By Beverly Ann Curtis, APRN, PNP-BC, IBCLC

At the Breastfeeding Center of Pittsburgh, we hope that expectant families feel well-informed and empowered to breastfeed their babies. We hope that you will be proactive in finding out about the breastfeeding policies and practices of your delivery hospital.

You have a right to know how committed your healthcare facility is in helping you breastfeed, as well as their plan to support your breastfeeding immediately after birth. A few questions, asked at the appropriate time (well before delivery), will arm you with the information you need and signal to the hospital staff and your health care providers that you are committed to breastfeeding your baby. They will be aware of your expectation for help and guidance that mother’s often need at this critical stage of your baby’s life.

Here’s a simple, handy set of questions, organized into a series of steps (organized to reflect the Ten Steps of the Baby-Friendly Hospital Initiative (BFHI)), that will help you gather the most helpful information regarding your hospital and the lactation care they offer. The steps are evidence-based; they come from the scientific research into what is best practice for breastfeeding for you and your baby. These questions can be incorporated into a birthing plan or asked during your prenatal visits as well as during a prenatal breastfeeding class or a hospital tour. You may not need to ask all of the questions but you may want to pick and choose the ones that seem most appropriate or important for your needs. By asking these questions, it communicates to the hospital that you expect them to follow these steps, and provide what you need to get breastfeeding off to a great start. As Henry Ford said, “Preparation is the key to success;” and this is all about making your delivery – and the first feeding of your baby – a success. Here are the steps, and the questions, that will give you the information you need.

Step #1: Have a written breastfeeding policy that is routinely communicated to all health care staff.

• Is the policy in writing? Ask if you can be provided with a copy.

• Find out how the policy is carried out – What does the staff do to help you breastfeed after delivery?

• Does the policy apply to all of the staff – doctors, nurses, specialists, weekend staff, etc.?

Step #2: Train all health care staff in the skills necessary to implement this policy.

• Is your delivery team trained so that they not only are aware of the policy, but skillful in implementing it?

• Do they get refresher training and are they up to date on the latest ideas and techniques?

• Are there International Board Certified Lactation Consultants available to help during all shifts?

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

• How is this information given –patient education materials, personal consultation?

• Are there classes available that will help you get ready for delivery and immediate breastfeeding?

Step #4: Help mothers initiate breastfeeding within one hour of birth.

• If all has gone well with the delivery, when (how soon) can I breastfeed my baby?

• Will my baby be put skin-to-skin?

• Will someone in the delivery room be there to help me?

• What if there are complications in the delivery – how will that effect my ability to breastfeed at the earliest possible moment?

Step #5: Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

• Can anyone help me with latching and “doing it right” or will only a lactation specialist be able to help?

• What about breastpumps? If I am separated from my baby, is a breastpump available, and will someone be able to guide me in its use, within the recovery period 1-2 hours after delivery.

• Will there be someone available for these and other breastfeeding-related questions and issues on a 24-hour basis?

Step #6: Give infants no food or drink other than breast-milk, unless medically indicated.

• Whether my baby is with me or out of sight for a while, what assurance will I have that the child is not given supplements?

• If there is a “medical indication,” (a condition noticed by a medical professional) in favor of a supplement, will this be communicated to me before being given to my baby?

• Does the hospital receive and give out free formula, bottle nipples and other free product from formula companies? What is your policy on this? Is there sometimes a conflict between a mother’s decision to breastfeed, and the readily available free formula – how is this resolved and my wish for mother’s milk only respected and adopted by all?

Step#7: Practice rooming in – allow mothers and infants to remain together 24 hours a day.

• What is the hospital’s policy on rooming the baby with the mother?

• Are there any barriers (policies, practices) against having the mother and baby together at all times?

• Will the pediatrician or neonatologist make rounds to my room in order to see both my baby and me? Can any of the usual procedures for the baby such as blood work, or bathing be done right in my room as well?

• What situations might arise where my baby would be removed from my room?

• Will I be able to go with my baby and visit my baby, if special medical care is needed, elsewhere in the hospital?

Step #8: Encourage breastfeeding on demand.

• Does the hospital do more than just allow or facilitate breastfeeding – does the staff actually teach mothers at the bedside to recognize newborn feeding behaviors and how to respond appropriately?

• How is this done? Do lactation specialists and other staff help mothers individually during each shift or is help more limited?

Step #9: Give no pacifiers or artificial nipples to breastfeeding infants.

• Are pacifiers and other artificial nipples handed out routinely?

• Are they given to babies without the mother’s knowledge or permission?

Step #10: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

• Will there be a support group available when my baby and I are still at the hospital?

• Does the hospital routinely recommend specific support groups for breastfeeding mothers when mother and baby are going home?

• Is the staff aware of community resources, and are they trained to help the mother to access these resources?

• Will I be provided with a list of such help, complete with names, phone numbers, e-mail addresses and websites where I can go to get help, if I need it?

Bev Curtis is the former Executive Director of the Breastfeeding Center of Pittsburgh.