Massachusetts Breastfeeding Coalition

10 Steps to a Breastfeeding-Friendly Pediatric Practice

  1. Create and implement a breastfeeding promotion and support policy for use in your practice that is communicated to all staff. Provide copies to those who cover for you.
  2. Arrange for all staff to attend in-services or workshops that teach the skills necessary to promote and support breastfeeding.
  3. Inform all pregnant women about the benefits and management of breastfeeding. Give written, non-commercial information about breastfeeding. Avoid giving out packages of formula or baby items from formula companies. Remove sign-up sheets for formula clubs. Recommend that parents attend prenatal breastfeeding classes that include fathers; refer parents to childbirth education classes. Leave orders in the hospital that breastfeeding mothers not receive commercial discharge bags from formula companies, but instead are given materials that are known to support breastfeeding
  4. Help mothers initiate and continue breastfeeding during hospital rounds. Conduct the newborn exam in the mother’s room, showing her how well baby is designed for breastfeeding.
  5. If mother and baby are separated due to illness, prematurity, etc, confirm that an electric breast pump is available for expressing milk; that milk is expressed at least 8 times each 24 hours; that no nipple soreness, engorgement, or breast problems arise from use of the pump. A prescription for breast milk may be written if necessary, to cover the cost of renting an electric breast pump post discharge
  6. Avoid the use of sterile water, glucose water, or formula for breastfed newborns unless medically indicated. Adequate amounts of breast milk are present at delivery in the form of colostrum.
  7. Encourage mothers to room-in 24 hours a day in the hospital; this protects baby from disease in the nursery, provides opportunities for unrestricted contact and feeding, and enables mothers to become aware of their baby’s needs and rhythms. Mothers do not obtain more sleep by sending the baby back to nursery at night.
  8. Advise mothers to feed their infants on cue, 8-12 times each 24 hours. Teach behavioral feeding cues to avoid underfeeding or over-hunger with resulting infant behavioral disorganization.
  9. Avoid the use of artificial nipples and pacifiers in newborn breastfed infants. This decreases the incidence of nipple preference.
  10. Have available on staff a nurse practitioner or lactation consultant whose responsibility can include prenatal teaching, hospital rounds, call-in times, office visits, etc. Refer mothers to community resources which may include breastfeeding support groups, WIC agencies, mother-to-mother support groups, or a certified lactation consultant with the IBCLC credential.

Marsha Walker, RN, IBCLC

For more information

Ten Steps to a Breastfeeding-Friendly Obstetrics Practice

Ten Steps to Support Parents’ Choice to Breastfeed Their Baby
An American Academy of Pediatrics publication. (PDF File)