BFI Practices
Why is mother-baby togetherness important?
Being together helps mothers/birthing parents learn to recognize and respond to their infants’ cues for feeding, closeness and comfort. This helps mothers/birthing parents build a caring, nurturing relationship with their infants and increases their confidence in themselves, in feeding baby, and in their infants’ growth and development.
What products are covered by the WHO Code?
Breastmilk substitutes, feeding bottles and teats.
This includes any formulas or products that can be used to replace human milk that are specifically marketed for feeding infants and young children up to the age of 3 years. It includes special needs, follow-up and growing up formulas and other foods and beverages such as teas, juices and waters being promoted as suitable for feeding baby during the first 6 months of life.
Describe two practices that increase breastfeeding success.
Examples
Immediate and uninterrupted skin-to-skin with the birthing parent and baby unless their is a justifiable medical reason for not doing this.
Early frequent breastfeeding.
Responding infant hunger cues in a timely manner.
Effective latching.
Describe one way that human milk differs from infant formula.
Examples
Human milk is species specific and the healthiest milk for human babies.
Human milk is a living fluid and changes from the start of the feeding to the end of the feeding, from one feeding to the next, and over time.
Human milk has many more ingredients than infant formula and many of the ingredients have not been able to be replicated by formula manufacturers.
Human milk has immunologic and anti-inflammatory properties that are not in infant formula.
Feeding infant formula is more costly than breastfeeding.
Describe a common barrier to successful breastfeeding.
Examples
Misconceptions about the importance of human milk/breastfeeding for infant health.
Misconceptions about the impact of infant formula supplementation when it is not needed for the wellbeing of the baby.
Practices of healthcare providers such as giving a breastfeeding parent infant formula in case breastfeeding doesn't work out.
Marketing strategies of infant formula companies.
Feeding according to a schedule and timing feedings rather than feeding baby responsively according to baby's feeding cues.
Not being able to access timely help if a breastfeeding problem arises.
Incorrect information and misconceptions about normal infant behaviour, infant growth and development, breastfeeding, supplementation for non-medical reasons etc.
Describe one way to show that you welcome breastfeeding at your facility.
Examples
Post signage that breastfeeding is welcome at reception, waiting areas, cafeteria etc.
Indicate on website and social media platforms that breastfeeding is welcome in all public areas of your facility.
Display posters, life-size cut-outs etc. of people breastfeeding.
Describe one reason why the WHO Code remains relevant in Canada.
Examples
A lack or strong legislation, monitoring and enforcement of the WHO Code and subsequent World Health Assembly resolutions allows many violations to occur.
Companies that fall under the scope of the Code promote their products with expectant and postpartum families in a variety of ways including mass media, television, promotions at retail stores and pharmacies, baby clubs etc.
Companies that fall under the scope of the Code continue to connect with health care providers and provide them with free samples, coupons, promotional materials and free gifts.
Some health care providers lack knowledge about the WHO Code and the importance of complying with the WHO Code.
What is responsive, cue based feeding?
Responsive feeding is feeding in response to the infant's cues and puts no restrictions on the frequency or length of the infant’s feeds.
It is better to feed tin response to early hunger cues. Optimal positioning and attachment (latching) are more difficult when an infant is in distress.
It is important for parents to also learn and respond to stress cues during a feeding and signs of satiety.
Why is it important to prepare infant formula according to the instructions on the package?
Examples
Incorrect preparation can jeopardize the health of the baby.
Harmful germs can cause the baby to become sick.
Adding too much water to concentrated or powdered formula dilutes the formula and can prevent the baby from getting adequate nutrition.
Adding too little water to concentrated or powdered formula can place a burden on the baby's kidneys and digestive system and can also cause baby to become dehydrated.
Canada's Breastfeeding Progress Report 2022 indicates that over 91% of mothers initiate breastfeeding in Canada. The biggest decline in both exclusive and any breastfeeding happens before baby reaches the age of 1 month. The top reason for stopping breastfeeding during the first month is "not enough breastmilk". Describe one way to help lessen the breastfeeding drop off rate prior to baby reaching 1 month old.
Examples
Prenatal education about importance of breastfeeding, effects of supplementing baby for no medical reason, normal infant growth and development etc.
Improve access to pasteurized human donor milk when there is a medical reason for supplementation.
Access to timely breastfeeding help when it is needed and for as long as it is needed.
Improve rates of immediate and uninterrupted skin-to-skin at birth.
Increase number of health care providers with adequate knowledge and skill to help with breastfeeding concerns.
Increase enforcement of the WHO Code - eg marketing strategies of manufacturers.
Describe two topics included in the international protocol for prenatal discussion.
Importance of breastfeeding; global recommendations on exclusive breastfeeding for the first 6 months, the risks of giving formula or other breast-milk substitutes, and the fact that breastfeeding continues to be important after 6 months when other foods are given; the importance of immediate and sustained skin-to-skin contact; the importance of early initiation of breastfeeding; the importance of mother-baby togetherness (rooming-in); the basics of comfortable and effective positioning and attachment; recognition of infant feeding cues.
Describe one way that a healthcare facility can show compliance with the WHO Code.
Examples:
All infant formula, feeding bottles and teats used in the facility are purchased through normal procurement channels and not received through free or subsidized supplies.
There is no display of products covered under the Code or items with logos of companies that produce breast-milk substitutes, feeding bottles and teats, or names of products covered under the Code.
