Human Milk Feeding Initiative Enrollment WisPQC Human Milk Feeding Initiative Enrollment Please complete this survey to enroll in the WisPQC Human Milk Feeding Initiative. Name of site* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Name* First Last Title or position* Email* We will use this email address for communication related to the initiative. You will be able to add additional contacts below.Do you want to add additional contacts?* Yes No Additional contactsYou may enter names and email addresses for up to three additional contacts in the spaces below. If you would like to add others, please send an email to wispqc@perinatalweb.org.Name First Last Email Do you wish to add another contact? Yes No Name First Last Email Do you wish to add another contact? Yes No Name First Last Email Measure SelectionUse this section to indicate interest in the measures. The measures included in the 2018 initiative are indicated by the asterisk and require a response. Note that some measures are required based on site setting. Selection of measures is non-binding.Measure 1: Prenatal education (Required for community-based obstetric care providers)* Yes No Unsure 100% documented prenatal education on human milk feeding using Criterion 3.4.1 from the Baby Friendly guidelines. Criterion 3.4.1: A written description of in-house and/or community-based programs and projects the facility has fostered will be available and will cover, at minimum, the importance of breastfeeding, the importance of exclusive breastfeeding for about 6 months, and basic breastfeeding management (e.g., skin-to-skin contact, rooming-in, and risks of supplements while breastfeeding in the first 6 months). Ref: https://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria Measure 1: Unsure Please explain.Measure 2: Skin-to-skin after delivery* Yes No Unsure 90% of mothers hold healthy term newborns (≥ 37 weeks 0 days gestation) skin-to-skin, uninterrupted, for at least 60 minutes, or until the completion of the first feeding, beginning within one hour of birth for uncomplicated vaginal births and within 2 hours of uncomplicated Cesarean deliveries.Measure 2: Unsure Please explain.Measure 3: Skin-to-skin during procedures Yes No Unsure 90% of mothers hold healthy term newborns (≥ 37 weeks 0 days gestation) skin-to-skin while necessary routine newborn procedures and assessments are done within the first hour after uncomplicated vaginal deliveries. Measure 3: Unsure Please explain.Measure 4: Rooming-in* Yes No Unsure 90% of healthy term newborns (≥ 37 weeks 0 days gestation), regardless of feeding method, remain with their mothers ≥ 23 hours per day.Measure 4: Unsure Please explain.Measure 5: Exclusive human milk feeding during hospitalization* Yes No Unsure Greater than 70% of healthy term (≥ 37 weeks 0 days gestation) infants receive human milk exclusively through the day of dischargeMeasure 5: Unsure Please explain.Measure 6: Pumping or manual expression after separation Yes No Unsure Increase by 5-15 percentage points* the number of women separated from their infants for a medical condition (maternal or neonatal) who pump or manually express milk within 6 hours of separation during maternal hospitalization *Sites will select the target based on an assessment of their baseline. Measure 6: Unsure Please explain.Measure 7: Mother's milk feeding in the NICU (Required for NICUs)* Yes No Unsure Increase the use of maternal milk by 10-20%* in infants with birth weights of 1500 grams or less during their 28th day of life in the NICU *Sites will select the target based on an assessment of their baseline. Measure 7: Unsure Please explain.Measure 7a: Any human milk at discharge from the NICU* Yes No Unsure Measure 7a: Unsure Please explain.Measure 7b: Exclusive human milk feeding at discharge from the NICU* Yes No Unsure Measure 7b: Unsure Please explain.Measure 8: Human milk feeding after discharge (Required for community-based infant/pediatric care providers)* Yes No Unsure Increase human milk feeding at 3-4 months. Measure 8: Unsure Please explain.Measure 9: Exclusive human milk feeding after discharge* Yes No Unsure Increase exclusive human milk feeding at 3-4 months. Measure 9: Unsure Please explain.Measure 10: Human milk feeding at discharge (Required for hospitals)* Yes No Unsure Measure 10: Unsure Please explain.Can we list your site on the WisPQC Web site for this initiative?* Yes No One of the strengths of a perinatal collaborative is the opportunity to develop relationships with new stakeholders. WisPQC wants to promote those relationships by listing the sites involved in initiatives on its Web site.
