Office Received
Use
Filed
Only
Site ID
Minnesota Breastfeeding Friendly Maternity Center Designation
STEP 6 Application
To apply for completion of STEP 6:
Complete this form electronically using Adobe Acrobat or Adobe Reader 10.0 or later.
Save this PDF form to your computer and submit by email as an attachment to
[email protected], along with the Cover Sheet, any supporting documentation,
and the other applications for additional steps that your facility has completed. See the
Application Instructions on the MDH web page for more details.
Note: When asked to attach a document or enter text, it is acceptable to provide a link to
a current web page. An attachment is also an acceptable alternative to entering text
directly on this form. For all attachments, provide a file name and a brief description in
the Supporting Documents Table at the end of this application form.
STEP 6: Give newborns no food or drink other than breast milk, unless medically
indicated.
The expected breastfeeding method, from birth until discharge, is exclusive
breastfeeding, unless there are documented medical reasons.
Mothers who decide not to breastfeed or request that their breastfeeding baby is given a
breast milk substitute are educated about the possible consequences to their infant's
health and/or breastfeeding success. If a mother still requests a breast milk substitute, her
request is honored and the process of informed decision making is documented in the
medical record.
The facility tracks exclusive breast milk feeding rates based on the definition in Joint
Commission Perinatal Care Core Measures Set #PC-05.
NOTE: Facilities that are interested in pursuing designation from Baby-Friendly USA, Inc.
should refer to their specific guidelines and criteria here.
Page of
6.1 In what ways does your facility track exclusive breast milk feeding rates?
6.2 a. What percent of mothers who have decided not to breastfeed
receive education and support for alternative feeding options, including
feeding expressed milk, and are helped to decide what is suitable in their
situations?
%
If there is a standard method for documenting this practice, include a copy.
b. This percentage is based on:
an Estimate - Explain Method:
a Patient Chart Review
an Alternative System - Specify:
STEP 6: Supporting Documents Table
File Name
Brief Description
Page of