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MO-07-0034 BFP

The hospital will encourage medical staff to perform a breast exam on all pregnant women and provide anticipatory guidance for conditions that could affect breastfeeding. Breastfeeding mothers will have an assessment of the breast prior to discharge and will receive anticipatory guidance regarding conditions that might affect breastfeeding.




3.1 The perinatal caregiver should examine the breast to assess

  • previous breast surgery.
  • nipple protractility.
  • progressive breast enlargement during pregnancy.
  • breast pathology.
  • skin condition.
  • lesions (herpes, yeast, etc).

This assessment should to be documented in the patient chart.






3.1 Perinatal caregivers should identify and document mother’s breast abnormalities prior to birth and postpartum, and provide appropriate anticipatory guidance and resources.1,2,3,4,5,6


Examples of Prenatal Breast Assessment forms designed by Kay Hoover, M Ed, IBCLC, Philadelphia Department of Public Health

Examples of clinical practices

International Board Certified Lactation Consultant (IBCLC)

United States Lactation Consultant Association (USLCA)


3.2 Both a visual and palpation exam needs to be performed by the primary caregiver(s).


3.2 A thorough breast exam is imperative to ensure successful breastfeeding and will enable the clinician to help the mother avoid or circumvent problems that may otherwise interfere with breastfeeding. 3


Examples of charting of postpartum breast/nipple evaluations.

  • IBFAT: MK Matthews, Midwifery 4(4) p154, 1988
  • MBS: Mother-Baby Assessment: Mulford C The Mother-Baby Assessment (MBA): An "Apgar Score" for Breastfeeding. JHumLact (1992) 8:2, 79-82.
  • LATCH: Authors: D Jenson, S Wallace, P Kelsay – JOGN 23(1) p29, 1994
  • LATCHES: Marie Davis, RN, IBCLC (Guidelines) from University of Illinois Medical Center)

Policy #3 References:

1. Huggins, K. (1999). The Nursing Mother’s Companion (4th ed.). (pp. 14-16). Boston: Harvard Common Press.
2. Lawrence, R. A. (1987). The management of lactation as a physiologic process. Clinics in Perinatology, 14(1), 1-10.
3. Lawrence, R. A., & Lawrence, R. M. (2005). Breastfeeding: A guide for the medical professional (6th ed.). St. Louis, MO: Mosby (p. 266).(Ordering information)
4. Marmet, C. & Shell, E. (2004). Lactation forms: A Guide to Lactation Consultant Charting. Encino, CA: Lactation Institute Press.
5. Merewood, A., & Phillip, B. (2001). Breastfeeding Conditions & Diseases, A Reference Guide. Hale Publishing, 32, 137-199. (Hale Publishing)
6. Powers, N. & Slusser, W. (1997). Breastfeeding update 2: Clinical lactation management. Pediatrics in Review, 18(5), 147-161

Additional References:

Hale TW, Hartmann PE, (Eds). (2007) Hale and Hartmann’s Textbook of Human Lactation; Hale Publishing, Amarillo, TX

Johnson, T. S., Mulder, P. J., & Strube, K. (2007). “Mother-Infant Breastfeeding Progress Tool: a guide for education and support of the breastfeeding dyad”. J Obstet Gynecol Neonatal Nurs, 36(4), 319-327. [Abstract]

Walker, M. (2006). Breastfeeding management for the clinician : using the evidence. Sudbury, Mass: Jones and Bartlett.

Walker, M. (2008). “Maternal Breastfeeding Anatomy”. In R. Mannel, P. J. Martens & M. Walker (Eds.), Core Curriculum for Lactation Consultant Practice (2nd edition ed., pp. 195-207). Sudbury, Massachusetts: Jones and Bartlett Publishers.

Walker, M. (2008). “Physiology of the Breast During Pregnancy and Lactation”. In R. Mannel, P. J. Martens & M. Wallker (Eds.), Core Curriculum for Lactation Consultant Practice (2nd edition ed., pp. 223-232). Sudbury, Massachusetts: Jones and Bartlett Publishers.

Last modified on: 2/22/2011 1:23 PM