Healthcare Providers

Breastfeeding - At the Hospital

Healthcare Providers provide leadership in breastfeeding support from delivery through discharge.

Immediately after delivery:

• All mothers should be given their infants to hold with uninterrupted and continuous skin-to-skin contact immediately after birth and until the completion of the first feeding, unless there are documented medically justifiable reasons for delayed contact or interruption.
• Routine procedures (e.g. assessments, Apgar scores, etc.) should be done with the infant skin-to-skin with the mother. Procedures requiring separation of the mother and infant, (bathing, for example) should be delayed until after this initial period of skin-to-skin contact and should be conducted, whenever feasible, at the mother's bedside.
• Skin-to-skin contact should be encouraged throughout the hospital stay. If mother and infant are separated for documented medical reasons, skin-to-skin contact should be initiated as soon as mother and infant are reunited.

Optimize breastfeeding by:

Education as the mother prepares to go home:

• Breastfeed when baby exhibits early hunger cues like rooting, hands to mouth, increased movement and sucking noises. Do not wait for baby to cry.

• Colostrum is rich, thick, small in volume, and all baby needs.

• Feedings should be frequent, at least 10 times per 24 hours in the first few days after birth. Babies should be aroused to feed if 4 hours have elapsed since the beginning of the last breastfeeding.

• During growth spurts, the baby may want to feed more frequently.

• Mother's milk supply will increase and she may not feel changes in her breast until day 3 or 4.

• Offer both breasts at a feeding until milk supply is established. Alternating breasts if baby only takes one breast at a feeding will help to establish a good milk supply.

• Time should not be limited at the breast. Healthy, full-term babies will signal satiety by falling asleep, letting go of the breast, or no longer actively sucking and swallowing.

• Pacifiers and bottles can interfere with establishing a good milk supply. They should be avoided until breastfeeding is well-established, usually around 3–4 weeks postpartum.

   

  Resources

  1. Breastfeeding and the Use of Human Milk. American Academy of Pediatrics Policy Statement. Pediatrics 2005; 115(2): 496–506. (PDF)
  

  (http://pediatrics.aappublications.org/content/115/2/496.full.pdf)
  

  2. Breastfeeding and the Use of Human Milk. American Academy of Pediatrics Policy Statement. Pediatrics 2012; 129 (3): e827–e841. (PDF)
  

  (http://pediatrics.aappublications.org/content/pediatrics/early/2012/02/22/peds.2011-3552.full.pdf)
  

  3. The Guidelines & Evaluation Criteria. Baby-Friendly USA. 2016.

  (http://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria)
  

  4. The Ten Steps to Successful Breastfeeding.Baby-Friendly USA.
  

  (https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps)

  5. Breastfeeding Model Hospital Policy Recommendations On-Line Toolkit. California Department of Public Health.
  

  (http://www.cdph.ca.gov/HealthInfo/healthyliving/Childfamily/Pages/mainPageofBreastfeedingToolkit.aspx)
  

  6. Senate Bill No. 402. Hospital breastfeeding support law. 2013.

  (http://leginfo.legislature.ca.gov/faces/billNavClient. xhtml?bill_id=201320140SB402)
  

  7. A Clinician's Guide: Suggested Questions to Assess Breastfeeding in Primary Care Practice. American Academy of Pediatrics. (PDF) (http://www.aap.org/en-us/Documents/Breastfeeding_ SAMPLE.pdf)
  

  8. Wight N, Marinelli K. Academy of Breastfeeding Medicine. ABM Clinical Protocol #1: Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014. Breastfeeding Med. 2014; 9(4):173–179. (PDF)
  

  (http://www.bfmed.org/Media/Files/Protocols/HypoglycemiaEnglish922.pdf)
  

  9. Evans A, Marinelli KA, Taylor JS, Academy of Breastfeeding Medicine.

  ABM Clinical Protocol#2: Guidelines for Hospital Discharge of the Breastfeeding Term Newborn and Mother:"The Going Home Protocol," Revised 2014. Breastfeeding Med.2014; 9(1): 3–8. 
  

  (http://www.bfmed.org/Resources/Protocols.aspx)