2.3.2 Managing Breastfeeding
Positioning and Latching to the Breast
Every mother should be able to
- describe the early feeding cues her baby exhibits, before he has the need to cry;
- position and latch her baby independently and confidently;
- indicate to you signs that the baby is well latched and breastfeeding effectively.
All staff should be competent to teach positioning and latching using a hands-off technique, and supervise the mother hand expressing her breastmilk after receiving instruction.

Early hunger cue.
© E.Grunis IBCLC

Indicating signs that baby is well latched and breastfeeding effectively.
© D.Fisher IBCLC
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![]() | ![]() Clinical Skills Competency: Observing, assessing and assisting breastfeedingClick on the link to download the Skills Competency. Even if this is not a requirement of you at this time it will provide good 'refresher' training, ensuring you continue to provide the very best care. Recall:
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When mothers and babies are separated
Mothers and babies may be separated for various reasons. In hospital it may be due to prematurity or illness in the baby, or the mother may be unwell or require additional medical care. In the community setting it may be due to work or social commitments.
Every mother must report she received individual instruction to
- hand express her breastmilk, and
- collect and store her breastmilk safely.
- A written leaflet should be provided that describes safe collection, transport and storage of breastmilk.
Additionally, mothers whose babies require medical care in a neonatal nursery should report
- they were supported to initiate lactation within a short time of birth if the mother's condition permitted, and
- encouraged to express their breastmilk regularly, effectively and frequently to establish and maintain lactation
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![]() | ![]() Clinical Skills Competency: Hand expressing and safe milk storageClick on the link to download the Skills Competency. Even if this is not a requirement of you at this time it will provide good 'refresher' training, ensuring you continue to provide the very best care.
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Rooming in: 24-hours a day
- In hospital babies are to remain with their mothers, unless there is a medical reason that necessitates separation.
- All separations of greater than one hour must be recorded, with duration and reason noted.
- In the home situation, co-sleeping with the baby sleeping on a safe sleeping surface in close proximity to a responsive adult, preferably the mother, is most desirable.
- Mothers should be able to describe why remaining together is important.
Implementation
The clinical protocols to support the policy will cover
- when mothers are to be given individual instruction on how to breastfeed
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additional information:
- no restrictions on frequency or length of breastfeeds
- breastfeeding encouraged whenever baby is hungry, or shows readiness to breastfeed
- how the mother can recognise her baby is receiving sufficient breastmilk
- when, and how, hand expressing is taught
- the procedure to follow when a well baby is separated from his mother
Community protocols could also include
- Provision to make appointments for early, routine review of all mothers and infants, as well as urgent appointments for mothers and babies experiencing difficulties
- Observation of a breastfeed and provision to develop a breastfeeding plan at the first face-to-face visit.
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Educational discussion at the first face-to-face visit should confirm maternal confidence in
- skin-to-skin contact, which facilitates effective breastfeeding at any age
- effective milk transfer, and what to do if she suspects it is insufficient
- feeding cues and responding to her baby's needs, not limiting frequency nor duration of breastfeeding
- co-sleeping for infant safety and to support breastfeeding
Refer to your Policy
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![]() | ![]() Identify the statements that support
Identify in your Procedures or Protocols manual the method of recording which mothers have received individual assistance with positioning, latching and hand expressing. How is this information communicated when the mother moves from her birthing facility care to community care? Is there a procedure in place to alert community health staff of the education the mother has received and what is still to be covered? How are difficulties the mother may be having that were not resolved prior to discharge from the birthing facility communicated? Should you not have a procedure in place to ensure continuous care of the mother and baby, discuss with your colleagues and the other agency the development of a method to handover care. | ![]() |
What should I remember?
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