Safety in Maternity Care
CDC supports programmatic work to improve maternity care practices and policies that support breastfeeding including safe implementation of the evidenced-based Ten Steps to Successful Breastfeeding and the Baby-Friendly Hospital Initiative in US birth facilities. The Ten Steps include evidence-based practices such as rooming-in and skin-to-skin care. These steps facilitate breastfeeding initiation within the first hour of life and help mothers who choose to breastfeed, continue to do so while in the hospital and beyond the hospital stay. Public health professionals, hospital administrators, medical providers, maternity staff, and others involved in providing care to mothers and newborns, may refer to the documents and resources below for current guidance related to breastfeeding and infant safety in the hospital setting.
Skin-to-skin care is the practice of placing the infant directly on the mother or other caregiver in an effort to maximize surface-to-surface contact. This practice has numerous health benefits for both the mother and newborn, including helping initiate breastfeeding, stabilizing glucose levels, and maintaining infant body temperature. Therefore, skin-to-skin care is encouraged immediately after delivery for medically stable mothers and newborns.
The American Academy of Pediatrics’ (AAP) clinical report titled “Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns” outlines suggested procedures for safe skin-to-skin care immediately following delivery as well as proper positioning of the newborn during skin-to-skin care.
Rooming-in is defined as allowing the mother and infant to remain together 24 hours per day during the birth hospitalization. Similar to skin-to-skin care, rooming-in has multiple benefits in addition to facilitating breastfeeding. AAP recommends that 1) mothers and infants have close but separate sleep surfaces, 2) infants are placed on their backs to sleep, and 3) soft bedding and overheating should be avoided. These safe sleep guidelines should be followed by hospitals for the duration of the birth hospitalization.
AAP’s clinical report titled “Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns” provides suggestions to improve safety while mother and infant are rooming-in.
There is evidence that early introduction of pacifiers negatively impacts breastfeeding outcomes. However, pacifier use during the birth hospitalization can provide comfort during painful procedures (e.g., circumcision) when the infant cannot otherwise be comforted. Pacifiers can also reduce the risk of SIDS, which occurs most commonly between 2-4 months of age. Therefore, the AAP’s policy statements (Policy Statement: Breastfeeding and the Use of Human Milk | Pediatrics | American Academy of Pediatrics (aap.org), and SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment) recommend that introduction of pacifiers for breastfed infants be delayed until breastfeeding is firmly established, which is generally within the first few weeks.
- American Academy of Pediatrics Clinical Report: Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns
- American Academy of Pediatrics Clinical Report: Skin-to-Skin Care for Term and Preterm Infants in the Neonatal ICU [PDF-723KB]
- American Heart Association: Neonatal Resuscitation Algorithm
- Baby-Friendly USA: Safety of Baby-Friendly Practices