In the first few hours and days after a baby’s birth, hospital staff play a key role in helping a mother and baby begin breastfeeding successfully. Parents choosing a hospital for their baby’s birth may want to consider whether it’s a “baby-friendly” hospital—one that adheres to “The Ten Steps to Successful Breastfeeding.”
What are the “Ten Steps”?
The “Ten Steps” are a set of hospital care practices shown to support mothers in initiating and continuing breastfeeding. These steps were developed in 1989 by global health experts, including the World Health Organization (WHO) and UNICEF. They’ve been endorsed by leading health groups, including the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the Centers for Disease Control and Prevention (CDC).
The steps are as follows.
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in the skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate immediate skin-to-skin contact and initiate breastfeeding as soon as possible after birth
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
- Give infants no food or drink other than breast milk, unless medically indicated.
- Practice rooming in—allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups, and refer mothers to them on discharge from the hospital or birth center.
Have the “Ten Steps” changed over time?
The “Ten Steps” have largely withstood the test of time since 1989. However, newer research has shown the importance of skin-to-skin care for newborns immediately after birth for mother-infant bonding, stable infant body temperature, and good infant blood pressure and blood flow.
Not only is the goal for mothers to breastfeed as soon as possible after birth, but they should be supported in putting the baby skin-to-skin on their chest for the first hour as well, recognizing and responding to infant feeding cues. (Learn more about the benefits of skin-to-skin care here.) This practice supports the overall goal of the “Ten Steps”—to make the birth experience as baby-friendly as possible.
How do I know if a hospital is “baby-friendly”?
Hospitals and birthing centers that adhere to the “Ten Steps” can be recognized with an official “Baby-Friendly” designation. In the United States, Baby-Friendly USA, the agency that accredits maternity care facilities, verifies and certifies that hospitals and birthing centers comply with the steps. Currently, there are about 450 “Baby-Friendly” birthing facilities in the United States, in all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico. That number is growing. The percentage of U.S. births taking place in Baby-Friendly facilities was just 2.9 percent in 2007 and had increased to about 16.2 percent as of 2015.
To search for a baby-friendly hospital near you, consult this list of Baby-Friendly hospitals available online.