Frequently Asked Questions About Education and the Baby-Friendly™ Hospital Initiative (BFHI)

From the Breastfeeding Committee for Canada
 

1. What does it mean to have "all staff" trained in hospitals as in Step 2 of the Ten Steps to becoming a Baby-Friendly™ Hospital?

All staff providing direct care to pregnant women and breastfeeding mothers should have, as a minimum, 18 hours of current breastfeeding education, including 3 hours of clinical skills training, as recommended in the WHO UNICEF Global Hospital Assessment Criteria. The education and practice model as defined in Breastfeeding Management and Promotion in a Baby-Friendly™ Hospital (the 18 Hour Course)* or its equivalent would meet this requirement. All education should include information on evidenced-based practice, as is referenced in "Evidence for the Ten Steps to Successful Breastfeeding" **

2. Does this training include support staff such as housekeeping and ward clerks?

Yes. All staff that may interact with pregnant women or breastfeeding mothers should demonstrate a positive attitude and behaviors supportive of breastfeeding. On-site orientation for new staff and continuing education for all staff should include current information regarding attitudes, cultural sensitivity, barriers and supports to breastfeeding.

3. Our physicians are not technically employees of the hospital. Do they require training?

Yes. Such doctors, even though they are not technically hospital staff but do interact with pregnant women or breastfeeding mothers, should demonstrate a positive attitude and supportive behaviors towards breastfeeding, and this may be supplemented through a continuing education program in breastfeeding management. It should also be recognized that according to Step 2 of the Global Criteria as determined by the External Assessors Manual: "Maternity staff interviews should include doctors--including outside physicians and midwives with admitting privileges and house staff--clinical officers, senior midwives, junior nurses and whoever talks most with mothers. This latter group could include medical students, dietitians, pharmacists, medical assistants and health aides."

The WHO/UNICEF Global Hospital Assessment Criteria applies in Canada. It clarifies that any pediatrician, obstetrician or family practice physician with a practice including breastfeeding families, and who have staff privileges at the hospital or maternity facility, must have a minimum of 18 hours of education (including 3 hours clinical skills training) in the advantages and management of breastfeeding.

4. Do we have to use UNICEF's Breastfeeding Management and Promotion in a Baby-Friendly™ Hospital, (the 18 Hour Course)* as the training program for staff?

No. The education requirement does not mandate the use of this course. Many hospitals choose to use this program because of its availability, credibility and low cost. Institutions and agencies that use this program may wish to supplement it with information that is culturally relevant, or further address issues such as attitudes towards breastfeeding. Adequate counseling skills need to be assured in all those who will care for breastfeeding women and their families. This component of training is emphasized in Breastfeeding Counseling - A Training Course (this 40 hour course is a WHO/UNICEF publication which can be ordered through the Canadian Public Health Association). ***

5. Are there alternatives or other recommended education programs available to hospitals as they prepare staff for a Baby-Friendly™ assessment?

Yes. There are often many different breastfeeding education programs available at a local level. These may include credit courses at colleges and university, distance education courses, conferences and meetings, guest speakers, and in house continuing education. Continuing education opportunities may also include staff rounds and case study discussions. The type of education program employed should depend on the educational needs of staff. A record and description of the education or training session must be maintained in preparation for the hospital's request for pre-assessment.

6. Do all staff have to take the same education program?

No. All staff do not have to take the same education program. It is important that all staff have current evidenced-based knowledge and skills required to meet the BFHI criteria. However, this can be achieved through a variety of educational opportunities, depending on the needs of individual staff members. For example, recent graduates from an approved School of Nursing, lactation consultants, senior staff, midwives, dietitians, public health workers, social workers, therapists, and physicians, etc. may each have different education requirements. Learners may also use a self-assessment guide to identify specific education needs.

7. Why do some hospitals insist that all staff, regardless of clinical experience and education, take the same course?

While this may not be necessary, the hospital may choose to offer the same course to all staff to enhance the consistency of information and education that is presented to staff. Having all staff participate in the same course may also facilitate a change in the breastfeeding cultural environment of the facility through discussion in an educational context. Staff members with experience and current knowledge may also be encouraged to attend to share their expertise with less knowledgeable or experienced staff. In many institutions, the staff with expertise in breastfeeding is asked to facilitate the education program.

8. Is there a way to determine if a particular course or program is best suited to the education needs of the staff?

Yes. Any program considered for implementation by a hospital, to address education needs, should be assessed to determine if appropriate content is included. Resources are available to assist this assessment, including: Ten steps for Breastfeeding Education as outlined in National Breastfeeding Guidelines for Health Care Providers (CICH, 1996) and the Family-Centered Maternity and Newborn Care: National Guidelines (Health Canada, 2000). The International Code of Marketing of Breast-milk Substitutes: A Common Review and Evaluation Framework (WHO, 1996) would also be an appropriate resource to assist in determination of content for a breastfeeding education program which is consistent with the principles of the BFHI.

9. Do we have to document the recent breastfeeding education activities of all staff caring for pregnant women and breastfeeding mothers?

Yes. During the assessment for the BFHI, any staff member may be asked to answer questions that reflect their current knowledge and practices. A record of recent education that includes the nature of the educational activity, time frame, and attendance must be submitted with the hospital's request for pre-assessment and be available to the assessors.

* Breastfeeding Management and Promotion in a Baby-Friendly™ Hospital (the 18 Hour Course) and Training Guide in Lactation Management (the 80 Hour Course) are available from UNICEF Canada. Contact UNICEF Canada at secretary@unicef.ca or phone (416) 482-4444 or fax (416) 482-8035 for an order form.

** Evidence for the Ten Steps to Successful Breastfeeding. Vallenas, C., and Savage, F., WHO, Geneva, 1998, available from INFACT Canada 416-595-9819.

*** Breastfeeding Counseling-A Training Course(the 40 Hour Course) is a WHO/UNICEF publication which can be ordered through the Canadian Public Health Association, Ste. 400, 1565 Carling Avenue, Ottawa, ON K1Z 8R1 Tel: (613) 725-3769 Ext. 190 Fax (613) 725-9826.