Medical Office Sample Lactation Policy

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For many parents, including myself, a family’s primary care providers are critical to successful lactation. Especially when you have a child with health challenges, you see your primary care provider every few days in the beginning. Our primary care provider was our point of contact for everything. Having truly supportive healthcare clinics, means having support that expands beyond birth centers and hospitals. Supportive primary care is critical to creating a truly Breastfeeding Family Friendly Community. The nurses, front desk staff, and other care providers in the office had a tremendous impact on our breastfeeding success. The front desk person warmly invited us to breastfeed anywhere and helped to normalize breastfeeding. The nurse allowing us extra time in the room to nurse my little one after shots and painful treatment helped to make our clinic feel like a home away from home rather than a dark and scary place. Over the years and the birth of more children, we often saw other doctors in the practice when our primary care provider was unavailable. Unfortunately, not all the doctors in the office were as supportive of breastfeeding. Over the years, we transferred our care to a clinic that was closer to home rather than driving 30 minutes to the provider. While our one primary care provider was the best, her office had gaps in care. Creating lactation policies can help to smooth over these gaps and create a more uniform experience for families. Having a breastfeeding policy that is implemented and regularly reviewed can help you retain current patients and bolster your clinic’s reputation in the community. Lactation policy should always start with the why…Why does your  practice believe in this work? A comprehensive lactation policy addresses equity and inclusive language in the practice. A comprehensive policy should describe how your practice 1) Addresses and works to reduce the structures in your practice that create barriers for families of color to provide human milk; 2) Works to identify cases of inequities and health disparities to ensure that your practice provides adequate lactation support to families of color; 3) Uses your in-clinic skilled lactation support or determines referrals (e.g., when, to whom); 4) Decides when formula is “medically necessary” (e.g., Do you discuss alternatives with families, such as supporting families to supplement with expressed milk?) 

Love Anderson
On October 11, 2022, Dr. Annie Dotson, M.D. and Breastfeed Durham discussed writing and creating breastfeeding friendly policies.
Sample-Lactation-Policy-for-Clinics-and-Medical-Offices DOCXDownload

Sample Lactation Policy 

Contributors

The Breastfeeding Family Friendly Communities Board of Directors; Dr. Anne Berry, MD, MPH; Dr. Andrea Dotson, MD, MSPH, IBCLC; Dr. Elaina L. Lee, MD; Gina Rose, BSN, RN, IBCLC; The Breastfeed Durham Team

Recognition of the Health Advantages

In recognition of the well-documented health advantages of chest/breastfeeding and the particularly important role of the medical provider in supporting, promoting, and protecting chest/breastfeeding, [Office] observes the following policy to ensure a supportive environment and practices that can optimize breastfeeding success for our patients. This includes breastfeeding, chestfeeding, other forms of human milk feeding, and body feeding (all of this may be referred to as “breastfeeding,” for simplicity, in this policy). This plan is aligned with the recommendations from the American Academy of Family Physicians (AAFP), the Academy of Breastfeeding Medicine (ABM), and the World Health Organization (WHO). 

Philosophy


Human milk feeding has been shown to be the preferred form of infant nutrition. Alternate forms of infant feeding carry known health, social, and economic risks to both parent and baby. To support families who are human milk feeding (whether breastfeeding, chest feeding or feeding expressed human milk milk), [Office] subscribes to the following policy:

————–Or————-

Because chest/breastfeeding has been shown to be the superior form of infant nutrition, and because alternate forms of infant feeding carry significant health, social, and economic risks to both parent and baby, [Office] subscribes to the following policy: 

