Tasmanian Health Organisation - North

HEALTH AND HOSPITALS - TASMANIAN HEALTH ORGANISATION NORTHLAUNCESTON GENERAL HOSPITAL

Breastfeeding Policy
SDMS Id Number LGH Policy No. Effective From Functional Sub Group Summary P2010/0299-001 27/12 (7.2/12WACS) 17 July 2012 Women's and Children's Services - Lactation The LGH Breastfeeding Policy is based on the "Ten Steps to Successful Breastfeeding" and BFFHI principles. It is used in conjunction with the Breastfeeding Guidelines to underpin practice and to ensure consistent advice and information is given. The Wor LGHCLINProc 02/09; WACSClinProc7.2/09 1. Health and Hospitals - Tasmanian Health Organisation NorthLaunceston General Hospital Womens and Childrens Services Jill Hanson & Dianne Haworth, Clinical Nurse Consultant: Lactation All Employees - LGH All Staff 17 July 2015

Replaces Doc. No. Version No. Author Area

Contact Applies to Policy Type Review Date

Introduction/Purpose
The World Health Organisation (WHO) recommends all infants be exclusively breastfed for the first six months of life, with the introduction of complementary foods and continued breastfeeding for up to two years and beyond, as mother and baby wish. This hospital recognises the vast research showing the important health benefits for the breastfeeding mother and infant. The choices parents make about infant feeding should be based on an informed understanding of the risk of alternative approaches.

Policy Statement
The Breastfeeding Policy of this hospital is based upon the Ten Steps to Successful Breastfeeding and BFHI principles. It is to be used in conjunction with the Breastfeeding Guidelines to underpin practice and to ensure current, evidence-based and consistent advice and information is given.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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Key Definitions
DHHS and the Agency refer to the entire Department of Health and Human Services made up of: Departmental Units responsible for policy, planning and performance; and interface with government, and Operational Units responsible for delivering services against policies, plans and standards set by the departmental units, the Tasmanian Health Organisations (the THOs) responsible for providing hospital and primary and community health services. Baby Friendly Health Initiative (BFHI) was developed jointly by the World Health Organisation (WHO) and UNICEF in 1991. The initiative is a global effort for improving infant health by supporting mothers to breastfeed their babies. Health facilities play a key role in educating parents and guiding their choices regarding feeding and caring for their babies. BFHI provides the standards facilities must meet to ensure they are providing best-practice care and maintaining a breastfeeding-supportive environment. The Ten Steps to Successful Breastfeeding are the criteria against which hospitals are assessed and accredited. BFHI is administered in Australia by the Australian College of Midwives. BFHI in Australia manages the assessment and accreditation of facilities and provides information and advice relating to BFHI standards. Australian Federal and State government initiatives and health goals mirror the WHO breastfeeding recommendation and support BFHI establishment within maternity hospitals. Exclusive Breastfeeding refers to a breastfed or breastmilk fed baby having no other liquids or solids with the exception of drops or syrups consisting of vitamin or mineral supplements or medicines. Supplementary feeding refers to a breastfed baby having one or more fluid feeds, including infant formula, but excluding expressed breastmilk. A supplement is considered acceptable if it complies with the WHO Acceptable Medical Reasons for Use of Breastmilk Substitutes (2009), or there is documentation of mothers request of an informed choice.

Principles
The Ten Steps to Successful Breastfeeding, provide standards for implementation to promote, protect and ensure successful Breastfeeding. Every Australian facility providing maternity services and care for newborn infants should: 1 2 3 4 Have a written breastfeeding policy that is routinely communicated to all health care staff. Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about the benefits and management of breastfeeding. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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5 6 7 8 9 10

Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants. Give newborn infants no food or drink other than breastmilk, unless medically indicated. Practice rooming-in allow mothers and infants to remain together 24 hours a day. Encourage breastfeeding on demand. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. Foster the establishment of breastfeeding support and refer mothers on discharge from the facility.

BFHI standards ensure that any mother, undecided about breastfeeding, is provided with information and options, and encouraged to make an informed decision for herself and her baby. Mothers who are not breastfeeding receive one-to-one support in feeding and caring for their baby. Optimal infant health and a positive and empowering experience for mothers is the focus, regardless of feeding choices. The Ten Steps to Successful Breastfeeding are beneficial for all mothers and babies: promoting bonding, confidence and responsiveness to their babys individual need.

