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?*YesNoAdditional 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 email@example.com.Name First Last Email Do you wish to add another contact?YesNoName First Last Email Do you wish to add another contact?YesNoName 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)*YesNoUnsure100% 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: UnsurePlease explain.Measure 2: Skin-to-skin after delivery*YesNoUnsure90% 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: UnsurePlease explain.Measure 3: Skin-to-skin during proceduresYesNoUnsure90% 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: UnsurePlease explain.Measure 4: Rooming-in*YesNoUnsure90% of healthy term newborns (≥ 37 weeks 0 days gestation), regardless of feeding method, remain with their mothers ≥ 23 hours per day.Measure 4: UnsurePlease explain.Measure 5: Exclusive human milk feeding during hospitalization*YesNoUnsureGreater than 70% of healthy term (≥ 37 weeks 0 days gestation) infants receive human milk exclusively through the day of dischargeMeasure 5: UnsurePlease explain.Measure 6: Pumping or manual expression after separationYesNoUnsureIncrease 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: UnsurePlease explain.Measure 7: Mother's milk feeding in the NICU (Required for NICUs)*YesNoUnsureIncrease 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: UnsurePlease explain.Measure 7a: Any human milk at discharge from the NICU*YesNoUnsureMeasure 7a: UnsurePlease explain.Measure 7b: Exclusive human milk feeding at discharge from the NICU*YesNoUnsureMeasure 7b: UnsurePlease explain.Measure 8: Human milk feeding after discharge (Required for community-based infant/pediatric care providers)*YesNoUnsureIncrease human milk feeding at 3-4 months. Measure 8: UnsurePlease explain.Measure 9: Exclusive human milk feeding after discharge*YesNoUnsureIncrease exclusive human milk feeding at 3-4 months. Measure 9: UnsurePlease explain.Measure 10: Human milk feeding at discharge (Required for hospitals)*YesNoUnsureMeasure 10: UnsurePlease explain.Can we list your site on the WisPQC Web site for this initiative?*YesNoOne 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.