  • We will make a deliberate and diligent effort to be inclusive and welcoming of all patients, starting with our terminology. Human milk feeding is a gender and anatomically neutral term, while maintaining medical accuracy. We support all human milk feeding, breastfeeding, and chestfeeding families inclusive of their race, ethnicity, immigration status, nationality, creed, age, sexual orientation, gender identity, family structure, primary language, ability, or class. 
  • We recognize that nursing families are vulnerable during the early days/weeks and that suggesting artificial baby milk (formula) use or promoting artificial baby milks (formula) through free samples and advertisements can undermine the parent’s confidence that they can successfully meet their nursing goals.
  • We support the right of all parents to make informed decisions about infant feeding. This includes breastfeeding, chest feeding, and other forms of human milk feeding. All of our staff will support families in their decisions. We believe that chest/breastfeeding is the healthiest way to feed a baby, and we recognize the importance of breastfeeding, chestfeeding, and human milk feeding for both parent and child. We protect human milk feeding by allowing no advertising or distribution of artificial baby milk (formula) or feeding supplies within our office.
  • The World Health Organization (WHO) and the American Academy of Family Physicians recommend  exclusive chest/breastfeeding for the first 6 months, and continued chest/breastfeeding with the addition of complementary foods until 12 months and beyond, for as long as parent and baby desire. The WHO also  recommends breastfeeding for two years or beyond. We will support families in achieving their own breastfeeding successes, whatever those may be. This policy outlines the ways in which we will help families achieve success in breastfeeding, chestfeeding, and human milk feeding. 

Lactation will be actively promoted

Obstetric patients will receive comprehensive and accurate information regarding human milk feeding. This includes, but is not limited to, the benefits of human milk, establishing and maintaining milk supply, the benefits of skin-to-skin and the health and mental health benefits for the feeding dyad. Any printed material used should NOT be sponsored by or contain advertisements for artificial baby milk (artificial baby milk (formula)). Human milk feeding persons will be given the necessary support to human milk feeding for as long as they choose. Clinicians providing prenatal care, both individually and via Centering, will be trained to include discussion of feeding modalities throughout the pregnancy. This will include distribution of educational materials and community resources during each trimester of pregnancy.

Lactation will be passively promoted

No artificial baby milk (formula) samples, literature, or promotional items from artificial baby milk (formula) companies shall be visible to patients. This includes posters, cups, pens, pads of paper, lanyards, and name badges. This clinic shall maintain a supportive human milk feeding environment.

Always Welcome and Respected

Within our clinic, parents may chest/breastfeed their children in any location in which they are comfortable. If they request a more private location, they may use an unoccupied exam room, or the clinic nursing baby’s room. At [Office], families are always welcome and respected. They will never be treated poorly, asked to stop breastfeeding, human milk feeding, or asked to cover up or move.

Lactating Employees

All lactating employees are allowed breaks to express milk or nurse their children. Our office provides access to a private space for expressing milk or nursing. The space is not a bathroom, is lockable and shielded from view, includes an electrical outlet, and has hand hygiene available.

————–Or————-

Lactating staff may schedule breaks for milk expression. A designated space is available to them for milk expression during the workday; this space is not a bathroom or toilet stall. Milk may be stored in the kitchen refrigerator or a personal cooler. Other arrangements or concerns can be addressed with Dr. XXXX] or Dr. XXXX].

————–Or————-

Staff members who are human milk feeding will have access to a private space to feed or express milk with sufficient time for pumping or feeding. That space is distinct from the lavatory. The space includes an electric outlet and access to hand hygiene. There is also a staff-only refrigerator available for safe milk storage. 

Formula Use: 

We protect human milk feeding by allowing no advertising or coupons for artificial baby milk (formula) to families. The clinic shall comply with the World Health Organization Code of Marketing of Breastmilk. No artificial baby milk (formula) samples or artificial baby milk (formula) company “gift packs’ ‘ shall be distributed to pregnant patients or to new mothers. We do not distribute artificial baby milk (formula) or other feeding supplies within our office. 

