I write in response to Barb Whitehead's recent concern about whether a hospital could deceive a Baby-Friendly assessment team by pretending to be compliant without actually having made much change. In the US, birth facilities can apply for a Certificate of Intent at any time by completing the self-appraisal tool and sending it together with a letter of support from an administrator and an annual fee. Baby-Friendly USA encourages facilities to obtain a Certificate of Intent early in their working process in order to enhance the information flow and to provide technical support in the implementation of the Ten Steps to Successful Breastfeeding. This means that new Certificate of Intent facilities may appear to be, and truly may be, very unprepared for assessment when achieving this first milestone in the BFHI process. It may take years for some facilities to fully implement all Ten Steps and be ready for on-site assessment. In our experience, facilities that create multi-disciplinary working groups (including ideally the breastfeeding advocates as well as key breastfeeding disbelievers, together with representatives of marketing, administration, women's health, obstetrics, pediatrics, quality assurance, ethics/vendor policy and community benefits) to work through the self-appraisal tool are best able to get everyone's beliefs, objections and thoughts out in the open. This group experience often opens possibilities for transformation that do not exist if BFHI is perceived to be the soapbox of only one or two rabblerousers. (:>) Decision about the actual designation of "Baby-Friendly" hospitals is made after an intensive on-site assessment. While the assessment process is not perfect, it does entail several features which build a multi-faceted picture of the breastfeeding and maternal/infant care delivered. The bulk of the material generated in the assessment process comes not from what hospitals report, but from tens of interviews with RANDOMLY selected mothers (prenatal and postpartum) and staff members, as well as through observation, review of documentation and meetings with administrators. Facilities do not get to choose which mothers and staffers are selected for interviews. I strongly agree with other posters who have suggested that the type of situation Barb presents here is a great opening for community breastfeeding advocates and experts to help transformation happen. That is, rather than feeling exasperated that facilities would think they were ready for BFHI, one could choose to see this as a great opportunity to support positive change and to help identify what is going well and what is NOT. Community members are encouraged to contact the working group and offer their support. Many of the Ten Steps are optimized by the involvement of the facility with the larger breastfeeding community. Kudos to all who strive to improve the environment for new families! Cindy Turner-Maffei, MA, IBCLC; Coordinator, Baby-Friendly USA 8 Jan Sebastian Way #13 * Sandwich, MA 02563, USA ph (508) 888-8092 * fax (508) 888-8050 http://www.aboutus.com/a100/bfusa/ mailto: [log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html