Every facility providing maternity services and care for newborn infants should follow the following 10 steps to successful breastfeeding:
STEP 1: Have a written breastfeeding policy that is routinely communicated to all health care staff
The health facility should have a written breastfeeding policy that addresses all 10 steps ensures compliances with the International Code of Marketing of Breastmilk Substitutes implements mother friendly care practices and supports HIV positive women with regards to safe infant feeding.
The orientation, availability and visibility of the policy should be covered here as well as the languages it will be available in.
STEP 2: Train all health care staff in skills necessary to implement this policy
Describe what training will be implemented to support the implementation of this policy:
Who will be trained in what?
How will training be done?
What are the training targets?
Who/how will conduct the training?
STEP 3: Inform all pregnant women about the benefits and management of breastfeeding
How will antenatal education be done and to whom?
Who is responsible for this education?
What topics will be covered in the antenatal education?
A written description of the minimum content of the antenatal education (also called the standard minimum content) should be available and include the following topics (under each topic you need to have the key messages that will be relayed to the mother in the antenatal education session):
Benefits of breastfeeding for both the mother and the baby
Skin to skin contact after birth
Early initiation of breastfeeding
Rooming-in/bedding in 24 hours a day
Feeding on cue on baby lead feeding (including the cues) – Demand feeding & assuring enough milk
Positioning and attachment
Risks of formula feeding and mix feeding
Complimentary feeding and the continued breastfeeding
Routes of HIV infection
Approximate proportion of children that will and will not become infected by breastfeeding
Testing and counselling
Making an informed choice and the importance in infant feeding
STEP 4: Help mothers initiate breastfeeding within half an hour of birth
Define skin to skin
How is skin to skin implemented in this facility?
Under what circumstances will skin to skin not be done, interrupted or delayed?
For how long will skin to skin be done?
How will early initiation of breastfeeding be done and who will be responsible to support the mother in the labour room and in the postnatal room?
Are mothers with previous bad / difficult experiences given extra support?
How will this facility deal with mothers who have opted to replacement feed with regards to skin to skin, early initiation of feeding, stopping the breastmilk supply?
STEP 5: Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants
When and by whom will the support after delivery be done? (Further assistance is required within 6 hours of delivery).
How, by whom and when will the mother be taught how to express, handle breastmilk, position and latch her baby correctly?
You also need to cover the non breastfeeding mother in this section.
How will babies in special care be fed and what skills will be taught to their mothers.
STEP 6: Give newborn infants no food or drink other than breast milk, unless medically indicated
Exclusive breastfeeding – how is this done in this facility?
What are the medical indications for supplementation and what will be used in those circumstances? How will it be documented if supplements are used?
Who will express and how will the milk be handled?
How does this facility comply with the “Code”? You will need to cover the following:
Contact with staff and patients
Samples and gift to mothers
Free gifts, resource material, equipment, money or support towards in-service training
Demonstrations of formula preparation
Free or low cost supplies of BMS
How does the mother maintain exclusive breastfeeding once she is discharged?
Also cover the non breastfeeding mother.
STEP 7: Practice rooming in – allow mothers and infants to remain together 24 hours a day
Why is this facility practising rooming in?
Are mothers and babies kept together in this facility and how is this implemented? What happens if the baby is abandoned or the mother dies?
What is the maximum separation time and under what circumstances does it happen?
STEP 8: Encourage breastfeeding on demand
What is demand feeding and why and how does this facility implement demand feeding – feeding frequency, feeding cues, sleepy babies, overfull breasts, preterm infants, etc?
Are restrictions placed on breastfeeding? (Length and frequency)
Also cover the replacement feeding mothers/babies.
Reinforce exclusive feeding practices especially after discharge.
STEP 9: Give no artificial teats or pacifiers (also called soothers) to breastfeeding infants
Use of bottles with artificial teats (nipples) and pacifiers in the facility.
What feeding tools or mechanisms will be encouraged in this facility? (Breast milk and replacement feed babies must be covered.)
STEP 10: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
What support system does this facility have in place? (support groups/referral slips/postnatal visits.)
How is this information relayed to the patient and when is the information relayed? Are mothers with previous bad/difficult experiences given extra support after discharge?
Is there extra support for a HIV-positive mother?