Written by Pamela Lim,  https://joyfulparenting.sg

If you have heard the phrase “baby-friendly hospital,” you might have wondered if that implies there are hospitals that are not friendly toward babies. “Baby-Friendly Hospital” actually means a hospital has achieved the gold standard in maternal-child care, a designation bestowed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).

The Baby Friendly Hospital Initiative (BFHI) is supported by Singapore’s Health Promotion Board (HPB) and is part of a global effort founded by UNICEF and the World Health Organisation (WHO) to ensure maternity hospitals meet best practice standards in supporting mothers to breastfeed successfully.

Breastfeeding provides all the nutrients for optimal growth and infant health. WHO and HPB recommend all babies to be exclusively breastfed for the first six months. Infants should receive nutritionally adequate and age-appropriate complementary foods while breastfeeding continues for up to 2 years of age and beyond.

Why Choose a Baby Friendly Hospital?
Worldwide, it has been shown that mothers who give birth in Baby Friendly Hospitals have increased exclusive breastfeeding rates and longer duration of breastfeeding as a result of initiatives such as one hour of skin-to-skin contact immediately after birth and 24-hour rooming in of mother and child.

For instance, research has shown that most babies grasp the nipple and begin to suckle only at approximately 55 minutes post-birth. With these initiatives in place, maternity hospitals such as KK Women’s and Children’s Hospital (KKH) have seen an increase in exclusive breastfeeding from 75 percent in 2013 up to 85 percent in 2016.

Moreover, it also allows mothers to build a closer bond with their babies and become more confident in caring for them.

Benefits for Babies

• Contact with the mother immediately after birth calms babies down and keeps them warm; it also stabilises their heart rate, breathing and blood sugar and allows them to sleep better
• Skin-to-skin contact immediately after birth takes advantage of the baby’s early alertness, to naturally latch on to the breast and encourage successful breastfeeding as well as facilitate enhanced bonding between mother and child
• Breastfeeding half an hour after birth also boosts the baby’s immune system, as the mother’s gut bacteria will colonise her baby’s system
• 24-hour rooming in allows babies to be fed according to their hunger cues, allowing them to more readily recognise their own signs of hunger and satiety. This reduces the frequency of a baby’s crying as mum is able to quickly respond to their needs
• Being near their mothers at all times encourages baby-led feeding, which enables babies to get more immune-rich colostrum (the first milk produced by a mother’s breast during pregnancy) and enhanced protection from illnesses, as well as decrease the likelihood of neonatal jaundice
• Ensures that babies receive the right nutrition to gain weight and promote healthy growth while reducing exposure to allergens or intolerances

Benefits for Mothers

• There is holistic breastfeeding support and information to empower mothers to provide the best care for their baby in a stress-free environment, as well as continue breastfeeding for as long as desired
• Immediate skin-to-skin contact after birth facilitates enhanced bonding between mother and child
• Being close to their babies at all times allows mothers to recognise their feeding cues and patterns, developing their confidence to breastfeed successfully and care for her baby optimally
• By ensuring that no artificial teats or pacifiers are given to breastfeeding infants, chances of "nipple confusion" are reduced and this allows the baby to be accustomed to suckling and feeding from the mother’s breast

What to Expect from a Baby Friendly Hospital

Breastfeeding Education

• Antenatal breastfeeding classes to teach expectant mothers about the benefits of breastfeeding
• Showing new mothers how to breastfeed and maintain lactation even when separated from the infant
• When breastfeeding is not feasible or if a mother chooses not to breastfeed, education on the safe and hygienic preparation and handling of formula milk will be provided

Conducive Environment

• Ensuring skin-to-skin contact between mother and child immediately after birth
• Allowing 24-hour rooming in for mothers and newborns to stay in close proximity
• Advocating breast milk-only diets for newborns, unless other types of food and drink are medically required
• Providing referrals to breastfeeding support groups upon discharge from hospital

How are Hospitals Certified?

