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Overview of Maternity Care Practices and Breastfeeding

In the U.S., nearly all infants are born in a hospital or free-standing birth center. Their stay is typically very short, but events during this time have lasting effects. Many of the experiences of mothers and newborns in the hospital affect breastfeeding.

In most cases, these experiences reflect routine practices at the facility level, and patients rarely request care different from that offered them by health professionals. Experiences with breastfeeding in the first hours and days of life significantly influence an infant’s later feeding. Due to its inextricable relationship with the birth experience, breastfeeding must be established during the maternity hospital stay, not postponed until the infant goes home.

A Cochrane review1 found that institutional changes in maternity care practices effectively increases breastfeeding initiation and duration rates. Birth facilities that have achieved designation as part of the World Health Organization/UNICEF Baby-Friendly Hospital Initiative (BFHI)2 typically experience an increase in breastfeeding rates.3 In addition, DiGirolamo et al.4 found a relationship between the number of Baby-Friendly   steps (included in the Ten Steps to Successful Breastfeeding   of BFHI) in place at a birth facility and a mother’s breastfeeding success. The authors found that mothers experiencing none of the Ten Steps to Successful Breastfeeding   required for BFHI designation during their stay were eight times as likely to stop breastfeeding before 6 weeks as those experiencing six steps.

Supportive Hospital Practices
Birth facility policies and practices that create a supportive environment for breastfeeding begin prenatally and continue through discharge, and include:

  • Skin-to-skin contact – Doctors and midwives place newborns skin-to-skin with their mothers immediately after birth, with no bedding or clothing between them, allowing enough uninterrupted time (at least 30 minutes) for mother and baby to start breastfeeding well.
  • Teaching about breastfeeding – Hospital staff teach mothers and babies how to breastfeed and to recognize and respond to important feeding cues.
  • Early and frequent breastfeeding – Hospital staff help mothers and babies start breastfeeding as soon as possible after birth, with many opportunities to practice throughout the hospital stay. Pacifiers are saved for medical procedures.
  • Exclusive breastfeeding – Hospital staff only disrupt breastfeeding with supplementary feedings in cases of rare medical complications.
  • Rooming-in – Hospital staff encourage mothers and babies to room together and teach families the benefits of this kind of close contact, including better quality and quantity of sleep for both and more opportunities to practice breastfeeding.
  • Active follow-up after discharge – Hospital staff schedule in-person breastfeeding follow-up visits for mothers and babies after they go home to check-up on breastfeeding, help resolve any feeding problems, and connect families to community breastfeeding resources.


  1. Fairbank L, O’Meara S. Renfrew MJ, Woolridge M, Snowden AJ, Lister-Sharp D. A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding. Health Technology Assessment 2000;4(25):1-171.
  2. World Health Organization/UNICEF. Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services. A joint WHO/UNICEF statement. Geneva: World Health Organization, 1989.
  3. Philipp BL, Merewood A, Miller LW, et al. Baby Friendly Hospital Initiative improves breastfeeding initiation rates in a U.S. hospital setting. Pediatrics 2001;108(3):677-81.
  4. DiGirolamo AM, Grummer-Strawn LM, Fein S. Effect of Maternity care practices on breastfeeding. Pediatrics 2008;122(Supp 2):543-49.