February 2020
Midwifery Special Feature + Water immersion for labour and birth + Maternal depression rising in developing nations + Midwifery in a global context, instrumental to student development + Why nurses are instrumental in times of natural disaster and traumatic events
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HealthTimes - February 2020 | Page 03
February 2020 We hope you enjoy perusing the range of opportunities included in this issue. If you are interested in pursuing any of these opportuities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au DISTRIBUTION 46,300
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HealthTimes - February 2020 | Page 05
If you don’t have the latest book, you simply don’t have the latest information! The Australian Medicines Handbook offers clear, concise, up-to-date and clinically relevant information. Designed to find information quickly. Recommendations incorporate the latest research and best practice advice. January 2020 AMH release out now. Available in print, online or as an App for desktop.
The AMH Book is available as an App The Australian Medicines Handbook App has replaced the AMH Download, and is available for installation onto PC’s, Surface Pros and Mac Computers. To access the full content of the AMH a subscription for the App is required.
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HealthTimes - February 2020 | Page 09
Water immersion for labour and birth
W
aterbirth is an attractive prospect for many women to help reduce the pain of labour without the need for excessive pain medication and to achieve a calm birth. But risks and benefits need to be carefully considered, and obstacles overcome to achieve successful water labour and birth. In a study on midwives’ views on water immersion during labour, almost 90 per cent of the midwives interviewed supported it as an option for pregnant women for pain relief, relaxation and in promoting a positive birthing experience. The most significant concerns cited by midwives were maternal collapse, difficultly estimating blood loss and postpartum haemorrhage. There were also barriers to offering water immersion during labour, which included a lack of accredited staff, lifting equipment and overcoming negative attitudes. The midwives also indicated that the ability to facilitate water immersion was hindered by policies and guidelines, which didn’t always support a women’s informed choice for water labour and birth. What is waterbirth? A waterbirth means that at least part of a woman’s labour, delivery – or both – occur in a birthing pool filled with warm water. A woman
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can elect to have a water birth in a hospital setting, a birthing centre or at home as part of home birth. What are the benefits of water birth? As well as promoting a calm birth, water immersion in a bath or pool during the first stage of labour has been shown to decrease the need for pain medication and make the labour a more enjoyable experience.1 A water experience
birth
Mother of three, Mabble Munyimani, chose a water birth for her first child to avoid excessive pain management and a caesarean section. Ms Munyimani entered the water in the last stage of labour, using gas as pain relief in the earlier stages. “Water was effective pain management in labour, even in the last stages of labour when pain is very high. “As I entered the water, and started moving around in the pool, the bouncy of the water was relieving. “There was a lot of pressure caused by the contractions and water provided the soothing and cooling effect. “Not long after the I had been in the water, the midwife said I was ready to push so I believe the water did speed up things up.
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“Throughout the time in the pool, the midwife closely monitored the baby and me. “I was allowed to move freely in the pool. There is plenty of room to move around, water is warm, like room temperature, it was like I was going for a swim. “I felt that I was in control of the situation and the pain was manageable - probably because I had the freedom to move around the water. It made me feel light and buoyant. It was like I was floating. “I felt I had more control over what was happening, and I pushed the baby out with less invasive support from a midwife. “I feel the buoyancy of the water makes labour easier, and friction from baby pushing is reduced and somehow eases the baby’s transition out.” Tips on preparing for a waterbirth Drawing on her own positive experience,
Ms Munyimani offers the following advice for preparing for a successful water birth. • Get as much information as possible from your midwife so you can make an informed decision. • If it’s your choice, make sure it is in your birthing plan, so all carers are aware when labour starts. • Be as open-minded as possible if your birth plan has to change due to unforeseen circumstances that may arise. A midwife waterbirth
on
delivering
a
positive
Kathy Fray, a senior midwife performed many waterbirths, says often misunderstandings around choice. “To begin with, fundamentally,
who has there are this birth there are
HealthTimes - February 2020 | Page 11
