BFHI Assessment Tool
(Extended Version) /
Breastfeeding Support / Demonstrates the ability to both:
· effectively and safely support a breastfeeding woman to gain independence
· assess a breastfeed /
Name of Group 1 Personnel[1]:
Tick the appropriate box / Developing / Achieved
Reviews maternal and infant history including labour and birth for any factors that may impact on breastfeeding. Reviews feeding history including use of additional feeds and/or lactation aids.
Establishes a midwifery relationship with the woman e.g. gives greeting, uses appropriate body language and open communication, obtains verbal consent to observe and provide support.
Determines woman’s level of physical comfort, offers analgesia if required and evaluates efficacy if previously administered.
Assesses the woman’s current level of knowledge and understanding of breastfeeding, positioning and attachment. Recognises and validates the woman’s experience to date.
Observes baby’s behavioural state, discusses feeding cues with woman and identifies readiness to feed. Offers skin to skin contact to settle if baby distressed.
Assesses general condition of the baby. Discusses baby’s intake and output and identifies appropriateness for hours/days of age.
Assists the woman into a position which is physically comfortable and facilitates optimal attachment. Ensures privacy according to woman’s stated needs.
Attends visual assessment of the condition of the woman’s breasts and nipples as required. Discusses breast changes since birth, any management strategies already in place to facilitate comfortable attachment and effectiveness of same.
Discusses principles of positioning stating that no ‘best’ position exists and encourages woman to try different positions until comfort achieved. Exhibits respect for positioning preferences that may be based on physical limitations or previous experience.
Discusses and supports attachment techniques according to the woman’s choice:
A) Infant-led attachment (ideal): woman in semi-reclining position. Baby placed on his or her stomach between her breasts. Baby self-attaches with little or no assistance from the woman except to prevent falling. Woman and baby use innate reflexes.
B) Mother-led attachment: woman places her hand at the base of the baby’s head, supporting the neck. Baby’s nose and mouth aligned with the nipple and areola, body level, well supported. Baby facing woman, woman brings baby to breast not breast to baby.
Identifies need for additional breast support and discusses various hand and finger holds to facilitate deep latch:
- Fingers far enough back to allow full access to the woman’s areola;
- Folded wash cloth to support and elevate a large breast;
- Heel of the hand on the chest wall for small breasted women to help direct rather than support;
- C hold, scissors hold, dancer hold, ‘sandwich’ analogy may be used if useful.
Tick the appropriate box / Developing / Achieved
Recognises and discusses signs of optimal latch:
- Position of baby’s mouth on the breast may be central or asymmetrical (lower > upper);
- Nipple and good amount of areola should be in baby’s mouth;
- Wide open mouth;
- Full cheeks;
- Both lips flared outwards;
- Nipple not misshapen on detachment;
- Most important factor is maternal comfort
o Uses quantitative terms to help woman objectify sensations, e.g. ‘pinching’, ‘rubbing’, ‘stinging’, ‘burning’;
o Encourages repositioning and re-latching if required.
Recognises and discusses with woman signs of milk transfer:
- Rhythmical sucking with pauses;
- Deep jaw movement, ears may ‘wiggle’;
- Audible swallowing as supply increases, suck swallow ratio 1:1 or 1:2 in response to milk ejection reflex;
- Slight movement of top of areola inwards to baby’s mouth;
- Breast softens and milk flow slows as feed progresses.
Recognises if woman and baby need extra assistance and offers suggestions including:
- Never force baby to the breast. Wait for the baby’s tongue to be on the floor of the mouth. Settle a distressed baby before trying to latch again;
- Try a different technique/position;
- Brush the baby’s lips lightly with the nipple to encourage a wide gape;
- The baby’s chin and cheeks should touch the breast first to help with orientation for effective latch;
- Wrapping the baby around the mother’s waist may help clear the nose away from the breast.
Discusses common aspects of breastfeeding young babies:
- Changing nature of breastmilk to suit baby’s needs;
- Baby may take one or both breasts per feed;
- Observing for and responding to baby’s cues to indicate fullness or need to offer second breast (fussing, restless);
- “Cluster” and night feeds.
Discusses feeding recommendations: no need for other fluids/foods until around 6 months of age.
Encourages questions and discussion. Communicates with mother in easily understood language and evaluates her understanding throughout the session.
Discusses importance and accessibility of community-based peer support for breastfeeding.
Closes encounter with the woman appropriately, offering positive reinforcement.
Documents interaction and outcome according to hospital protocol.
Name of Assessing Clinician:
Signature:
Date:
Comments:
(Adapted from Davis, M Guidelines for Facilitating and Assessing Breastfeeding’ in Mannel, R, Martens, P, and Walker, M (ed) Core Curriculum for Lactation Consultant Practice (3rd Ed)Burlington, MA: Jones & Bartlett Learning)
[1] Group 1 Personnel: Those who assist mothers with breastfeeding, or provide education in relation to breastfeeding, in any part of the maternity unit, antenatal clinic and/or neonatal nurseries.