Implementation/Policy in Operation
Have a written breastfeeding policy that is routinely communicated to all staff:
o o All staff who have access to pregnant and breastfeeding families must utilise the Breastfeeding Policy and Breastfeeding Guidelines The policy summary (Attachment 1) is to be displayed in all areas of the Womens and Childrens Services.

Educate all staff in skills necessary to implement this policy:

o All current midwifery and nursing staff who care for pregnant and breastfeeding women will receive 8 hours education in lactation management, BFHI, the Breastfeeding Policy and Guidelines every 3 years. All new staff since preceding BFHI accreditation, who assist mothers with breastfeeding in the maternity, neonatal or paediatric area are required to have 20 hours of education, commencing within 6 months of starting work. This can include 12 hours of Recognition of Prior Learning (RPL) from the last 10 years and a minimum of 3 hours of supervised clinical practice (SCP). Medical and allied health staff working within WACS, who may provide advice but do not assist mothers with breastfeeding, will complete a minimum of 2 hours of education on lactation, including orientation to this policy.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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Orientation to the policy and a basic understanding of lactation support will be provided to all staff who have regular access to pregnant women, mothers and babies within the LGH, but do not provide advice or assistance All staff commencing work at LGH will be given brief orientation to this policy and information regarding BFHI accreditation and its impact on patient care.

Inform all pregnant women of the benefits and management of breastfeeding:

o Information will be given to parents at opportunities during booking-in, antenatal clinic appointments, antenatal education classes and antenatal admission with documentation within patient records as applicable. Pregnant women will be given opportunity to discuss previous experience or anticipated problems and if indicated, an appointment can be made to discuss further with a Lactation Consultant.

Initiation of feeding:
o All mothers, irrespective of type of birth and feeding intention, are encouraged to hold their baby skin-to-skin as soon as possible after birth. This can continue until after the first feed, or for at least an hour and for as long as mother and baby desire. Encourage breastfeeding mothers to recognise their babies feeding cues and innate behaviours seen in preparation for commencing breastfeeding, offering support and assistance if needed.

Show mothers how to breastfeed, and how to maintain lactation if they have to be separated from their infants:
o Staff should aim to observe a mother breastfeed at least once each shift. Provide verbal cues and reassurance when needed and offering to use hands-on assistance only if clinically indicated. Document findings and feeds in Neonatal Pathway or feed chart. Every breastfeeding mother will be shown how to hand express and given information about safely storing breastmilk. Where a mother and her infant are separated, the mother is encouraged to express as soon as practical after birth and frequently thereafter, at least six to eight times per 24 hours.

o o

Indications for Supplementary Feeds

o An infant whose mother plans to breastfeed, shall receive no food or drink other than breastmilk, unless medically indicated or at the parents request, after making an informed decision, which is documented. When indicated for medical reasons, midwifery, nursing or medical staff will discuss this with the parents and provide appropriate information and document same. Refer to Breastfeeding Guidelines WACS ClinProc 7.4, Appendix 3 regarding Acceptable Medical Reasons for use of Breastmilk Substitutes.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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Support mothers and infants to be together 24 hours a day

o Staff provide support to the mother and partner/significant other, to enable them to develop skills to assume primary responsibility for the care of their infant/s. Assistance with settling may be achieved through effective and frequent feeding, a range of settling techniques and use of the Parenting Room. Babies should only be separated from their mothers for short periods for medical procedures or assessment. Whenever possible, this should be done at the bedside. Mothers can request to be temporarily separated from their infant provided they have given informed consent which has been documented. If clinically, the mother requires a short time away from her infant to allow rest, the infant is to be observed at all times by a responsible person, with appropriate documentation. The circumstances and duration of all separations lasting more than one hour must be documented.

o o

Encourage demand feeding

o o o No restrictions shall be placed on a healthy term infant regarding the frequency or length of breastfeeds. Midwives and nurses will teach and support parents to recognise early feeding cues. Mothers will be made aware of what to do if their breasts become uncomfortably full and their baby is asleep or separated from them.

Use of artificial teats, dummies and nipple shields

o o o o Parents will be advised that use of these devices during the early weeks may disrupt the establishment of lactation. If direct breastfeeding is not possible, staff will facilitate informed parental decision-making regarding alternative methods of feeding. Dummies will not be provided, unless medically indicated and with parent consent If it is identified that a nipple shield may assist breastfeeding establishment, the midwife or nurse shall discuss the risks and benefits of this intervention with the parents and ensure prompt referral or follow up with Lactation Consultant (via Out-Patient Breastfeeding Clinic) or Child Health nurse.

