Isabella Medoza asks for input about step 3 of Baby-Friendly practice,
because her boss interprets it to mean a requirement to hold classes
for women postpartum before they go home.

As far as I know, Isabella's understanding is correct, that step 3
concerns pregnant women.  When we evaluated our hospitals, we checked
to make sure that the women who are getting most or all of their
antenatal care at the hospital (a minority, as this is normally a
primary care responsibility and they see a community midwife and/or
their family doctor) have at least been provided with the standard
information booklet from the Dept of Health about breastfeeding by the
third trimester. Staff had to demonstrate familiarity with official
recommendations for duration of exclusive and any breastfeeding and
the rationale for the recommendations, and women had to be able to
confirm that they had been informed of the recommendations.

Most of the steps for hospital certification do apply to the time
immediately after birth, in the institution. The last step, if I
remember correctly, has to do with follow up and support available
after the mother and baby go home. One part we really haven't hammered
on hospitals about here is the requirement to help set up support
groups for mothers where such groups do not already exist. The
existence of our national BF mothers organization was considered
sufficient (about 100 mothers available by phone for the whole
frigging country, with 60 000 births per year!) to satisfy the
requirement. All the hospital had to do was tell mothers how to get in
touch with it.  With what we are finding out about the difference
between proactive support and support that is only provided on
request, that step is looking very dated. It was the best thing going
when it came out some 20 years ago but it's too bad the whole process
hasn't been budgeted for necessary revisions.  Probably no one
imagined it would take decades to get Baby-Friendly implemented across
the globe :-(

Rachel Myr
midwife and sometime external assessor for BFHI Norway
Kristiansand, Norway

PS pro-active support is more effective in improving breastfeeding
duration beyond the first week :-)

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