Good day, these are the things that every personnel should know about

breastfeeding and about our policy, please try to read and make sure to keep it from
the DOH assessor or any inspector.
1. Does your hospital have a written policy on breastfeeding?
Answer: yes.
2. When was the last delivery in your hospital?
Answer: around December 2014
3. Are all staff given instruction on the implementation of this policy with
mothers and babies?
Answer: yes
4. Could you describe how instruction on the policy is given?
Answer: before we had undergone the 20 hours training from our maternity
nurse ms.nurkida ismael. It was divided into a couple of days (4 days/5 hours
per day). To new employees, included in the orientation day.
5. The written breastfeeding policy addresses all ten steps. Answer: yes
6. The policy does not permit posters and promotion for breastmilk substitutes,
bottles, teats or pacifiers. Answer: does not permit
7. The policy does not permit group instructions in the use of infant formula.
Answer: does not permit
8. Where are the breastfeeding policy displayed?
Answer: ER, LOBBY, BREASTFEEDING STATION, ALL PRIVATE ROOMS.
9. Is the policy displayed in the language(s) most commonly understood by
staff?
Answer: yes, it is in English and Visayan dialect
10.Are there written curricula or course outlines for the training in breastfeeding
and lactation management? Answer: yes
11.Are mothers told any recommendations on how often or how long they feed
their normal babies? Answer: yes.
What are they told? Answer: breastfed per demand,
12.Are breastfeeding babies ever given feeds using bottles with artificial teats or
nipples?
Answer: no
13.Are breastfeeding babies allowed to suck on pacifiers (dummies or soothers)
while in the hospital? Answer: no
14.Does the hospital have a system of follow-up support for breastfeeding
mothers after they are discharged?
Answer: yes, we give them breastfeeding referral slips mostly addressed to
their nearest rural health unit.
15.How are mothers referred to them?
Answer: through written materials (breastfeeding referral slip) and through
counseling (health teaching

For nurses only:

1. Do you show or teach mothers how to position and attach their babies for
breastfeeding? Answer: yes.
Note: you might be ask to demonstrate how you do the teaching to a mother
in the ward.
Key points: babys body must be turned to mother, close, in alignment;
mouth wide open, lips flanged; chin touching breast; more of areola below
nipple in mouth; cheeks not drawn in, rhythmic burst-pause suckling and
swallowing.
2. Do you show or teach mothers how to express their breastmilk, by hand in
case they are separated from their infants?
Answer: yes.
Note: you might be ask again to describe the techniques for expressing milk
manually. Key points: thumb on areola, fingers opposite; press inwards; do
not slide fingers on skin; repeat press-release for several minutes; stimulates
milk ejection reflex; rotate around nipple to compress all sinuses.
(Note: it is not expected that staff will manipulate a mothers breast. They
may teach her to do it herself, or simply describe the technique. If they
demonstrate on a mother, the assessor should ask the mother if it hurt. A
yes answer indicates inadequate hard expression technique has been used.
3. Could you please mention at least three policies or procedures that can help
promote breastfeeding in hospital maternity wards.
Key points: early start; 24 hour rooming-in, demand feeding; no bottles; no
prelacteal feeds; helping mothers self confidence.
4. Does prelacteal feeding interfere with breastfeeding?
Answer: yes.
Key points: nipple confusion; decreased eagerness to breastfeed; allergic
sensitization; mothers sense of inadequacy.
5. What is the major cause of painful nipples?
Key points: poor attachment; baby not taking enough of breast into mouth.
6. What is the common cause of insufficient milk?
Key points: not enough effective brestfeeding
7. What is the common cause of engorgement?
Key points: not enough effective breastfeeding in the first few days.
8. How often does the mother should breastfeed her baby?
Answer:
9. What will you tell the mother if her baby sleeps too long or her breast
become overfull?
Answer:

