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Prince of Wales Hospital Policy on Breastfeeding

  1. Have a written breastfeeding policy that is communicated to all healthcare staff.

    1.1 The policy summary is displayed in areas where pregnant women, mothers and infants are served.

    1.2 The policy summary is written in both English and Chinese.

    1.3. The policy is to be communicated to all staff of PWH.

    1.4. All the protocols related to breastfeeding and infant feeding are in line with current evidence-based standards.

  2. Train all relevant healthcare staff the necessary skills to implement the policy.

    2.1. The healthcare professionals are responsible for educating, supporting and evaluating the mothers on breastfeeding. They are to help the mothers to overcome their breastfeeding challenges or make referrals to appropriate personnel if necessary.

    2.2. All staff members caring for pregnant women, mothers and infants are oriented to the breastfeeding policy of the hospital when they start work.

    2.3. All professional and supporting staff who take care of pregnant women, mothers and infants would be trained in breastfeeding management at a level appropriate to their professional group. Training should also be provided for these staff on the care for women and infants who are not breastfed as an informed choice. New staff will receive training within six months of commencing their work.

    2.4. All non-clinical staff such as clerical and housekeeping staff are orientated to the policy and should be able to refer infant feeding queries appropriately.

    2.5. Training curricula are available for staff training. The curricula would cover ¡¥The Ten Steps to Successful Breastfeeding¡¦ and ¡¥the International Code of Marketing of Breastmilk Substitutes' and subsequent relevant World Health Assembly resolutions.

    2.6. The training records are kept by designated personnel.

  3. Inform all pregnant women of the benefits and management of breastfeeding.

    3.1. The responsible professional staff will ensure that all pregnant women are given verbal and non-commercial written information of the benefits and management of breastfeeding and the potential health risks of formula feeding in their antenatal visits in PWH or in the shared care organisations (Maternal & Child Health Centres of the Department of Health). The information given is documented in the mothers' hospital notes.

    3.2. The breastfeeding classes are organised routinely for the pregnant women. All pregnant women are encouraged to participate in the breastfeeding classes in PWH, the shared care organisation (Maternal & Child Health Centres of the Department of Health) or the private sector.

    3.3. Healthcare professionals should discuss with pregnant women their concerns on breastfeeding in their antenatal visits and if necessary, refer them to the lactation consultants.

  4. Help the mothers to start skin-to-skin contact with their infants immediately after birth.

    4.1. All mothers who delivered vaginally or by Caesarean sections without general anaesthesia are encouraged to start skin-to-skin contact with their infants immediately after birth in an unhurried environment if the mothers and their infants are physically fit.

    4.2. For mothers who have undergone general anaesthesia, skin-to-skin contact with their infants should be performed as soon as they are responsive and alert.

    4.3. Skin-to-skin contact should last for at least one hour without interruption except due to clinical reasons. If skin-to-skin contact is interrupted under such circumstances, it should be resumed as soon as the mothers and infants are fit to continue.

    4.4. All women are encouraged to recognize the feeding cues and to offer the first breastfeed uninterruptedly in skin-to-skin contact when they and their infants are ready, with the help from a midwife.

    4.5. Infants who are cared in the neonatal unit have chances to be held by their mother skin-to-skin if they are physically fit.

  5. Show the mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.

    5.1. All breastfeeding mothers are offered further help with breastfeeding within the subsequent six hours of delivery.

    5.2. The breastfeeding mothers should be ensured to acquire the skills of positioning, attachment and recognition of effective feeding.

    5.3. All mothers will be shown how to hand express their milk.

    5.4. Breastfeeding mothers are encouraged to maintain lactation if their infants are separated from them or have to stop direct breastfeeding temporarily. Mothers are taught the use of milk pumps as necessary.

    5.5. Mothers who are separated from their infants are offered help to express milk within six hours of delivery and continue to express at least six to eight times in a 24-hour period.

    5.6. For mothers who have to prepare expressed breastmilk for their infants, the healthcare professionals should provide them the necessary education that includes the sterilisation technique, storage and labeling of milk bottles.

    5.7. Mothers who have decided not to breastfeed are to have individual discussions on various feeding options and helped to decide what is suitable in their circumstances. They should be shown on the preparation for their infant feeds, with return demonstrations. Breast care should also be advised.

    5.8. A referral to the lactation consultant service is made for mothers who have more complex breastfeeding problems.

  6. Feed newborn infants with breastmilk only. Other food or drink will be given only if medically indicated.

    6.1. In the first six months, breastfed infants should receive no other food or drink except in cases of medical indication or fully informed mothers' choice.

    6.2. The breastfeeding mothers must be consulted and discussed in full if formula is prescribed as supplement for medical reasons. Any formula prescribed must be documented in infants' hospital notes.

    6.3. Breastfeeding mothers who request for formula supplement are counselled to make aware of the possible health implications and the negative effects so that they can make a fully informed choice. Prior to introducing formula, mothers are encouraged to express breastmilk to give their infants via supplementary aids, such as cups, syringes and spoons. Supplementation should be regularly reviewed and discussed with the mothers. These discussions and procedures are documented in the mothers' and infants' hospital notes.