The facility has a BFI policy that describes how it abides by the Code.
Staff do not give samples or coupons for breast-milk substitutes, feeding bottles or teats to mothers/families.
Describe two signs that a baby is feeding effectively.
Examples
Deep, rhythmic sucking.
Audible swallowing.
Adequate number of wet and dirty diapers for age.
Why is colostrum (mother's first milk) important for a newborn baby?
Examples
The composition of colostrum differs from mature human milk and is perfect for the newborn baby.
Colostrum protects the baby against many bacteria and viruses.
Colostrum has a laxative effect that stimulates the elimination of meconium (baby's first bowel movements) and this helps to prevent jaundice.
Survey findings show that many families are being helped at the first feeding but leaving hospital feeling like they are not getting the help that they need with infant feeding and care. Describe one action that might help narrow this gap.
Examples
Complete chart audits to see what information about infant feeding and care is being covered with families during their hospital stay and at time of discharge.
Provide inservice to direct care providers and give them a checklist of information to review with postpartum families during their hospital stay,
Establish a workgroup to explore ways to increase support around infant feeding and care. Include both hospital and community health services. See if peer support volunteers could meet with families in hospital and transition to community when family is discharged from hospital.
Why is skin-to-skin care important for the birthing parent and baby?
Examples
It stabilizes the baby's body temperature, heartbeat, breathing and blood-oxygen levels.
It decreases stress in both the baby and the birthing parent.
It facilitates breastfeeding.
It strengthens the baby's immune system.
It promotes bonding.
Describe two marketing strategies used by formula companies.
Examples
Provision of free and highly subsidized products to healthcare facilities.
Using social media influencers for product promotion and endorsement.
Advising pregnant and postpartum families about infant feeding.
Giving free samples and coupons for products covered by the Code to families.
Sponsoring education for healthcare workers etc.
At what age should complementary foods be introduced to baby?
The global recommendation is exclusive breastfeeding for 6 months and continued breastfeeding, with the addition of appropriate complementary foods, up to age 2 years and beyond.
Why is feeding pasteurized donor human milk from a regulated human milk bank to babies in the NICU better than feeding commercial infant formula?
Pasteurized donor human milk is superior to infant formula because it supports optimal growth of the baby, improves immune function, helps the baby's neurodevelopment and lessens the risk of health complications such as necrotizing enterocolitis.
A city is trying to revitalize it’s downtown. There are no comfortable spaces in the plans for infant feeding or milk expression. Describe one action that could be part of a gap busting plan.
Examples
Notify planning committee of concern and offer to meet with them to provide further information.
Offer to attend a meeting of the planning group to explore options for inclusion of comfortable spaces for infant feeding/milk expression. Eg. a few benches in the downtown revitalization plan and a private space for infant feeding/milk expression in public buildings such as arena, city hall, post office etc.
Talk with restaurant owners, provide an information package, and have them post signs welcoming breastfeeding in the restaurant.
Why is ongoing monitoring of practices and breastfeeding surveillance important for hospitals and community health services?
Ongoing monitoring of practices is helpful in determining trends, areas that need strengthening, and areas of achievement.
A quality-improvement approach is very relevant for the BFI and helps to improve sustainability.
The overall goal of the BFI is to protect, promote and support breastfeeding. Breastfeeding surveillance at key time points is fundamental in determining breastfeeding rates, trends, and whether targets are being met.
Canada's Breastfeeding Progress Report (2022) shows that 9/10 mothers initiate breastfeeding and the biggest decline in breastfeeding happens in the first month of life (1 in 7). Canada has an exclusive breastfeeding rate of 34.5% at 6 months. The global target is an exclusive breastfeeding rate of at least 50% by 2025 and 70% by 2030. More work is needed in our country!
Why should health care providers not give samples of infant formula to families?
Examples
This is a violation of the WHO Code.
It can undermine the parent's confidence in breastfeeding.
It implies endorsement of the product by the health care provider. This is a marketing tactic of manufacturers of infant formula.
Describe one reason why continued breastfeeding after the introduction of complementary foods at 6 months is recommended.
Examples
Breastmilk is nutritious and changes over time to best suit baby's needs.
Breastmilk continues to provide the baby with immunologic protection.
Breastfeeding is comforting to babies and can soothe them when distressed.
Describe one reason why combining breastfeeding and formula feeding is not recommended unless there is a medical reason to supplement the breastfed baby with infant formula.
Examples
Combining breastfeeding and formula feeding can lessen the breastfeeding parent's milk supply.
Impact of infant formula on baby's microbiome.
The amount of breastmilk consumed by baby will be less and this lessens the amounts of the nutrients, antibodies etc. baby receives from the breastmilk.
No in-person prenatal classes are being offered in the area. Online prenatal classes are available in English. Survey findings show that few families have received prenatal education and those that signed up for online classes often did not complete the sessions. Describe one action that could be helpful in the action plan to narrow this gap.
Examples
Establish a workgroup with representation from hospital, community health services, providers of online prenatal classes, peer support people such as La Leche League etc.
Share survey findings with area physicians/obstetricians and see if they will give patients a questionnaire to complete to help determine the causes and possible ways to increase prenatal education of families.
Consult with other providers of prenatal education in Ontario (and beyond) and see how they are providing prenatal education, their attendance, and client/staff satisfaction with level of knowledge of attendees around topics in the international protocol for prenatal discussions.