| Ten Steps to Successful Breastfeeding* |
mPINC Indicator |
| 1. Have a written breastfeeding policy that is routinely communicated to all health care staff |
Model breastfeeding policy: Hospital has a written breastfeeding policy that includes 10 model policy elements§ |
| 2. Train all health care staff in skills necessary to implement this policy |
Staff competency assessment: Nurses/birth attendants are assessed for competency in basic breastfeeding management and support at least once per year |
| 3. Inform all pregnant women about the benefits and management of breastfeeding |
Prenatal breastfeeding education: Breastfeeding education is included as a routine element of prenatal classes |
| 4. Help mothers initiate breastfeeding within an hour of birth |
Early initiation of breastfeeding: ≥90% of healthy full-term breastfed infants initiate breastfeeding within one hour of uncomplicated vaginal birth |
| 5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants |
Teach breastfeeding techniques: ≥90% of mothers who are breastfeeding or intend to breastfeed are taught breastfeeding techniques (e.g. positioning, how to express milk, etc.) |
| 6. Give breastfeeding newborn infants no food or drink other than breastmilk unless medically indicated |
Limited use of breastfeeding supplements: <10% of healthy full-term breastfed infants are supplemented with formula, glucose water, or water |
| 7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours per day |
Rooming-in: ≥90% of healthy full-term infants, regardless of feeding method, remain with their mother for at least 23 hours per day during the hospital stay |
| 8. Encourage breastfeeding on demand |
Teach feeding cues: ≥90% of mothers are taught to recognize and respond to infant feeding cues instead of feeding on a set schedule |
| 9. Give no artificial teats or pacifiers to breastfeeding infants |
Limited use of pacifiers: <10% of healthy full-term breastfed infants are given pacifiers by maternity care staff |
| 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic |
Post-discharge support: Hospital routinely provides 3 modes of post-discharge support to breastfeeding mothers: physical contact, active reaching out, and referrals¶ |
| *These are the Ten Steps to Successful Breastfeeding as implemented by Baby-Friendly USA. In the U.S. these are the same as the WHO/UNICEF Ten Steps to Suceesful Breastfeeding except for step 4, which in the U.S. says mothers should initiate breastfeeding within one hour of birth, compared to thirty minutes elsewhere. |
| §Model policy elements are 1) in-service training, 2) prenatal breastfeeding classes, 3) asking about mothers' feeding plans, 4) initiating breastfeeding within one hour of uncomplicated vaginal birth, 5) initiating breastfeeding after recovery for uncomplicated c-sections and/or showing mothers how to express milk and maintain lactation if separated from infant, 6) giving only breast milk to breastfed infants, 7) rooming-in 24 hr/day, 8) breastfeeding on demand, 9) no pacifier use by breastfed infants, 10) referral of mothers with breastfeeding problems and/or referral of mothers to appropriate breastfeeding resources at discharge. |
| ¶Physical contact: home visit, hospital postpartum follow-up visit; Active reaching out: follow-up phone call to patient after discharge; Referrals: hospital phone number to call, hospital-based support group, other breastfeeding support group, lactation consultant/specialist, WIC, outpatient clinic. |