Office Received
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Site ID
Minnesota Breastfeeding Friendly Maternity Center Designation
STEP 4 Application
To apply for completion of STEP 4:
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 4: Help mothers initiate breastfeeding within one hour of birth.
At least 80% of infants are placed in skin-to-skin contact with their mothers, regardless of
feeding method, immediately following birth for at least one hour or through the first
feeding. After cesarean section, infants are placed skin-to-skin as soon as possible after
their mother is responsive and alert. In the case of delay, efforts are made to keep infants
and mothers in the same room, ideally with the infant skin-to-skin on another family
member. Mothers are encouraged to recognize when their babies are ready to breastfeed
(cues) and offered help if needed.
Routine newborn procedures (e.g. Apgar scores, assessment) are performed while the
baby is skin-to-skin. Procedures that require separation (e.g. infant bathing) are delayed
until after the initial period of skin-to-skin and then take place at the mother's bedside.
Skin-to-skin contact is encouraged throughout the hospital stay.
NOTE: Facilities that are interested in pursuing designation from Baby-Friendly USA, Inc.
should refer to their specific guidelines and criteria here.
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4.1 a. For vaginal deliveries: What percent of infants are placed skin-to-skin
with their mothers right after birth (or immediately after mother becomes
responsive and alert) and encouraged to continue this contact,
uninterrupted, through the first feeding or for at least one hour?
%
b. This percentage is based on:
an Estimate - Explain Method:
a Chart Review
an Alternative System - Specify:
c. How / where is this information documented in the medical record? Include a copy.
4.2 a. For cesarean deliveries: What percent of infants are placed skin-toskin with their mothers right after birth/immediately after mother becomes
responsive and alert and encouraged to continue this contact through the
first feeding or for at least one hour?
%
b. This percentage is based on:
an Estimate - Explain Method:
a Chart Review
an Alternative System - Specify:
c. How / where is this information documented in the medical record? Include a copy.
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4.3 a. In the first two hours of life, what percent of mothers are helped to
recognize the signs that their babies are ready to eat (hunger cues) and
offered help, if needed?
%
b. This percentage is based on:
an Estimate - Explain Method:
a Chart Review
an Alternative System - Specify:
c. How / where is this information documented in the medical record? Include a copy.
STEP 4: Supporting Documents Table
File Name
Brief Description
Page of