>can anybody tell me the official variations that occur in step 4
>of the Ten Steps (BFHI)?

You have asked an interesting question  Sara to which I (as BFHI project
Officer for Redland Hospital in QLd) also have found difficulty resolving.

I'd like to know the name of the paper you have that states the BFHI
guidelines for Step four in Australia state the 60 minutes

>I'm reviewing a paper where it states that in the USA and Australia step
4
>reads 'help mothers initiate bf within 60 minutes" - instead of the 30
>minutes laid out by the official WHO / UNICEF Ten Steps.

Because the official  assessment guide I have been given through ACMI/BFHI
Australia still states 30 minutes. When I have asked about it I
consistently get the answer that the guidelines are under review and BFHI
is not meant to be prescriptive. I'd say the review is way over due.

If you go to the BFHI news website and check through the BFHI news letters
there is one which discusses the wording of Step 4 and the variations of
interpretation for BFHI. I think it is (1999, March/April). 'Ten Steps' now ten years old: a
standard around the world. BFHI News.

On looking through the literature you will find the focus remains upon the
time interval between birth and the first breastfeed but what about the
quality and time spent in skin to skin contact. This is the research
underpinning  'step 4' yet it is not  clearly  expressed in the way Step 4
is written. In fact I say it gives the impression that to attach the baby
for the mother asap is the important  practice but the  research points
more to the importance of protecting the mother and baby from separation
until at least 1 - 2 hours if possible. As Nills Bergman says "it is the
mothers job to hold her baby and it is the baby's job to breastfeed".

You will see the UK have reworded their guidelines to match the research
evidence. Perhaps there is more work to be done on Step 4 and the way it
is worded for global guidelines.

Ruth

Ruth Cantrill
Brisbane QLD 4111
Australia

Ph  61 7 38755224
Mobile  0438987261
Email [log in to unmask]





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 The Netherlands
version also says 60 minutes. Basically I would like to know how this is
in
the UK and Germany - being neigbours of the Netherlands.

Thanks in advance

Sara Bernard
The Netherlands

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