The following ten steps summarize the recommended practice standards for all facilities that provide maternity services and care for newborn infants. These ideal practices should help you know what to ask for at your own hospital to assure the best possible start with breastfeeding.
1. Have a written breastfeeding policy that is routinely communicated to all health-care staff. The written policy should address all ten steps, prohibit the promotion of formula, be available to all staff, and be evaluated for its effectiveness.
2. Train all health-care staff in skills necessary to implement this policy. All staff should be trained in the advantages of breastfeeding and the basics of practical management. Selected staff members should receive specialized training to allow them to serve as resource people.
3. Inform all pregnant women about the benefits and management of breastfeeding. Pregnant women attending prenatal services at the hospital should be informed about the benefits and practical aspects of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth. Healthy babies should be given to their mothers to be held skin-to-skin within thirty minutes of delivery and allowed to remain with their mothers for at least an hour. Mothers who have had cesarean deliveries should be given their babies to hold skin-to-skin within a half hour after they are able to respond to their babies.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. Nursing staff should offer all mothers further assistance with breastfeeding and verify that mothers can demonstrate correct breastfeeding technique. Mothers of babies in special-care nurseries should be shown how to express their milk frequently to maintain lactation.
6. Give newborn infants no food or drink other than breast milk, unless medically indicated. Staff should know the valid medical reasons for offering supplements to breastfed infants. Formula used in hospitals should be purchased by the facility and not accepted for free or promoted in any way.
7. Practice rooming-in—allow mothers and infants to remain together twenty-four hours a day. Rooming-in should start within an hour of a normal birth or within an hour of when a cesarean mother can respond to her baby. Separations should occur only for necessary hospital procedures or medical indications.
8. Encourage unrestricted breastfeeding. Mothers should be advised to breastfeed whenever their babies show signs of hunger. No restrictions should be placed on the frequency or length of feeding
9. Give no pacifiers or artificial nipples to breastfeeding infants. Mothers should be taught to avoid pacifiers and bottle feeds because they can interfere with breastfeeding.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. Key family members should be taught how to support the breastfeeding mother at home. Hospitals should have a system of follow-up for breastfeeding mothers after discharge, such as early prenatal visits, home visits, or telephone calls.