1. This breastfeeding policy is routinely communicated to all health care staff and parents.
    1. All hospital staff will be informed of the breastfeeding policy in their orientation programs.
    2. A copy of the policy will be prominently displayed in all obstetric, neonatal and Paediatric units.
    3. An information summary on the Policy in English and Chinese will be given and introduced to parents during their antenatal visits.
    4. This policy will be reviewed every three years.
  2. All health care staff involved with implementing the Policy will be trained with the requisite knowledge, skills and competence to support breastfeeding.
    1. All health care providers responsible for pregnant women, mothers and babies will be trained on breastfeeding management skills and assess their competences at levels applicable to their professional roles.
    2. New staff will receive training within six months of work commencement.
    3. All training will be based on the Hospital’s documented and regularly updated curriculum that includes the “Ten Steps to Successful Breastfeeding (revised 2018)” advocated by the WHO.
    4. Staff who provide antenatal, delivery and/or newborn care will receive competency assessments in breastfeeding in a regular base.
    5. All clerical and ancillary staff will be made cognizant of the hospital’s breastfeeding policy and trained on appropriate referral of related queries to health care staff.
    6. Practices recommended by “The International Code of Marketing of Breastmilk Substitutes” and subsequent relevant WHA resolutions will be included in all orientation and training programs.
    7. All departments are to keep accurate and detail staff training record on breastfeeding.
  3. All pregnant women and their families will be discussed on the benefits and management of breastfeeding.
    1. Information will be provided by non-commercial educational material and in person at antenatal classes.
    2. All pregnant women and their families attending antenatal clinic will have their breastfeeding knowledge, infant feeding choice and concerns, and previous feeding experience discussed with them. Information collected on each case will be documented on record.
    3. Information on infant feeding must include the benefits and superiority of breastfeeding, skin-to-skin contact, responsive feeding, positioning and effective sucking, rooming-in and exclusive breastfeeding for the first six months of life.
    4. Information about the risks of giving supplements to babies during the first six months will be discussed with pregnant women.
    5. Information provided to mothers should also include the value and methods of developing a positive and loving relationship with their babies.
    6. Women who have previous unsatisfactory breastfeeding experience or breast problems will be referred to a Lactation Consultant.
    7. Information on practices supporting mother-friendly childbirth will be included in antenatal talks.
  4. The Hospital will facilitate mothers to start immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth.
    1. Mothers will be advised of the benefits of skin-to-skin contact.
    2. Babies are to have at least an hour of uninterrupted skin-to-skin contact with their mothers immediately or within 5 minutes after birth regardless of the intended feeding mode. The duration of skin-to-skin contact should last till after the first feed or for as long as the mothers’ wish.
    3. If skin-to-skin contact has to be delayed or interrupted due to medical conditions of either mother or infant, it should be facilitated once the situation allows.
    4. For Caesarean-section birth, mothers and babies are to remain together once their conditions stabilize and the mothers become responsive.
    5. Mothers will be taught to recognize baby feeding cues and assisted to get started with breastfeeding.
    6. Nursing procedures and practices are to provide attentive care for both the mother and the infant.
    7. Mothers with babies in neonatal units are encouraged to hold their babies with skin-to-skin contact whenever conditions allow.
  5. Mothers will be supported how to breastfeed, maintain lactation and manage common difficulties.
    1. Mother will be shown how to breastfeed within six hours of delivery and offered assistance with breastfeeding during their hospital stay. Midwives and nurses will assess and document the effectiveness of the feeding.
    2. All breastfeeding mothers are taught correct positioning and attachment of their babies.
    3. Mothers will get help to manage common difficulties, and be referred to a lactation consultant on maternal and infant breastfeeding difficulties.
    4. Mothers will be taught how to assess on the adequacy of breastfeeding.
    5. Before their discharge from hospital, all mothers will be taught methods to facilitate milk production, hand expression techniques and when to have them practiced.
    6. Mothers separated from their babies after birth are offered help and encouraged to have early milk expression (preferably within 1-2 hours after delivery) at least 8 times a day.
    7. Mothers will be taught proper ways to clean utensils, store and transfer expressed breastmilk.
    8. Expressed breastmilk are to be brought to babies in neonatal units.
  6. Newborn infants will be fed breastmilk only. Other food or drink will be given only if medically indicated.
    1. No water or formula will be given to a breastfed baby unless prescribed by doctors, nurses or midwives with clear indications and proper documentation.
    2. Health care professionals must assess the condition of the baby and the breastfeeding process before considering supplementary feed. Parents must be informed of the decision.
    3. If a baby cannot be breastfed or extra supplementary feed is required, expressed breastmilk should always be the first choice.
    4. If a mother is unable, or does not wish, to breastfeed her infant directly, the infant is to be fed using alternate feeding methods such as cup, spoon, or feeding tubes, in accordance with the principles of preserving breastfeeding.