10. For pregnant mothers and breastfeeding mothers they should know about at
least two benefits of breastfeeding.
Key notes: nutritional, protective, promote bonding, health benefits to
mother.
11.Nurses must do health teaching to mothers and expectant mothers especially
teachings about how important rooming-in is, benefits of breastfeeding to
both mother and baby, importance of feeding on demand, how important is
proper positioning and attachment of baby during feeding.
12.Risk to children who are NOT breastfed:
1. More likely to get sick or die from diarrhea and GI infections or chest
infections
2. Become underweight, not grow well
3. Overweight and to have later heart problems
13.Women who DO NOT breastfeed are likely to:
1. Develop anemia, retain fat deposited during pregnancy later obesity
2. Become pregnant soon
3. May develop breast cancer
4. May have hip fracture in older age
14.Benefits to the FAMILY:
ECONOMICAL
1. Readily available / no preparation
2. Simple / no equipment needed
3. Reduced absences of parents from work
4. No lost of income
15. What are the practices that can help breastfeeding go well?
Answer: Hospital practices:
- Companion during labor
- Avoidance of labor & birth interventions
Skin to skin immediately after birth
- Rooming-in / bedding-in
- Know feeding signs / frequent feed
- Exclusive BF
16. What are the practices that can help breastfeeding go well?
Answer: TEACHING how to position and attach the baby correctly.
GIVING support when needed.

Information on HIV

All pregnant women are offered voluntary and confidential HIV

counselling and testing. If a woman is HIV-infected there is a risk of
transmission to the baby during the pregnancy and birth, as well as
during breastfeeding. If the pregnant woman knows that she is HIVpositive then she can make informed decisions.
About 5-15% of babies (one in 20 to one in seven) born to women who
are HIV infected will become HIV-positive through breastfeeding. This
means most infants born to women who are HIV-positive will not be
infected through breastfeeding.
Can you breastfeed an older baby during a succeeding pregnancy?

 No need to stop
Has history of premature labor/ uterine cramping - consult
Should take care of herself eat & rest
Protecting Breastfeeding; PHILIPPINE CODE OF MARKETING OF
BREAST-MILK SUBSTITUTES (E.O.51)
Main Points Of the Milk Code
Health workers should promote and protect breastfeeding, and help
women initiate, sustain and maintain breastfeeding (Public and Private)
No donations of products (breastmilk substitutes and other products)
covered by the Law
No promotion in the health care system (private and public)
No free samples to mothers
No gifts to health workers (private and public)
No company personnel/med rep/milk rep to advise/educate/inform
mothers/pregnant women
All advertising of breast-milk substitutes and other covered products to
the public should be.
No pictures of infants and young children, or other pictures idealizing
artificial feeding, on the labels of the products.
Information to health workers should be scientific and factual.
Information on artificial feeding, including that on labels, should
explain the benefits of breastfeeding and the costs and dangers
associated with artificial feeding.
Step 4 of the Ten Steps to Successful Breastfeeding states:
Help mothers to initiate breastfeeding within a half-hour of
birth.
To focus on the importance of skin-to-skin contact and watching
for infant readiness, this step is now interpreted as:
Place babies in skin-to-skin contact with their mothers
immediately following birth for at least half an hour or at
least an hour and encourage mothers to recognize when
their babies are ready to breastfeed, offering help if
needed.

What practices HELP a woman initiate breastfeeding soon after

birth?
Practices that Helps: Emotional support during labor, Attention on
the effects of pain medications on the baby, Offering light foods and
fluids during labor, Freedom of movement during labor, Avoidance of
unnecessary CS, Early mother-baby contact, Facilitate the first feed.

 Practices that may HINDER: Lying on bed during labor & delivery,
Lack of support, Withholding food and fluids, Pain medications / IV
lines, Episiotomy, Wrapping baby, Separating the mother from the
baby.
Skin to skin contact
ENSURE uninterrupted, unhurried skin to skin contact
Start immediately, even before cord clamping,
Arrange that this skin to skin contact continue for at least one hour
after birth.
Importance of skin to skin contact
Enables colonization of babys gut with mothers normal
body bacteria
Facilitates bonding
Allows the baby to find the breast and self
How milk get from breast to baby