Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Practice Recommendations

Nurses in all practice settings, endorse the Baby-Friendly Hospital Initiative (BFHI) which was jointly launched in 1992 by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), and the Baby-Friendly Initiative in Community Health Services (Breastfeeding Committee for Canada). The BFHI directs health care facilities to meet the “Ten Steps to Successful Breastfeeding”.

1.1 Nurses have a role in advocating for “breastfeeding friendly” environments by:

  • Advocating for supportive facilities and systems such as day-care facilities, “mother and baby” areas for breastfeeding, public breastfeeding areas, 24-hour help for families having difficulties in breastfeeding; and
  • Promoting community action in breastfeeding.

2.0 Nurses and healthcare practice settings endorse the WHO recommendation for exclusive breastfeeding for the first six months, with introduction of complementary foods and continued breastfeeding up to two years and beyond thereafter.

3.0 Nurses should perform a comprehensive breastfeeding assessment of mother/baby/family, both prenatally and postnatally, to facilitate intervention and the development of a breastfeeding plan.

3.1 Key components of the prenatal assessment should include:

  • Personal and demographic variables that may influence breastfeeding rates;
  • Intent to breastfeed;
  • Access to support for breastfeeding, including significant others and peers;
  • Attitude about breastfeeding among health care providers, significant others and peers; and
  • Physical factors, including breasts and nipples that may affect a woman’s ability to breastfeed.

3.2 Key components of the postnatal assessment should include:

  • Interpartum practices and interventions including medications;
  • Level of maternal physical discomfort;
  • Observation of positioning, latching and sucking;
  • Signs of milk transfer
  • Parental ability to identify infant feeding cues;
  • Mother-infant interaction and maternal response to feeding cues;
  • Maternal perception of infant satisfaction/satiety cues;
  • Woman’s ability to identify significant others who are available and supportive of her decision to breastfeed;
  • Delivery experience;
  • Infant physical assessment; and
  • Maternal breastfeeding self-efficacy

4.0 Nurses should provide informational support to couples during the childbearing age, as well as to expectant mothers/couples/families and assist them in making informed decisions regarding breastfeeding. Education should include, as a minimum, the following:

  • Benefits of breastfeeding
  • Lifestyle issues
  • Milk production
  • Breastfeeding positions
  • Latching/milk transfer
  • Prevention and management of problems
  • Medical interventions
  • When to seek help
  • Where to get additional information and resources
  • Benefits of skin to skin contact; and
  • Recognizing feeding cues

4.1 Women’s partners should be encouraged to attend breastfeeding education classes.

5.0 Nurses should perform a comprehensive breastfeeding assessment of mother/baby prior to hospital discharge

5.1 If mother and baby are discharged within 48 hours of birth, there must be a face-to-face follow up assessment conducted within 48 hours of discharge by a qualified health care professional, such as a Public Health Nurse or Community Nurse specializing in maternal/newborn care.

5.2 Discharge of low-risk mothers and infants after 48 hours may be followed by a telephone call within 48 hours of discharge, rather than a home visit.

6.0 Nurses should provide information, emotional and physical support to breastfeeding mothers with an attitude that conveys support for breastfeeding.

7.0 Nurses should support local peer support breastfeeding programs, ensuring that women are provided with peer support resources.

8.0 Nurses should initiate skin to skin contact between mother and infant immediately after birth as part of ongoing, routine care.