————–Or————-

The clinic will comply with the World Health Organization Code of Marketing of Human Milk Substitutes. No formula samples or formula company “gift packs” shall be distributed to pregnant or lactating persons.  Furthermore, human milk feeding will be passively promoted by not allowing artificial baby milk (formula) samples, literature, or promotional materials in the clinic. This includes posters, cups, pens, pads of paper, coupons, magazines, brochures, lanyards, and name badges. If artificial baby milk (formula) is required in a clinic for medical reasons, this formula will be purchased by the clinic and will not be obtained through free samples from formula companies. 

Staff Responsibilities

Physicians, advanced practice providers, and nurses are expected to maintain accurate and current knowledge regarding the benefits of human milk feeding, normal infant feeding patterns, human milk feeding as it relates to mental health, and the basics of feeding problems. Copies of resources should be made available in the clinic and all staff members, including clerical staff, should be familiar with these resources. All physicians, advanced practice providers, nurses and CMAs who are serving pregnant or postpartum patients, infants and children will complete an annual 3-hour online human milk feeding training. This includes all staff who interact with this patient population through direct care, clinical supervision, triage, education, and in-clinic encounters. New staff and providers will complete this training within 3 months of hire. 

————–Or————-

Physicians and nurses are expected to maintain accurate, current knowledge regarding all forms of lactation and human milk feeding. Copies of resources are available in the clinic and are familiar to all staff members, including clinical and clerical staff. References for telephone triage of  human milk feeding questions are available and should be consulted when answering patient concerns. Designate a qualified staff person(s) to be available to answer questions or provide patient assistance. Staff is responsible for:

  • Reading and understanding this policy.
  • Attending appropriate lactation training according to one’s role in the office.
  • Providing a welcoming attitude and environment for breastfeeding/chest feeding/human milk feeding  families.
  • Providing follow-up and referrals, as indicated.

Leadership

A point person ([Dr. XXXX]) within [Office] has been identified to oversee the details of the Policy within our office and will facilitate communication and modifications, as necessary.

Training

Each member of our medical office/staff has received or will access regular lactation training and updates according to their role in the office. The training includes the following topics:

  •  Basic lactation management
  •  Supply and demand
  •  Building a milk supply
  •  Latch and poisoning
  •  Hand expression
  •  Feeding cues
  •  Newborn behavior
  •  Expectations by age
  •  Resources and referrals
  •  Using a breast pump
  •  Triage protocol
  •  Cultural considerations

Triage

Human milk feeding clinical questions will be triaged and answered promptly.  Patients calling for appointments regarding feeding problems should be given an appointment within 24 hours or the next business day. References for telephone triage of human milk feeding questions are to be made available and should be consulted when answering patient concerns. Questions regarding infant feeding will be answered the same day during business hours. Qualified staff persons will be designated and available to answer questions or provide patient assistance. Protocol for addressing phone calls about human milk feeding and lactation concerns is in place for all staff members who respond to communication at [Office]. The triage protocol is reviewed regularly and updated, as necessary.

  • New or established patients who request appointments for acute human milk feeding concerns (pain, fever, concerns about supply and baby’s weight gain, etc.) or for newborns discharged from the hospital or birthing center, will be triaged by a medical assistant to determine when to schedule them. If there are questions regarding the urgency, the MA will discuss the situation with [Dr. Jan/John Doe] to determine appropriate scheduling and, if indicated, measures to try before the appointment. 
  • Most patients with acute need will be scheduled within 24 hours with [Dr. Jan/John Doe] or another provider who can consult with [Dr. Jan/John Doe] if needed. 
  • Newborn human milk feeding infants will be given an appointment within the first three days of discharge from the birthing facility (or sooner if discharge instructions specify this, or parents have acute concerns).
  • New or established patients who wish to discuss inducing lactation, re-lactating, or chest feeding may be able to wait a few days or weeks for an appointment, if they anticipate having at least several months before the baby is due. If the baby has already been born, or there is less than 5-6 months before the baby is due, an appointment with [Dr. Jan/John Doe] will be made within a week. 
  • Triage tools for MAs and providers include:
    • The Outpatient Breastfeeding Champion triage book
    • Nancy Mohrbacher’s book or app
  • More information

