A Baby-Friendly Hospital is a maternity facility that has been accredited for adhering to a specific set of care standards designed to optimize infant feeding and mother-baby bonding. This global program, known as the Baby-Friendly Hospital Initiative (BFHI), was established by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991. The initiative’s primary goal is to provide a healthcare environment that supports the best possible start in life for every baby by improving the quality of maternal and newborn care. By implementing evidence-based practices, these facilities aim to protect, promote, and support a mother’s decision regarding how she feeds her infant.
The Ten Steps to Successful Breastfeeding
Achieving the Baby-Friendly designation requires facilities to successfully implement the “Ten Steps to Successful Breastfeeding,” which serve as the foundational policy framework. These steps begin with administrative requirements, such as maintaining a written infant feeding policy that is routinely communicated to all staff and parents. The policy must also comply fully with the International Code of Marketing of Breast-milk Substitutes, prohibiting the acceptance of free or low-cost formula and the marketing of breast-milk substitutes within the facility.
Another structural requirement is establishing ongoing monitoring and data-management systems to track and evaluate the facility’s performance against the Ten Steps. The initiative also mandates that health providers discuss the importance and management of breastfeeding with pregnant women and their families before the baby is born. The Ten Steps also require facilities to ensure staff possess the necessary knowledge, competence, and skills to support breastfeeding mothers. Before a mother is discharged, the facility must coordinate care to ensure parents have timely access to ongoing support in the community.
Mandatory Care Practices During Hospital Stay
The Baby-Friendly designation is most visible to patients through specific, non-negotiable care practices during the hospital stay. One of the most significant practices is facilitating immediate and uninterrupted skin-to-skin contact between the mother and the newborn right after birth. This contact should be initiated as soon as possible and continue until the first feeding is completed, or for at least one hour, unless medically necessary to interrupt. Routine procedures like Apgar scoring, weighing, and medication administration are performed while the baby remains on the mother’s chest to maintain this bond.
Another defining practice is the requirement for 24-hour rooming-in, which means the mother and infant remain together in the same room throughout the entire hospital stay. This continuous proximity supports the mother in learning her baby’s feeding cues and encourages responsive feeding on demand. This helps mothers recognize and respond to early hunger signals, rather than relying on a schedule.
Furthermore, a Baby-Friendly facility strictly limits the use of supplemental food or drinks, including water, unless a medical indication is documented. This practice is designed to protect the newborn’s stomach capacity and prevent interference with the establishment of the mother’s milk supply. The use of artificial nipples, such as bottles and pacifiers, is also discouraged for breastfeeding infants, as they can interfere with the baby’s latch and create confusion.
Staff Competence and Ongoing Education
A hospital cannot achieve Baby-Friendly status without demonstrating that its staff, including nurses, doctors, and support personnel, are highly competent in providing lactation support. The initiative mandates rigorous training requirements to ensure a high standard of skill and knowledge across all employees who interact with mothers and infants. Clinical staff who counsel mothers are often required to complete a significant number of hours of education, which can include both classroom instruction and supervised clinical experience.
This comprehensive training covers not just the mechanics of breastfeeding, but also how to effectively support a mother experiencing common difficulties, such as latch problems or pain. Training emphasizes a standardized approach, ensuring that all mothers receive consistent, evidence-based guidance, regardless of which staff member is assisting them.
This commitment to staff education extends to the discharge process, where a facility must coordinate with community resources to ensure continuity of care. This includes fostering the establishment of support groups and referring mothers to them before they leave the hospital.
Documented Benefits for Mothers and Infants
The implementation of Baby-Friendly practices has been shown to result in significant positive outcomes for both mothers and their infants. Studies consistently demonstrate that adherence to the Ten Steps leads to higher rates of breastfeeding initiation and increased duration of exclusive breastfeeding. This evidence-based care system directly supports the WHO recommendation for exclusive breastfeeding for the first six months of life.
For infants, breastfeeding provides protection against infectious diseases, including a reduced risk of gastroenteritis, respiratory infections, and ear infections. Breastfed babies are also less likely to be overweight or obese later in life, and they often perform better on intelligence tests. The early and sustained skin-to-skin contact helps newborns regulate their temperature, heart rate, and breathing, leading to a calmer transition to life outside the womb.
Mothers also experience health advantages from these standards. The improved bonding facilitated by rooming-in and skin-to-skin contact can enhance maternal self-efficacy in caring for her newborn. Biologically, breastfeeding is associated with a reduced lifetime risk of developing breast cancer, ovarian cancer, and Type 2 diabetes.