I have recently interviewed (for an article I wrote for the day job)  Mandy
Abbett, midwife, who is one of the two co-workers in charge of the
implementation of Baby Friendly at Derby City General Hospital, large urban
hospital in the Midlands of England.  DCGH has been awarded the UK standard
baby friendly certificate.

I asked her how they ensure babies are not given unnecessary
supplementation (one of the 10 steps). Of course it is part of the detailed
hospital policy on bf *not* to give supps unless at mother's request or if
medically indicated.  But having the policy is not enough...as posters on
Lactnet have stated.

At DCGH  this is what they do:

* they document that when the mother requests a supplement, she has had a
chance to discuss alternatives (eg skin-to-skin, cupfeed of EBM) and
understands the implications of her choice
* they document the medical reason for the supplement
* they have a monthly audit of all the supplements given - they are entered
along with all the rest of the bf data on the computer, and once a month
Mandy and her colleagues print it out and study it
* they have more informal 'spot audits', talking to mothers about what
their bf experience has been
* if either of these audits reveals cause for concern (a midwife who has
failed to document a supplement, or the reason for it,  or a midwife who
seems to be discovering a medical reason to supplement more often than her
colleagues), Mandy and her co-worker ask her what's been happening. Their
colleagues know they have to be prepared to justify their actions. Mostly,
this is done gently and effectively, and where a training need is
identified, it is met. There is general support for the whole bf policy now
at Derby, though Mandy says it has taken some time to feel that everyone
was on board.

The overall supplement rate is recorded and publicised so everyone can see
how the policy is working.

Supplement rates are well down on the UK  national figures, which show that
36  per cent of breastfed babies get supplements in hospital. At Derby the
figures are between 1 and 3 per cent.

That's right - between just 1 and 3 per cent!  Isn't that amazing???? It
shows what can be done with a consistent approach...and not allowing health
professionals to get away with going against the policy.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK