Baby Friendly Manitoba
Manitoba’s Breastfeeding Strategy
The Need for a Vision
“Here is Edward Bear coming
downstairs now, bump, bump, bump,
on the back of his head, behind
Christopher Robin. It is, as far as
he knows, the only way of coming
downstairs, but sometimes he feels
that there really is another way, if only
he could stop bumping for a moment
and think of it”
A.A. Milne 1926
Illustration E.H. Shepard
192614
Vision
Babies in Manitoba are Breastfed
Engage Stakeholders
Promote Best Practice
Build Capacity
Address
Gaps
BF
Strategy
•Baby Friendly Hospital Working
Group
•Baby Friendly Community
Working Group
•Formula Purchasing Ad Hoc Grp
•Baby Friendly MB Annual Conference
•Breastfeeding Clinical and Research
Rounds (CERPs provided)
•BFI Mock Assessments
•Baby Friendly/Breastfeeding Strategy Provincial
Lead
•Baby Friendly Consultant
•5 BFI Assessor Candidates
•SharePoint Site for WG members
•Provincial Breastfeeding Website
•Baby Friendly Manitoba Resources
•Builds on 2006 Breastfeeding Strategy
•Aligned with Healthy Living Strategy, Women’s Health Strategy,
Chronic Disease Prevention, Maternal and Child Health
•Sets targets for hospitals and community health offices for 2018
Breastfeeding Strategy
Targets
Increase BF Rates
Initiation 85%
Exclusive 75%
Increase Duration Rates
Entry 75%
Public Health & Health
Literacy
Policy & Planning
6 Months 55%
18 Months 25%
Babies in
Manitoba
Are
Breastfed
Social Determinants &
Equity
Achieve BFI
75% Hospitals
75% Community
Services
Community Relationships
Achieving Our Targets
Prairie Road Health Centre Baby Friendly Manitoba Status Report 2014/15
Please provide information on the following:
1. Contact information: Indicate the lead for the facility’s Baby Friendly multi-disciplinary committee, phone number and email information
2. Data: Indicate the year or reporting period for:
a. # of Total Newborns born in your hospital for (past year).
b. Your Hospital Initiation rate (any breastfeeding while in hospital)
c. Your Hospital exclusivity rate at hospital discharge
 Infant was given no other liquids or food aside from medication
 Donor milk and expressed mother’s milk is considered exclusive breastfeeding if no other liquids or food were given
 Exclusivity rate may include those infants supplemented due to documented medical reasons (see BCC Integrated Ten Steps
Practice Outcome Indicators document page 32 for infant and/or maternal indications for supplementation)
d. Chart Audit results (if these are available)
3. Baby Friendly Accreditation Status
4. Target date for Baby Friendly Accreditation: (date)
5. Status Update on the BFI Integrated 10 Steps Practice Outcome Indicators for Hospitals and Community Health Services and the World
Health Organization Code for Marketing Breast-Milk Substitutes with each step including relevant updates on Previously Reported
Achievements: 2013/2014, on Priority Areas listed in 2013/14 that were achieved, in process or not met in 2014/2015, on Achievements in
2014/2015 and on New Priority Areas for the coming year (2014/15).
6. World Health Organization Code of Marketing of Breast-milk Substitutes Compliance
 Formula and feeding supplies are purchased: Yes or No
 If no, when is your formula contract due? ____ Month/Year
 Quantity of free formula received in 2014: ___
 Quantity of purchased formula received in 2014: ___
 Price of purchased formula received in 2014: ___
 Working towards a Baby Friendly Compliant contract __Yes __No
 If work is underway please describe:
7. Use of Donor Human Milk
 Do you use pasteurized donor human milk that has been purchased from a milk bank: __ yes __ no
 Quantity of donor human milk purchased in 2013/14: ________
Achieving Our Targets
RHA
Manitoba Hospital
Manitoba Hospital
Director:
Email:
# Total Newborns
born in hospital
(2014/15):
Data: Hospital breastfeeding initiation and exclusivity
rates at discharge (2014/15):
BFI Accreditation
Status (A-F)
# Newborns:
(2013/14): 1100
2014/15:
Initiation of breastfeeding at birth = 87%
Any breastfeeding at discharge = 83%
Exclusive breastfeeding at discharge = 73%
BFI Status: D
Term: 1060
Preterm: 40
CRN:
Email:
Target date for Baby Friendly Accreditation: Fall 2017
Chart audit for July 2014. Data from both mother and
baby charts. N= 90
Any breastfeeding= 77/90= 86%
Exclusive breastfeeding = 63/90= 70%
Other data:
Skin-to-skin=65%
Hand Expression=40%
Spoon / Cup=4%, Finger Feeding=4%, Bottle=6%
Supplementation= 3 for medical reasons (3%)
Informed consent=2 parental consent (2%)
2013/14:
Initiation of breastfeeding at birth /
Any breastfeeding at discharge: 857/932= 91.9%
Exclusive breastfeeding at discharge: 734/932= 78.7%
Achieving Our Targets
Status Update on the BFI Integrated 10 Steps Practice Outcome Indicators for Hospitals and Community Health Services and the World
Health Organization Code for Marketing Breast-Milk Substitutes
Steps
Indicators: Progress: Indicate __Y __N __IP
If IP Include Target Date:
Step 1
__Y Multidisciplinary Breastfeeding Committee Formed
__Y Committee meets at least 4 times a year
__IP More members needed to be multidisciplinary
__Y Provincial / BCC Participation Certificate Received
__IP BFI Document Binder started
__IP Facility has a plan to implement the BCC Indicators
__Y Policy complete, signed by Administrator, lists date of completion and next revision date
If IP or No Include Comment & Target Date: 2016
 Social Worker, pharmacist will be asked to join committee
 BFI Implementation Plan in process
Previously Reported Achievements 2013/2014 for Step 1:
 BFI committee in place and working with the Regional Mat/Child Team.