three stages of childbirth potentially involved in the process: 1. Labouring in warm water to assist with managing the contraction pain of cervical dilatation 2. Birthing the baby under-water 3. Birthing the placenta while still in the birthing-pool “And not every woman, at the time, feels like she wants to do all three - and not every woman should. “Also, many women expect that birthing their baby will be a stronger pain than their labour contractions during dilatation, but for most, it’s not the case.” Not every woman will be a candidate for waterbirth, but under the right circumstances, there’s no reason why women can’t use water immersion as part of their birth plan. “For a healthy normal woman with a healthy normal baby on board, who has established spontaneously into active labour, there should be no reason she can’t spend some of her labour being soothed by water.” However, there are benefits to deferring water immersion until the later, more active stages of labour, according to Ms Fray. “I’ve found that deferring getting into the pool until at least seven centimetres dilatated can be a greatly beneficial strategy because it ‘takes the edge off’ as she enters the transition. “Research has also shown that getting into the water too early can water-log the cervix, and slow down dilatation.” There is mostly little disagreement amongst health professionals that there is any
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harm in labouring in water, said Ms Fray, but controversy occurs when women choose to birth their baby underwater. “Midwives experienced with waterbirths are comfortable assisting their clients to achieve this, but few medicalised obstetricians have ever personally routinely assisted at waterbirths. So [they] don’t really have much of a qualified opinion - in my opinion - or they are an unusually holistic obstetrician who is supportive of the idea. “Most Special Care Baby Unit and Neonatal Intensive Care Unit paediatricians loathe waterbirths because they manage the care of the occasional newborn who has accidentally inhaled water during their birth and has respiratory distress requiring admittance for a few hours or even a few days.” There are circumstances where it is advisable to give birth out of the water, explained Ms Fray, such as when a baby measures large or if a woman is at risk of haemorrhaging. “Getting out of the pool to give birth once some peeps of the head are seen - especially if the baby measures generous for its size – is sensible. As dealing with shoulder dystocia with the woman and baby both underwater is far from ideal! “Also because of the impossibility to accurately gauge blood-loss in a pool, any woman at risk of haemorrhaging, such as those with iron-deficiency anaemia or low platelets, ideally should birth her placenta on terra firma. Then her estimated blood-loss can be properly monitored and managed to avoid her body unnecessarily going into shock.”
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HealthTimes - February 2020 | Page 13
Maternal depression rising in developing nations
W
omen living in low and medium-income nations experience many health-related issues during pregnancy and in childbirth. Still, little attention is given to antenatal depression, which a PLOS ONE study reveals is on the rise in developing countries. The study by Flinders University public health researchers found rising levels of reported antenatal depression in these countries and recommends more services are urgently needed – particularly in low-income economies. “Depression during pregnancy is often believed to be an issue of developed countries,” says biostatistician Abel Fekadu Dadi, who led the systematic review and analysis of antenatal depression levels in low and middle-income countries.
“From the study, we found 34 per cent and 22.7 per cent of pregnant women in low and middle-income countries respectively had depression symptoms during pregnancy.” Mr Dadi, who is also affiliated with the Institute of Public Health at the University of Gondar, Ethiopia, said depression was a precursor to adverse birth outcomes. “Moreover, compared to non-depressed pregnant women, depressed women had respective rates of 2.41 times and 66 per cent
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higher risk of preterm birth and low birth weight.
“We found that antenatal depression is highly prevalent and increases over the duration of pregnancy. We also noted increases in prevalence over the last ten years.” Antenatal depression impacts the physical, psychological, mental, and overall wellbeing of mothers and newborns, said Mr Dadi, and awareness is critical amongst health practitioners and policymakers in developing countries. “It is vital for these governments to address women’s mental health issues before and during pregnancy to improve health outcomes for both mothers and babies, and contribute to socio-economic development and Sustainable Development Goals,” said co-author Associate Professor Lillian Mwanri, Flinders College of Medicine and Public Health. Key findings • One in three (34%) and one in five (22.7%) pregnant women in low-and middle-income countries, respectively had depression. • Having depression during pregnancy increased the risk of low birth weight and preterm births. Severe depression is known to directly lead
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to suicide in women during pregnancy or after birth – and to neonatal, infant and child mortality. • A poor obstetric history, previous episodes of common mental disorders, poor social support, financial difficulties, a history of exposure to violence (during pregnancy or earlier), and unsatisfactory relationships were factors that increased chances of depression. • Low-cost interventions such as psychotherapy services at maternity clinics – and relationship and partner support advice – are among the social and health system interventions badly needed in these countries.
a mental disorder – primarily depression. A rate which is much higher in developing countries, 15.6 per cent during pregnancy and 19.8 per cent after childbirth.
“In severe cases, mothers’ suffering might be so severe that they may even commit suicide. In addition, the affected mothers cannot function properly.” “As a result, the children’s growth and development may be negatively affected as well. Maternal mental disorders are treatable. Effective interventions can be delivered even by welltrained non-specialist health providers,” reports WHO.
These findings are consistent with the World Health Organisation’s position, which states that 10 per cent of pregnant women and 13 per cent of women who have recently given birth experience
HealthTimes - February 2020 | Page 15
Midwifery in a global context instrumental to student development
U
nderstanding midwifery from a global perspective, particularly within culturally diverse nations, is instrumental to the development and training of Australian midwives, says Charles Darwin University Lecturer in Midwifery, Mpho Dube. Which is why Ms Dube has spearheaded the international placement of Charles Darwin University midwifery students in Bali for the past four years “The placement itself was prompted by a need to promote students’ understanding factors that affect and promote global maternal and neonatal wellbeing,” says Ms Dube.
“By stepping outside the Australian context into a country that is culturally diverse, and has different health systems and economic resources, students can gain more insight into how midwives in different contexts practice.” Ms Dube says it’s also important that students from host countries benefit from the placement, by learning about midwifery practices in Australia. “The students are able to build relationships and exchange knowledge about midwifery in their contexts. “They learn a lot from each other through exploring the similarities and differences in how they practice.” The Charles Darwin University placement is funded by the New Colombo plan, with students receiving a $3,000 grant to help them to cover costs for the duration of the placement. The placement is part of a theory unit called Midwifery in Global Perspectives which aims to give midwifery students an opportunity to experience midwifery in a setting that is different from Australia.
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“Students visit an array of maternity services in Bali, immerse themselves in the Balinese culture and work alongside the Balinese midwives. “In 2019 we changed the placement arrangement, further collaborating with two Schools of Midwifery in Bali to ensure that CDU students worked alongside Balinese students in the clinical areas. “We then conducted a joint research project to understand ways that promote shared learning between students from host and visiting countries during short term international placements.” Ms Dube, who has been nominated for a Ryan Family Award for her dedication to the shared learning experiences for CDU and Balinese midwifery students, says it takes a lot to arrange the placement, but it’s well worth it for the mutual benefits for students in both countries.
“Giving students a unique opportunity to step outside of their comfort zone is important for me.” Angela Bull, CDU Senior Lecturer in Midwifery, who nominated Ms Dube for the award, says her previous experience working in midwifery in Zimbabwe and in Australia placed her in a unique position to gain access to Bali’s health system. “Her experience of walking two worlds of health and maternity services has enabled Mpho to effectively use her negotiation skills, and her respectful communication style allows her to navigate Indonesia’s patriarchal and deeply cultural society and health system for the best outcomes for midwifery student placement opportunities,” says Ms Bull in her nomination. “This collaboration has seen opportunities for midwifery staff and students to be practically
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including private midwifery birthing centres, public health centres, village midwifery, and large public and private hospitals. “The experience is rich and profound for students and staff.” While Ms Dube says the opportunity enhances students’ personal and professional growth, she also personally benefits from the experience. “In an online learning environment, you do not have an opportunity to interact with students for a period of two weeks. “Having close personal contact with students provides an opportunity for the students and academics who attend the placement to support and learn from each other.
leads initiatives to contribute to Balinese health services, such as coordinating a toy drive for toys to be gifted to the Balinese public health centres and an orphanage. Ms Dube says the research project demonstrates that strong partnerships between countries are crucial to implementing strategies for improving global maternal and neonatal wellbeing. “Working with Balinese researchers has also improved my knowledge and understanding of how to work and communicate with people from cultures that are different from mine. “The lifelong growth that comes with stepping outside of a person’s comfort zone is a phenomenal.”
“We all leave our families at home and the success of the placement depends on the bond and teamwork that we foster during the two weeks.” Throughout the placement, Ms Dube also
HealthTimes - February 2020 | Page 17
Breakthrough Autism treatment uses Minecraft to empower children with ASD
I
t’s no secret that children of all ages love internet gaming, and in particular, the world’s most popular video game, Minecraft. And children with Autism are no exception to this global phenomenon. “When working with children with ASD I noticed that almost all of them play Minecraft,” says Clinical Psychologist Luke Blackwood. “Minecraft is an open world game with a number of plugins that allow you to create almost anything, there is even an equivalent to electricity called Redstone.” Which is why he’s put the game at the centre of his online therapy program Legend Land, which enables children with Autism to access unique and effective treatment, regardless of their ability to visit a clinic. “Legend Land is a powerful a way of engaging younger children online. Children learn best through play and Legend Land offers a fun, interactive way of bringing therapy to life.
“This allows clients to see and interact with the therapeutic content in a way that has not been possible before and gives them a fun, familiar and safe place to scaffold social and emotional learning.” “It can be difficult for people to access
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specialist services in rural and remote areas. My goal for Legend Land is to solve that problem by bringing engaging, specialist services that can be accessed by anyone, regardless of the postcode.” The online therapy program begins with a video conference between the therapist and the child’s parent, to gauge treatment requirements. “The client and I will then enter the therapy world, Legend Land, with our Minecraft characters whist being connected via video and audio. “The game acts as tool for the clinical psychologist to bring the therapeutic concept to life through characters, puzzles and activities to learn about the topic whilst. We will also be completing a worksheet while they move through the session activity. At the end of the session the worksheet is reviewed with the client and parent and we discuss how the content can be applied to the real world.” Mr Blackwood says using a popular game like Minecraft to engage children, is similar to the difference between a boring teacher, and an interactive one. “Children learn better and remember more when the content is fun and engaging and look forward to coming back. “Full Potential Psychology’s Minecraft
Therapy Server, Legend Land brings the session activities to life in a fun and interactive way that I have not been able to do before, especially on an online platform.” While the concept of Legend Land is still new, Mr Blackwood says the response has been positive.
“There is a real need for specialist ASD services in rural and remote areas and I have loved working with them.” “We are constantly building more therapeutic content that brings these evidence-based interventions to life. “Right now we are constructing a giant floating brain but I can’t give too much away.” Mr Blackwood says using Minecraft as a therapy tool has also been effective in face-to-face consultation in children with both ADHD and ASD, who found concentration difficult. “Children previously found it difficult to engage because of high levels of anxiety and have responded really well.” But Mr Blackwell says Legend Land is more than just a name. “Children are encouraged to be legends at home and school by managing our strong emotions, being kind and looking after other people.” Crucial to the successful treatment of children with ASD is that they feel empowered by the process. “Two days ago, I congratulated a 9-year-old for having Autism Spectrum Disorder (ASD), as his mother and I informed him of his diagnosis,
explained ASD and described the roles of the team that will be working with him. “These therapies seek to empower and begin by giving the person with ASD and their families an understanding of condition and their child’s profile of strengths and needs.” People with Autism have difficulty understanding and predicting the social world and the actions and intentions of others, he says. This can lead to anxiety, depression and issues with identity and self-esteem. People with Autism can also have difficulty with executive functioning which is why there are higher rates of ADHD than in general population and can contribute to a lack of flexibility in thinking. “This therapy brings the concepts from cognitive behavioural approaches and social skills training to life,” says Mr Blackwell. “There is strong focus on education, empowerment, emotions and social skills. “However not all the skills are developed in the Minecraft Therapy World, a lot of work is done with parents, particularly in younger children.
“I often say to parents that I have them for 1 hour every two weeks, the other 335 hours is primarily spent with them, so their involvement is essential in supporting their child to become one of Legend Land’s little legends.” For more information visit https://fullpotentialpsychology.com.au/autism-online/
HealthTimes - February 2020 | Page 19
Safe movement – avoiding back injury and pain
H
ealth professionals, specifically nurses, midwives and allied health professionals, are at a higher risk of back injury and pain due to the nature of their job, which often involves lifting. So, how do health professionals protect their back? A common belief is that bending the back is dangerous, according to physiotherapist Scott Wescombe, which often leads to protective and fear-avoidance behaviours. It is a misconception recently busted with research out of Curtin University, which found that lifting with a straight back may not be protective. The study suggests that neither lifting with a straight nor a rounded back results in a higher chance of back pain. “In most cases, movement and exercise is a big part of what helps people get better and stay better - including moving the spine in the ways it’s designed to be moved - forwards, backwards, sideways, rotation.
“It’s nourishing for the spine to be moved in a variety of ways, and the body will adapt to how it gets used, which can make movements easier or harder depending on how people are using their body,” said Mr Wescombe. Rather than focusing on lifting with a straight back, it’s important to consider other factors that promote safe lifting, such as the nine fundamental forces that influence the experience of back pain. “[When we] try and isolate one thing that causes back pain, which in this case is lifting with a flexed back, misses the bigger picture of how humans work - we are not a piece of machinery.” Mr Westcombe said he uses nine key forces
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that influence one’s experience of back pain, which helps clients feel better. 1. Modulate Movement [DO] 2. Filter Food [DO] 3. Settle Sleep [DO] 4. Create Calm [FEEL] 5. Verify Vision [FEEL] 6. Refine Recovery [FEEL] 7. Choose Community [THINK] 8. Master Meditation [THINK] 9. Bolster Beliefs [THINK] “To keep it simple, it’s a DO, FEEL, THINK framework that I call The WescombeMethod. “We use a traffic light system - red, orange, or green - to rate each force. “Red means it’s not going well and needs to change; orange means it’s so-so - some things are going well and others not so well - and green means it’s doing well. “If someone was to think that lifting with a flexed back causes damage to the spine, number nine, Bolster Beliefs, would be a red, and it would have a flow-on effect to Modulate Movement and then other forces like Create Calm and then Settle Sleep. “People who believe bending their back is bad will release stress hormones and go into more of a fight or flight zone, which might send off pain signals in itself. “They’ll avoid certain movements, brace their body, move less and differently, and over time their body will adapt to how it’s being used or not used, making it harder in future to perform those basic movements they’ve been avoiding. It turns into a vicious cycle,” said Mr Wescombe. Dr David McIvor, a workplace health and safety expert, says while the traditional message
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is to keep a straight back while lifting, it’s challenging to do so. Instead, it may be more appropriate to focus on moving the legs. “Our mantra is ‘the more you bend your legs, the less you will bend your back,” said Dr McIvor. Selina Tannenberg, physiotherapist and Director of MoveMedics, agreed, stating that while a perfect posture is appealing, it’s impractical. “The human body comes in diverse shapes and sizes, so how can we possibly expect there to be one standard posture to suit all? “It is not so much how you move but how well conditioned you are to a particular movement that matters.” What is critical is having the appropriate movement capacity, which involves strength, mobility, coordination, balance and skill, explained Mrs Tannenberg. Those without
movement capacity will naturally be at higher risk than someone who is well-conditioned for the same movement. “Often, it is when we attempt movements beyond our current capacity that we put ouselves at risk of injuries, lifting heavier than we have the capacity for and continuing physically demanding movement when fatigued.” “A good approach to safe movement is to move in ways you find comfortable and natural, get strong, and develop your movement options. “Where lifting is a concern, lift in a position you feel strong in, one that you feel you have a good hold of the load and can handle sudden surprises such as a missed step or a sneeze. “Perhaps most importantly, practise smart and honest lifting and only lift a load that you, not the hero in you, truly think you have the capacity to lift.”
HealthTimes - February 2020 | Page 21
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Flexible study options. Depending on your course, you may be able to study online or on campus, full-time or part-time. We appreciate your experience. If you already have industry experience, you may be eligible for credit towards your qualification, which means you’ll get your degree faster. Let’s keep your career moving. Enhance your skill set in allied health with Charles Sturt.
Find out more csu.edu.au/allied-health CRICOS Provider Number for Charles Sturt University is 00005F. © Charles Sturt University, 2019. F6339.
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HealthTimes - February 2020 | Page 23
Why nurses are instrumental in times of natural disaster and traumatic events
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n Australia, natural disasters are a part of life, with extreme weather events taking place in different parts of the nation on a semi-regular basis. This reality was made abundantly clear in late 2018, when bushfires ravaged multiple Australian communities across three states, causing both extensive loss of property, and sadly, loss of lives. Making up more than half of Australia’s healthcare sector, nurses play an integral role in managing the aftermath of such events. “Nurses play an integral role in all aspects of community life, but this is particularly important when disasters or traumatic events occur,” says Dr Jessica Biles, Senior Lecturer, School of Nursing, Midwifery and Indigenous Health, at Charles Sturt University. “Nurses will be found assisting in a range of capacities, from trauma management community mental health support. In regional communities, this is heightened further with many nurses taking on community responsibilities in their towns such as being active members of St Johns ambulance and CFA.” Registered nurses are highly qualified professionals that have a depth and breadth of knowledge in their training that enables them to diversify their skills when required, which is why there are many situations where nurses will play
Page 24 | HealthTimes.com.au
an active role in disasters. “Often in these circumstances it will be the responsibility of nurses to ensure that healthcare remains accessible to all,” says Dr Biles. “Natural disasters and traumatic events stimulate a range of emotional and physical responses. “All situations will be unique and will require the nurse to use all of her comprehensive skills in healthcare, from trauma to counselling.” Leadership also plays a significant role in the effective management of such events, Dr Bile says. “In many instances, day to day life in health services will continue, requiring nursing leaders to consider nursing contributions to both the traumatic events and the operational management of the health service.” Along with the physical trauma which often takes place following a catastrophic event, nursing also need to be able to assist with a range of emotional and psychological responses to injury, shock and grief. “Nursing is an accredited profession and the Australian and Nurses Midwifery Accreditation Council and AHPRA ensures that all undergraduate education is responsive to health across the lifespan. “This is inclusive of skills and capabilities in emotional and physiological responses for both
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client and the nurse. “Many situations involving grief and trauma will focus on non-traditional physical health assessment skills.” As highly skill health professionals that encompass 57 per cent of the healthcare workforce, Dr Biles says nurses are well equipped to manage both physical and non-physical distress. But that doesn’t make them immune to the emotional consequences of being exposed to people experiencing trauma. “On a day to day basis they are often laced in situations that involve fellow humans in their most vulnerable moments. “This can and does impact nurses on a personal level. However, with undergraduate education and ongoing support from health services, nurses recognise the importance of self-care.” In fact, Dr Biles says much of the research
conducted over the past five years has focused on the importance of self-care to prevent burnout and caring fatigue. “Organisations like the Australian College of Nurses offer publications and short course in resilience and self-care. Self-care will look differently for each nurse/individual but it’s about finding what works for you as an individual and making the self-care a habit. “Mindfulness apps, breathing exercises, a healthy diet, exercise, have all been shown to help us combat stress. “Many workplaces also offer free counselling or emotional support for health professionals. Normalising this support is imperative to the future of healthcare. “The key is making adding these care routines into our lives, they then become a habit and are particularly useful when experiencing trauma or stress.”
HealthTimes - February 2020 | Page 25
BFHI: Separating fact from fiction
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n increasing number of maternity facilities and community health services are making an important commitment to mothers, their babies and families by becoming Baby Friendly accredited. Despite the increase in Baby Friendly Health Initiative (BFHI) accreditation, misinformation is still rife amongst mothers and even some health professionals surrounding the program, what it stands for and what it actually involves. What is the BFHI?
The Baby Friendly Health Initiative is an international program initially launched by the World Health Organisation (WHO) and The United Nations Children’s Fund (UNICEF) in 1991 to protect, promote and support breastfeeding. It achieves this by promoting practices known to enhance the wellbeing of all mothers and babies. In Australia, the BFHI is now successfully implemented by the Australian College of Midwives. The accreditation programme is based on the Ten Steps to Successful Breastfeeding and demonstrates a facilities or health services commitment in offering the highest standard of maternity care to mothers, babies and their families. Accreditation occurs every three years, ensuring regular independent assessment and providing facilities and healthcare services with the framework and support to continuously improve their practices. “The BFHI ensures that mothers are heard
Page 26 | HealthTimes.com.au
regarding the experience of their care and draws attention to areas of excellence, which can improve staff morale.” Why should you choose a BFHI accredited facility? The BFHI appreciate that mothers depend on medical professionals to provide guidance, advice and support. In a Baby Friendly facility, it is paramount that a mother’s informed choice of infant feeding is encouraged, respected and supported. At no time should mothers be ‘forced’ to breastfeed. The Ten Steps to Successful Breastfeeding are beneficial for ALL mothers and babies, promoting bonding, parental responsiveness, empowerment and informed choice - regardless of feeding method. “BFHI is in place to protect, promote and support breastfeeding, however, the woman’s choice is paramount and should always be respected and supported, regardless of how she chooses to feed her baby.” Supporting and Protecting Breastfeeding The core purpose of the BFHI is to ensure that mothers, their babies and families receive timely and appropriate care before and during their stay in a facility providing maternity and newborn services. Given the proven importance of breastfeeding, it is true that that the BFHI protects, promotes and supports breastfeeding. However, at the same time,
it also aims to enable appropriate optimal care and feeding of newborn babies who are not (yet or fully) breastfed, or not (yet) able to do so. All Baby Friendly facilities implement Critical Management Procedures that are designed to ensure that policies, guidelines and processes are in place to allow health-care providers to implement the Baby Friendly standards effectively. Research shows that mothers and families are most vulnerable to the marketing of artificial formula when they are making decisions about infant feeding. The BFHI states that facilities and community health services must comply with the International Code of Marketing of Breastmilk Substitutes in order to protect families from these commercial pressures. But I’m breastfeeding‌
not
Written policies ensure women and their families receive consistent, contemporary, evidencebased care, and are an essential tool for facility alignment with BFHI principles. All Baby Friendly facilities must have a policy which addresses standards of care for the mother who is artificially feeding her baby. This policy will include points relating to staff education, skills and knowledge about artificial feeding. It also advises staff that mothers who are considering artificial feeding are supported to make a fully informed choices, appropriate to their circumstances. The BFHI believes that mothers who are unable to breastfeed must be supported to make fully informed decisions regarding the method of feeding their baby which is most suitable to their individual circumstances. In a Baby Friendly facility, mothers who are
discharged from hospital using infant formula are provided education regarding the safe preparation, storage and handling of powdered formula using National Health and Medical Research Council (NHMRC) guidelines. They will receive a demonstration, and supervision on the correct way to make-up a bottle feed using powdered infant formula. Education and guidance are also provided to mothers on the best practice for feeding their babies by bottle, and where to obtain support with feeding after discharge from their facility or health service. Your choice Ultimately, the BFHI believes that all families must receive quality, unbiased information about infant feeding. BFHI accredited facilities and health services providing maternity and newborn care have a responsibility to promote breastfeeding, BUT they must also respect the mother’s preferences and provide her with the information required to make an informed decision about the best feeding option for HER AND HER BABY in her particular circumstances. Every Baby Friendly facility has an obligation to support mothers to successfully feed their newborn infants in the manner they choose. For more information please visit the BFHI website at www.bfhi.org.au Written by Melanie Henrikson and Samantha Tutton - Australian College of Midwives
HealthTimes - February 2020 | Page 27
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HealthTimes - February 2020 | Page 29
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