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Be Prepared for Baby-Friendly Hospital Initiative Questions

Woman preparing for Baby-Friendly Hospital Initiative questions.

Every testing cycle, candidates ask me what kinds of exam questions they should expect. So much content can be considered fair game, and that includes Baby-Friendly Hospital Initiative questions.

Why I feel sure this question will be on the exam

The Clinical Competencies for IBCLCs stipulate that an IBCLC “has the duty to protect, promote and support breastfeeding and will …” (4) “Support practices which promote breastfeeding and discourage practices which interfere with breastfeeding by: (a) Promoting the principles of the Baby-Friendly Hospital Initiative …”

IBCLCs are also called to advocate for Baby-Friendly Hospital Initiative within the IBCLC® Detailed Content Outline.

Note that the IBCLC is called to enact a duty, provide support, and advocate for the Initiative in both of those major documents. To me, that is screaming test fodder!

Questions to ask yourself

Plan on answering some Baby-Friendly Hospital Initiative questions on the IBLCE exam. But before you get to the exam, ask yourself some questions.

Who or What Does the BFHI Apply to?

The Baby-Friendly Hospital Initiative (BFHI) is a global initiative that began in 1991 by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). BFHI is for healthy, term babies and their mothers, not just those who are breastfed. An updated version of the BFHI was published in 2018.

For a little history, listen to my podcast with Dr. Mark Belsey, the former head of WHO’s Maternal and Child Health Division. He and three colleagues started the Initiative.

What are the Ten Steps?

If you aren’t already familiar with the updated Ten Steps to Successful Breastfeeding, you should review them. However, the exam won’t ask you to recognize or write the Ten Steps verbatim. 

Rather, the Baby-Friendly Hospital Initiative questions will be about implementing the program.. That is, what practices are or aren’t in line with the Initiative and how to implement those practices.

What about implementation?

Let me take a broad-brush sweep at this. All or nearly all of what you’ll need to know about implications and implementation come down to:

  • Communication with clients, colleagues, and the community
  • Compliance, i.e., writing, communicating, and monitoring a policy that covers the Ten Steps.
  • Staff training; What would or would not be appropriate for training?
  • Problem-Solving: A situation would be presented, and you would need to figure out a way to solve the problem within the Baby-Friendly Ten Steps.
  • Research Reading, Given the research results, what kind of analysis and application should you make in the clinical area?   
  • Decision-making and trade-offs:  In a clinical scenario, what would be least disruptive to the initiation and continuation of breastfeeding?
  • Design and development:  In the real world, how would you go about putting into place the Ten Steps?
  • Team coordination and cooperation. This would include (but not be limited to) forming a hospital committee, and then creating a dialogue or publicity with the community.

Although I did not name every possible scenario you might encounter on the exam, I am very sure that my list reflects BFHI-type questions/content.

Common myths about Baby-Friendly Hospital Initiative

I have stacks of 3 x 5 cards where attendees in my 90-hour course have written Baby-Friendly Hospital Initiative questions. Yes, by now, I have thousands of questions. Many boil down to these myths:

  • Formula-feeding parents need to bring their own formula to the hospital. (No, not true.)
  • The hospital must have an IBCLC if they go Baby-Friendly. (No, not true.)
  • Rooming in causes lack of maternal sleep. (No, research simply does not bear this out.)
  • You can’t go BFHI if you have a NICU. (No, not true.)
  • Pacifiers can’t be given to any baby. (No, not true.) There are exceptions. For example, pacifiers are okay for premature babies or babies who are undergoing a painful procedure.
  • The hospital “forces” mothers to breastfeed. (No. That’s absurd.)
  • Baby-Friendly is unrelated to breastfeeding outcomes. (No, not true.) Duration of breastfeeding for couplets has improved worldwide when the birth occurs in a BFHI hospital.
  • BFHI deals with only the hospital, not prenatal issues. (No, not true.) The BFHI gives some specific directives about promoting breastfeeding during the prenatal period.   
  • You can use bottles to feed babies their mothers’ milk. (No, not true; bottles are discouraged.) The preferred alternative method is cup feeding.

What the bottom line in Baby-Friendly Hospital Initiative questions on the exam?

The exam will not require you to recite the Ten Steps, verbatim. Rather, you’ll need to know what the BFHI does and doesn’t require and how to implement such a requirement.

Are you prepared for Baby-Friendly Hospital Initiative questions on the exam? Is there anything that is tripping you up? Share your questions in the comments below!

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