Patient Education

Educational and support resources to promote human milk feeding will be available to patients. All clerical personnel will be familiar with these documents and how to locate them within the clinic.  A comprehensive educational packet, and community resource list will be available and updated annually. This will include factsheets, links to websites and videos about human milk feeding, as well as local organizations that support human milk feeding and young families. Funding will be obtained to maintain a stock of electric pumps and other feeding supplies, pillows, storage containers, pads, etc. for those that are human milk feeding and do not have other means to obtain these resources (i.e. insurance, WIC, other community organizations).

  • Education: Breastfeeding, chest feeding, and human milk feeding education and resources are provided to patients during pregnancy, adoption process, postpartum, and/or well-baby/child visits according to the scope of practice of this medical office. Education follows a [periodicity table or other protocol (see appendix)]  to optimize messages, and resources are based on families’ needs.
  • Classes: All human milk feeding families are provided with information and referrals for classes and support groups, as locally available.
  • Environment: [Office] has fostered an environment in the waiting area, exam rooms, and other spaces that is fully supportive of and optimizes chest/breastfeeding success for our patients. This clinic will maintain a supportive human milk feeding environment for both patients and staff.
    • Patients within our clinic may feed their children in any location in which they are comfortable. If they request a more private location, they may use the clinic’s designated space. Staff will be trained to never ask lactating patients to cover up, move or stop feeding. 
    • Visual cues to support and welcome human milk feeding in our office will include signs and posters in the waiting area as well as in exam rooms and lavatories.  Signs and posters will be representative of the patient population we serve, so patients are able to see images that look like them.
  • Formula: We protect chest/breastfeeding by allowing no visible display of artificial baby milk (formula) messaging from formula companies. We do not provide artificial baby milk (formula) samples or free gifts that are provided by formula companies.

Evaluation and Sustainability

  • Documentation:  [Office] documents information gathered about breastfeeding and our patients so as to understand our populations’ breastfeeding rates. This information is collected in electronic medical records and may be used to improve office policies and practices in order to optimize breastfeeding outcomes for patients.
  • Billing: Lactation education and services are billed with appropriate ICD 10 CM codes and follow best practices for optimal reimbursement. The billing specialist for [Office] will include proper billing practices in accordance with regular lactation training that they receive. Patients will be notified of our office’s billing practices.

Continuity of Care

  • Follow-up:  According to [Office] scope of practice, a protocol for follow-up or assurance of follow-up is in place for the breastfeeding infant  within the first three days of delivery discharge from the birthing facility. (See  Appendix 1 and Appendix 2)
  • Referrals: [Office] maintains a list of lactation management professionals or lactation-related specialists in our community to facilitate referrals for our patients, as needed. This list is reviewed and updated regularly. (In Durham see https://breastfeeddurham.org)
  • References:  Lactation-related reference books and materials are available within [Office] and replaced as updates or new additions are released. Special consideration is given to resources for lactation management, medications, and breastfeeding, and triage protocols.

Sources

The following Lactation Policy was adapted from the following sources: 

