What wonderful Baby Friendly news! Please use the tins of formula and teach parents how to make it up for themselves! Some parents have no idea how complicated this can be, Make sure you emphasise how sterile the bottles and nipples need to be, how to make sure the amount of formula is exactly correct, not to boil the water too long or reboil water, we know the risks of lead poisoning, not to mention other nasties that can be concentrated by boiling. Then the storage, ensuring that they do not carry warmed bottles with them, as bacteria grows well in warm bottles. Wash them out immediately after a feed, so that they don't smell and they are easier to clean properly.... Oh, and don't forget they should taste the stuff! Then make sure they know that if baby has problems, they may need to use one of the expensive brands of formula, as nothing is as compatible with their little insides as breastmilk and some babies need special formulas to be able to digest the stuff. With a bit of effort, the mums may leave hospital breastfeeding happily every time! Then the staff will actually have less to do. To get the initial breastfeeding rates up, there probably needs to be an expectation that mums will breastfeed, not a "will you breastfeed or bottle feed" option. Look carefully at the literature given to the mothers, even the "what to bring to hospital" lists. Do these make bottle feeding be seen as an equal choice? When a mother books in, is she told about the birthing options and that, "of course you are able to feed your baby straight away, and we encourage this". Are there beautiful posters of breastfeeding mothers everywhere? If you find a supplier, maybe the local LLL Group will donate one, or if a mother wants to give a gift, it can be one of these, to promote breastfeeding. In Wollongong, we had posters showing proper attachment next to every bed, NMAA information in the take home information packages, visits by NMAA Counsellors, a full set of NMAA Booklets in the nursery and videos available to watch. When it is assumed that all mothers will breastfeed, at least for X time (to give them a good start in life) you will probably find those b/f initiation rates go up all by themselves. Now, if you can manage to get all those mums breastfeeding comfortably pretty quickly you will have HUGE success! Hope it works out well. Best wishes, Querida David Querida David Alyangula, NT. Australia NMAA Counsellor, Editor 'Upfront' NT Publications review team Email: [log in to unmask] :o) :-> :o) :-> :o) :-> :o) :-> :o) -----Original Message----- From: Jon Ahrendsen <[log in to unmask]> Date: Wednesday, 1 April 1998 15:22 Subject: Transition to BFHI Our small 30 bed hospital that does 100 births a year is finally getting serious about implementing ALL the 10 steps for the BFHI. We have been trying over the past 4 years to do all the right things but of course the free formula was the last obstacle. We now have a sympathetic administrator that believes becoming "Baby Friendly" will help in marketing our OB services to our rural service area. [[We should be popular with the BF and LLL crowd, we offer rooming in for mom and dad, we don't do any epidurals, any number of mom's support people can be present for the birth (my record was five people besides the mother, me and the nurse. There was; husband, mother of preg. mom, 14 yo sister of husband, mother and father of husband), and my moms can put the baby to breast immediately after birth if the APGARS are good and the cord long enough. ]] At any rate I am asking for help on what to do with the 40 % of moms that we have that still don't initiate BF. What do the other Baby Friendly Hospitals do with the bottle feeding mothers? I know about the need to purchase formula, we got the administrator to agree to that, but do we buy ready to feed so that the nursing staff doesn't grumble about using non ready to feed ABM? Or do we include a large can of powdered ABM to the mother and then help teach her how to mix it while she is at the hospital. (Most of our post-partum moms still stay about 48 hours.) One of our concerns is that the change in present procedure of using "free ready to feed ABM" will cause the nursing staff to view the new policy as more work and hassle and lead them to not be as supportive of the BFHI. Any input from those with experience in this matter would be appreciated. Thanks. Jon Ahrendsen MD FAAFP Clarion, Iowa