Supporting Breastfeeding During Maternal or Child Hospitalization
Publication Date: September 16, 2021
Last Updated: March 14, 2022
1. Create a policy to support the lactating mother and breastfeeding child.
a. Any institution admitting women of child-bearing age or children <2 years of age should have such a policy in place. A facility should have a written policy about breastfeeding management in the hospitalized lactating mother or breastfeeding child whenever they are hospitalized outside a maternity or neonatal ward. A policy should include elements that allow a child and their breastfeeding mother to be together as much as possible, barring no medical contraindications. It should specify where the infant is permitted to be, which staff can routinely handle the infant, who takes responsibility for the care of the infant if the mother is the patient, and what allowances are made for an infant caregiver who must have unrestricted visitation. It may specify the preferred type of room for the dyad (e.g., private room if available). The policy should also include instructions concerning safe sleeping equipment for the infant (e.g., specifying that the facility will provide such equipment and whether parents can bring their own). If the facility does not routinely provide maternity care or inpatient pediatric services, or does not have access to qualified lactation support staff and basic equipment that would ordinarily be available in other local hospitals (e.g., breast pumps and human milk storage containers, bassinets or cribs, and qualified lactation support staff), then a policy should consider including arrangements for transfer to a nearby facility where the patient(s) needs could best be met.
Lactating mothers may also find themselves hospitalized far from home or far from their child. If the mother and child both require hospitalization, the policy should include expedited efforts for them to be at the same facility, even if this requires transfer. If the child requires hospitalization, a facility should ideally be able to provide for the basic needs of their lactating mother (food, hygiene, accommodation, etc.). Key stakeholders from the hospital should be involved in creating the policy.
Level of evidence: 3. Strength of recommendation: C.
b. The policy should include elements necessary for adequate lactation support. In addition to a policy about keeping mothers and children together, a policy should include access to lactation support; plans that include milk expression, storage, and handling whenever needed; equipment4 and staff access to high-quality resources on medication safety. The policy should also include communication strategies for handoffs to ensure all members of the patient's health care team are aware of the breastfeeding or milk expression plan. For example, if surgery is planned, the multidisciplinary team from the inpatient unit should be communicating the mother's breastfeeding or pumping plan to the surgical and anesthesia teams, particularly if the mother is the patient. Documentation of the last breastfeeding or milk expression, and the expectation for the time of the next breastfeeding or milk expression should be part of the routine handoff between shifts or care teams, and should be communicated with the mother if the child is the patient.
Level of evidence: 3. Strength of recommendation: C.
Lactating mothers may also find themselves hospitalized far from home or far from their child. If the mother and child both require hospitalization, the policy should include expedited efforts for them to be at the same facility, even if this requires transfer. If the child requires hospitalization, a facility should ideally be able to provide for the basic needs of their lactating mother (food, hygiene, accommodation, etc.). Key stakeholders from the hospital should be involved in creating the policy.
Level of evidence: 3. Strength of recommendation: C.
b. The policy should include elements necessary for adequate lactation support. In addition to a policy about keeping mothers and children together, a policy should include access to lactation support; plans that include milk expression, storage, and handling whenever needed; equipment4 and staff access to high-quality resources on medication safety. The policy should also include communication strategies for handoffs to ensure all members of the patient's health care team are aware of the breastfeeding or milk expression plan. For example, if surgery is planned, the multidisciplinary team from the inpatient unit should be communicating the mother's breastfeeding or pumping plan to the surgical and anesthesia teams, particularly if the mother is the patient. Documentation of the last breastfeeding or milk expression, and the expectation for the time of the next breastfeeding or milk expression should be part of the routine handoff between shifts or care teams, and should be communicated with the mother if the child is the patient.
Level of evidence: 3. Strength of recommendation: C.
2. Keep breastfeeding mothers and infants together.
Breastfeeding infants should have unlimited access to their lactating mothers, whose food and basic needs should be accommodated by the facility as much as possible. The mother is the infant's source of nutrition and her milk has therapeutic effects. Breastfeeding is vitally important in a situation in which infants are outside their usual surroundings, and are ill, injured, or require any medical or surgical procedure.
The younger the infant, the more essential it is for mother and infant to be together as much as possible to establish and maintain breastfeeding. Keeping breastfeeding mothers and infants together is important to directly breastfeed, respond to feeding cues, share immune response to pathogens, prevent engorgement and mastitis, prevent maternal and infant distress, preserve maternal milk production, preserve shared circadian rhythms, and, ultimately, maintain exclusive breastfeeding. If both the mother and infant are hospitalized, they should be hospitalized in the same facility, and share a room if possible.
Levels of evidence: 1–3. Strength of recommendation: B.
The younger the infant, the more essential it is for mother and infant to be together as much as possible to establish and maintain breastfeeding. Keeping breastfeeding mothers and infants together is important to directly breastfeed, respond to feeding cues, share immune response to pathogens, prevent engorgement and mastitis, prevent maternal and infant distress, preserve maternal milk production, preserve shared circadian rhythms, and, ultimately, maintain exclusive breastfeeding. If both the mother and infant are hospitalized, they should be hospitalized in the same facility, and share a room if possible.
Levels of evidence: 1–3. Strength of recommendation: B.
Overview
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Supporting Breastfeeding During Maternal or Child Hospitalization
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