Establishing Successful Breastfeeding in the Newborn Period

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Key points

  • Patient education and preparation for successful breastfeeding should occur before and during pregnancy.

  • The immediate period after delivery is crucial for breastfeeding success. Time skin-to-skin and early, unrestricted breastfeeding should be strongly promoted.

  • The Baby-Friendly Hospital Initiative's “Ten Steps” are evidence-based measures that birth facilities can employ to improve breastfeeding initiation, duration, and exclusivity.

  • Breastfeeding can be supported and continued through common

The Decision to Breastfeed

Women make the decision to breastfeed before becoming pregnant, or early in the first trimester—often before their first prenatal visit.7, 8 The influence of the primary care clinician on the decision to breastfeed is strong.9, 10, 11 In a 2001 study of 1229 women, Lu and colleagues10 found that prenatal encouragement to breastfeed was most influential for women from population groups that were least likely to breastfeed. Prenatal encouragement from a physician was associated with a more than

The Importance of Skin-to-Skin Contact

Immediately after delivery, the placement of the newborn skin-to-skin on his or her mother's chest has immense positive effects both on newborn physiologic parameters, and on numerous metrics of breastfeeding success (Fig. 3). In a 2012 systematic review, Moore and colleagues31 demonstrated that skin-to-skin contact in the immediate post-delivery period improves physiologic transition in the newborn, increases the success of the first breastfeed, and leads to more effective breastfeeding. More

Baby-friendly hospitals and the Ten Steps

In 1991, the WHO and UNICEF sponsored the BFHI, based on the “Ten Steps to Successful Breastfeeding” as a global health initiative to protect, promote, and support breastfeeding. The BFHI uses evidence-based interventions to promote breastfeeding initiation, duration, and exclusivity by educating hospital staff, reviewing and changing hospital policies, and decreasing the influence of commercial formula in the hospital setting.6

More than 10,000 hospitals world-wide have achieved BFHI

Supporting breastfeeding during medical problems

Although the BFHI Ten Steps work well for term newborns without medical problems, there are common issues in the well nursery that can have detrimental effects on breastfeeding if they are addressed without concern for preserving an exclusive diet of human milk. Three of the most common are hyperbilirubinemia, hypoglycemia, and the late preterm infant.

Readiness for going home

Breastfeeding should be assessed and supported during the hospital discharge process, with an array of supports put in place for continued breastfeeding resources and support once the mother and infant are home. A trained staff member should observe at least 1 successful breastfeeding within 8 hours before discharge.111 All breastfeeding issues should have been already attended to during the birth hospitalization, with a follow-up plan in place for unresolved issues. All medical professionals

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