AO - MBFHI. 2ppt

Adm ini stra ti ve Or der
No. 20 07-00 26
dat ed: July 10. 2007
Revitalization of the Mother-Baby

Friendly Hospital Initiative in Health
Facilities with Maternity and
Newborn Care Services
Historical Background
1992
Rooming-In and Breastfeeding Act
(RA 7600) Ten Steps to Successful
Breastfeeding, UNICEF/WHO Global
Criteria
1999
The Golden Era of Breastfeeding: DOH
certified 1,427 or 83% of targeted
hospitals and lying-in clinics
LEGAL MANDATES
 Philippine Infant and Young Child

Feeding (IYCF) policy as adopted
from the WHO/UNICEF 2002 Global
Strategy on IYCF
 PHIC Circular No. 26 s. 2005
 Administrative Order No. 2005-0023

of the DOH, Formula One for Health
New Guidelines:
AO 2007-0026
Dated July 10, 2007
Objectives:
• transform all health institutions with

maternity and newborn services …
government & private health
facilities….
• build the critical capacity and

commitment of health care staff…
• staff establish linkage…

What’s new in the AO?
> Mother-Friendly Indicators

> Hospital as a Workplace
> Milk Code
> Process of Accreditation
Steps to a Mother-Friendly /
Safe Motherhood Initiative 1/5
 Hospital shall incorporate mother-

friendly labor and birthing practices…
• Clean birthing technique

• Delayed cord clamping
• Placenta removal & disposal
• Collaboration/ Referral
Steps to a Mother-Friendly Care
1. Train staff on essential and

emergency obstetric and newborn
care and non-drug methods of pain
relief
3. Motivate and refer pregnant

women for STD / HIV/AIDS
screening and voluntary
counseling and treatment
3. Birthing mothers may be offered

access to a birth companion
4. Birthing mothers may be allowed

the freedom to walk and move about
5. Assume positions not limited to the

lithotomy position
 …avoid unnecessary instrumentation

that may inhibit breastfeeding
 Babies born by C/S are less likely to

• have early skin to skin contact
• more likely to have nursery care
• increasing the risk of cross infection
• restricting breastfeeding
 Linking the mother and baby to

appropriate community
breastfeeding support group
 Encourage mothers to take care of

their premies, NB with defects
Hospital as a Workplace
2/5
 Milk code enforcement

 Breastfeeding breaks
 Breastfeeding rooms
 Breastfeeding storage facilities
 Support group
 Supportive environment
Baby- Fri end ly Indi ca tors
3/5
Mother-Baby Friendly
Hospital Initative (MBFHI)
Th e Glo bal Cri te ri a to
Baby F rien dl y Ho spi ta l
Ini tiative
THE TE N STE PS TO
SUCC ES SFUL
BREA STFEED IN G
Step 1 - Have a written breastfeeding policy
that is routinely communicated to all health
care staff.
 Written policy which addresses the

10 steps
 Visibly posted in:
 maternity ward
 all infant care areas
( well baby / sick baby )


antenatal care services
 Language commonly used
Pr ohibi ts… ..
 promotion of BM substitutes /
teats /pacifiers
 distribution of gift packs
Mec hanis m fo r eval uat ing

effectiveness of the policy
Sample only
Cli ent Surv ey on t he M BFHI

Impl eme nt at ion
for Succes sful Bre as tfee di ng
We want mothers to give their newborn

babies the BEST and the best is
mothers’ milk.
In order for us to evaluate if we achieved

our goal, please fill up this survey
form.
Ye s No
1. Did you have pre -natal ch eck -up?

If yes , wher e? _______________
2. Have you li st ened to le ct ure s in bre astfee din g?
If no, wh at is th e re ason ?
___________________
3. We re you inform ed on the followin g?
3.1 . Adv antages of br ea stfeedi ng…
3.2 . Corr ect attach me nt and pos it ion ing…
3.3 . Mil k expr es sion, coll ect ion and stora ge…
3.4 . Manage men t to comm on bre ast proble ms…
4. Wa s you r ba by pl aced be twe en o you r brea st

