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Pursuing the Baby-friendly Hospital Initiative – From the Public to the Private Hospital
Ms Grace Hui Wan Kam
Nursing Manager, Gleneagles Hospital Hong Kong
I have been working as a nurse for decades. I used to take care of babies in the intensive care unit in a busy hospital with maternity service under the Hospital Authority (HA). The promotion of breastfeeding has been ongoing in hospitals since the 1990s, having gone through the initial public resistance to wide acceptance nowadays. I have also progressed through these experiences, having learned many teaching and training skills, had opportunities to communicate with different teams and gained their staunch support and cooperation, thus moving step-by-step towards the goal of fully supporting breastfeeding.
The Difficulties and Advantages of Supporting Breastfeeding in HA Hospitals
In HA hospitals, the workload was so heavy that meal or washroom breaks were a luxury and colleagues had developed the habit of minimising water intake at work. One can imagine the difficulty of squeezing time to implement the Baby-friendly Hospital Initiative (Initiative) there.
Under tight manpower, it was difficult to arrange colleagues of all ranks to receive training. On the other hand, HA hospitals had the advantage that all staff were its employees and had to take the training as required.
Post-training practice was another challenge. It demanded time and manpower for the staff to acknowledge the concepts and put them to practice, such as practising cup feeding and coaching mothers in proper positioning during direct breastfeeding. The support and encouragement from the management were crucial.
Since there was no additional charge for formula milk supplementation in HA hospitals, staff would spend time in explaining how to facilitate breastmilk coming-in as soon as possible and the benefits of exclusive breastfeeding. In HA hospitals, the postnatal stay was 2 days 1 night for vaginal deliveries and 3 days 2 nights for caesarian deliveries. The first few days were most critical for breastfeeding mothers as they would face many difficulties. However, with such a short stay, the new mothers would have been discharged from the hospital well before they had acquired all the breastfeeding related skills. Fortunately, all HA hospitals and Maternal and Child Health Centres operated lactation clinics to assist the mothers.
Opportunities and Challenges of Supporting Breastfeeding in a Private Hospital
Before I talk about the progress of Baby-friendly Hospital designation, let me first share my views of the hospital I work in.
This private hospital is a very different world to me. The excellent hardware being the nice environment and the advanced facilities, and the soul is its staff and culture. As I tell my supervisor, it feels like being in a small British town where every staff greets each other and mostly by name. I strongly feel the respect, friendliness and harmony here.
Putting Words into Actions
Soon after I had joined the Hospital, my supervisor instructed me to set up a lactation clinic. I was so impressed by the fact that it took only a month from planning, confirmation of site, furnishing the room, setting up the admission procedures, etc. to the official establishment of the clinic. The inter-departmental team spirit and working together to achieve a common goal is the hospital culture.
Trust & Support for me
The management has absolute trust on the staff and provides them with substantial backing. The top management fully supports any initiatives it considers appropriate and beneficial to the clients, and resources are not an issue. In pursuing the Initiative over these years, my supervisor’s words have been a strong motivation for me: “Feel free to do it. Just let me know the progress and voice any help you need.” I was deeply moved. Throughout this period, she has kept her promise and given me support in all aspects.
The Culture and Characteristics of the Hospital
Right from the start, the Hospital possesses one of the important features for being a Baby-friendly Hospital: encouraging 24-hour rooming-in. Nurses go into a mother’s room and coach her direct breastfeeding one-on-one at the bedside. Sometimes they also need to assist and coach the mother in manual milk-expression and then feed the baby with a cup. It is manpower- and time-demanding having to coach the mother one-on-one, particularly with an increasing number of clients. The culture of unity and teamwork has allowed the smooth implementation of the initiatives.
Furthermore, the mothers have postnatal stay of 3 days 2 nights or 5 days 4 nights at the Hospital. They have more time to learn about baby care and breastfeeding. Thus, most mothers have mastered the skills in breastfeeding and milk expression before discharge and gained the confidence to continue breastfeeding after returning home.
Babies in Special Care
The Hospital is not only equipped with advanced facilities but also an experienced medical team to take care of newborn babies in intensive care. Parents are able to visit and breastfeed their baby any time, as well as allowed unlimited skin-to-skin contact at the bedside when the baby is in stable condition.
Towards Baby-friendly Hospital Designation
The environment, facilities and management philosophy of the Hospital are all oriented towards the goal of Baby-friendly Hospital designation. When I joined the hospital in 2018, I was appointed as the Baby-friendly Hospital coordinator, responsible for planning and leading the team to implement the Baby-friendly initiative. The first step was setting up a Lactation Clinic to provide practical support to clients on breastfeeding, then the submission of an application to the Baby Friendly Hospital Initiative Hong Kong Association (Association). Step by step, we went through the first three stages, having been awarded the Certificate of Intent, Certificate of Commitment and Certificate of Level I Participation.1
Much deliberation had been put in the formulation of the Infant Feeding Policy and relevant work guidelines, staff training plan and service monitoring system. The definition and implementation of each step, the scope of personnel involved for each item and the expected progress were required to be clearly described. There were many back-and-forth discussions and exchanges of views between the Hospital and the Association before reaching a consensus and obtaining the certificates successfully. In the next phase, actions will be taken according to plan. The focus will be on training healthcare professionals to meet service standards for the implementation of the Infant Feeding Policy; facilitating pregnant women in understanding the importance of breastfeeding and the impact of breastfeeding on infant health; supporting mothers to breastfeed their newborn babies; and following all the steps of the Initiative.