    6.4. All mothers are encouraged to breastfeed exclusively for six months and continue breastfeeding for two years or more. All weaning information should reflect this recommendation.

    6.5. Mothers who have decided not to breastfeed will have individual discussions on other feeding options and advised on breast care.

    6.6. Data of infant feeding on discharge are transferred to the shared care organisation (Maternal & Child Health Centres of the Department of Health) or the private sector.

  7. Practice rooming-in of infants 24 hours a day except when separations of mothers and infants are necessary due to health issues.

    7.1. Mothers and their infants are to stay together immediately after birth in postnatal wards. This practice applies to both breastfed and formula fed infants.

    7.2. Mothers who have delivered by Caesarean sections should be given appropriate care but the policy of keeping mothers and infants together will apply.

    7.3. Separation of mothers and infants in postnatal wards occurs only due to justifiable reasons.

    7.4. Mothers are encouraged to learn how to interpret their infants¡¦ needs and feeding cues.

    7.5. For mothers who choose not to practice room-in of infants 24 hours a day as an informed choice, mothers are advised on the risk and these discussions are documented in the mothers' hospital notes.

  8. Encourage breastfeeding on demand (responsive feeding).

    8.1. Feeding according to need and with no restriction on frequency or duration is encouraged for all infants unless clinically contraindicated.

    8.2. All breastfeeding mothers are to be educated about the feeding cues and encouraged to practice responsive feeding. The importance of night-time feeding for milk production should be explained to mothers. Mothers can also be advised that if their breasts become overfull they could try to breastfeed.

  9. Give no artificial teats or pacifiers to breastfeeding infants.

    9.1. Artificial teats or pacifiers are not to be given to breastfeeding infants during the establishment of breastfeeding.

    9.2. Mothers wishing to use them should be advised of the possible detrimental effects on breastfeeding so that they can make a fully informed choice.

    9.3. The information given and the mothers¡¦ decisions should be documented in the appropriate health record.

  10. Foster the liaison with community services on breastfeeding support groups and refer mothers to join them on discharge.

    10.1. Before discharge from the hospital, mothers will be provided with postnatal education and communicated on their infant feeding planning.

    10.2. PWH will liaise with the Maternal & Child Health Centres of the Department of Health on breastfeeding support and refer mothers to join them on discharge from the hospital. Mothers are encouraged to access these support within 2-4 days after birth and again in the second week.

    10.3. All new mothers will be provided the contact details of healthcare professionals who can support them with breastfeeding, including lactation consultants, Maternal & Child Health Centres, telephone hotline for breastfeeding support and peer support groups.

    10.4. Mothers who choose not to breastfeed as an informed choice will be provided the contact details of healthcare professionals who can support them with infant feeding, including Maternal & Child Health Centres and telephone hotline of the hospital.

  11. Support mother-friendly childbirth practices and procedures.

    11.1. Encourage women to have the companion of their significant others to provide constant or continuous physical and/or emotional support during labour and birth.

    11.2. Allow women with low risk labour to drink during labour, except in women who develop complications in their labour process.

    11.3. Encourage women to consider the use of non-pharmacological methods of pain relief unless analgesic or anaesthetic drugs are necessary because of complications.

    11.4. Encourage women to walk and move about during labour. Offer birth position choices suitable for the women, unless a restriction is specifically required for a complication and the reason is explained to the mother.

    11.5. Avoid invasive procedures, such as rupture of the membranes, episiotomies, inductions of labour, instrumental deliveries, and Caesarean sections unless specifically required due to complications and explain the reasons to the mothers.

    11.6. All obstetric staff are informed of the mother-friendly labour and birthing policies and procedures.

  12. Support employees to continue breastfeeding after returning to work.

    12.1. PWH supports employees to continue breastfeeding after returning to work.

    12.2. A breastfeeding room with facilities for expression and storage of breastmilk is set up for staff.

    12.3. Employees who need to express breastmilk during working hours should approach their supervisors to work out an appropriate arrangement.

    12.4. All other staff members are requested to support their colleagues to breastfeed by adopting a positive and accepting attitude.

  13. Implement the 'International Code of Marketing of Breastmilk Substitutes' and Subsequent Relevant WHA Resolutions (adopted from the Annex 2 of the Hospital Authority Breastfeeding Promotion Policy, 2010).

    13.1. No advertising of all breastmilk substitutes, feeding bottles and teats.

    13.2. No free samples to mothers.

    13.3. No free or low cost supplies of breastmilk substitutes.

    13.4. No promotion of products in or through health care facilities.

    13.5. No company personnel to contact mothers. No gifts or personal samples to healthcare workers. Healthcare workers should never pass samples on to mothers.

    13.6. No use of space, equipment or educational materials sponsored or produced by companies when teaching mothers about infant feeding.

    13.7. Labels should be in an appropriate language and have no words or pictures idealizing artificial feeding e.g. pictures of infants on the labels.

    13.8. All information on artificial infant feeding should clearly explain the benefits of breastfeeding, warn of the costs and hazards associated with artificial feeding.

    13.9. Information to health workers should be scientific and factual.