im med ia tel y
upo n del iv er y or wi th in 1 hou r after birt h ? If no,
wh y? ________________________________
4.1 . Wer e you in form ed on th e impor ta nce of
im med ia te latch in g?
Yes No
5. W er e y ou gi ve n inf or mati on on br ea st fe eding when y ou
were
6. Dtr id
ans fer red
y ou neet dohel
y our
p onroom
yourwith
f ir sty our b aby
bre as ?
tf eeding ?
7. I f y es , w hy ?
__ ______ ____ ______ ____ ______ ____ ______ ___
8. B ef or e ho spita l dis cha rge , w er e i nfor med whe re t o go /
whom
9. to
W cill aly l ou
if you e nc ount
r ec omme er eas
nd br a nytfe
pr eding
obl em? r elat ed to
br eas tfe eding?
If no, why
__ ______ ____ ______ ____ ______ ____ ______ ____ _
10 . W ha t c an y ou rec ommend / sugge st so w e c ould impr ov e our bre as tf eeding
ser vic es for mothe rs and babies .
__ ______ ____ ______ ____ ______ ____ ______ _
Man ner of D eliv er y ______ ____ ______ ____ __ G rav idit y

__ ______ ____ __
Date / T ime Deliv ered

__ ______ ____ ______ ____ ______ ____ ______ ____ ______ ___
Step 2 - Train all health care staff in skills
necessary to implement this policy.
 All staff ( involved with mother and baby )
received orientation on BF policy
 Trained on 20 hours w/ 3 hours clinical
experience
 New employees - orientation & training w/in 6
months
 copy of the curricula or course outline – be
available
 Training include 10 steps & Milk
Code (EO 51)
 20 hours of training
 Training of non-clinical staff (given

their roles) to support
 Importance of breastfeeding (BF)
 Hospital practices that support BF
Step 3 - Inform all pregnant women about the
benefits and management of breastfeeding.
 Breastfeeding counselling to most

pregnant women at antenatal service
 written antenatal education:
 importance of exclusive breastfeeding for
6 months
 benefits of breastfeeding
 basic breastfeeding management
Antenatal education
includes:
Importance of :
 skin to skin contact
 early initiation
 rooming in 24 hours
 reflect attendance
to BF lecture

on demand feeding

exclusive BF for 6  protected from oral
months & written instruction

risk of artificial for artificial feeding
feeding
Step 4 - Help mothers initiate breastfeeding
within an hour after birth.
 Immediate Skin to
skin contact at least
for one hour after
birth
 immediately after
birth for I hr - NVD
 as soon as mother is
responsive - CS
First Crawl Video
Step 5 - Show mothers how to breastfeed &
maintain lactation, even if they should be
separated from their infants.
 Offer assistance with

breastfeeding within 6 hours of
delivery
 show how to express milk
 proper positioning / attachment
 where they could get help
Mother with
previously
encountered
problem
should be given
special
attention and
support
Step 6 - Give newborn infants no food or
drink other than breastmilk, unless
medically indicated.
 Cup feeding is recommended
 Dental Obturator for cleft lip / palate
 Breastmilk storage
Step 7- Practice rooming in – allow
mothers & infants to remain together
– 24 hours a day.
 EXCEPT
- for a period of 1 hour for
hospital procedures
- separation is medically
indicated
Step 8 - Encourage Breastfeeding
on Demand.
 NO restrictions on  As often as baby

frequency or length wants
of breastfeeding
 Advised to  awaken & feed

breastfeed when
babies are hungry
Step 9 - Give NO artificial teats or pacifiers
(dummies or soothers) to breastfeeding
infants.
 Mothers informed on the risk

associated with feeding milk /
other liquids with teats & bottles
and the use of pacifiers
Step 10 - Foster the establishment of
breastfeeding support groups and refer mothers to
them on discharge from the clinic or hospital.
 Mothers should confirm their plans to BF
 Staff should describe how / where to

reach the breastfeeding support group
Community
Hospital
 Nursing staff should also be aware of it

 Printed materials available before
discharge
 Encouraged follow up after 2-4
days & in the 2nd week
 Facility has / allows trained BF
mother support counsellors
Compliance to the Philippine Code of Marketing
of Breast-milk substitutes 4/5
 The head / director of maternity

services reports that:
NO employees of manufacturers or
distributors of breastmilk substitutes,
bottles, teats, pacifiers have direct
contact with pregnant women
Compliance to the Philippine Code
 The hospital does

not receive
 No pregnant
women, mothers or
 free gifts, their families are
 non-scientific given
lectures,  marketing materials,
 materials or samples,
equipments,  gifts by the facility
 money or support
for in-service
education…..
Acceptable Medical Reasons
for supplementation
Exclusive breastfeeding IS TH E
NOR M
There is a small number of situations that

maybe a medical indication for
SUPPLEMENTING breastmilk or for NOT
USING breastmilk…..
for supplementation
1. Infants who cannot be fed at the breast but

