1. What the heck is it?Achieving Baby Friendly USA Status meanswe have adopted and implemented 10steps that are evidence-based steps thatincrease breastfeedingrates among all familiesregardless of race orsocio-economic status.These steps narrow theracial disparities inbreastfeeding. If we areBaby Friendly we alsofollow the Code of Infant Marketing. Wedon’t glamorize formula, we don’tadvertise bottles, pacifiers or formula, andwe purchase all our formula at fair marketprice.

2. Where is our Breastfeeding Policy?Our policy is located in three places: In thenurse manager’s office, in the educator’soffice, and in Carelinks. Go to the orangecolums, Department of Nursing > NursingManuals > Women Children > Birth Center> Newborn Nursery > BreastfeedingTechniques

3. Who is trained and how much?A minimum of 80% of our providers aretrained three hours in pertinentinformation regarding Baby Friendly, and80% of our nurses are trained 20 hours inBaby Friendly and breastfeeding.

4. Providers must educate their prenatalpatients in at least three advantages ofbreastfeeding for their and their baby’shealth. Below are listed advantages ofbreastfeeding:

Advantages to mothers who breastfeed:less metabolic syndrome, lesspremenopausal breast cancer, less ovariancancer, less osteoporosis, deeper sleepwhile breastfeeding, less depression whilebreastfeeding, less Type 2 Diabetes

Advantages to babies who breastfeed: Lesschildhood cancers, less respiratoryinfections, higher IQ, less risk for asthma,atopic disease if at risk, increased touch(up to 2x more), less obesity, less Type 1and 2 Diabetes.

5. Why is the first feed after a vaginalbirth or cesarean birth so important?Mothers and newborns have the correcthormonal milieu that is most likely to leadto a successful first feed. If a baby nursesduring that first hour of time, that baby ismore likely to be successfully nursing in sixweeks.

6. What is important about skin-to-skincare during the first hour and beyond?Skin-to-skin care increases the chance forbaby to latch-on when baby is ready.Babies kept skin-to-skin perform asequence of actions thatlead to nursingincluding pre-feedingbehaviors. Skin-to-skincare should continuepostpartum: babies arewarmer, cry less, nursemore often, and aremore protected by theirmother’s antibodieswhen they are skin-to-skin.

BabyFriendlyCheat Sheet

7. What about pumping?The sooner pumping starts and the morefrequent, the more milk. “8 or more in 24”refers to number ofbreastfeeds weexpect, and also thenumber of times youshould pump whenseparated from yourbaby. Pumpingincludes hand-expression, and allour patients shouldbe taught hand-expression.

8. Why exclusive breastmilk – nothingbut Mama’s milk?Human milk is species specific. Humanprotein and human antibodies protect thedefense system and don’t expose thesystem to allergenic proteins. Human milkhas the right nutrients that are bioavailableand 100% breastfed or exclusively breastfedbabies are more likely to be breastfeedingsix weeks later and even six months laterthan combination-feeding babies.

9. Why rooming in?Babies who room-in nurse more frequentlyand their parents learn to watch for cues.While taking the baby away might seem tohelp the family if they are exhausted,opportunities to teach them how to survivethe night feeds, how to rest while nursing,how to nurse while side-lying, and work asa team, are lost. Babies who room in athome after discharge have less SIDS. TheAAP recommends rooming in the first year,especially the first six months, so we arerole-modeling how this can be done.

10. Why cue-based feeds?Babies communicate with us, and a healthynewborn will cue appropriately. Theyknow-we don’t. Babies whose cues are notfollowed, are fed less and lose more weight.

Baby-watching, looking for early cuesleads to better, longer feeds. “Watch thebaby, not the clock”. Even preterm babiesare fed by cues, but if they go too longbetween feeds we awaken them unlikehealthy term babies. But even pretermbabies feed better when their internalrhythms are followed.

11. Why no pacifiers?Pacifiers are not recommended for termbreastfeeding newborns. They areappropriate for some preterm babies,formula fed babies, and also as a painrelief. Babies who are breastfeeding missfeeds when given pacifiers and they aresucking on a pacifier when they should befeeding. There is one study that sayspacifiers worsens their suckling skills atthe breast also.

12. Alternates to bottles recommendedwith baby friendly like cup feeding, ortube feeding at the breast. Why?If a baby needs supplementation,supplementing at the breast keeps thembreast-oriented. The faster flow of thebottle and firm stimulation of the baby’spalate by the artificial teat can lead somebabies to reject the breast and prefer theartificial nipple. Until breastfeeding is wellestablished, bottles are usually betteravoided. Culturally, a bottle is viewed as away to feed a baby while a cup or spoonis viewed as a temporary measure.

13. What are some of the outsideresources to help patients continue tobreastfeed?Our two largest clinics, Mission Bay, andMt. Zion, have breastfeeding supportgroups called MILK group as well as one-on-one lactation consultants. Outside ofUCSF, there is W.I.C. with many resources,for women who qualify, as well as LaLeche League.