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Integrating Breastfeeding Promotion, Protection, and Support

• International models exist for integrating breastfeeding promotion, protection, and support.
• These models balance technical information, programs, and protocols.

Jose Fabella Memorial Hospital: A Case Study

• The hospital is located in the Philippines.
• Since 1986, the hospital has undergone radical changes to become baby-friendly.
• Previously, mothers and babies were separated at birth, with infants sent to nurseries.
• This separation led to issues like women abandoning their newborns.

Changes Implemented

• Mothers and babies now share the same rooms to foster a strong emotional bond.
  • Staff retraining and mother re-education were necessary to promote breastfeeding.
• This change has significantly reduced the number of mothers deserting their children.
• Tandem beds were introduced to eliminate the risk of babies falling and to allow mothers to support each other.
• Closing the nursery resulted in savings of approximately $6,500,000.0$ pesos per year.
  • This is due to not buying milk formulas, feeding bottle sets, sterilization equipment, and reduced staff salaries.
• The cost saving is equivalent to 8% of the hospital's total budget.

Impact on Infection Rates

• Initially, some doctors feared increased infection rates with rooming-in.
• However, infection rates actually decreased after implementing the changes.

Breastfeeding and Family Planning

• Breastfeeding helps in family planning by increasing the time between births (e.g., two to three years).

Challenges and Considerations

• Managing visitor access in the ward with 100 babies is challenging due to security concerns.

Ministry of Health Support in The Philippines

• The Ministry of Health supports breastfeeding.
• They are strongly behind the UNICEF and WHO initiative to create baby-friendly hospitals.

Jose Fabella Memorial Hospital: Overview

• Located in the Central Market District of Manila.
• It is the largest government maternity and childcare institution in The Philippines.
• The hospital delivers approximately 35,000 babies each year.

Overcoming Challenges in Implementing Changes

• Campaigns by infant food companies had created the misconception that formula is as good as breast milk.

Benefits of Breastfeeding

• Babies have fewer illnesses when exclusively breastfed for the first four months of life.
• 30% of babies born at Fabella are in a high-risk category and need breast milk the most.

Antenatal Classes

• Antenatal classes educate mothers about breastfeeding and address their concerns.

Duration of Breastfeeding

• UNICEF and WHO recommend breastfeeding up to two years and beyond.

Training of Midwives

• Student midwives are trained in the care and protection of breastfeeding.
• Proper breastfeeding positions are taught.
• Tapping a baby's cheek to encourage feeding is an accepted custom, though not always necessary.

Addressing High-Risk Babies

• Premature babies are nourished with breast milk, even if they cannot breastfeed directly.

Milk Expression and Storage

• Mothers express milk soon after birth.
• The milk is stored in a milk bank and given via choke or syringe.
• As the infant gets stronger, milk is given by cup.
• Bottles are avoided to prevent nipple confusion.
• Mothers breastfeed premature babies in a special room.

Breastfeeding and Hospital Staff

• Breastfeeding impacts the work of various staff members.
• Men modify beds to allow mothers to sit comfortably while breastfeeding.
• Dentists fit plates for babies born with cleft palates to aid breastfeeding.
• Midwives ensure mothers and babies are together within minutes of birth to initiate breastfeeding.

The Role of Oxytocin

• Suckling stimulates uterine contractions, reducing the need for oxytocin.

Maternal Care and Nutrition

• Mothers receive three regular meals a day, with additional snacks in the mornings and afternoons.
• Upon discharge, all mothers are breastfeeding.

Post-Discharge Support

• The lactation brigade of community volunteers provides continued support.
• Without support, problems can arise at home.

Addressing Issues Like Thrush

• Mothers may return to the hospital if their baby develops issues like thrush.

Nikki's Story

• Nikki, born prematurely, had a better start in life due to exclusive breastfeeding and hospital follow-up.