breastmilk still remains the food of
choice
ex…infant weak / oral abnormality /
separated from mom
2. Infants who may need other nutrition in

addition to breastmilk
ex…low birth weight or preterm < 1500 gms or
32 weeks / infants at risk of hypoglycemia because
of medical problem
for supplementation
3. Infants who should not receive breastmilk

or any other milk including the usual BM
susbstitutes
ex…inborn errors of metabolism like
galactosemia / phenylketonuria
4. Infants for whom breastmilk is not

available
ex… mother who died
no nursing mother available
Acceptable Medical Reasons for supplementation
5. Maternal conditions that affect

breastfeeding recommendations
 mother very weak

 mother taking medications
antimetabolities / radioactive
iodine / some anti-thyroid
 maternal addiction
tobacco / alcohol / drug
 HIV infected mothers
HIV and In fant Feeding
Have policy to support feeding the HIV

positive mother
Mother informed on:

 Transmission of HIV
 Feeding options
 Importance of testing & counselling
 Maintain confidentiality
UNIC EF/ WHO / UNAID S
In fant Feed ing Re commen da tio n for HIV-
posi ti ve Wo me n
When replacement feeding is acceptable,

feasible, affordable, sustainable and safe,
(AFASS) avoidance of all breastfeeding
by HIV-infected mothers is recommended.
Otherwise, exclusive breastfeeding is
recommended during the first months of
life and should be then discontinued
as soon as it is feasible.
Roles and Responsibilities
National Management Committee of DOH

Chair-Usec for Health Operatios
Co-chair-Usec for External Affairs
CHD Assessor’s Team Regional Coordinators
Dr. Jose Fabella Memorial Hospital

MB FH I Accr ed it atio n Pr oce ss 5/5
Sel f Ass essme nt of th e h eal th faci li ty
CHD Val id ation of submitted self-a sse ssme nt for m
Issuance of a Certi fi ca te o f Comm itmen t vali d f or tw o years
Re-As ses sment b y the CHD MBFH I As se ssors Team af te r 2

years
Iss uance of Pl aque of Acc redita ti on for susta ined

imp lementation
an d int egration of th e moth er-fri end ly ind icators
Ann ual MBFH I Imp leme ntation Rep ort su bmi tte d b y th e hea lth
facil ity to th e CHD

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Adm ini stra ti ve Or der

Revitalization of the Mother-Baby

 Philippine Infant and Young Child

 PHIC Circular No. 26 s. 2005

 Administrative Order No. 2005-0023

• transform all health institutions with

• build the critical capacity and

• staff establish linkage…

> Mother-Friendly Indicators

 Hospital shall incorporate mother-

• Clean birthing technique

1. Train staff on essential and

3. Motivate and refer pregnant

3. Birthing mothers may be offered

4. Birthing mothers may be allowed

5. Assume positions not limited to the

 …avoid unnecessary instrumentation

 Babies born by C/S are less likely to

 Linking the mother and baby to

 Encourage mothers to take care of

 Milk code enforcement

 Written policy which addresses the

 all infant care areas

( well baby / sick baby )

Mec hanis m fo r eval uat ing

Cli ent Surv ey on t he M BFHI

We want mothers to give their newborn

In order for us to evaluate if we achieved

1. Did you have pre -natal ch eck -up?

3.4 . Manage men t to comm on bre ast proble ms…

4. Wa s you r ba by pl aced be twe en o you r brea st

Man ner of D eliv er y ______ ____ ______ ____ __ G rav idit y

Date / T ime Deliv ered

 Training of non-clinical staff (given

 Breastfeeding counselling to most

 Offer assistance with

 Cup feeding is recommended

 Dental Obturator for cleft lip / palate

 NO restrictions on  As often as baby

 Advised to  awaken & feed

 Mothers informed on the risk

 Mothers should confirm their plans to BF

 Staff should describe how / where to

 Nursing staff should also be aware of it

 The head / director of maternity

 The hospital does

There is a small number of situations that

1. Infants who cannot be fed at the breast but

2. Infants who may need other nutrition in

3. Infants who should not receive breastmilk

4. Infants for whom breastmilk is not

5. Maternal conditions that affect

 mother very weak

Have policy to support feeding the HIV

Mother informed on:

 Importance of testing & counselling

When replacement feeding is acceptable,

National Management Committee of DOH

CHD Assessor’s Team Regional Coordinators

Dr. Jose Fabella Memorial Hospital

Man ner of D eliv er y __ G rav idit y