Better Bama Breastfeeding Seven Steps

  1. Teach moms about the importance of exclusive breastmilk feeding and rooming-in
    1. Education provided to pregnant mothers covers
      1. The importance of exclusive breastfeeding, non-pharmacologic pain relief methods for labor
      2. The importance of STS contact and early initiation of breastfeeding
      3. Rooming-in on a 24-hour basis
      4. Cue-based feeding, effective latch and position
      5. Risks associated with formula feeding before breastfeeding is established
      6. Available breastfeeding related community resources.
    2. Education materials/presentations/artwork are free of messages that promote or advertise infant food or drink other than breastmilk. All educational materials should be WHO Code compliant.
  2. Meet first hour best practices of early skin-to-skin (STS) care and first feeding
    1. STS contact is encouraged within 5 minutes of a vaginal birth and infant is kept in STS contact until completion of the first feeding, or at least 1 hours following birth.
    2. STS contact is encouraged for the alert, responsive mother and her infant within the first 30 minutes following a cesarean birth. During the recovery period the infant is kept in STS contact until completion of the first feeding, or at least 1 hours following birth.
    3. Non-emergent, routine procedures (vitamin K, eye ointment, baths) or procedures requiring separation of the mother and baby will be delayed until after this initial period of STS care or will be done while the infant is on the mother’s chest.
    4. Mothers are provided education in order to recognize the signs (cues) that their babies are ready to feed and are offered assistance with initiation of breastfeeding during this first hour.
    5. When appropriate mothers are provided with education regarding how to initiate lactation even when separated from their infants (i.e. NICU admission)
  3. Teach basic infant feeding management
    1. Visual assessment of the mother and infant’s breastfeeding technique at the 2nd feeding or feeding attempt will be documented within 6 hours of birth and once per shift following the initial assessment.
    2. Milk expression (hand expression/breast pump use) is taught to all mothers, with special attention to high risk/special needs mothers and mothers who must be separated from their infant or have decided to provide milk through milk expression rather than feeding directly at the breast. Expression of milk in mothers who will be pump-dependent will have hand expression initiated within the first hour of birth with follow-up instructions on breast pumping within 6 hours of birth.
    3. Mothers who choose to formula feed are given individual instruction on the safe preparation and handling of formula, with focus on responding to feeding cues and signs of satiety.
  4. Avoid non-medically indicated supplemental feedings and the use of bottle nipples and pacifiers in breastfeeding infants.
    1. When a breastfeeding mother requests supplementation with formula staff will:
      1. Use critical thinking in assessing the breastfeeding status
      2. Offer assistance with breastfeeding as appropriate and needed
      3. Provides information on the risk associated with non-medically required supplementation. Assessment and education is documented in the mother’s chart.
    2. Mothers are educated on how the early use of artificial nipples or pacifiers may interfere with optimal breastfeeding.
      1. Pacifiers may reduce the risk of SIDs and other sleep related deaths but should not be introduced until at least one month of age OR when breastfeeding has been successfully established.
      2. Pacifiers should be used at naptime and bedtime, with no need to replace if the infant spits the pacifier out during sleep.
    3. Alternate feeding methods are used when appropriate if supplementation is necessary with required demonstration by staff to properly educate mother and family.
    4. Pacifiers are not given by the staff, with the exception of limited use or decrease pain during procedures when the baby cannot safely be held or breastfed. Pacifiers should be discarded after the procedure.
    5. Mothers are not given discharge packs that are sponsored by breastmilk substitute companies.
    6. When supplementation is ordered by a physician for a clinical condition, the reason is documented in the chart.
    7. Initiation and exclusive breastmilk feeding rates according to the Joint Commission’s definition of exclusive breastmilk feeding is tracked and maintained by the facility.
  5. Practice rooming-in to allow mothers and infants to remain together 23 out of 24 hours a day and encourage breastfeeding on cue.
    1. Policy reflects rooming-in 23 out of 24 hours a day for all infants regardless of feeding method.
    2. Staff educates the mother on the importance of rest and help plan for periods of rest during rooming-in.
    3. When an infant is kept in the nursery for medical reasons the mother should have access to feed her baby at each feeding or be allowed to do STS care as soon as medically safe.
    4. Staff should encourage and support cue-based feedings for breastfeeding and non-breastfeeding infants.
    5. Staff should educate mothers on the following:
      1. Newborns usually feed a minimum of eight times in 24 hours.
      2. Infants use recognizable cues to signal readiness to begin and end feedings.
      3. Physical contact and nourishment are both important.
      4. How to record and assess parameters of adequate intake and what to do if these parameters are not met.
      5. The principles outlined in the 2016 AAP Position Statement on Safe Sleep
        1. Breastfeeding reduces the risk of SIDs or sleep related deaths.
        2. Infants and mothers rest better when the infant is in the room but not in the bed (room sharing but not bed sharing).
        3. Infants should always be placed on their back to sleep, with no clutter in their sleeping area (crib).
        4. After feeding, infants should be returned to their crib, to avoid suffocation from lay over layover or from sheets, blankets, or pillows from the adult bed OR from persons, pillows, or cushions in a recliner or sofa.
        5. Mothers should be particularly mindful of any type of co-sleeping, particularly when the adult is under the influence of drugs, alcohol, or prescription medications.
  6. Provide mom post-discharge education and resources
    1. Patient discharge teaching should include plans for infant feeding with focus on importance of exclusive breastfeeding for about six months.
    2. Telephone follow-up after discharge for breastfeeding mothers should be conducted by lactation or other staff. Mothers should be given warm line numbers as a resource for post-discharge lactation information or assistance.
    3. The development of Mother Support Groups (MSG) should be supported and/or mother should be referred to an existing MSGs following discharge.
  7. Train all health care staff in the basics of their role in breastfeeding management within six months of employment.
    1. Training includes the following:
      1. Use motivational interviewing skills to counsel a pregnant woman about breastfeeding
      2. Use skills for building confidence when giving support and/or assistance to a mother
      3. Assess a breastfeed
      4. Help a mother to position herself and her baby for breastfeeding
      5. Help a mother attach her baby to the breast
      6. Teach basic breastfeeding management to a mother, including optimal pattern of breastfeeding
      7. Help a mother to express her breastmilk
      8. Help a mother to cup feed her baby
      9. Help a mother to initiate breastfeeding within the first hour after birth
      10. Help a mother who thinks she does not have enough milk
      11. Help a mother with a baby who cries frequently
      12. Help a mother whose baby is refusing to breastfeed
      13. Help a mother who has flat or inverted nipples
      14. Help a mother with engorged breasts
      15. Help a mother with sore or cracked nipples
      16. Teach a mother choosing to formula feed safe formula preparation
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