LACTATION SUPPORT IN HOSPITALS

The World Health Organization (WHO) and the United Nations’ Children’s’ Fund (UNICEF) developed a global initiative to increase breastfeeding in hospitals called the Baby-friendly Hospital Initiative. It includes ten steps that must be achieved in order to become certified as “Baby-friendly”. Baby-friendly USA is the “accrediting body and national authority” for the Baby-friendly Initiative in the United States. Hospital Facilities can find information about the process at babyfriendlyusa.org. Parents can find information and locate a facility at babyfriendlyusa.org . South Carolina currently has 12 hospitals that have achieved the Baby-friendly designation. Information about how South Carolina is doing in upholding practices that support breastfeeding can be found in the annual Maternity Practices in Infant Nutrition and Care (mPINC) survey results located at www.cdc.gov

Baby Friendly Designation

The Baby Friendly Hospital Initiative is a non-profit organization advocating for maternal and child health. They hold 3 core philosophies that drive their goals: 

  1. Human milk-fed directly from breastfeeding is the optimal way for human infants to be nurtured and nourished 

  2. The precious first days of life in the birth facility should be protected as a time of bonding and support not influenced by commercial interests 

  3. Every lactating parent should be informed about the importance of breastfeeding and respected to make their own decisions


All baby friendly hospitals hold policies that allow babies to room in with their birthing parent, meaning they will not spend their first night in a nursery. Being together in the hospital allows for parents to have more time to practice chestfeeding with hands-on assistance from lactation providers, which sets them up for a more successful experience with chestfeeding once they go home. 


The Ten Steps to Successful Breastfeeding is the framework for the Baby Friendly Hospital Initiative. These steps are endorsed by the most highly prestigious organizations in the field of maternal and child health, including the U.S. Surgeon General and the Centers for Disease Control. They are as follows: 


Management procedures- 

  1. Policy

    1. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.

    2. Have a written infant feeding policy that is routinely communicated to staff and parents.

    3. Establish ongoing monitoring and data-management systems.

  2. Ensure that staff have sufficient knowledge, competence, and skills to support breastfeeding.


Clinical procedures- 

  1. Discuss the importance and management of breastfeeding with pregnant women and their families.

  2. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth.

  3. Support mothers to initiate and maintain breastfeeding and manage common difficulties.

  4. Do not provide breastfed newborns any food or fluids other than breast-milk, unless medically indicated.

  5. Enable mothers and their infants to remain together and to practice rooming in 24 hours a day.

  6. Support mothers to recognize and respond to their infants’ cues for feeding.

  7. Counsel mothers on the use and risks of feeding bottles, artificial nipples (teats), and pacifiers.

  8. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.


Optimal number of Lactation Consultants (LC’s)

Estimates were derived from the nursery data provided in the American Hospital Directory. The number of inpatient days in the nursery was used to act as the estimated number of live births in that hospital per year, as most parents stay one night after delivering their child unless there are complications. In a position paper published by the United States Lactation Consultant Association*, it is recommended that 1 LC is optimal per 783 births, and 1 LC is optimal per 235 NICU births. Since we do not have access to data specifying how many births were well and how many births required NICU, we used the equation (x births / 783) and rounded up all answers within a reasonable degree. 


*Lober, Angela, et al. Position Paper- Professional Lactation Support Staffing in the Hospital Setting, United States Lactation Consultant Association, 2021, uslca.org/wp-content/uploads/2013/02/Professional-Lactation-Support-Staffing-in-the-Hospital-Setting.pdf. 


Confirmed number of Lactation Consultants (LC’s)

Hospitals with a confirmed number of LC’s have directly reported the data to SCBFC through the organization’s surveys or over the phone. Hospitals are encouraged to continue to report updated data regarding staffing through the contact us form on our website. 


Breastfeeding Classes

Classes are typically offered to pregnant parents and parents of newborns. In most cases, the birthing parent and their partner are both welcome to attend, but check the policy at your local hospital to confirm. Classes generally cover the following topics; health benefits of breastfeeding for babies, health benefits of breastfeeding for lactating parents, pumping, storage of breastmilk, hospital procedures, lactation consultant services, and more. They also serve as a space to build community with fellow lactating parents. SCBFC highly recommends attending a breastfeeding class at your local hospital to access additional education and resources which will make your breastfeeding experience smoother. 


Rental Pumps

Some hospitals offer rental pumps for chestfeeding staff and new parents. These programs are an opportunity to use the highest-quality pumps during your stay at the hospital. 


Other Services

Many hospitals offer unique classes, support groups, or other services to make chestfeeding a more accessible and enjoyable experience. The programs included are not an exhaustive list, so we recommend calling your local hospital to inquire about additional lactation services if you are interested in a specific kind of program. 



Nursery Level: 

Each Labor and Delivery unit is given a nursery ranking* on a scale of 1-4. All nurseries are equipped to care for the physical health of newborns, however, some offer a variety of programs that offer additional factors that positively impact newborn development. 

Level one is for wellborn babies, and offers health and safety for newborns. Capabilities include:  

  • Provide neonatal resuscitation at every delivery 

  • Evaluate and provide postnatal care to stable-term newborn infants 

  • Stabilize and provide care for infants born 35–37 week gestation who remain physiologically stable 

  • Stabilize newborn infants who are ill and those born at <35 week gestation until transfer to a higher level of care 

Level two is the special care nursery. This level offers a positive learning environment and health and safety for newborns. Capabilities include all those of the previous levels and: 

  • Provide care for infants born ≥32 week gestation and weighing ≥1500 g who have physiologic immaturity or who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis 

  • Provide care for infants convalescing after intensive care 

  • Provide mechanical ventilation for brief duration (<24 h) or continuous positive airway pressure or both 

  • Stabilize infants born before 32 week gestation and weighing less than 1500 g until transfer to a neonatal intensive care facility  

Level three is the neonatal intensive care unit (NICU). This level offers a planned curriculum, a positive learning environment, and health and safety for newborns. Capabilities include all those of the previous levels and:

  • Provide sustained life support 

  • Provide comprehensive care for infants born <32 weeks gestation and weighing <1500 g and infants born at all gestational ages and birth weights with critical illness 

  • Provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists, and pediatric ophthalmologists 

  • Provide a full range of respiratory support that may include conventional and/or high-frequency ventilation and inhaled nitric oxide 

  • Perform advanced imaging, with interpretation on an urgent basis, including computed tomography, MRI, and echocardiography  

Level four is the Regional NICU. This level offers national accreditation, a planned curriculum, a positive learning environment, and health and safety for newborns. Capabilities include all those of the previous levels and:

  • Located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions 

  • Maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists, and pediatric anesthesiologists at the site 

  • Facilitate transport and provide outreach education 

*COMMITTEE ON FETUS AND NEWBORN, Wanda Denise Barfield, Lu-Ann Papile, Jill E. Baley, William Benitz, James Cummings, Waldemar A. Carlo, Praveen Kumar, Richard A. Polin, Rosemarie C. Tan, Kasper S. Wang, Kristi L. Watterberg; Levels of Neonatal Care. Pediatrics September 2012; 130 (3): 587–597. 10.1542/peds.2012-1999