Laying a Foundation for Breastfeeding

Professional support throughout pregnancy and postpartum is essential

Breastfeeding a newborn baby is an excellent way to support a lifetime of health and strengthen the bond between mother and infant. One of the most effective measures a mother can take to protect the health of her infant is to breastfeed.1

Researchers have found that exclusive breastfeeding for 6 months can decrease the likelihood of a child developing ear infections, diarrhea and respiratory illnesses. It can also help protect against future obesity. Breastfeeding can also reduce breast cancer and ovarian cancer risk in mothers.2

The Surgeon General’s Call to Action to Support Breastfeeding,3 published in 2011, outlines 20 actions to increase breastfeeding rates in the United States. Another helpful resource, The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies,4 lists nine strategies to achieve increased breastfeeding rates in the United States. In addition, the Academy of Breastfeeding Medicine has developed a protocol for creating a breastfeeding-friendly office.5

In Office Settings

So what is the consensus of these statements? Support for the breastfeeding mom should begin prenatally and continue throughout her pregnancy and breastfeeding.

If healthcare providers do not promote breastfeeding, mothers may get the false impression that formula feeding is equivalent. It is a healthcare professional’s duty to educate mothers about the benefits of breastfeeding.

The groundwork for breastfeeding should be laid in the prenatal period. During the first trimester, clinicians should encourage mothers to attend a breastfeeding class as part of childbirth education. They should also display and provide breastfeeding literature in the office for patients to read. Ready, Set, Baby is an excellent resource.6

Since research has shown that distribution of formula samples in the obstetric office increases the likelihood of cessation of breastfeeding by the time an infant turns 2 weeks of age,7 no formula advertising or samples should be available in the obstetric or pediatric setting.

In Hospital Settings

In the hospital, staff members need to support mom by providing education and hands-on assistance with breastfeeding. At the time of delivery, mothers need to be encouraged to put the baby skin-to-skin immediately after birth to facilitate early latch when the baby is alert.

Studies have shown that skin-to-skin contact in the first hour of life increases breastfeeding rates at 1 and 4 months postpartum.8 Assessing the effectiveness of milk transfer during breastfeeding is another critical role of inpatient staff. Providers of inpatient healthcare should also be familiar with support services for breastfeeding mothers after they leave the hospital. All breastfeeding babies should see a healthcare provider within 48 to 72 hours of discharge.

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Evidence shows that breastfeeding is a way to support a lifetime of health. Exclusive breastfeeding for 6 months can decrease the likelihood of ear infections, diarrhea and respiratory illnesses. Kallyn Boerner/courtesy of Mother and Infant Lactation Center at the Women’s Birth and Wellness Center

This is critical to make sure that feeding is going well. Mothers need to have access to phone consultation with hospital staff or their pediatrician so that they can ask questions about breastfeeding when they are at home.

Baby-Friendly hospitals practice all of these as well as other important levels of support.9

The term “Baby-Friendly” is reserved for use by facilities that have demonstrated, through an on-site assessment, that they have met criteria set by Baby-Friendly USA, a nonprofit organization that provides mothers and babies with early support.

Research shows that mothers who give birth at Baby-Friendly hospitals and birthing centers are more likely to initiate exclusive breastfeeding and more likely to sustain breastfeeding at 6 months and 1 year of age.10

Back at Home

Nurse practitioners who care for babies or postpartum mothers need to continue to provide support for the breastfeeding dyad.

If mothers ask about supplementing, it is a healthcare provider’s duty to make sure they understand that supplementation, especially in the first few weeks of life, will affect milk production.

Determining the cause of the mother’s desire to supplement is important. Correcting any misconceptions the mother has can make a big difference, and possibly prevent early weaning.

If a nurse practitioner is not able to give a new mother the breastfeeding help she requires, it is important to help her find a local lactation specialist who can help her work through the problem. NPs should be familiar with local lactation support resources.

Mothers can also receive targeted, expert help from professionals who are International Board Certified Lactation Consultants (IBCLC).

Another helpful resource is a professional such as a certified lactation counselor (CLC).

Lay organizations such as the La Leche League, or online support groups focused on breastfeeding, may also provide the support and encouragement many mothers need to continue breastfeeding.

If no lactation specialists are available in a nurse practitioner’s local area, she should consider earning certification as an IBCLC or CLC.

The choice about which certification to pursue would depend on the amount of time the nurse practitioner has and the level of expertise she wishes to acquire. Readers can find information about both certifications at and

Healthcare providers are one piece of breastfeeding support. For breastfeeding to become the norm in our society, political, economic and social supports are needed as well.

Visit the United States Breastfeeding Committee website to find a coalition in your state, city or region.

Remember, it takes a village to raise a child. By providing increased support of breastfeeding mothers and babies, nurse practitioners actively help improve the health of this country’s children-and ultimately, the health of our nation and world.

The theme for World Breastfeeding Week 2016 (Aug. 1-7) was Breastfeeding: A Key to Sustainable Development. This reminds us all that breastfeeding is a critical factor to ensuring prosperity.11


1. Centers for Disease Control and Prevention. Breastfeeding Promotion and Support. CDC website.

2. Ip S, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess. 2007;153:1-186.

3. Department of Health and Human Services. Office of the Surgeon General. Surgeon General’s Call to Action to Support Breastfeeding.

4. Centers for Disease Control and Prevention. Strategies to prevent obesity and other chronic diseases: The CDC guide to strategies to support breastfeeding mothers and babies. CDC website.

5. Grawey AE, et al; Academy of Breastfeeding Medicine. ABM clinical protocol #14: Breastfeeding-friendly physician’s office: Optimizing care for infants and children. Breastfeed Med. 2013;8(2):237-242.

6. Carolina Global Breastfeeding Institute. Prenatal breastfeeding education. Tool and recommendations for action.

7. Howard C, et al. Office prenatal formula advertising and its effect on breast-feeding patterns. Obstet Gynecol. 2000;95(2):296-303.

8. Moore ER, et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2012;16(5):CD003519.

9. Baby-Friendly USA. The ten steps to successful breastfeeding.

10. Baby-Friendly USA. Why seek designation.

11. World Breastfeeding Week.

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