Breastfeeding Regulations

130.601 Definitions

• The following definitions apply in 105 CMR 130.000 when used with regard to maternal and newborn services:
  • Lactation Consultant shall mean an individual certified as an International Board Certified Lactation Consultant or an individual with equivalent training and experience

130.615 Patient/Family Services

• B. Each hospital with a maternal newborn service shall provide prenatal, postnatal and family-planning services either directly or through referral to an outside agency, including the following:
  • 3. Infant feeding instruction and support during hospitalization and provision of information on resources to assist the mother and family after discharge, including, for breastfeeding mothers, community-based lactation consultant resources and availability of breast pumps
• J. Each service shall have a written policy that provides for discharge planning and referrals to community agencies and healthcare providers, including lactation consultants as needed

130.616 Administration and Staffing

• D. Patient care policies. Each maternal and newborn service shall develop and implement written patient care policies and procedures, supported by evidence based resources, which shall include provisions for the following:
  • 11.* Support of lactation initiation and maintenance for mothers who choose breastfeeding. Such policies shall provide for the following:
    1. No standing orders for antilactation drugs
    2. Unless medically contraindicated, encouragement of breastfeeding as soon after birth as the baby is interested. A mother separated from her infant shall be assisted to initiate and maintain her milk production.
    3. Frequent nursing periods, based on the infant’s needs.
    4. Supplemental bottle feeding for medical reasons or on request of the mother only.
    5. Sample formula and/or formula equipment distributed to breast-feeding mothers only when an individual physician order is written or on the request of the mother.
  • 18. Policies for safe and secure storage and handling of infant feedings, formula and breast milk, including policies to ensure the correct labeling and identification of all infant feeding
• F. Nurse staffing
  • All licensed nursing staff caring for maternal-newborn patients shall receive orientation and periodic inservice education that provides training or documents skill in at least the following areas:
    • Initiation and support of lactation
• G. Lactation Care and Services
  • Each hospital shall deliver culturally and linguistically appropriate lactation care and services by staff members with knowledge and experience in lactation management. At a minimum, each hospital shall provide every mother and infant requiring advanced lactation support with ongoing consultation during the hospital stay from an International Board Certified Lactation Consultant (IBCLC) or an individual with equivalent training and experience
  • Each maternal and newborn service shall develop written, evidence-based breastfeeding policies and procedures and include these in staff education and competency reviews
  • An educational program of lactation support for maternal-newborn staff shall be offered by qualified staff and shall address the following areas:
    • The nutritional and physiological aspects of human lactation
    • Positioning of mother and infant to promote effective sucking, milk release and production
    • Practices to avoid, recognize, and treat common breastfeeding complications
    • Nutritional needs of the mother during lactation and monitoring the nutritional needs of the infant
    • Safe techniques for milk expression and storage of milk
    • Information about community support services available to the family after discharge
    • Cultural values related to breastfeeding

• Electric breast pump and collection kits

• A. Maternal
  • Method of infant feeding, infant feeding plan of care and progress, and documentation of lactation care and services provided
• B. Newborn record
  • Method of feeding including feeding plan of care
  • Documentation of at least 2 successful feedings for both breastfed and formula-fed infants

• A lactation consultant shall be available seven days a week. Lactation consultants shall have training and experience in providing care and services to infants with special needs and their families
• Breastfeeding support
• Availability of breastfeeding pump room
• Electric breast pumps and collection kits

Note:
*(11) (a)-(e) replaces original language initially approved by the Public Health Council on 12/20/2005, which read as follows:

• 11. Support of lactation initiation and maintenance for mothers who choose breastfeeding. Such policies shall provide for the following:
  • no standing orders for antilactation drugs
  • unless medically contraindicated, encouragement of breastfeeding as soon after birth as the baby is interested. Mothers separated from their infants shall be assisted to initiate and maintain their milk production
  • the direct marketing of commercial formula materials to mothers, including the distribution of commercial formula discharge gift bags, shall not be permitted

Breastfeeding Support

The proposed regulations add new provisions that strengthen breastfeeding support. Numerous professional organizations, including the American Academy of Pediatrics and the American College of Obstetrics and Gynecology recommend exclusive breastfeeding for the first six months of life. Exclusive breastfeeding provides ideal nutrition for growth and development as well as significant protection against acute illness and chronic disease for both a mother and her infant. Effective breastfeeding support, education and management in the first days of life are excellent predictors of future breastfeeding success. Public health regulations pertaining to birthing hospitals must include strong provisions to promote and protect exclusive breastfeeding.

Distribution of commercial formula gift bags: The Department received comments from 47 individuals, groups, or organizations relative to the proposed changes regarding the distribution of commercial formula gift bags to mothers upon discharge. This practice is currently widespread throughout Massachusetts. The Department recommends an amendment to the regulations that prohibits the direct marketing of formula to mothers, including the distribution of gift bags from commercial formula companies. Randomized clinical trials demonstrate that formula company gift bags are linked with decreased breastfeeding duration.

The proposed revisions had included a proposal to limit the display of any items that advertise formula products, such as nametags, stethoscope tags, or crib cards with the name or logo of any formula company. After consideration of public comments, we have withdrawn these proposed revisions. While potentially a valuable practice that would eliminate the perception that the hospital endorses formula, we recognize that this type of regulation would be impractical and very difficult to enforce. The Department of Public Health’s Guidelines for Breastfeeding Initiation and Support available as a resource to hospitals recommends avoiding promotional items that endorse formula feeding or contain a formula company’s name. The Department at this time will continue to recommend this practice rather than add it to the regulation.

Availability of Hospital Lactation Support: The proposed revisions include the following requirement for lactation support to new mothers. "At a minimum, each hospital shall provide every mother and infant requiring advanced lactation support with ongoing consultation during the hospital stay from an International Board Certified Lactation Consultant (IBCLC) or an individual with equivalent training and experience". Many commenters recommended that we eliminate the provision that allows for an equivalently trained and experienced individual and require only IBCLCs to meet this regulation. While requiring each hospital to have an IBCLC available to mothers may be ideal, it would present a hardship for small or geographically isolated hospitals. Instead, the Department proposes to evaluate the hospital’s lactation support program to ensure that the Lactation Consultant who does not possess the IBCLC credential is an individual with advanced training, demonstrated experience in breastfeeding management and counseling and regular continuing education. This provision builds upon the Department of Public Health’s Guidelines for Breastfeeding Initiation and Support released in 2003 that recommends a "lactation specialist" be on staff. We propose future modifications to these Guidelines could outline the qualifications considered to be "equivalent" to the IBCLC designation.