Welcome to the State of California 


MO-07-0041 BFP

At discharge, mothers should be given information regarding community resources for breastfeeding support.




10.1 Breastfeeding mothers should, routinely, be referred to a breastfeeding support group and given the telephone number of a lactation specialist or community resource for breastfeeding assistance.



10.1 Discharge often occurs before breastfeeding is well established. 1,4,6,7,8,9,10,11


Discharge Protocol:

Pediatric visit/evaluations

Resources for patient referral:

Cal Health & Saf Code §123365

  1. All general acute care hospitals, as defined in subdivision (a) of Section 1250, and all special hospitals providing maternity care, as defined in subdivision (f) of Section 1250, shall make available a breast feeding consultant or alternatively, provide information to the mother on where to receive breast feeding information.
  2. The consultant may be a registered nurse with maternal and newborn care experience, if available.
  3. The consultation shall be made available during the hospitalization associated with the delivery, or alternatively, the hospital shall provide information to the mother on where to receive breast feeding information.
  4. The patient may decline this consultation or information.

Resources for Breastfeeding Education and Support

Handouts and patient information:

Getting help for mothers and babies:

10.2 If a gift pack is provided, it should be appropriate for breastfeeding or formula feeding mothers. Many gift packs provided in the hospital contain items that discourage breastfeeding mothers. Commercial advertising of artificial infant milk or promotional packs should not be given to breastfeeding mothers.


10.2 Hospitals should carefully consider any items they give to mothers. Providing items to patients suggests hospital endorsement of these products. Giving parents artificial infant milk or advertising/ promotional packs prepared by artificial milk companies endorses supplementation and implies that breastmilk is inadequate to meet infants’ needs.2,3,5


Examples of non-commercial handouts to provide anticipatory guidance and resources:

Patient Evaluation/Survey

Information, research and responses to concerns about the removal of gift bags in delivering hospitals:

Policy #10 References:

1. California Health and Safety Codes § 123360 and § 123365, 1995 Cal ALS 463; 1995 Cal AB 977; Stats 1995 ch 463.
2. Chezem, J., Friesen, C., Montgomery, P., Fortman, T., Clark, H. (1998). Lactation duration: Influences of human milk replacements and formula samples on women planning postpartum employment. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 27(6), 646-651.
3. Dungy, C., Christensen-Szalanski, J., Losch, M., Russell, D. (1992). Effect of discharge samples on duration of breast-feeding. Pediatrics, 90(2), 233-237.
4. Gartner, L., & Newton, E. (1998). Breastfeeding: Role of the Obstetrician. ACOG Clinical Review, 3(1), 1-15.
5. Howard, F. Howard, C., Weitzman, M. (1993). The physician as advertiser: The unintentional discouragement of breast-feeding. Obstetrics and Gynecology, 81(6), 1048-1051.
6. Lawrence, R. (1987). The management of lactation as a physiologic process. Clinics in Perinatology, 14(1), 1-10.
7. Lawrence, R. A., & Lawrence, R. M. (2005). Breastfeeding: A guide for the medical professional (6th ed.). St. Louis, MO: Mosby (p. 282)
8. Locklin, M., & Jansson, M. (1999). Home visits: Strategies to protect the breastfeeding newborn at risk. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 28(1), 33-40. [Abstract]
9. Moore, E., Bianchi-Gray, M., & Stevens, L. (1991). A community hospital-based breastfeeding counseling service. Pediatric Nursing, 17(4), 383-389. (Abstract)
10. Page-Goertz, S. (1989). Discharge planning for the breastfeeding dyad. Pediatric Nursing, 15(5), 543-544.
11. Shealy, K. R., Li, R., Benton-Davis, S., & Grummer-Strawn, L. M. (2005). The CDC Guide to Breastfeeding Interventions. Maternal and Child Nutrition Branch, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Retrieved March 22, 2007 from: http://www.cdc.gov/breastfeeding/resources/guide.htm

Additional References:

Bruschweiler-Stern N; Early Emotional Care for Mothers and Infants. Pediatrics 1998;102;1278-81.

Labarere J, Gelbert-Baudino N, Ayral AS, Duc C, Berchotteau M, Bouchon N, Schelstraete C, Vittoz JP, Francois P, Pons JC. Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs. Pediatrics. 2005 Feb;115(2):e139-46. [Abstract] [Full Text (PDF)Opens a new browser window.]

Li R , Fein SB, Chen J, and Grummer-Strawn LM   Why Mothers Stop Breastfeeding: Mothers' Self-reported Reasons for Stopping During the First Year; PEDIATRICS Vol. 122 Supplement October 2008, pp. S69-S76  [Abstract]

Nommsen-Rivers, L. A., Heinig, M. J., Cohen, R. J., & Dewey, K. G. (2008). Newborn wet and soiled diaper counts and timing of onset of lactation as indicators of breastfeeding inadequacy. J Hum Lact, 24(1), 27-33. [Abstract]

Rosenberg, K. D., Eastham, C. A., Kasehagen, L. J., & Sandoval, A. P. (2008). Marketing infant formula through hospitals: the impact of commercial hospital discharge packs on breastfeeding. Am J Public Health, 98(2), 290-295. [Abstract]

Shrago, L. C., Reifsnider, E., & Insel, K. (2006). The Neonatal Bowel Output Study: indicators of adequate breast milk intake in neonates. Pediatr Nurs, 32(3), 195-201. [Abstract]

Taveras, E. M., Li, R., Grummer-Strawn, L., Richardson, M., Marshall, R., Rego, V. H., et al. (2004). Mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits. Pediatrics, 113(5), e405-411. [Full Text]

POWERPOINT PRESENTATION ON: “Evidence-Based Breastfeeding Promotion: The Baby Friendly Hospital Initiative (PDF, 1MB)Opens a new browser window.” by Rafael Pérez-Escamilla, Ph.D.; Professor of Nutrition, Director, Connecticut Latino Health Disparities NIH EXPORT Center. E-mail: rafael.perez-escamilla@uconn.edu

Hospital Self-Appraisal Questionnaire (Word)Opens a new browser window.

Back to Main Page of Breastfeeding Toolkit

Last modified on: 11/7/2012 4:03 PM