Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services

Overview

This guideline provides global, evidence-informed recommendations on protection, promotion and support of optimal breastfeeding in facilities providing maternity and newborn services, as a public health intervention. It is intended to contribute to discussions among stakeholders when selecting or prioritizing appropriate actions in their efforts to achieve the Sustainable Development Goals and the global targets for 2025 as put forward in the Comprehensive implementation plan on maternal, infant and young child nutrition, endorsed by the Sixty-fifth World Health Assembly in 2012, in resolution WHA65.6, the Global strategy for women’s, children’s, and adolescents’ health (2016–2030), and the Global Strategy for infant and young child feeding.

The document presents the key recommendations, a summary of the supporting evidence and a description of the considerations that contributed to the deliberations and consensus decision-making.

Related information

• Implementation guidance
• Ten steps to successful breastfeeding (revised 2018)

Evidence

A. Immediate support to initiate and establish breastfeeding

Early skin-to-skin contact

Moore ER, Bergman N, Anderson GC, Medley N.
Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;(11):CD003519. doi:10.1002/14651858.CD003519.pub4.

Conde-Agudelo A, Díaz-Rossello JL.
Kangaroo mother care to reduce morbidity and mortality in low birth weight infants. Cochrane Database Syst Rev. 2016;(8):CD002771. doi:10.1002/14651858.CD002771.pub4.

Early initiation of breastfeeding

Smith E, Hurt L, Chowdhury R, Sihna B, Fawzi W, Edmond K.
Delayed breastfeeding initiation and infant survival: a systematic review and meta-analysis. Plos One. 2017 (https://doi.org/10.1371/journal.pone.0180722).

Showing mothers how to breastfeed

McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S.
Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2017;(2):CD001141. doi:10.1002/14651858.CD001141.pub5.

Crowe L, Chang A, Wallace K.
Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation. Cochrane Database Syst Rev. 2016;(8):CD005586. doi:10.1002/14651858.CD005586.pub3.

Becker GE, Smith HA, Cooney F.
Methods of milk expression for lactating women. Cochrane Database Syst Rev. 2016;(9):CD006170. doi:10.1002/14651858.CD006170.pub5.

Rooming-in

Jaafar SH, Ho JJ, Lee KS.
Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding. Cochrane Database Syst Rev. 2016;(8):CD006641. doi:10.1002/14651858.CD006641.pub3.

Demand feeding

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D.
Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database Syst Rev. 2016;(9):CD009067. doi:10.1002/14651858.CD009067.pub3.

Watson J, McGuire W.
Responsive versus scheduled feeding for preterm infants. Cochrane Database Syst Rev. 2016;(8):CD005255. doi:10.1002/14651858.CD005255.pub5.

B. Feeding practices and additional needs of infants

Early additional foods or fluids

Smith HA, Becker GE.
Early additional food and fluids for healthy breastfed full-term infants. Cochrane Database Syst Rev. 2016;(8);CD006462. doi:10.1002/14651858.CD006462.pub4.

Avoidance of pacifiers or dummies

Jaafar SH, Ho JJ, Jahanfar S, Angolkar M.
Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev. 2016;(8):CD007202. doi:10.1002/14651858.CD007202.pub4.

Foster JP, Psaila K, Patterson T.
Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev. 2016;(10):CD001071. doi:10.1002/14651858.CD001071.pub3.

Greene Z, O’Donnell CPF, Walshe M.
Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database Syst Rev. 2016;(9):CD009720. doi:10.1002/14651858.CD009720.pub2.

Avoidance of feeding bottles and teats

Ganchimeg T, Sugimoto K, Fukazawa KR, Rayco-Solon P, Ota E.
Avoidance of bottles and artificial teats during the establishment of breastfeeds in healthy term infants: a systematic review of randomized controlled trials [protocol]. PROSPERO. 2016:CRD42016041370 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=41370 2017).

Flint A, New K, Davies MW.
Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database Syst Rev. 2016;(8):CD005092. Doi:10.1002/14651858.CD005092.pub3.

Collins CT, Gillis J, McPhee AJ, Suganuma H, Makrides M.
Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane Database Syst Rev. 2016;(10):CD005252. doi:10.1002/14651858.CD005252.pub4.

C. Creating an enabling environment

Breastfeeding policy of facilities providing maternity and newborn services

Abe SK, Jung J, Rahman M, Haruyama R, Kita M, Koyama M et al.
Hospitals with a written breastfeeding policy statement and implementation of the steps of breastfeeding: a systematic review [protocol]. PROSPERO. 2016:CRD42016038143.

Training of health workers

Gavine A, MacGillivray S, Renfrew MJ, Siebelt L, Haggi H, McFadden A.
Education and training of healthcare staff in the knowledge, attitudes and skills needed to work effectively with breastfeeding women: a systematic review. Int Breastfeed J. 2016;12:6. doi 10.1186/s13006-016-0097-2.

Balogun OO, Dagvadorj A, Yourkavitch J, da Silva Lopez K, Suto M, Takemoto Y, et al.
Health facility staff training for improving breastfeeding outcome: a systematic review for step 2 of the Baby-friendly Hospital Initiative. Breastfeed Med. 2017;20 September [epub ahead of print] PubMed PMID: 28930480.

Antenatal breastfeeding education for mothers

Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M.
Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database Syst Rev. 2016;(12):CD006425. DOI: 10.1002/14651858.CD006425.pub4.

Balogun OO, O’Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, Renfrew MJ, MacGillivray S.
Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev. 2016;(11):CD001688. doi:10.1002/14651858.CD001688.pub3.

Discharge planning and linkage to continuing support

da Silva Lopez K, Ohde S, Suto M, Rayco-Solon P, Miyazaki C, Balogun OO et al.
Providing linkage to breastfeeding support to mothers on discharge to improve breastfeeding outcomes: a systematic review [protocol]. PROSPERO. 2016:CRD42016041273.