Staff training is an important component as well as a major challenge of the Initiative. Since the training targets both resident and non-resident medical staff, thorough considerations are needed for preparing the curriculum, promotion and implementation. Nurses in obstetrics can be exempted as they are midwives who have already completed recognized breastfeeding courses. Nurses in paediatrics are required to undergo a 20-hour course of theory and practicum. As the breastfeeding course organized by the Family Health Service of the Department of Health (FHS) has been suspended due to the COVID-19 pandemic, an agreement was made to provide training videos and resources for the Hospital to conduct the training. In spite of the pandemic, it was decided to start the training in May this year so that colleagues could obtain the required knowledge and start the practice the soonest to serve the clients. For doctors, they will take an online self-learning professional course2 that meet the designation requirements. The initial target is to encourage all resident doctors and visiting doctors with caseload of 50 or more per year to complete the course. The goal is to have doctors equipped with the professional knowledge in breastfeeding that align with the Infant Feeding Policy of the Hospital. For the other staff, briefings will be arranged according to their work nature to ensure all staff understand and support the policies implemented. With the direction clearly set and the collaboration among all parties, the team is confident in achieving the ultimate goal notwithstanding obstacles ahead.
Most of the clients of the Hospital have their antenatal check-ups at private obstetricians of their choice. Prior to the COVID-19 pandemic, the Hospital regularly held ante-natal classes to promote breastfeeding. It has been changed to online mode in recent years. Therefore, for most clients, when they turn up at the hospital, it is the first time we meet the clients. Nevertheless, all colleagues will actively communicate with them to understand their plans on childbirth and feeding. We also let the expectant parents know about our services and how we will work together with them.
After the baby is born, the team provides the mother with full support to enhance her competence and confidence in breastfeeding. These include assistance to the mother for starting breastfeeding or milk expression as early as possible; unlimited skin-to-skin contact for the mother-baby dyad and individual guidance on breastfeeding techniques.
The Hospital highly recommends exclusive breastfeeding and 24-hour rooming-in for mothers and babies. If a client requests supplementary formula milk, our staff will explain to her the benefits of exclusive breastfeeding and the negative impact of formula supplementation. The client is encouraged to adopt responsive feeding, increase the number of feeds or milk expression and maintain night feeding to increase milk supply. When the client has made an informed choice, the staff will provide the most appropriate service accordingly to ensure the physical and mental health of the mother and baby.
The journey to Baby-friendly Hospital designation is challenging yet satisfying. It is most rewarding that I have been able to earn support from all parties, witness the joy of successful breastfeeding of the clients as well as contribute to promoting breastfeeding and guarding the health of the future pillars of our society. I will keep the momentum to lead the team towards the goal of acquiring the Certificate of Level II Participation and Baby-friendly Hospital1 designation.
- Affirming the goal of pursuing "Baby-friendly Hospital" designation, along with team spirit and inter-departmental collaboration are essential elements of success.
- Training is an important component of the Baby-friendly Hospital Initiative. However, training non-resident medical personnel is a major challenge.
- The aim of training doctors is to equip them with sufficient professional knowledge on breastfeeding to align with the Infant Feeding Policy implemented by the hospital. Doctors can use a recognised online course (about four hours) for self-learning.
- The hospital policy encourages 24-hour rooming-in and unlimited skin-to-skin contact for mother-baby dyads. Nurses coach mothers one-on-one in direct breastfeeding. Adequate postnatal hospital stay enables mothers to master the skills of breastfeeding and milk expression before discharge. All these contribute to enhancing mothers' confidence in continuing breastfeeding after returning home.
- How do hospitals and MCHCs in Hong Kong become designated as baby-friendly? Hong Kong Association of Baby-Friendly Hospitals Website: https://www.babyfriendly.org.hk/en/faqs-on-baby-friendly-hospital-initiative-in-hong-kong/
- The Baby-Friendly Hospital Initiative Hong Kong Association recommends using BELLA Breastfeeding: Provider Training. This is a four-hour free course with certificate upon completion. (https://www.openpediatrics.org/)
All rights reserved by Baby Friendly Hospital Initiative Hong Kong Association.
Editor-in-Chief: Dr Shirley Leung
Editorial Team: Mrs Francis Au, Ms Sally Wan, Ms Sing Chu, Ms Christine Lam, Ms Iris Lam, Ms Yiu Po Chu, Ms Julia Yeung
All rights reserved by Baby Friendly Hospital Initiative Hong Kong Association.