Breastfeeding - Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding in Newborns, Infants and Young Children
Purpose and scope
The purpose of this best practice guideline (BPG) is to enhance the capacity of nurses, the interprofessional team, peers, policy-makers, and employers to meet the needs of
- breastfeeding persons
- their healthy term newborns, infants, and young children
- their partners, family, and support network
This BPG is meant to be used by
- the interprofessional team
across the perinatal period to enhance the quality of their practices to support
- breastfeeding initiation
- exclusivity for newborns and infants to six months of age
- continuation for infants and young children to two years or longer, in addition to complementary feeding.
Registered Nurses’ Association of Ontario. Breastfeeding - Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding for Newborns, Infants, and Young Children. 3rd ed. Toronto (ON): Registered Nurses’ Association of Ontario; 2018.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Breastfeeding - Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding in Newborns, Infants and Young Children.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.1: Assess the breastfeeding process, using validated and reliable tools, during pregnancy and at key stages of lactogenesis, including the following:
- During Stage I, (i.e., within the first 24 hours postpartum and prior to discharge from the childbirth setting), to support breastfeeding initiation.
- During the transition of Stage I to Stage II, (i.e., between days two to eight postpartum), to support the significant increase in breast milk volume.
- During Stage II and Stage III, (i.e., from approximately day nine postpartum and onwards) to support the maintenance of breast milk production, as long as breastfeeding continues.
Recommendation 2.1: Facilitate skin-to-skin contact with the breastfeeding dyad immediately following childbirth or once clinically stable.
Recommendation. 2.2: Support the early initiation of breastfeeding, within one hour of childbirth or once the breastfeeding dyad is clinically stable, through multi-component perinatal interventions including:
- prenatal education and
- immediate postpartum bedside assistance.
Recommendation 2.3: Support the breastfeeding dyad to achieve effective positioning, latch, and milk transfer.
Recommendation 2.4: Support responsive cue-based breastfeeding through strategies such as:
- education and promotion and
- recognition of the needs of the breast-feeding person
Recommendation 2.5: Teach hand expression to all breastfeeding persons prior to discharge from the childbirth setting.
Recommendation 2.6: Implement individualized breastfeeding self-efficacy interventions throughout the perinatal period to enhance breastfeeding confidence including:
- one-on-one counseling prior to discharge from the childbirth setting and
- follow-up post-discharge.
Recommendation 2.7: Provide individualized assistance to support or enhance breast milk production, where appropriate.
Recommendation 2.8: Provide ongoing proactive breastfeeding support services to address the individualized needs of the breastfeeding dyad.
Recommendation 2.9: Facilitate informed decision-making regarding pacifier use.
Recommendation 2.10: Provide breastfeeding education throughout the perinatal period and as long as breastfeeding continues:
- across a variety of settings and
- through diverse approaches, including those tailored to the needs of vulnerable populations.
Recommendation 2.11: Include family members, such as partners and grandmothers, in breastfeeding education and support.
Recommendation 3.1: Provide continuing education on breastfeeding to nurses, the interprofessional team, and peers that incorporates theoretical knowledge and practical skills.
Recommendation 4.1: Consider integrating lactation consultants in the provision of care to the breastfeeding dyad throughout the perinatal period in health services and local communities.
Recommendation 4.2: Routinely implement the provisions of the Baby-Friendly Initiative and the World Health Organization’s “International Code for Marketing of Breast-Milk Substitutes” within the health-care setting. Seek Baby-Friendly Initiative designation, where applicable.
Recommendation 4.3: Implement breastfeeding support in the workplace, including parental leaves of absence and accommodations for breastfeeding persons.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
Current edition published: July 2018
This BPG is intended to replace the RNAO BPG Breastfeeding Best Practice Guidelines for Nurses (2003) and its supplement (2007).