Ballarat Health Services (BHS) recognises that breastfeeding is the normal method of infant feeding. It provides species-specific nutrition for normal growth and development of infants.

Breastfeeding has a positive influence on the physical and emotional health of both mother and infant. This includes the unique anti-infective properties of breast milk that provide protection against many diseases and infections for both mother and baby. Additionally, there are also social, economic and environmental reasons to support women who are breastfeeding. Therefore, the long-term health benefits for mother and baby are a strong incentive for all health professionals to protect, promote and support breastfeeding.

BHS supports staff members who continue to breastfeed on their return from maternity leave.

In line with the Baby Friendly Health Initiative (BFHI) standards, all staff are expected to be familiar with, and adhere to this policy.

• To promote normal infant feeding.

• To support the right of the parents to make an informed decision about their infant's nutrition.

• To promote and support the successful initiation and establishment of breastfeeding.

• To increase both the incidence and duration of breastfeeding for women who give birth at BHS.

• To provide support to women within the region who have given birth at other health services.

• To provide a plan of care that gives mothers choices for dealing with breastfeeding problems.

• To provide evidenced-based education to medical, midwifery and nursing staff, pregnant women and their families.

• To meet the requirements of the '10 Steps to Successful Breastfeeding' and achieve and maintain BFHI accreditation.

• To provide support services to mothers and babies when breastfeeding difficulties are identified.

• To support BHS staff who are breastfeeding on return to work.

• To enhance staff recruitment and retention.

Baby Friendly Health Initiative (BFHI): An international program that aims to give every baby the best start in life by creating a health care environment where breastfeeding is the norm and practices known to promote the health and well-being of all babies and their mothers are followed. The BFHI Ten Steps to Successful Breastfeeding are the global standards by which health services are assessed and accredited. A 'Baby Friendly' health service is one where mothers' informed choice of infant feeding is supported, respected and encouraged.

The principles of this policy are based on the BFHI Ten Steps to Successful Breastfeeding.

Step 1a. Have a Written Infant Feeding Policy that is Routinely Communicated to Staff and Parents

This policy outlines the implementation of Baby Friendly Health Initiative (BFHI) 10 steps at Ballarat Health Services (BHS). This includes:

• clinical guidance on breastfeeding support

• implementation of the WHO International Code of Marketing of Breastmilk Substitutes,

• support for BHS staff to continue breastfeeding on return to work

• standards of care provided to women who are using infant formula.

A summary of this policy is made available in all Women's and Children's healthcare areas and other areas frequently visited by pregnant women, mothers and their families such as the emergency department.

Step 1b: Comply Fully with the International Code of Marketing of Breastmilk Substitutes and Relevant World Health Assembly Resolutions

• BHS fully complies with the International Code of Marketing of Breast Milk Substitutes and Subsequent Resolutions in relation to the promotion, purchase and use of artificial infant formula and feeding materials, and visits, staff education, gifts, sponsorship and access to parents by representatives of companies within the scope of the code. Please refer to the policies and guidelines listed below for more information.

• Promotion of artificial feeding, infant formula, bottles and teats is prohibited at BHS.

• Infant formula is purchased according to the Health Purchasing Victoria requirements as outlined in POL0097 Collective Purchasing. Low cost, free or subsidised infant formula is prohibited at BHS.

• Parents are not to receive take home samples or supplies of infant formula. bottles and teats.

• Access to BHS and to its staff by representatives from companies which distribute or market products within the scope of the WHO Code is restricted in accordance with the POL0117 - Visitor Management Policy.  Access to pregnant women, mothers and their families by these representatives is prohibited.

• BHS staff will not accept gifts, non-scientific literature, materials or equipment, money, or support for in-service infant-feeding-related education or events from these companies.

• Interaction with company representatives for the purpose of obtaining and trialing specialist equipment will occur away from the inpatient area and will be with specialist clinicians only.

