by Anne Eglash MD, IBCLC, FABM
The protocol’s up to date literature search is of great value for anyone needing references to instigate policy changes in their institutions. It also recognizes that individuals giving birth and their partners may not be traditionally female/male, and suggests appropriate wording to be inclusive.
The policy recommends implementation of the Baby Friendly Hospital Initiative and the International Code of Marketing of Breastmilk Substitutes to promote, protect and support breastfeeding. Key topics in this policy include details on staff training, antenatal counseling, labor and delivery care, postnatal care, and coordination of care for discharge.
Instead of reviewing detailed recommendations, test yourself on evidence-based measures of supporting breastfeeding dyads in the longer-than-usual question below. And then I suggest reading the policy.
on evidence-based practices in the care of breastfeeding dyads? Choose one or more:
- If a mother develops chickenpox (varicella) within 5 days before delivery and up to 48 hours after delivery, she should be separated from her infant and advised to pump and dump until she is no longer contagious.
- Mothers who are currently using heroin or cocaine should not breastfeed.
- Cesarean birth and instrumental vaginal delivery (such as forceps) are associated with adverse breastfeeding outcomes.
- A trained birth companion or doula should be allowed according to mother’s wishes.
- There is no evidence that skin to skin is beneficial for non-breastfeeding infants.
- Uninterrupted skin to skin immediately after birth is recommended for at least 2 hours or until the first breastfeed, unless there is a justified medical reason.
- Infants who are born with meconium in the amniotic fluid and are breathing on their own should routinely have oral, nasal, or tracheal suction done while skin to skin.
- A delay in cord clamping is not recommended in stable preterm infants due to the risk of polycythemia.
- Bathing should be done within 24 hours after birth.
- All mothers should be taught breast massage and hand expression during their maternity stay.
- Preterm infants do not demonstrate latch and suck skills at the breast until 32 weeks.
- Eliminating the nursery is a requirement of BFHI.
- Follow up after maternity care discharge should occur by 2-4 days after birth, and again in the next week.
See the Answer
See the link for the entire article.
The policy includes a table that addresses special considerations in breastfeeding. Mothers who are infectious with chickenpox need to be separated from their newborns, but their expressed colostrum/milk can be given to the newborn. Mothers currently using illicit drugs who wish to breastfeed should be advised on a case-by-case basis.
Skin to skin is considered appropriate for all dyads, even if not breastfeeding. Skin to skin confers emotional and physiologic stability, prevents hypoglycemia, excessive crying, and hypothermia.
Infants who are breathing well after birth do not need oral, nasal or tracheal suction if meconium is in the amniotic fluid.
A delay in cord clamping is recommended for preterm infants unless they are unstable. It is recommended that bathing be delayed for at least 24 hours after birth. They are not dirty!
Preterm infants as young as 27 weeks display skills of licking, latch and suckling at the breast, so mothers should be supported in bringing their preterm infants to the breast this early.
The Baby Friendly Hospital Initiative does not require elimination of nurseries.
I am thrilled that the policy recommends another newborn visit between the immediate post-discharge visit and the 2 week check. Breastfeeding dyads need a tight safety net to ensure optimal infant weight gain and to provide early management of maternal health problems.