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2.1 Preparation Before Birth

Key Points - Case Study B

Joanne asks you what she can do before the baby is born to help her successfully breastfeed.

The Ten Steps to Successful Breastfeeding, designed by the ExternalWHO and ExternalUNICEF summarise the maternity practices needed to support and encourage breastfeeding.

Topic 2.1: Preparation Before Birth
Inform all pregnant women about the benefits and management of breastfeeding

The Ten Steps to Successful Breastfeeding, designed by the ExternalWHO and ExternalUNICEF summarise the maternity practices needed to support and encourage breastfeeding.

Every facility providing maternity services and care for newborn infants should:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement the policy.
  3. Inform all pregnancy women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within a half-hour of birth.
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infant.
  6. Give newborn infants no food or drink other than breastmilk, unless medically indicated
  7. Practice rooming-in - allow mothers and infants to remain together – 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Step 3Inform all pregnant women about the benefits and management of breastfeeding

Joanne should be encouraged to access breastfeeding information and support within her local community. Women who feel they have sufficient knowledge and information about breastfeeding before their babies are born are more likely to continue to breastfeed1,2. Some studies have found no effect of antenatal breastfeeding education on breastfeeding initiation or duration 3,4especially if breastfeeding initiation rates are already high. Others have found a positive relationship between antenatal breastfeeding education and breastfeeding initiation 5,6 and duration7,8 particularly if breastfeeding skills are also taught9,10. Individual sessions with a lactation consultant or other qualified person appear more beneficial than a non-individualised instruction8. Therefore, it is the breastfeeding information and support received during the antenatal period to prepare mothers that is important rather than attendance at a specific class. McLeod1 suggests that as well as creating realistic breastfeeding expectations and providing consistent and relevant breastfeeding information, antenatal breastfeeding preparation also needs to include “quality ongoing support from partners, family, friends, professionals and the community”.

There is no evidence that antenatal nipple preparation, including the use of creams or ointments prevents nipple tenderness or damage in the postpartum period and is therefore not necessary11,12 although some women find gentle breast massage during their pregnancy enables them to become more familiar with handling their breasts.

Notes

  1. # McLeod D et al. (2002) Factors influencing continuation of breastfeeding in a cohort of women
  2. # Chezem J et al. (2003) Breastfeeding knowledge, breastfeeding confidence, and infant feeding plans: effects on actual feeding practices
  3. # Lavender T et al. (2005) Breastfeeding expectations versus reality: a cluster randomised controlled trial
  4. # Forster D et al. (2004) Two mid-pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial
  5. # Deshpande AD et al. (2000) Breast-feeding education and support: association with the decision to breast-feed
  6. # Giugliani ER et al. (1994) Effect of breastfeeding support from different sources on mothers' decisions to breastfeed
  7. # Su LL et al. (2007) Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial
  8. # Mattar CN et al. (2007) Simple antenatal preparation to improve breastfeeding practice: a randomized controlled trial
  9. # Duffy EP et al. (1997) Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates.
  10. # Pugin E et al. (1996) Does prenatal breastfeeding skills group education increase the effectiveness of a comprehensive breastfeeding promotion program?
  11. # Moreland-Schultz K et al. (2005) Prevention of and therapies for nipple pain: a systematic review
  12. # Hewat RJ et al. (1987) A comparison of the effectiveness of two methods of nipple care