Appendix

 Appendix 1: Specific Recommendations for Clinical Management

  1. Preconception and prenatal education
    • Ensure that all discussions take place in a culturally sensitive manner.
    • Address the infant feeding decision before conception or as early in pregnancy as possible. Prenatal intention to breastfeed affects initiation and duration of breastfeeding. Continue to bring up the issue of infant feeding and express support for breastfeeding throughout the prenatal period. Provide appropriate education and anticipatory guidance to encourage breastfeeding and determine what support is needed to make and carry out this decision.
    • Elicit any factors in the family medical history that may make breastfeeding especially important (e.g., atopic diseases, diabetes, obesity, cancers) and provide counseling and advice specific to these factors.
    • Elicit any risk factors for potential breastfeeding problems and any medical contraindications to lactation. Provide appropriate support and education.
    • For previous births, document the duration of lactation for each infant, reasons for weaning, and any problems that occurred. (If possible, document this history and include the labor history of each infant). For the current pregnancy (or pending adoption, if appropriate), document a plan for intervention, including lactation consultation if indicated, on the patient’s record.
    • Encourage the participation of the patient’s support network and educate them as appropriate. Remember that anyone present during a patient’s prenatal visits or hospital stay is likely to have influence over breastfeeding and other health care decisions.
    • Recognize the feelings of relatives who did not breastfeed or who weaned prematurely. Encourage them to learn what is known about breastfeeding for the optimal health of the parent and baby.
    • Encourage the parent and people from their support network to attend breastfeeding classes and/or support group meetings during the prenatal period.
    • Provide accurate, noncommercial breastfeeding literature and recommend accurate lay breastfeeding resources (e.g., books, websites).
    • Provide education regarding potential breastfeeding problems associated with the use of intrapartum analgesia and anesthesia. Encourage the use of a labor support person, such as a doula.
  1. Early postpartum education and support
    • Advocate for 24-hour rooming-in for the breastfeeding parent and baby.
    • Involve family members and others from the support network in breastfeeding education and enlist their support for breastfeeding.
    • Ensure that breastfeeding is being adequately assessed on a regular basis by qualified professionals. Advocate for lactation consultation services at all hospitals where maternal and infant care is provided.
    • Educate parents about the importance of frequent, unrestricted breastfeeding with proper positioning and latch.
    • Help parents recognize the baby’s early feeding cues (e.g., rooting, lip smacking, sucking on fingers or hands, rapid eye movements) and explain that crying is a late sign of hunger. It is also important to help them recognize signs that the baby is satisfied at the end of a feeding (e.g., relaxed body posture, unclenching of fists).
    • If separation of the parent and infant is necessary, assist with maintenance of breastfeeding and/or ensure that the parent receives assistance with expressing milk. Encourage expression of milk within two hours after being separated from the infant.
    • Educate patients about the risks of unnecessary supplementation. The decision to use a pacifier should be based on personal preferences as the use of pacifiers has not been associated with an increased risk of not breastfeeding in motivated parents.
    • Develop an appropriate follow-up plan for any identified problems or concerns. (See Appendix 3)
    • Provide the family with information about breastfeeding support groups or other providers (including but not limited to lactation consultants, speech therapists who assess infant sucking skills, physicians and dentists who perform frenotomy, chiropractors and other body workers who are trained to help breastfeeding families) who support breastfeeding in the community. (In Durham see https://breastfeeddurham.org and Appendix 5)
  1. Ongoing support and management
    • Provide evaluation within 24-72 hours after hospital discharge to assess adequacy of milk intake, newborn jaundice, and any breastfeeding concerns. Evaluation may need to occur within 24 hours after hospital discharge if breastfeeding was not going well in the hospital.
    • Continue to support breastfeeding throughout the first year of life and beyond at well-child and other visits. Encourage exclusive breastfeeding for the first six months of life.
    • Be knowledgeable about prevention and management of common breastfeeding challenges.
    • Educate office staff on breastfeeding topics so that they can provide optimal breastfeeding triage and support.
    • Develop a working relationship with professionals who have expertise in lactation issues, such as International Board Certified Lactation Consultants (IBCLCs). Consult when breastfeeding concerns exceed your level of expertise.
    • Encourage parents who are returning to work to continue to breastfeed.
    • Encourage partial breastfeeding for as long as possible if exclusive breastfeeding is not feasible
  2. Substance Use

Appendix 2: Specific Recommendations for Ethnicity and Culture Clinical Management

