Nov 2019 Newsletter: Milk Talk – BFHI-certified Hospitals

What it is and why it is important for your breastfeeding journey
By BMSG Editorial Team


The Baby Friendly Hospital Initiative (BFHI) is a concerted effort pioneered by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) to help new mothers receive the right care and breastfeeding support after giving birth to their babies in medical and birthing facilities. Following the Innocenti Declaration in 1990, which was a global effort to raise breastfeeding onto a higher plane in order to protect the rights of babies to be breastfed, the BFHI came about to ensure that medical facilities are prepared to help initiate breastfeeding in the mother and her new baby. To date, more than 150 countries have joined the global effort to make maternity wards and medical institutions become BFHI certified since then.

The care and support you receive after delivering your baby is important and contributes to the outcomes of your breastfeeding journey. [Stock Photo]

What makes a hospital BFHI certified?

To be BFHI certified, hospitals and medical institutions need to fulfil a ten-step framework. This framework encompasses the following:

  1. Hospital Policies
    Hospitals are not to promote formula milk or have advertisements for formula milk, encouraged to track the effectiveness of breastfeeding support in the facility, as well as  to make care of a breastfeeding dyad a standardised practice across the board.
  2. Staff Competencies
    Staff should be trained sufficiently to provide ample support and accurate knowledge in caring for breastfeeding mothers and their babies. This step also includes assessing the extent of breastfeeding knowledge that staff possess.
  3. Antenatal Care
    When mothers are pregnant, they should be informed about the benefits of breastfeeding during their antenatal appointments and should be able to prepare themselves mentally and logistically to breastfeed their babies after giving birth.
  4. Care Right After Birth
    Skin-to-skin contact between mother and baby is vital during the first hour after birth as it takes advantage of baby’s alertness to initiate effective latching for successful breastfeeding. This should be highly encouraged to initiate the first latch. Studies show that mothers who have been provided with this care, breastfeed successfully with a good latch.

    WHO has lined up 10 steps for hospitals to craft policies that will provide a rigorous breastfeeding support system for mothers. [Credits: WHO]

  5. Support Mothers with Breastfeeding – initiating breastfeeding and maintaining supply when separated
    Medical caregivers should be trained in correcting a baby’s poor latch or positioning as well as to advise mothers on remedies to common breastfeeding challenges. When babies and mothers have to be separated (eg. phototherapy for a jaundiced infant), staff would be able to teach mothers how to maintain their breastfeeding supply and express milk for the infants.
  6. Nothing else but Breastmilk unless medically required
    BFHI-certified hospitals would prioritise supplementation of the mother’s own milk rather than using artificial milk. Should a mother’s milk not be available, donated human milk should be prioritised. Mothers who wish to give their babies formula would be advised on how to do so safely.

    Rooming in allows baby to have unlimited access to the mother’s breasts, a crucial action frequently missed by new parents.


  7. Rooming In
    Rooming in is an important contributing factor to breastfeeding success, especially in the early days of a newborn’s life. Rooming in means baby gets unlimited access to his or her mother’s breasts and also allows ample time for mother and child to bond and practice latching. Being with your baby around the clock also helps you to learn your baby’s hunger cues and feed your baby at the right time. Rooming in also allows mothers with sick babies to be closer to them.
  8. Responsive Feeding – recognising feeding cues
    Understanding when to feed the baby and learning the feeding cues which the baby demonstrates are important for the new mother to learn. This allows the mother to respond quickly and appropriately to their baby.
  9. Counsel Mothers on the Use of Bottles, Teats and Pacifiers
    Bottles, teats and pacifiers can inhibit effective breastfeeding for very young babies. Maternity wards and medical institutions would be able to advise mothers who need to provide supplemental feeds safely using alternative methods such as syringes, cups and straws so that they do not interfere with breastfeeding.

    Aftercare that encourages breastfeeding makes a whole lot of difference. For example, if mum is separated from baby, using a cup instead of a bottle bodes well for baby to return back to the breast and prevents nipple confusion.


  10. Support Upon Discharge
    When a new mother leaves the hospital, she may become overwhelmed at the sudden loss of help and support she received from medical staff previously. BFHI hospitals should be able to direct mothers to suitable resources and support communities in the event that she needs breastfeeding support and counselling when faced with challenges.

Discussing your options with your medical caregiver is necessary to relay your expectations, including breastfeeding support at the hospital.

Obtaining BFHI Certification – The Process

Maternal facilities and hospitals who are keen to obtain BFHI certification will have to undergo a rigorous assessment process conducted by accredited assessors. In Singapore, this is usually done by members of the Association for Breastfeeding Advocacy (Singapore) (ABAS). The process takes a few months and will require the hospital to transform the way breastfeeding is encouraged from the hospital administration, all the way down to the staff and the cleaners who work on the wards of the hospital. The goal is to ensure that the hospital is able to provide a supportive and conducive environment for a breastfeeding dyad to thrive.

BFHI Hospitals in Singapore

We are happy to announce that more hospitals in Singapore are now moving towards becoming BFHI certified.

All government hospitals have received BFHI certification. These hospitals include: NUH, KKH and SGH.

Recently, the following hospitals have also come on board the certification process and have successfully obtained BFHI status:

  • Gleneagles Hospital
  • Mount Elizabeth Hospital
  • Mount Elizabeth Novena Hospital
  • Parkway East Hospital
  • Raffles Hospital

This means that new parents will have more options in making their choice of which hospital to give birth at.

[Credits: WHO]

Giving Birth in a Non-BFHI Hospital – The Infant Feeding Plan

If you have just learnt that the hospital you are giving birth at is not BFHI-certified, there is a way around this. Just like how you would plan for your birth (i.e. through a birth plan), it is also possible to do so through an Infant Feeding plan (click here to see the Health Promotion Board’s template for this document). This is a document that you can craft and then hand it to your obstetrician and hospital staff so that they will know what your feeding plans are for your baby after birth. It is also a good practice to start to think about your options in the event that you are unwell or unavailable to feed your baby after delivering. Do speak with your obstetrician and the hospital about this.

Continue to be Proactive

Even in BFHI hospitals, changes take time. You and your spouse, especially, should remain proactive and make known your preferences  so that you ensure that baby your has unrestricted time at your breasts. This is important so that you and baby will have ample time to bond and practice breastfeeding. If you find yourself in a situation where your preferences are not met, speak with your medical support staff to ensure that your baby receives the best care while still being able to receive your breastmilk.