Background
Every facility providing maternity services and care for newborn infants should:
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1. | Have a written breastfeeding policy that is routinely communicated to all health care staff. |
2. | Train all health care staff in skills necessary to implement this policy. |
3. | Inform all pregnant women about the benefits and management of breastfeeding. |
4. | Help mothers initiate breastfeeding within one half-hour of birth.*
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5. | Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants. |
6. | Give newborn infants no food or drink other than breast-milk, unless medically indicated. |
7. | Practice rooming in – that is, allow mothers and infants to remain together 24 hours a day. |
8. | Encourage breastfeeding on demand. |
9. | Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. |
10. | Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. |
A natural birth experience is a significant prerequisite for successful breastfeeding. Therefore, mother-friendly care is a compulsory part of BFHI-certification. The criteria require, unless medically indicated that:
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a) | Mothers can bring a companion of their choice to provide continuous physical and/or emotional support during labor and birth, as desired. |
b) | Mothers can drink and eat light foods during labor, as desired. |
c) | Mothers can walk and move about during labor, as desired. |
d) | Mothers can choose a position while giving birth. |
e) | Mothers should be offered the use of non-drug methods of pain relief. |
f) | Invasive procedures such as rupture of the membranes, episiotomies, acceleration or induction of labor, instrumental deliveries, or cesarean sections should be used only for medical indications. |
g) | Standards, guidelines and training curricula of the maternity unit support mother-friendly care. |
Methods
Study design
Study setting
Participant selection
Participant and occupation
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Gender
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Position
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Years of work experience
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Female
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Male
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Management
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Non-executive
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<5 years
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5 – 15 years
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>15 years
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Hospital A* (n = 14)
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Physicians (n = 5) | 5 | 1 | 4 | 1 | 2 | 2 | |
Midwives (n = 5) | 5 | 1 | 4 | 2 | 3 | ||
Nurses (n = 4) | 4 | 1 | 3 | 1 | 3 | ||
Hospital B* (n = 11)
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Physicians (n = 4) | 3 | 1 | 1 | 3 | 2 | 2 | |
Midwives (n = 3) | 3 | 1 | 2 | 1 | 2 | ||
Nurses (n = 4) | 4 | 2 | 2 | 1 | 3 | ||
Hospital C (n = 11)
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Physicians (n = 4) | 3 | 1 | 1 | 3 | 2 | 2 | |
Midwives (n = 3) | 3 | 1 | 2 | 1 | 2 | ||
Nurses (n = 3) | 3 | 1 | 2 | 3 | |||
Quality manager (n = 1) | 1 | 1 | 1 |
Data collection
Personal information
| Please describe your position and field of action/responsibilities in this hospital. |
What is your role in relation to the implementation of the BFHI? | |
Selection of BFHI
| Why do you think BFHI was selected? |
Who was involved and how was it decided to become Baby-Friendly? | |
Installation of BFHI
| Once the decision to become Baby-Friendly has been made, what are the next steps to prepare BFHI operation? |
Facilitators of and barriers to BFHI operation
| Please describe the operation of the BFHI. |
What are the challenges that your hospital experienced in becoming Baby-Friendly? | |
What are your general views and opinions about the BFHI? | |
How were barriers overcome? |
Data analysis
Ethical approval
Results
Selection of BFHI
Motives
Category
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Sub-category
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Motives | Marketing tool |
Improvement of existing services | |
Improvement of collaboration among professional groups | |
Promoters and decision-making | Individual persons in the role of change agents |
Consensus of managers of different professional groups | |
Consent of top management |
Promoters and decision-making
Installation of BFHI
Category
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Sub-category
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Project management | Launch of a project group |
Launch of sub-groups | |
Development and dissemination of new standards | Manifestation of new work procedures |
Dissemination of Baby-Friendly standards | |
Training for all health care staff | Participation in training following Austrian training requirements |
Training as a lactation consultant |
Project management
Development and dissemination of new standards
Training of all health care staff
Facilitators of and barriers to BFHI operation
Category
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Sub-category
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Facilitators of BFHI operation | Skills of the staff |
Management support | |
Getting staff on board | |
Barriers to BFHI operation | Lack of time and staff resources |
Old patterns | |
Personal experiences | |
Lack of physician buy-in | |
Tensions between care for mothers and care for babies | |
Intra- and inter-professional discontinuation of the BFHI care-chain | |
Language and literacy barriers of mothers and their relatives | |
Expectations of mothers and their relatives |