There are a number of complex factors that influence the decision to initiate and continue breastfeeding, including those “external” to families, such as cultural beliefs. The cultural context and environment of decision making are illuminated through the prism of traditions and historical and cultural events. The ideology and sentiment of breastfeeding, chestfeeding, and human milk feeding have changed during the course of history and have evolved within the culture communities. Throughout the evolution of infant feeding practices, historical aftermaths have contributed to the legacy and emotional context of infant feeding trends. First-generation immigrants from countries where breastfeeding is the norm are more likely to breastfeed than are second- and later-generation parents. This may be because of convenience, belief in modern food technology, and/or attempts to acculturate into a society where bottle feeding is perceived to be the norm. Thus, breastfeeding role models are lost with successive generations. Additionally, accurate breastfeeding information is less available in the languages of ethnic minorities with smaller U.S. populations.

  1. Aware of Personal Biases: Being aware of impact of the physician’s own personal cultural attitudes and implicit biases when interacting with patients
  2. Native Language: Providing all information and instruction, whenever possible, in the patient’s native language in a culturally relevant manner and assessing for literacy level, when appropriate.
  3. Trauma Informed Care: The decision to breastfeed and the act of breastfeeding may remain deeply affected by generational trauma.   1
    • We talk about how echoes of past oppression create an environment that is ripe for aversion to medical establishment recommendations.  1
    • We think about how this historical context lends itself to a psychosocial response to infant feeding decision making that is simultaneously steeped in familial or community influence on artificial baby milk (formula) feeding.   1
  4. Moderating Support That Families Need:  And data suggest that a family’s desires alone are not enough, but multiple and complex barriers exist, thus moderating support that families  need from health care providers, public health professionals, family members, society, their community, and employers is paramount to meet their breastfeeding goals. 1
    • We engage all family members in the first few discussions. Parents need to be supported by their partner, family, health care providers, and the community to be able to provide their infant the best preventative medicine for a healthy start to life, as well as promoting the critical bonding experiences.
    • Learning about the family structure of their patients. Support from key family members may assist greatly in the promotion of breastfeeding.
  5. Respectful Care: Promoting respectful care recognized by [office]  as a critical element to improve the quality of maternity care and add a humanistic approach to patient education and care.  1
    •  Respectful care can be defined as “an approach to care that emphasized the fundamental rights of parents, newborns, and families and that promotes equitable access to evidence-based care, while recognizing the unique needs and preference of both parents and newborns.”2 
    • Respectful care is touted through education, quality of care, shared decision making, informed consent, dignity, and nondiscrimination and support parents in being active decision makers in their birth experience and plans for feeding their infant.3
    • Several themes emerge in providing a typology of respectful maternal care, including being free from harm and mistreatment, maintaining privacy and confidentiality, preserving the family’s dignity, prospective provision of information and seeking informed consent, ensuring continuous access to family and community support, enhancing the quality of the physical environment and resources, providing equitable maternity care, engaging with effective communication, respecting families’  choices that strengthen their capabilities to give birth, availability of competent and motivated human resources, and provision of efficient and effective care and continuity of care.”2 
    • Respecting cultural traditions and taboos associated with lactation and adapting cultural beliefs to facilitate optimal breastfeeding, while also sensitively educating patients about traditions that may be detrimental to breastfeeding.
      • There are a number of complex factors that influence the decision to initiate and continue breastfeeding, including those “external” to families, such as cultural beliefs..4
    • Ensuring that parents from diverse cultures and family structures understand the importance of breastfeeding to their children’s growth and development.
      • Encouraging exclusive lactation in the hospital, when possible, in a culturally sensitive manner 5
  6. Black Families: Medical exploitation is one of the many nuanced cultural barriers that denies Black families and infants the many health benefits of breastfeeding. 1
    • We ensure that staff and providers are informed about the historical influences such as subjugation and marginalization of Black Americans that can contribute to implicit biases when it comes to making health decisions, not necessarily limited to infant feeding. 1
    • We know that establishing and supporting breastfeeding are critical to success; however, many Black parents decline to breastfeed their infants, possibly considering cultural and historical influences. Thus, the history of breastfeeding and abuse by the medical establishment are critical to the conversation on reproductive justice and birth equity, highlighting the rights of families in both the private and public sphere.1
  7.  LGBTQ+ Community: Members of the LGBTQ+ community also face significant obstacles to breastfeeding/chest feeding/human milk feeding. LGBTQ+ communities have been marginalized and experienced discrimination, both inside and outside health care settings. These experiences have led to both psychological pain and disparate health outcomes. This is most extreme in areas of sexual, reproductive, and mental health. Providing affirming health care, including using correct names and pronouns, and recognizing each person’s unique family and community, can help to improve outcomes.8