• Any research involving women or babies, undertaken with the organization, will clearly identify potential implications on infant feeding or any interference with the implementation of the policy and will require approval from the Ballarat Health Services and St John of God Ballarat Human Research Ethics Committee.

Step 1c: Establish Ongoing Monitoring and Data-Management Systems.

Refer to Appendix 1 for information on infant feeding monitoring and data management systems at BHS.

Step 2. Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding

• All new staff in the hospital are made aware of the breastfeeding policy during hospital induction and orientation.

• All staff who have contact with pregnant women, babies or young children, have a professional responsibility to ensure that their knowledge and skills in breastfeeding and infant formula feeding management are consistent with best practice guidelines within the scope of their own practice.

• BHS provides evidence based breastfeeding and infant feeding education sessions for relevant staff according to their professional group and scope of practice as detailed in the BHS Breastfeeding Education Curriculum (Appendix 2). Education is based on core skills and knowledge.

• BHS maintains records of infant feeding education for relevant staff and staff are also expected to maintain their own records.

Step 3. Discuss the importance and management of breastfeeding with pregnant women and their families

• Antenatal care of all pregnant women includes discussion about importance, initiation and management of breastfeeding and services available in the event of feeding difficulties. Written consumer information and recommended websites are provided.

• It is the responsibility of all health professionals to ensure that this information is communicated effectively to women and their families, tailored to their individual needs and at appropriate stages during pregnancy and beyond.

• All pregnant women and their support person/family members are offered the opportunity to attend breastfeeding education sessions.

• Women with a history of breastfeeding problems with identified medical/physical conditions that may impact on breastfeeding or with a relevant family history will be offered a referral to a Lactation Consultant and/or other relevant healthcare professional (such as Allied Health professionals) as indicated, either during the antenatal or postnatal period.

Step 4. Facilitate Immediate and Uninterrupted Skin-to-Skin Contact and Support Mothers to Recognise when their Babies are Ready to Breastfeed, Offering Help if Needed

• Mother-friendly labour and birth practices are facilitated as outlined in CPG0076 Normal Labour and Birth and CPG0187 Mother-Baby Skin to Skin Contact in the Operating Suite.

• Staff facilitate immediate skin to skin contact and early breastfeeding after birth unless contraindicated by medical issues or mother declines.

• Skin to skin contact is facilitated following caesarean birth on the theatre table and in recovery unless medical issues prevent this - see CPG0187 Mother-Baby Skin to Skin Contact in the Operating Suite.

• Staff encourage continued skin to skin contact after transfer to the postnatal area and during the postpartum period to facilitate the successful establishment of breastfeeding and optimal growth and development.

• Skin to skin contact is routinely facilitated for all stable babies in Special Care Nursery. Refer to CPG0217 Kangaroo Care.

Step 5. Support Mothers to Initiate and Maintain Breastfeeding and Manage Common Difficulties

• Staff assist parents in recognizing and responding to baby feeding cues and provide a supportive environment and sensitive, practical assistance to initiate and continue a normal pattern of breastfeeding. Refer to CPP0443 Breastfeeding the Healthy Term Newborn.

• Breastfeeding women receive instruction on the expression and storage of breastmilk and how to maintain lactation if they are separated from their infant. Refer to CPG0186 Breastmilk - expressing, storing and feeding.

• Breastfeeding women are provided with education and information to assist them to recognize and manage common breastfeeding difficulties and where to find peer and professional breastfeeding support.

Step 6. Do Not Provide Breastfed Newborns Any Food or Fluids Other than Breastmilk, Unless Medically Indicated

• Exclusive breastfeeding is promoted. Newborn infants are given no food or drink other than breast milk unless medically indicated. Refer to CPG0074 Supplementary Feeding of the Breastfed Baby.

• Use of donor breastmilk is guided by CPP0395 Breastfeeding - Donor Breastmilk.

