世界衛生組織剛剛公告BFHI10步驟的更新版，此次更新強調”國家層級”的高度與重要性，呼籲”普及性”及”持續性”的實踐策略。
將BFHI10步驟依”管理”與”臨床”兩大面向重新詮釋親善醫院的責任分工與實施方針。
精簡導讀此次更新的關鍵2點為；1b.增加與機構與家長溝通說明書面政策的必要性；2. 對於機構中工作人員母乳哺育的知識與支持技能，應有評量機制，以確保照護品質。
完整文件如下。 理事長 王淑芳
- (2018年4月11日更新版) 翻譯：國際事務主委 翁少萍醫師
世界衛生組織和聯合國兒童基金會發起了愛嬰醫院倡議(BFHI)，來激勵世界各地提供產婦和新生兒服務的機構實施成功母乳哺育的十大步驟。
十大步驟總結了一系列的政策和程序，協助提供產科和新生兒的服務，應該被執行以支持母乳哺育。
世衛組織呼籲所有全球提供孕產和新生兒照護的機構實施十大步驟。
BFHI的實施指引強調全面普及性並確保長期可持續性的實施策略。
該指引著重在將該方案更全面地納入衛生保健系統，以確保全國所有機構都實施這十大步驟。
呼籲各國透過全國性BFHI計畫履行9項關鍵職責：
成功哺乳十大步驟
關鍵管理程序
1a. 完全遵守『國際母乳代用品銷售守則』和世界衛生大會相關決議。
1b. 制定書面的嬰兒餵食政策，並定期將此與員工和家長溝通。
1c. 建議持續的監測和數據管理系統。
2. 確認工作人員有充足知識，能力和技能來支持母乳哺育。
重要的臨床應用
3. 跟孕婦和其家屬討論母乳哺育的重要性和處理。
4. 促進即時及無干擾的肌膚接觸，並協助母親們生產後儘快開始母乳哺育。
5. 支持母親們開始和持續母乳哺餵，以及常見問題的處理。
6. 除非醫療上有必要，否則不要提供母乳哺育的新生兒母乳以外的任何食物或液體。
7. 讓母親們和他們的嬰兒能保持在一起，並且執行24小時親子同室。
8. 支持母親們認識並回應她們的嬰兒之餵食徵象。
9. 忠告母親們使用奶瓶、奶嘴、安撫奶嘴的危險性。
10. 出院安排，讓家長們和他們的嬰兒需要時能及時獲得持續的支持和照護。
有大量實證顯示，實施十大步驟可以顯著提升母乳哺育率。
整合2016年發表的58個有關孕產婦和新生兒照護研究所做的系統性回顧清楚指出，
堅持實行這十大步驟會影響出生後即刻開始哺餵母乳，純母乳哺育，和總哺乳的時間。
Ten steps to successful breastfeeding (revised 11 April, 2018) http://www.who.int/nutrition/bfhi/ten-steps/en/
WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI) to help motivate facilities providing maternity and
newborn services worldwide to implement the Ten Steps to Successful Breastfeeding.
The Ten Steps summarize a package of policies and procedures that facilities providing maternity and
newborn services should implement to support breastfeeding.
WHO has called upon all facilities providing maternity and newborn services worldwide to implement the Ten Steps.
The implementation guidance for BFHI emphasizes strategies to scale up to universal coverage and ensure sustainability over time.
The guidance focuses on integrating the programme more fully in the health-care system,
to ensure that all facilities in a country implement the Ten Steps.
Countries are called upon to fulfill nine key responsibilities through a national BFHI programme:
Ten steps to successful breastfeeding
Critical management procedures
1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.
1b. Have a written infant feeding policy that is routinely communicated to staff and parents.
1c. Establish ongoing monitoring and data-management systems.
2. Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding.
Key clinical practices
3. Discuss the importance and management of breastfeeding with pregnant women and their families.
4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth.
5. Support mothers to initiate and maintain breastfeeding and manage common difficulties.
6. Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated.
7. Enable mothers and their infants to remain together and to practise rooming-in 24 hours a day.
8. Support mothers to recognize and respond to their infants’ cues for feeding.
9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.
There is substantial evidence that implementing the Ten Steps significantly improves breastfeeding rates.
A systematic review of 58 studies on maternity and newborn care published in 2016 demonstrated clearly
that adherence to the Ten Steps impacts early initiation of breastfeeding immediately after birth,
exclusive breastfeeding and total duration of breastfeeding.