Appendix 2 was adapted from The Historical, Psychosocial, and Cultural Context of Breastfeeding in the African American Community, and the following references:

References 

  1. The Historical, Psychosocial, and Cultural Context of Breastfeeding in the African American Community,
  2. Respectful Maternity Care: Country Experiences
  3. New York City Department of Health and Mental Hygiene Sexual and Reproductive Justice Community Engagement Group. New York City Standards for Respectful Care at Birth
  4. Factors That Influence Breastfeeding Initiation Among African American Women
  5. Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022
  6. ABM Clinical Protocol #14: Breastfeeding-Friendly Physician’s Office—Optimizing Care for Infants and Children
  7. ABM Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Setting, Revision 2015
  8. ABM Clinical Protocol #33: Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients

Appendix 3

Sample Medical Office Breastfeeding/Chest feeding/Human Milk Feeding Policy (to be available to patients)

We support the right of all parents to make informed decisions about infant feeding. All of our staff and volunteers will support you in your decisions. All of our staff and volunteers will support families in their decisions. We believe that chest/breastfeeding is the healthiest way to feed your baby, and we recognize the importance of chest/breastfeeding for both you and your child. We protect chest/breastfeeding by allowing no advertising of artificial baby milk (formula) to parents and their families. We do not distribute artificial baby milk (formula) or other feeding supplies within our office/clinic. The World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommends chest/breastfeeding for two years or beyond. We will support families in achieving their own successes, whatever those may be. This policy outlines the ways in which we will help families achieve success in breastfeeding. 

Training Our Staff

  • Ensuring that our health care providers are specially trained so they can support you in breastfeeding, chestfeeding, and human milk feeding.
  • Having our health care providers discuss chest/breastfeeding with you during your pregnancy, which includes explaining the importance of exclusive chest/breastfeeding for at least six months and answering any questions you may have.
  • Having our health care providers discuss options for breastfeeding, chest feeding, or other ways of providing human milk to babies who may enter your family in ways other than birthing (e.g., adoption, surrogacy). This includes inducing lactation, re-lactation, and various ways to feed babies human milk. We will help you make informed decisions about whether you want to pursue these options.
  • Ensuring that a knowledgeable and skilled health practitioner will be available to advise you on breastfeeding when you are at home and to help you in understanding any issues your baby may have.
  • Assisting you to meet any chest/breastfeeding challenges and giving you information on who to contact at any time, day or night, if you need feeding advice.
  • Addressing and working to reduce the structures in our practice that create barriers for families of color to provide human milk.
  • Working to identify the cases of inequities and health disparities to ensure that our practice provides adequate lactation support to families of color.
  • Tongue Tie- We leave it to the discretion of your office to discuss Tongue Tie (See Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads)

Educating Our Patients

  • Encouraging you to give frequent, unrestricted feedings whenever your baby signals hunger.
  • Recommending that you keep your baby near you whenever you can so you can get to know each other.
  • Recommending that you not use bottles, article nipples, or pacifiers while your baby is learning to breastfeed. These can make it more difficult for your baby to learn how to breastfeed and for you to establish a good milk supply.
  • Showing you how to express your breast milk by hand and providing you with written information about that and how to store your milk safely. We will also teach you how to use a breast pump, as necessary.

