanti-thyroid
maternal addiction maternal addiction tobacco / alcohol / drugtobacco / alcohol / drug
HIV infected mothersHIV infected mothers
Acceptable Medical Reasons for supplementationAcceptable Medical Reasons for supplementation
HIV and Infant FeedingHIV and Infant Feeding
Have policy to support feeding the Have policy to support feeding the HIV positive motherHIV positive mother
Mother informed on:Mother informed on: Transmission of HIV Transmission of HIV Feeding optionsFeeding options Importance of testing & Importance of testing &
counsellingcounselling Maintain confidentialityMaintain confidentiality
UNICEF/ WHO/ UNAIDS UNICEF/ WHO/ UNAIDS Infant Feeding Recommendation for HIV-Infant Feeding Recommendation for HIV-positive Womenpositive Women
When replacement feeding is acceptable, When replacement feeding is acceptable, feasible, affordable, sustainable and safe, feasible, affordable, sustainable and safe, (AFASS) avoidance of all breastfeeding (AFASS) avoidance of all breastfeeding by HIV-infected mothers is recommended. by HIV-infected mothers is recommended.
Otherwise, exclusive breastfeeding is Otherwise, exclusive breastfeeding is recommended during the first months of recommended during the first months of life and should be then discontinued life and should be then discontinued as soon as it is feasible.as soon as it is feasible.
Roles and Responsibilities
National Management Committee of DOHNational Management Committee of DOHChair-Usec for Health OperatiosChair-Usec for Health OperatiosCo-chair-Usec for External AffairsCo-chair-Usec for External Affairs
CHD Assessor’s Team Regional CoordinatorsCHD Assessor’s Team Regional Coordinators
Dr. Jose Fabella Memorial HospitalDr. Jose Fabella Memorial Hospital
Self Assessment of the health facilitySelf Assessment of the health facility
CHD Validation of submitted self-assessment formCHD Validation of submitted self-assessment form
Issuance of a Certificate of Commitment valid for two Issuance of a Certificate of Commitment valid for two yearsyears
Re-Assessment by the CHD MBFHI Assessors Team after 2 Re-Assessment by the CHD MBFHI Assessors Team after 2 yearsyears
Issuance of Plaque of Accreditation for sustained Issuance of Plaque of Accreditation for sustained implementation implementation
and integration of the mother-friendly and integration of the mother-friendly indicatorsindicators
Annual MBFHI Implementation Report submitted by the Annual MBFHI Implementation Report submitted by the health health
facility to the CHDfacility to the CHD
MBFHI Accreditation Process 5/5