Original Ten Steps to Successful Breastfeeding [40] Every facility providing maternity services and care for newborns should implement the following Ten Steps | Expanded BFHI for Neonatal Units [8] | Promoting and Protecting Breastfeeding for Vulnerable Infants in the Spatz Ten Steps Model [9] |
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1. Have a written breastfeeding policy that is routinely communicated to all health care staff. | No change. | |
2. Train all health care staff in skills necessary to implement this policy. | Educate and train all staff in the specific knowledge and skills necessary to implement this policy. | Correct breast milk management (storage and handling) |
3. Inform all pregnant women about the benefits and management of breastfeeding. | Inform all hospitalized pregnant women at risk for preterm delivery or birth of a sick infant about the management of lactation and breastfeeding and benefits of breastfeeding. | Providing parents with information to make an informed decision to breastfeed |
4. Help mothers initiate breastfeeding within a half-hour of birth. | Encourage early, continuous, and prolonged mother–infant skin-to-skin contact (kangaroo mother care) without unjustified restrictions. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to recognize when their babies are ready to breastfeed and offer help if needed. | Assisting mother with the establishment and maintenance of milk supply. Skin-to-skin care Create opportunities for NNS at the breast |
5. Show mothers how to maintain lactation even if they are separated from their infants. | Show mothers how to initiate and maintain lactation and establish early breastfeeding with infant stability as the only criterion. | Managing the transition to breast |
6. Give newborns no food or drink other than breastmilk unless medically indicated. | No change. | Develop procedures to feed the infant the breast milk |
7. Practise rooming-in – that is, allow mothers and infants to remain together 24 h a day. | Enable mothers and infants to remain together 24 h a day. | |
8. Encourage breastfeeding on demand. | Encourage demand feeding or, when needed, semi-demand feeding as a transitional strategy for preterm and sick infants. | Measuring milk transfer |
9. Give no artificial teats (also called dummies or soothers) to breastfeeding infants. | Use alternatives to bottle-feeding at least until breastfeeding is well established and use pacifiers and nipple shields only for justifiable reasons. | |
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. | Prepare parents for continued breastfeeding and ensure access to support services/groups after hospital discharge. | Preparation of infant and family for discharge; and appropriate follow-up care |