Breastfeeding Support Groups

o o Information on how to contact professional and voluntary breastfeeding and parenting support will be given to each mother prior to discharge. Lactation Consultant will follow-up referred complex breastfeeding cases in the Out-patient Breastfeeding Clinic during the immediate post discharge period.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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WHO Code implementation

o Discussion of alternative feeding methods may occur in the antenatal period, through the promotion of breastfeeding as the norm. Group education regarding artificial infant milk, bottles and teats is prohibited. Postnatally, parents who wish to artificially feed their infant will be individually shown how to prepare, give and store equipment and formula. Group instruction is not permitted. This facility will not accept free or low cost supplies of artificial infant milk (powder or ready-to-feed), nor the giving of discharge samples and supplies of artificial infant milk to parents. No advertising or promotion of breastmilk substitutes, dummies/soothers, bottles or teats is permissible in the hospital precinct. Formula company representatives are prohibited from accessing pregnant women, mothers or their families. They are also restricted from accessing nursing and midwifery staff. Education of staff regarding breastmilk substitutes, bottles and teats, will be via Lactation Consultants with Clinical Nurse/Midwifery Educator and Nurse Unit Manager. The acceptance of free gifts, non scientific literature, materials or equipment, money or support for in-service education or events from companies who manufacture artificial infant milk is prohibited. Any research which involves mothers and babies will be carefully scrutinized for potential implications on infant feeding or interference with the full implementation of this policy.

o o

Breastfeeding-Friendly Workplace
o o As per corporate protocol, flexible work arrangements and lactation breaks may be negotiated between manager and employee. Staff wishing to breastfeed or express breastmilk for their own infant, are encouraged to liaise with Lactation Consultants and their manager regarding access to a private area. If nil facility available elsewhere within the hospital, staff may negotiate a private area within a WACS ward.

Visitors to the hospital

o Visitors to the hospital are advised they are Welcome to Breastfeed anywhere within the hospital.

Breastfeeding mother or child admitted to hospital

o When hospitalisation of a breastfeeding mother is required, every effort will be made to accommodate the breastfed baby to enable breastfeeding to continue. Admission to Ward 4O during the early post partum period may be appropriate, alternatively ward 4K. Other areas of the hospital are also able to accommodate a mother and infant depending on condition and care needs.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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o Breastfed babies and children admitted to ward 4K will be accommodate such that their mother can room in with their child, the mother will receive food and fluids via normal catering services.

Rationale/Evidence Base
The Tasmanian Department of Health Food and Nutrition Policy of 2004 has Breastfeeding as one of its focus areas. The goal is: To promote and support breastfeeding in Tasmania. The sub-goals include: Increase community and environmental support for breastfeeding; Increase the percentage of infants breastfed on post-natal discharge from maternity services; Increase the percentage of infants exclusively and partially breastfed to six months of age. http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0004/54373/TFNP_final.pdf WHO/UNICEF statement (1989) Protecting Promoting and Supporting Breastfeeding: the special role of maternity services, World Health Organisation, Geneva. WHO Evidence for the Ten Steps to Successful Breastfeeding (1998) World Health Organisation, Geneva. Baby Friendly Health Initiative (BFHI) (2009) The Global Criteria for Baby Friendly Hospitals in Australia, booklet 1-5, Standards for implementation of the Ten Steps to Successful Breastfeeding, via Australian College of Midwives (ACM) the administrative body in Australia for BFHI.

Related Documents/Useful Resources

Breastmilk - Safe Management : LGH Policy 7.3-08WACS Care of Breastfeeding Equipment : LGH Policy 7.5-08WACS Donor Breastmilk and Wet Nursing : LGH Policy 7.6-08WACS currently under review currently under review currently under review

Lactation Consultant: Practice and Referral Guidelines: LGH Protocol 7.1-09WACS Hypoglycaemia in Healthy Term Newborns : LGH Protocol 4.16-07WACS

External documents/resources:
NHMRC Infant Feeding Guidelines for Health Workers (1996), update draft released Oct 2011 http://www.nhmrc.gov.au/guidelines/publications/n20 WHO Global Strategy for Infant and Young Child Feeding (2003) http://www.who.int/nutrition/topics/global_strategy_iycf/en/index.html WHO International Code of Marketing of Breastmilk Substitutes (1981) and subsequent WHA resolutions http://www.who.int/nutrition/publications/code_english.pdf Academy of Breastfeeding Medicine position statement and protocols http://www.bfmed.org/Resources/Protocols.aspx Baby Friendly Health Initiative accreditation guidelines http://www.babyfriendly.org.au/

