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Ten Steps to Successful Breastfeeding: Is Step Three Implemented?

Sevgi Özsoy and Hilmiye Aksu*

Department of Nursing, Faculty of Nursing Obstetrics and Gynecology, Aydın Adnan Menderes University, Aydın, Turkey

*Corresponding Author:
Hilmiye Aksu, PhD, RN
Department of Nursing
Faculty of Nursing Obstetrics and Gynecology
Aydın Adnan Menderes University, Aydın, Turkey
Tel: +905424107035
E-mail: [email protected]

Received Date: May 05, 2019; Accepted Date: May 27, 2019; Published Date: June 03, 2019

Citation: Özsoy S, Aksu H (2019) Ten Steps to Successful Breastfeeding: Is Step Three Implemented? J Healthc Commun Vol.4 No.2:3.

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There is no doubt that breastfeeding is one of the most important factors in improvement of infant, child, mother, family and public health. Therefore, the WHO and UNICEF launched the practice of baby friendly hospitals to initiate, maintain, spread and support breastfeeding and determined some criteria to become a baby friendly hospital. These criteria called ten steps to successful breastfeeding explain rules which obstetrics hospitals have to follow so that babies receive breastmilk starting from their birth and so that breastfeeding is maintained for minimum two years (Table 1) [1].

Every facility providing maternity services and care for newborn infants should:
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breastmilk unless medically indicated.
7. Practice rooming in - allow mothers and infants to remain together - 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Table 1: Ten steps to successful breastfeeding.

The third one of tens steps to successful breastfeeding is “to inform all pregnant women about benefits and management of breastfeeding” [1]. The aim of this step is to enable all pregnant women to acquire basic information and to receive positive messages about breastfeeding through various prenatal educational opportunities [1-3]. An examination of studies about antenatal breastfeeding education shows that this education has enhanced rates of breastfeeding [4-12], but that it is not sufficient [13-18]. These studies reveal that most of the women receive antenatal care regularly. They also show that the third step, i.e. “informing pregnant women about benefits and management of breastfeeding”, is neglected even in baby-friendly hospitals.

The “baby-friendly hospital” program has been implemented in 86% of the countries to a certain extent for 25 years. However, only 14% of the births are performed in baby-friendly hospitals in these countries [1]. Although benefits of breastmilk and breastfeeding are known well, only 42% of the babies are given breastmilk in the first hour of their birth and 41% of the babies are breastfed for the first six months of their lives [19]. While it is recommended that babies should be fed exclusively on breastmilk for the first six months and that breastfeeding should be maintained for at least two years, available evidence does not show that breastfeeding rates are not as high as desired.

Women can be more enthusiastic with and self-confident in breastfeeding if health professionals talk to them, discuss breastfeeding with them and provide them with accurate information. The most important factor in initiation and maintaining breastfeeding is that women have information about child and maternal benefits of breastfeeding and how to breastfeed their babies and decide to feed their babies with their breastmilk. In fact, insistence of mothers on initiation and maintenance of breastfeeding is a very important factor in successful breastfeeding. Research has shown that mothers start giving formula or food other than breastmilk earlier under the influence of the people around them or for such reasons that they do not have sufficient breastmilk, simply do not breastfeed and have problems with their breasts and that their babies do not feel full and cry a lot [20-26]. This evidence reveals that mothers have insufficient information about and low self-confidence in breastfeeding. When pregnant women are not given education and are not self-confident in the antenatal period, they may not be eager to initiate and maintain breastfeeding and successful breastfeeding may not be achieved.

It has been noted that out of ten steps to successful breastfeeding, the third one is to “inform all pregnant women about benefits and management of breastfeeding”. However, both mothers and health professionals are more interested in and share more information about maternal and fetal health during pregnancy. How babies are fed after their birth may not be prioritized by women and health professionals. İt has been shown in a research that health professionals have inadequate up-to-date knowledge to give women breastfeeding support, have insufficient skills for evaluation of breastfeeding and therapeutic skills and do not know how to help mothers and that there is a gap between available knowledge and clinical practice [27]. In addition, it has been reported that health professionals are not sufficiently aware of their role in maintenance of breastfeeding [18,28]. Research has shown that health professionals recommend initiation of food other than breastmilk instead of solving problems with breasts and breastfeeding and maintenance of breastfeeding [23,29,30]. A systematic review of 58 studies revealed that sticking to ten steps to successful breastfeeding in baby-friendly hospitals has enhanced breastfeeding rates [24].

If countries want to increase exclusive breastfeeding rates and the total duration of breastfeeding, they should effectively implement ten steps to successful breastfeeding and prioritize and place importance on education of pregnant women. However, an adequate number of qualified health professionals are needed so that women can receive sufficient and effective education and support for breastfeeding in antenatal and postnatal periods. To increase effectiveness of breastfeeding and the number of breastfeeding mothers, attitudes and beliefs of healthcare professionals should be changed and their competence should be enhanced through educational programs. As Callister L. noted in an article and as Pérez-Escamilla and Chapman said, “it is the best time to encourage health professionals for promotion of and support for breastfeeding [30,31].


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