Infant feeding and breastfeeding advice

What it is

The Baby-Friendly Hospital Initiative is a global program established by UNICEF and WHO to promote healthy infant feeding and mother-baby bonding. Its primary objective is to educate the public on the benefits of breastfeeding and to encourage, promote and facilitate breastfeeding as set out in the UNICEF/WHO Ten Steps to Successful Breastfeeding chart. The steps promote breastfeeding to the public and give hospitals and birthing centers guidelines for the successful initiation and continuation of breastfeeding.

How it is treated

A baby-friendly facility must have a written breastfeeding policy that is routinely communicated to all health care staff, and all staff must be trained in the skills needed to implement it. All pregnant women should be informed about the benefits and management of breastfeeding. The advice at the cot side is:

• Help the mother start breastfeeding within an hour after birth, and show her how to breastfeed and how to maintain lactation even if she is separated from her infant.
• Give a breastfeeding infant no food other than breast milk unless medically indicated.
• Practise rooming in, so mother and infant stay together 24 hours a day.
• Encourage the mother to breastfeed on demand.
• Do not give a breastfeeding infant pacifiers or artificial nipples.
• Refer the mother to breastfeeding support groups on discharge from the hospital.

If a mother chooses formula after proper education, she should be instructed in its proper preparation and use. The hospital must also comply with the International Code of Marketing of Breast Milk Substitutes: formula companies may not give free gifts to staff or mothers, breast milk substitutes are not marketed in the maternity unit, and supplements and infant feeding supplies are purchased at fair market price. On contraception while feeding, lactational amenorrhea requires exclusive breastfeed with a baby under 6 months and should not be used in a patient with HIV. Combined pills are contraindicated in the first 6 months in a lactating woman, the injectable is used from 6 weeks postpartum, and an IUD is inserted after 6 weeks in a breastfeeding woman. Progesterone only pills are listed the same way on the contraception table, but they are also set down as started at any time postpartum, with an additional contraception method used for 2 days if they are started after day 21; and the FSRH advice is that postpartum women, breastfeeding and non-breastfeeding, can start the POP at any time postpartum. A small amount of progestogen enters breast milk, but this is not harmful to the infant. Feeding is continued through breast pain rather than stopped for it. If breastfeeding is too painful the mother is advised to express milk by hand or using a pump until breastfeeding can be resumed, and breast feeding or expressing should continue during treatment with antibiotics, since only a small amount of these is excreted in milk and the infant is not usually affected.