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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National Institute for Health and Clinical Excellence: Promotion of breastfeeding initiation and duration evidence into practice briefing (2006) http://www.nice.org.uk/niceMedia/pdf/EAB_Breastfeeding_final_version.pdf Breastfeeding Friendly Workplace, Australian Breastfeeding Association (ABA) https://www.breastfeeding.asn.au/breastfeeding-friendly-workplaces-program Tasmanian Anti-Discrimination Law re breastfeeding http://www.antidiscrimination.tas.gov.au/complaints

Outcomes
Baby Friendly Hospital Initiative accreditation will be successfully maintained every three years. o o o o 80% of staff working within WACS will be educated re best practice guidelines. 75% minimum exclusive breastfeeding rate during hospital stay. 80% of supplements (minimum) meet criteria for having an Acceptable Medical Reason or at parent request. Staff returning to work from maternity leave report provision of support to continue breastfeeding

Responsibilities/Delegations
Compliance with this policy is the responsibility of all staff, with Lactation Consultants and Nurse Unit Managers utilised as resource persons when concerns arise Development and revision of this policy is the responsibility of the Lactation Consultants. Auditing of policy compliance is the responsibility of the Lactation Consultants, reporting to Nursing co-director of WACS, liaising with Nurse Unit Managers, Quality and Clinical Improvement Nurse and LGH Quality Office as required.

Audit and Compliance

Lactation Consultants will collect statistics, audit histories, staff and patients as necessary for BFHI requirements, reporting, education and quality management. BFHI assessment and accreditation undertaken every three years. Quarterly reporting of education activities. Failure to comply with this policy, without providing a good reason for doing so, may lead to disciplinary action.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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Prepared by Through Through Cleared by

Jill Hanson & Dianne Haworth Susan McBeath THON Executive Committee John Kirwan

Clinical Nurse Consultant: Lactation Co-Director WACS

6348 8934 6348 8972

14 February 2012 27 June 2012 16 July 2012

CEO Tasmanian Health Organisation North

6348 7043

16 July 2012

AUTHORISED BY CHIEF EXECUTIVE OFFICER ... John Kirwan 17 July 2012 Date

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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Attachment 1: Breastfeeding Policy Summary

To be prominently displayed in all WACs areas and appropriate areas hospital-wide.

Tasmanian Health Organisation North

LAUNCESTON GENERAL HOSPITAL

BREASTFEEDING POLICY: SUMMARY

All parents have the right to choose how they feed their infant. This choice should be based on an informed understanding of the risk and benefit of alternative approaches. The World Health Organisation (WHO) recommends all infants be exclusively breastfed for the first six months of life. UNICEF and the World Health Organisation established the Baby Friendly Hospital Initiative (BFHI). Australian Federal and State government initiatives and health goals mirror the WHO breastfeeding recommendation and support BFHI establishment within maternity hospitals. The breastfeeding policy of this hospital is based upon the Ten Steps to Successful Breastfeeding and BFHI principles. It is to be used in conjunction with the Breastfeeding Guidelines. All staff who care for pregnant and breastfeeding women will utilise the Breastfeeding Policy. Staff will receive regular breastfeeding education to increase their knowledge and skills. All women will have access to clear and correct information about the benefits of breastfeeding for themselves, their babies and their families. All mothers are encouraged to hold their infant skin-to-skin after the birth till first feed, or till one hour after birth. If mother and baby are separated, the mother is encouraged to express frequently to provide breastmilk for her baby. Each breastfeeding mother will be shown how to hand express and store breastmilk. Breastfed babies do not usually require any extra food or drink for the first six months of life. Most mothers and babies remain together so that baby's feeding patterns and mothers milk supply are better established. No restriction shall be placed on a healthy term infant regarding the frequency or length of breastfeeds. The hospital does not provide dummies for healthy babies as their use has been shown to reduce the chance of successful breastfeeding. All mothers, before leaving hospital, will be given written instruction about where to go for further help with breastfeeding.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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Individual education will be given to parents who wish to artificially feed their infant.

ORIGINAL POLICY AND REFERENCES AVAILABLE ON REQUEST

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current.
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