• Women who have chosen not to breastfeed or are supplementing with infant formula are provided with individual instruction on the safe preparation, storage and use of powdered infant formula. Refer to CPG0402 Artificial Feeding of the Healthy Term Newborn.

Step 7: Enable Mothers and their Infants to Remain Together and to Practice Rooming-in 24 Hours a Day.

• Unless there is a a health problem requiring mother/baby separation, babies are kept by their mother's side at all times (rooming-in), to enable unrestricted access to the breast and promote the establishment of lactation. Any separation of mother and baby is documented.

• Mothers of babies admitted to SCN are supported to stay close to their baby and there are no restrictions parents presence in SCN.

Step 8. Support Mothers to Recognize and Respond to their Infants Cues for Feeding

• Mothers are encouraged to recognize and respond to their babies cues for feeding and there are no restrictions placed on frequency or length of feeds.

• If timing of feeds is medically indicated, feeding plans encourage mothers to also feed their baby earlier than recommended in response to her baby's feeding cues.

Step 9: Counsel Mothers on the Use and Risks of Feeding Bottles, Teats and Pacifiers.

• Avoidance of teats and pacifiers (dummies) during the establishment of breastfeeding is recommended.

• If supplemental feeding is required, mothers are counselled on the most appropriate method of supplementation for her baby and her circumstance.

• Refer to CPG0074 Supplementary Feeding of the Breastfed Baby and CPG0186 Breastmilk - expressing, storing and feeding.

Step 10: Coordinate Discharge so that Parents and their Infants Have Timely Access to Ongoing Support and Care

• All women receive routine Domiciliary midwifery support after discharge home from hospital.

• All women are provided with information on community breastfeeding support groups and services such as the Australian Breastfeeding Association, Maternal and Child Health Service and Parent Place prior to discharge.

• Women and babies experiencing breastfeeding problems are offered a referral to an International Board Certified Lactation Consultant and/or other healthcare professionals as indicated, such as a General Practitioner, Paediatrician, Maternal and Child Health Nurse, Speech Pathologist, Dietician.

• When indicated, women and babies are referred to the breastfeeding support clinic, or paediatric feeding clinic.

Governance and Professional Development

• BHS provides policies, guidelines and protocols on the Governance Documentation system to support staff in providing evidence based care to breastfeeding mothers and babies. and to mothers using infant formula. Access to the policies and guidelines is readily available for all staff and clients.

• If a guideline is not available at BHS, the Royal Women's Hospital Victoria public website has a number of breastfeeding guidelines available. The Victorian Breastfeeding Guidelines (see link in references) may also be accessed for evidence based information about breastfeeding management which may not be available in a BHS guideline.

• BHS provides medical record forms for referral to the Breastfeeding Service and for documentation of infant feeding management and education given to parents.

Breastfeeding Friendly Workplace

BHS promotes a breastfeeding friendly workplace.

• Any BHS employee who is breastfeeding may discuss flexible work arrangements or lactation needs by contacting their manager prior to returning to or commencing work, if desired.

• Depending on the requirements of the employee's department, flexible work arrangements might include part time work, variable starting and finishing times, or working some periods from home.

• The manager will seek to strike a balance between the operational requirements of the department and the needs of the returning employee and her breastfed infant.

• BHS provides access to suitable facilities for breastfeeding and/or expressing and storing breast milk. 

• BHS ensures flexibility for employees to take lactation breaks during their workday in line with award entitlements.

• An employee may take lactation breaks during working hours to express milk or breastfeed her baby. The number of lactation breaks will largely depend on the age of the baby and/or the frequency of expression required. Lactation breaks might be taken as extra time with regular breaks, or taken separately depending on needs. It is expected that these will be scheduled to minimize disruption to the workplace.

• Managers and employees need to communicate to each other their expectations, depending on the needs of the employee and the relevant department.

• A managers guide to parental Leave is available on the BHS People and Culture is available by clicking here.