Priority Areas listed previously that were achieved, in process or not met in 2014/2015: __Achieved __In process __ Not Met
__IP Moving toward Baby Friendly Certification
Comments:
 BFI Implementation Plan in process
Other achievements in 2014/2015:
 Physician excited to join committee
New priority areas for the coming year (2015/16):
 Translate Breastfeeding policy/poster into Russian and Spanish
 Have Bethesda Hospital educator, Baby Friendly Manitoba Consultant and Assessor candidate Maria Mackay do capacity
building visit to Prairie Road – assess Binder, help with work plan.
Achieving Our Targets
Step 2
__IP Appendix 2.1: 80% compliance with Education and Orientation Checklist
__IP Appendix 2.2: 80% compliance with Breastfeeding Education for Hospital and Community Health Service (CHS) Employees,
Physicians and Midwives
__A Appendix 2.3: 80% compliance with Support for Non-breastfeeding Mothers Checklist
If IP or No Include Comment & Target Date: 2016
 Staff receive between 8 and 16 hours of orientation on breastfeeding. Resource materials are available to staff.
 Other staff development opportunities brown bag lunchtime series, grand rounds, education days, staff huddles etc…
 Staff have also participated in Annual Baby friendly conference and Manitoba Health telehealth sessions.
Previously Reported Achievements 2013/2014 for Step 2:
 Physician Education package developed along with education packages specific to PACU/ACU and Emergency department
 Have dedicated BFI bulletin board in conference room. Topics selected based on chart audits, staff requests
Priority Areas listed previously that were achieved, in process or not met in 2014/2015: __Achieved __In process __ Not Met
If IP or No Include Comment & Target Date:
__A Orientation program to include breastfeeding education for staff
__A Breastfeeding seminar with Dr’s education Day (Vera Froese)
Other achievements in 2014/2015:
 BFI General Staff Orientation/Education: continue the process of informing the general staff on Baby Friendly through poster
display and education sessions.
New priority areas for the coming year (2015/16):
 Collaborating with Public Health nurse to provide education (8 hours of the WHO Breastfeeding Course) to hospital staff
and public health care nurses as well as other outreach community staff. Process continues with positive feedback from staff.
 BFI bulletin board used to address focus topics: Step study to emphasis the requirements of each step. Each step was
presented on the board for about 1-2 weeks over a period of several months.
 Involve “ward” staff to do chart audits
Achieving Our Targets
Step 6
__Y Appendix 6.1: 80% compliance with Data Collection of Breastfeeding Rates
__IP Appendix 6.3: 80% compliance with Breastfeeding Rates - Hospitals & Birthing Centres or Community Health Centres
breastfeeding rates
If IP or No Include Comment & Target Date:
 Adherence to supplementation practices only when medically indicated (guidelines)
 Women who alternative methods of infant feeding are also provided with high quality information and supports, in recognition
that respecting and supporting a woman’s informed choice will result in better outcomes for her and her infant.
Previously Reported Achievements 2013/2014 for Step 6:
 Decreased use of supplement for post c- section infants D/T percentage weight loss. Now taking day one to day two weight loss
into consideration if infant appears to be feeding appropriately and all other parameters ‘normal’ prior to considering supplement
with formula. EBM always first line supplement if Mother able to supply
Priority Areas listed previously that were achieved, in process or not met in 2014/2015: __Achieved __In process __ Not Met
__Y Work on “Steps” based on chart audits and data collection.
__Y 2 Chart audits done: July 2013 & December 2014.
Other achievements in 2014/2015:
__Y Worked on “Steps” based on chart audits and data collection.
__Y 2 Chart audits done: July 2014
New priority areas for the coming year (2015/16):
__Y Work on “Steps” based on chart audits and data collection.
__IP 2 Chart audits done: July 2014 & December 2015.
Use of Donor Human Milk
Do you use pasteurized donor human milk that has been purchased from a milk bank: Y N
Quantity of donor human milk purchased in 2014/15: none
COMMENTS: We would be interested in purchasing donor human milk from a HMBANA milk bank as part of a Manitoba Health
process
Achieving Our Targets
WHO Code
__Y Appendix 11.1: 80% compliance with The WHO Code of the Marketing of Breast Milk Substitutes Compliance Checklist
If IP or No Include Comment & Target Date:
Formula and feeding supplies are purchased:  Y __N
If no, when is your formula contract due? Infant Formula is purchased by Purchasing Department
Quantity of free formula received in 2014/15: none
Quantity of formula purchased in 2014: 1,860 (2 oz) bottles purchased in total for 2013.
Majority of same discarded post feed of 1oz or less D/T
Single feed policy
Working on a Baby Friendly Compliant contract: No need
All Steps
__IP Facility audits of Practice / need for further education reveal 80% compliance with 10 Steps and WHO Code Appendices
If IP or No Include Comment & Target Date:
 Develop work plan in 2015 to meet the targets in Steps 1, 2, 4, 6, 8, 9
Final Steps
__IP Pre-Assessment contract has been signed
__IP Document Binder has been sent for Pre-Assessment Review
__N Pre-Assessment Site visit has taken place
__N External Site visit has taken place
__N Designation has taken place
__N Designation has taken place – with Re-Assessment planned for five years from Designation
__N Site is readying for Re-designation
If IP or No Include Comment & Target Date: Fall 2017
 Annual audits will track best practice
Reasons to Celebrate
First
Manitoba
Hospital achieves
BFI

External assessments planned for 2015
and beyond….
www.gov.mb.ca/health/bfm/strategy.pdf