    5. Parents who request formula feed will be counselled on its health hazards and the superiority of breastfeeding for mother and child. Counseling given and reasons for supplementation will be documented in the mother’s medical record.
  7. QEH practices 24-hours a day rooming-in of mothers and their babies.
    1. This practice applies to all babies regardless of their birth or feeding modes.
    2. Separations are only for justifiable reasons with written documentation.
    3. Separation of child from mother for medical procedures should not exceed one hour; otherwise mothers are to be invited to accompany their babies.
    4. If a mother objects to keeping her baby by her side, the health care staff must explain the rooming-in policy clearly and advise her on the potential problems of separation.
  8. QEH encourages responsive breastfeeding.
    1. Mothers will be taught to recognize and response to their infants’ cues for feeding, closeness and comfort.
    2. Healthy term newborns are to be fed with no restrictions placed on the frequency or duration of breastfeeding.
    3. Mothers will be taught how to wake a sleepy baby through skin-to-skin contact or gentle caresses.
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    4. Mothers will also be taught to breastfeed for her own needs, such as engorgement or enjoying the time with their babies.
  9. Mothers will be counselled on the use and risks of feeding bottles, teats and pacifiers.
    1. Teats or pacifiers should not be given to breastfed babies.
    2. Expressed breastmilk or supplementary feeds are to be given by cup, spoon or lactating aids.
    3. Parents who choose to use artificial teats, bottles and pacifiers will be counselled on their possible detrimental effects on breastfeeding and risks including hygiene, oral formation and recognition of feeding cues. The discussions have to be documented in the medical record.
  10. QEH provides discharge support, and refers mothers and their infants for ongoing support and care in the community.
    1. The Hospital will provide support to mothers after discharge with phone follow up and hotline service.
    2. Mothers who experience breastfeeding problems will be referred to the breastfeeding clinic for follow up.
    3. The Hospital fosters close collaboration with Maternal and Child Health Centers (“MCHC”) and breastfeeding support groups.
    4. All mothers will be advised to attend MCHC or Paediatric clinics for health follow up, preferably 2-4 days after discharge.
    5. The Hospital will provide mothers with information on where to access help and support on breastfeeding / infant feeding after they return home.
  11. QEH fully supports mothers who made the informed decision not to breastfeed.
    1. Mothers, who decided not to breastfeed or have conditions that do not allow them to exclusive breastfeed, will be informed of the infant feeding options available, the risks of not breastfeeding, the financial impact and socio-cultural factors to be considered.
    2. Mothers will be taught individually on how to prepare formula, and will be asked to demonstrate what they have learned.
    3. Mothers will be taught to feed in a safe and responsive manner that helps to build a close and positive relationship with their babies.
  12. QEH practices the “International Code of Marketing of Breastmilk Substitutes” and relevant subsequent resolutions of the World Health Assembly.
    1. The Hospital will not accept free or low-cost supply of breastmilk substitutes. All procurement of breastmilk substitutes, including bottles and teats, will follow the policy of the Hospital Authority.
    2. There shall be no promotion of breastmilk substitutes, bottles, teats, or pacifiers in the Hospital, nor the display or distribution of them to pregnant women or mothers.
    3. Hospital staff shall not accept from manufacturers or distributors any free gifts, non-scientific literature, materials or equipment, financial or material sponsorship for in-service education or events.
    4. The Hospital will not give pregnant women, mothers and their families any marketing material, samples or gift packs that contain breast-milk substitutes, bottles and teats, pacifiers, or coupons for such items.
    5. All printed materials on infant feeding shall not contain marketing information.
  13. QEH supports mother-friendly childbirth practices and procedures.
    1. Pregnant women will be counselled on birth plan preparation during their antenatal visits.
    2. When admitted for labour, the birth plan will be evaluated and administered in consideration of factors including labour companion, birth position, pain relief methods and specific needs of the woman or couple.
    3. Women are encouraged to have labour companion of their choice.
    4. Drinks and light food can be offered during labour for low risk cases.
    5. If food is not allowed due to labour conditions, sips of water or ice-cubes can be provided as alternatives.
    6. Non-pharmacological pain relief methods are to be encouraged and provided.
    7. Women are to be encouraged to move or walk during labour, and assume birth positions of their choice unless restrictions are specifically required.
    8. Invasive procedures will be avoided at all times and used only if medically indicated. Their use and possible effects have to be properly explained to the mother or couple.
  14. QEH is a breastfeeding-friendly hospital that supports mothers to breastfeed at a place they preferred.
    1. The Hospital respects the mother’s freedom to choose where to breastfeed and supports mothers to breastfeed at anytime, anywhere.
    2. The Hospital provides, as much as practicable, appropriate locations to mothers who wish to breastfeed in more privacy.
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