Monday, April 16, 2018

Tanggal 11 April lalu baru saja diluncurkan Ten Steps to Successful Breastfeeding (selanjutnya disebut Ten Steps) edisi revisi 2018. Dalam bahasa Indonesia, diterjemahkan sebagai 10 Langkah Menuju Keberhasilan Menyusui (10 LMKM). Sebelumnya telah disusun Ten Steps dan telah diadopsi dalam peraturan perundangan Indonesia yaitu antara lain dalam Peraturan Pemerintah no. 33 tahun 2012 tentang ASI Eksklusif. Sehingga kebijakan 10 LMKM ini sebenarnya merupakan kewajiban bagi semua fasilitas kesehatan (faskes) yang melayani kehamilan dan persalinan. 

Ten Steps edisi 2018 tentu saja belum diadopsi dalam peraturan Indonesia. Lebih lengkapnya, silakan baca di sini

Ini beberapa perbedaan kedua versi Ten Steps dan catatan dari saya.

Ten Steps
Ten Steps (2018)
1.       Have a written breastfeeding policy that is routinely communicated to all healthcare staff
1a. Comply fully with the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly resolutions.
Hospitals are encouraged to read and comply the Code
1b. Have a written infant feeding policy that is routinely communicated to staff and parents
Same with the previous one
1c. Establish ongoing monitoring and data-management systems
Hospitals are encouraged to make system to monitor and evaluate simultaneously. It is a non-stop process
2.       Train all healthcare staff in skills necessary to implement this policy
2.       Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding.
The word “train” explain that hospital only provide training but not responsible in its practice. While the newest version implies that hospitals should make sure that all staff are able to support breastfeeding, regardless the methods. It means hospitals can use any methods, not only training.
3.       Inform all pregnant women about the benefits and management of breastfeeding
3.       Discuss the importance and management of breastfeeding with pregnant women and their families.
The old version use the word “inform” and it implies one-way communication. While the newest version use “discuss” implying two-way communication. 
The old version mentions “all pregnant women”, while the new version mentions “…..and their families”, it means the infants’ families should be involved.
4.       Help mothers initiate breastfeeding within one half-hour of birth
4.       Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth.
·         The old version use the word “help” while the new version use word “facilitate” which means hospitals should not only help physically but also assist and provide anything to do initial breastfeeding. It is also interesting that in the new version, it use the term “skin-to skin contact” which means ‘”skin contact” is the priority.
·         The old version use term “one half hour of birth” means there is limitation to this process. While the new version use term “as soon as possible” which means it can be done as soon as the routine medical intervention, or other life-saving intervention, has done.
5.       Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants
5.       Support mothers to initiate and maintain breastfeeding and manage common difficulties.
·         The old version use term “show” which implies the hospital staffs should practice physically in front of the mothers. While the new version use term “support” which implies hospital staffs should provide anything to support including using counselling language and positive gesture.
·         The old version mention mother-infant separation, while the new one mention common difficulties. This implies not only separation, but also other challenges, such as nipple crack and low-supply breastmilk perception.
6.       Give newborn infants no food or drink other than breastmilk, unless medically indicated
6.       Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated.
The old version use term “give” means hospital could provide other food or fluid, just not allowed to give it to breastfed babies. While the new one use term “provide”. It implies that hospitals should not only give, but also prohibited to provide other food or fluids to breastfed baby
7.       Practice rooming in – that is allow mothers and infants to remain together 24 hours a day
7.       Enable mothers and their infants to remain together and to practise rooming-in 24 hours a day.
8.       Encourage breastfeeding on demand
8.       Support mothers to recognize and respond to their infants’ cues for feeding.
The new version prioritize the hospital to help and assist the mothers to learn their infants’ feeding cues. It is more “practical” term than “breastfeeding on demand” term.
9.       Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants
9.       Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
The old version prohibits hospitals to give artificial teats and pacifiers to breastfed babies without giving explanation the risk and reason behind this. While the new one, making the mother as the decision maker after receiving a valid information of the use and the risk.
10.   Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
10.   Coordinate discharge so that parents and their infants have timely access to ongoing support and care.
The establishment of breastfeeding support groups is no longer being hospital responsibility. Hospital just need to plan well on their discharge and make sure that the parent and infants will have access to proper support and care.

Panduan penerapan Baby Friendly Hospital Initiative 2018 bisa diunduh di sini

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