Providing Ongoing Support

  • Supporting you to exclusively breastfeed your baby for at least six months, as well as breastfeeding with complementary foods after six months.
  • Discussing why breastfeeding is so important. Most babies need only breast milk during their initial months, so you must be given a full explanation if you’re being told your baby needs other food or drink during that time. We will be available to discuss that and any questions you may have.
  • Helping you to recognize when your baby is ready for other foods, usually at about six months of age. We will discuss appropriate foods and how they can be introduced to your baby.
  • If supplementation is needed, we will discuss alternatives with families, such as supporting families to supplement with expressed milk.

Creating a Welcoming Environment

  • We welcome breastfeeding anywhere in our office. If you would prefer to breastfeed somewhere private, please ask a member of our staff.
  • Breastfeeding families are always welcome and respected. They will never be treated poorly, asked to stop nursing, or asked to cover up or move.
  • We support all breastfeeding, chestfeeding, and human milk feeding families inclusive of their race, ethnicity, immigration status, nationality, creed, age, sexual orientation, gender identity, family structure, primary language, ability, or class.

Connecting Our Parents with Resources

  • Providing contact details of parent support groups and other services in the community that also offer breastfeeding understanding and support. Our office’s full lactation policy is available for you to read upon request.
  • Uses your in-clinic skilled lactation support or determines referrals (e.g., when, to whom); 

Supporting Lactating Employees 

  • All lactating employees are allowed breaks to express milk or nurse their children and access to a private space for expressing milk or nursing. The space is [not a bathroom], is lockable and shielded from view, includes an electrical outlet, and has hand hygiene available.
  • We are happy to provide information on how you can express your milk at work.

 

Appendix 3 was adapted from Making Breastfeeding Work for Medical Offices Colorado A Six-Point Plan Breastfeeding  page 22.

Appendix 4: TEN STEPS TO SUCCESSFUL BREASTFEEDING

(doesn’t need to be part of our policy; policy uses many of these principles)

The Ten Steps to Successful Breastfeeding were developed by a team of global experts and consist of evidence-based practice that have been shown to increase breastfeeding initiation and duration. Baby-Friendly hospitals and birthing facilities must adhere to the Ten Steps to receive and retain a Baby-Friendly designation.

The Ten Steps to Successful Breastfeeding are:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff and comply fully with the International Code of Marketing of Breast-milk Substitutes.
  2. Train all health care staff in the skills necessary to implement the breastfeeding policy.
  3. Inform all pregnant [people] and their families about the benefits and management of breastfeeding.
  4. Facilitate immediate and uninterrupted skin-to-skin contact and help [families] invite breastfeeding [or chestfeeding] as soon as possible after birth.
  5. Show [families] how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give infants no food or drink other than breast milk unless medically indicated.
  7. Practice rooming in – allow [parents] and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand and support [families] to recognize and respond their infant’s cues for feeding.
  9. Give no pacifiers or artical nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups, and refer [families] to them on discharge from the hospital or birth center.

Appendix 5: Resource List

(This resource list will always need to be updated using the Breastfeed Durham <https://breastfeeddurham.org/> website.  Information below should be attuned to the culture of your patients.)

Support groups:

  • Durham Wide List: https://breastfeeddurham.org/mec-category/parent-information/

Finding local providers/community resources: 

Mental Health Support:

Milk Bank:  

General Information

  • Lymphatic drainage of breast–illustration/instructions https://eadn-wc01-5994650.nxedge.io/wp-content/uploads/2021/08/Lymphaticmassagehandout2.pptx.pdf
  •  Medication Safety during Pregnancy and Lactation http://www.infantrisk.com/
  • Information about safety of meds/drugs during lactation -https://www.ncbi.nlm.nih.gov/books/NBK501922/

Videos:

Infant Feeding Classes: 

Doulas: 

Tongue Tie Resources: 

Lactation Consultants: (specific)

Chiropractors:

Craniosacral Therapists: