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Women, Infants & Children (WIC)

Health Care Providers

Breastfeeding - At the Hospital

 

Health Care 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:

  • Encouraging rooming-in to support on-demand feeds. Inform the mother that unrestricted, frequent feedings will help baby learn how to breastfeed and improve milk supply.
  • Assessing the mother's breastfeeding techniques and, if needed, demonstrating appropriate breastfeeding positioning and attachment with the mother and infant, optimally within 3 hours and no later than 6 hours after birth.
  • Encouraging exclusive breastfeeding with no bottles and no supplementation unless there is a true contraindication.
  • Scheduling maternal procedures after breastfeeding or arranging the use of hospital electric pump prior to procedure if the mother will be away from baby for more than 2 hours.
  • Scheduling routine pediatric care and breastfeeding follow-up visit on day 3 to 5 of life.
  • Educating mothers on basic breastfeeding practices including:

    1. The importance of exclusive breastfeeding

    2. How to maintain lactation for exclusive breastfeeding for about 6 months

    3. Criteria to assess if the infant is getting enough breast milk, including signs of milk transfer, urine and stool output, and growth

    4. How to express, handle, and store breast milk, including manual expression

    5. How to sustain lactation if the mother is separated from her infant and will not be exclusively breastfeeding after discharge

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.

    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.

    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. 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.

    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

     

 

 

 

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