Baby-Friendly e-Newsletter : Baby Friendly Watch (March 2024)

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Date: 2024-03-18

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Giving All-Round Support to Breastfeeding

United Christian Hospital’s Designation as a “Baby-Friendly Hospital”

Authors: Breastfeeding Promotion Team, United Christian Hospital

The Baby-Friendly Hospital Initiative was established with the goal of giving every baby the best start in life. In Hong Kong, a hospital undergoes 5 stages to achieve designation as a Baby-Friendly Hospital.¹ With the mission of promoting breastfeeding and protecting children’s health, the United Christian Hospital (UCH) applied for Register of Intent in September 2016, and was successfully designated as a “Baby-Friendly Hospital” by the Baby-Friendly Hospital Initiative Hong Kong Association in June 2023. Provision of antenatal services in the Kowloon East Cluster is shared between UCH and Tseung Kwan O Hospital (TKOH). Over the past 7 years, various departments of UCH and the Obstetrics and Gynaecology Specialist Clinic of TKOH have actively participated in the process and closely collaborated with one another. This effort has no doubt facilitated a smooth process and laid a solid foundation for transition to a baby-friendly hospital.

The Challenges

Looking back, the designation process was not all smooth. At the beginning when colleagues knew the hospital was going baby-friendly, they inevitably had worries about the increasing workload. It took time for communication and explanation to allay their concerns. While going through the process, colleagues started to realise the need to improve the maternal and infant services and appreciate the value of designation. They became proactive in making suggestions for improvement and worked collaboratively towards the cause.

While working towards acquiring the Certificates of Commitment and Level 1 Participation, colleagues from the Departments of Obstetrics and Gynaecology and the Department of Paediatrics communicated actively and collaborated closely to develop various policies and guidelines. All parties strived to overcome the difficulties. A significant milestone was accomplished after a consensus had finally been reached.

Utilization of the Competency Verification Toolkit

Another important element is staff training in the stage of Level 2 Participation. Since 2021, the hospital had followed the staff training plan set down during the stage of Level I Participation. Assessments were conducted three monthly to ensure the staff’s knowledge would meet the criteria required by the Baby-Friendly Hospital Initiative. At the onsite assessment of Level 2 Participation, although the hospital had successfully met the standard to receive the award, the assessment report pointed out that staff had exhibited inconsistency in explaining and demonstrating breastfeeding-related skills. It recommended the hospital to provide a refresher course for the relevant staff and include a competency assessment in the subsequent staff audit. We agreed that our staff audit form in use then was inadequate in evaluating staff competence, so we followed the recommendations of the report and referred to the Competency Verification Toolkit published by the World Health Organization (WHO) and UNICEF.² A supplementary audit form was thus added to further evaluate staff competence.

Initially, we were unsure if this toolkit would be appropriate for use in Hong Kong as no other local hospital had used it before. Moreover, there were concerns that the designation process might be prolonged as extra time would be needed for staff to get familiar with the toolkit. However, we subsequently discovered it had included a Competency Verification Form, which obviated the need for our own design and verification. The toolkit could be applied to evaluate staff’s comprehensive or targeted competencies, using a variety of methods such as questioning, case discussion, and direct observation on skills and attitudes. The included “Examiner’s Resource” clearly outlined the criteria for achieving the assessment standards and provided examples of different assessments, which was comprehensive and convenient to use.

After thorough analysis and consideration, we decided to select 3 specific items from the toolkit for additional audit, tailored to the needs of the staff. These items were:

Showing mothers how to breastfeed
Hand-expressing breastmilk
Preparation of infant formula and feeding an infant a supplement in a safe manner

The toolkit had a comprehensive list of requirements for each item. For example, hand expressing milk involved assessing indicators like environmental preparation, hand hygiene, tools, and milk expressing skills to effectively evaluate knowledge and skills.³ However, not all items in the toolkit were directly applicable, for example, regarding the observation of infant stools, although there were indicators for observing infant bowel movements, these were different from those in use and were difficult to apply. It was necessary to make minor adaptations while adhering to the principles of auditing.

Before launching a new round of audit, we offered breastfeeding refresher training to all midwives of the Departments of Obstetrics and Gynaecology and performed an assessment trial to ensure it could be successfully completed. When the audit was officially conducted, a total of 32 staff were evaluated in three rounds, and the outcomes were satisfactory.

In order to carry out the new round of audit, all colleagues had worked very hard despite their busy clinical duties. The satisfactory audit results had assured us of the staff’s competence, thereby enhancing our confidence in completing the final stage of assessment for designation and motivating us to strive for the baby-friendly hospital status. In June of the same year, the hospital was finally designated as a Baby-Friendly Hospital, fulfilling our long-term goal.

Comprehensive Breastfeeding Support

Throughout the designation process, we have continuously improved our services to meet the needs of our users. We provide face-to-face education on breastfeeding at the Obstetrics & Gynaecology Specialist Clinic so that pregnant women and their families can receive accurate information. In recent years, we also offer online baby-friendly classes to those who are unable to visit the clinic, as well as interactive sessions for sharing by volunteers to enhance mothers’ confidence and capacity to breastfeed. Furthermore, our Natural Birth Tour allows expectant parents a chance to rehearse their first labour. The hospital has also consistently enhanced its postnatal services to promote uninterrupted, immediate skin-to-skin contact between mothers and their infants after childbirth, encourage mothers to initiate lactation immediately, and enable mother-infant dyads to remain together by practicing 24-hour rooming-in. Through implementing the “ten steps to successful breastfeeding”, the hospital has empowered mothers to establish and maintain breastfeeding, as well as navigate through challenges.

At the annual International Breastfeeding Week, we set up a booth in the hospital to promote its theme, so that both the staff and visitors can learn about the benefits of breastfeeding. The “Smart Mommy” certificate, given to staff who had nursed their babies for six months or more within the year, is the highlight of the event. Although not the requirements of Baby-Friendly Hospital designation, these programmes are popular among staff and the public alike.

The Way Forward

While we are pleased with the designation, we appreciate that it is just the beginning of the Baby-Friendly Hospital Initiative’s continuous journey of service quality improvement to ensure health of mothers and infants. As the ” best ally” of mothers, UCH provides comprehensive care for parents and babies from prenatal, childbirth to postnatal care. In years to come, the team will keep walking with mothers, providing all the assistance they need to breastfeed successfully.

Key Messages:

Colleagues from all departments of the United Christian Hospital worked together to successfully achieve the Baby-Friendly Hospital Designation.
Challenges encountered in the Level II Participation phase.
Using the Competency Verification Toolkit to ascertain staff competence, enhancing the confidence in preparing for designation assessments.
Providing comprehensive support for antenatal and postnatal women on breastfeeding and childrearing to ensure maternal and infant health.

Views expressed in this article are the authors’ and do not necessarily reflect the opinion or position of the BFHIHKA.

Editor-in-Chief: Dr Shirley Leung

Editorial Team: Mrs Francis Au, Ms Sally Wan, Ms Sing Chu, Dr Annie Fok, Ms Ivy Yiu, Ms Julia Yeung, Dr Ana Lee, Ms Tracy Ling, Ms Wong Ka Yin, Ms Lo Ka Yee

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