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Conditions for successful breastfeeding

Breast milk is the most natural and best nourishment for infants. The National Breastfeeding Committee joins the declaration of WHO and UNICEF (Innocenti Declaration, 1990) to create conditions which encourage breast-feeding and which enable mothers who wish to nurse their infants to do so exclusively for four to six months. If additional food (Beikost) is provided in adequate quality and sufficient quantity, breastfeeding can be continued as long as mother and infant desire. Since the tradition of breastfeeding has almost come to an end in our society and in the families, the medical profession will play a leading role in reinstituting a breastfeeding culture.

The German National Breastfeeding Committee recommends:

I. Written guidelines to encourage nursing - Breastfeeding Standard

For an effective promotion of breastfeeding, it is essential to provide regular training for doctors, nurses, midwives and paediatric nurses to arrive at a modern lactation management.

In order to create the conditions for successful nursing, it is essential to provide 'consistent' information which is passed on to the mothers by the medical staff in the respective institution. This information should be available in written form (Breastfeeding Standard).

II. Information for pregnant women about the benefits and practice of breastfeeding

Information about the benefits and practice of nursing should be provided by all persons who advise pregnant women. The future parents should be given objective information (e.g. information on nursing in the pregnancy surveillance booklet) which corresponds to the latest scientific knowledge about lactation and breastfeeding.

III. Successful breastfeeding

The unity of mother and child during pregnancy should be maintained beyond delivery by physical contact e.g. by bedding-in (mother and child in one bed, lochia is not infective).

Initial breastfeeding should take place in the delivery room before the infant is measured, weighed and bathed. When selecting a medication which facilitates labour and delivery, the mother is to be informed of possible influences on her condition and the alertness of her newborn child and should take part in the decision. Mothers who have undergone a Caesarean section should have their first physical contact with their newborn infants and initiate breastfeeding as soon as they have regained conscience and can communicate.

24-hour rooming-in promotes the self-confidence of the mother in handling of her newborn child and allows frequent and long nursing. Close physical contact is satisfying for both mother and child and the infant will cry less. Nursing can take place in a relaxed atmosphere according to the needs of the baby and without time limit. Thus, lactation and well-being of the infant are promoted and many of the common breastfeeding problems are avoided.

The health care staff should be able to show the mothers how to attach and position the baby in different ways. It is not necessary to limit the periods of nursing.

Sore nipples and other nursing problems can be avoided by proper positioning. For nipple care, some of the mother's milk should be allowed to dry on the nipples.

The use of nipple shields and nipple ointments is not recommended. They should be reserved for special situations.

Additional feeding is not necessary for healthy and mature newborns provided that nursing is on demand and it is properly managed.

In spite of frequent breastfeeding and good attachment and positioning it may become necessary in the first three days and later to feed supplementary glucose/polymer solutions by prescription of the attending paediatrician or, if the weight has decreased by 10 % or more, to feed additionally infant formula. Later, weight control should be performed only at greater intervals in order to be able to evaluate the health of the breast-fed infant.

If a breast-fed newborn child requires additional feeding for a short period when he or she learns to suck, it is recommended that other additional feeding methods be taken into consideration, i.e. feeding with the cup, spoon or finger in order to avoid the risk of nipple confusion.

The feeding of small for gestational age (sga), sick or premature infants requires individual decisions by the attending paediatrician.

In individual cases breastfeeding may not be possible, if the mother is ill.

Engorgement and beginning mastitis are not a primary reason for weaning. Good emptying of the breast (frequent feeding and proper positioning, if possible, additionally pressing out milk) accelerates the decrease of symptoms.

When medicines are prescribed, products should be used which are compatible with breastfeeding. If this is impossible, nursing should only be interrupted for the period necessary for medication.

The nursing mother should eat a balanced diet, drink more than usual and refrain from smoking.

IV. Promotion of counselling breastfeeding mothers

Physicians, nurses, midwives and staff from the social professions who care for pregnant women and mothers must be enabled to give practical help in the natural feeding of the infant over a prolonged period and to prevent or cope with nursing problems.

Each hospital should have a nursing specialist. Apart from counselling breastfeeding mothers, the specialist will also be responsible for the formulation of guidelines for nursing, the organization of ongoing training of health-care-staff and the control of quality and success of nursing promotion in the institution.

For immediate answers to breastfeeding problems, a 24-hour hospital hotline should be also available to mothers after their discharge from the hospital.

During pregnancy or, at the latest before discharge from the hospital, the mother should be informed about the possibility provided by law to secure a midwife's assistance while in childbed and, if necessary, beyond that period.

At health institutions who have a nursing specialist (e.g. IBCLC -International Board Certified Lactation Consultant), a specialized outpatient unit for the treatment and solution of severe problems of lactation and nursing could supplement the care offered.

Help for nursing mothers does not end after discharge from hospital. Mothers are advised to contact local mother to mother support groups (already during pregnancy) where experienced nursing mothers provide information and support. Information sheets on meetings of nursing groups with addresses/telephone numbers should be distributed to the mothers when discharged from hospital.

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