To be certified as a Baby Friendly Hospital, maternity hospitals must fulfil all criteria set by WHO in its “Ten Steps to Successful Breastfeeding”.

The criteria are:

1. Have a Written Breastfeeding Policy That Is Routinely Communicated to All Healthcare Staff
This gives all mothers a peace of mind, knowing that every member of staff is able to provide accurate, up-to-date information.

2. Train All Healthcare Staff in Skills Necessary to Implement the Policy
Mothers can be assured that the healthcare staff have the necessary skills to complement their knowledge.

3. Inform All Pregnant Women About the Benefits and Management of Breastfeeding
There can be overwhelming information about breastfeeding. Hearing about the benefits and receiving tips can help mothers better manage the learning curve associated with breastfeeding.

4. Place Babies in Skin-to-Skin Contact with Their Mothers Immediately After Birth for at Least an Hour
Encourage mothers to recognise when their babies are ready to breastfeed and offer help if needed.

 For first-time mothers, caring for a baby can be a daunting experience. Not only does skin-to-skin contact help mother and baby bond, having a helping hand nearby will help reduce the stress of the experience.

5. Show Mothers How to Breastfeed and How to Maintain Lactation Even When Separated From Infants
Maintaining a steady milk supply is one of the main challenges mothers face when breastfeeding and knowing how to maintain lactation is something that can be easily taught while rooming at a BFHI hospital.

6. Feed Newborn Infants Exclusively with Breast Milk, Unless Medically Indicated
New mothers might be anxious to know if their baby is getting enough nutrition from breast milk and might be tempted to provide supplements. However, staff at a BFHI hospital can easily address these concerns.

7. Practise Rooming-In — Allow Mothers and Infants to Stay Together 24 Hours A Day
Rooming in lets both mother and baby to get used to each other, forging a strong bond and helping the mother build confidence in knowing what her baby wants and respond faster to their needs. Babies who sleep close to their mother tend to be calmer and cry less.

8. Encourage Breastfeeding on Demand
Breastfeeding on demand helps the mother recognise patterns of when her baby is hungry and build confidence in her ability to satisfy the feeding demands of her baby.

9. Don’t Give Artificial Teats or Pacifiers to Breastfeeding Infants
Not using artificial teats or pacifiers helps mothers build confidence in her natural ability to calm her baby down.

10. Foster the Establishment of Breastfeeding Support Groups and Refer Mothers to Them Upon Discharge From the Hospital
Mothers have peers that they can relate to after discharge from hospital — having someone who shares the same experience can be beneficial.

Baby Friendly Hospitals in Singapore

The Baby Friendly Hospital Initiative (BFHI) is supported by Singapore’s Health Promotion Board (HPB) and is part of a global effort founded by UNICEF and the World Health Organisation (WHO) to ensure maternity hospitals meet best practice standards in supporting mothers to breastfeed successfully. 

“Educating parents on the many benefits of breastfeeding, such as an increased resistance to infections as well as the emotional bonding between mother and child, is key to securing commitment towards breastfeeding,’ said Dr Chua Mei Chien, Senior Consultant, Neonatology, KKH and President of Association for Breastfeeding Advocacy (Singapore).

Baby Friendly hospitals up to date - after their reaccreditation in 2022

• KK Women’s and Children’s Hospital (KKH)
• National University Hospital (NUH)
• Singapore General Hospital (SGH)
• Raffles Hospital

Certified maternity wards will adopt best practices that help mothers achieve long-term breastfeeding success. As such, the Health Promotion Board aims for all maternity hospitals to attain Baby Friendly Hospital Initiative certification from World Health Organisation.

What If I Am Planning to Deliver in a Hospital That is Not Certified Baby Friendly?

If you are planning to deliver in a hospital that is not certified baby friendly, don’t worry. Speak to your doctors or gynaecologist about your desire to have baby-friendly practices during your delivery experience such as 24-hour rooming in or ensuring skin-to-skin contact immediately after birth. You can refer to HPB’s Infant Feeding Plan to share with your doctor so that they are aware of your preferences.