U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Guideline: Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services. Geneva: World Health Organization; 2017.

Cover of Guideline: Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services

Guideline: Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services.

Show details

Annex 1Question in population, intervention, comparator, outcomes (PICO) format

A. Immediate support to initiate and establish breastfeeding

Early skin-to-skin contact

Should mothers giving birth (P) practise early skin-to-skin contact (I), compared to not practising early skin-to-skin contact (C), in order to increase rates of early initiation of breastfeeding within 1 hour after birth (O)?

Population
Any mother giving birth
InterventionComparator
Early skin-to-skin contact (immediate and continued direct contact between the mother and infant)
Subgroups:
By timing: within <5 minutes, 5–60 minutes, 1–4 hours, >4 hours
No early skin-to-skin contact (standard skin contact or use of infant wrap)
Outcomes
Infant outcomes
Early skin-to-skin contact
Early initiation of breastfeeding within 1 hour after birth
Early initiation of breastfeeding within 1 day after birth
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)

Early initiation of breastfeeding

Should mothers giving birth (P) practise early initiation of breastfeeding (I), compared to not practising early initiation of breastfeeding (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any mother giving birth
InterventionComparator
Early initiation of breastfeeding (latching and suckling)No early initiation of breastfeeding (late latching and suckling)
Outcomes
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)
Neonatal, infant or child mortality (all-cause)
Onset of lactation

Showing mothers how to breastfeed

Should mothers giving birth (P) be assisted with correct positioning and attachment, so that their infants achieve effective suckling (I), compared to not assisting mothers to position and attach (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any mother giving birth
InterventionComparator
Assisting mothers in correct positioning and attachment, so that their infant achieves effective suckling
Subgroups:
By type of support: face-to-face counselling, distribution of printed or video material (no direct contact), group sessions
By frequency: 1×, 2×, at least 3×
Not assisting mothers in positioning, attachment and suckling of their infants
Outcomes
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 3 months
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)
Duration of any breastfeeding (in months)
Neonatal, infant or child mortality (all-cause)
Breast conditions (sore or cracked nipples, engorgement, mastitis etc.)

Should mothers giving birth (P) be shown how to practise expression of breast milk (I), compared to not being shown expression of breast milk (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any mother giving birth
InterventionComparator
Showing mothers how to, and helping them to practise expression of breast milk
Subgroups:
By method: hand expression, manual pump expression, electric pump expression
Not showing or teaching hand expression of breast milk; not showing or teaching other methods of breast-milk expression
Outcomes
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 3 months
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding in (months)
Effectiveness of breast-milk expression (volume of breast milk expressed)

Rooming-in

Should mothers giving birth in hospitals or facilities providing maternity and newborn services and their infants (P) remain together or practise rooming-in (I), compared to not rooming-in (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any mother giving birth in a hospital or facility providing maternity and newborn services and their newborn infant
InterventionComparator
Rooming-in of infants with mothersNo rooming-in of infants with mothers (separate care for mothers and infants)
Outcomes
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)
Neonatal, infant or child mortality (all-cause)
Onset of lactation

Demand feeding

Should mothers giving birth (P) practise feeding on demand or infant-led breastfeeding (I), compared to not practising feeding on demand or feeding by schedule (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any mother giving birth
InterventionComparator
Feeding on demand throughout the hospital stayNot feeding on demand (scheduled breastfeeding) throughout the hospital stay
Outcomes
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 3 months
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)
Duration of any breastfeeding (in months)
Neonatal, infant or child mortality (all-cause)

B. Feeding practices and additional needs of infants

Early additional foods or fluids

Should newborn infants (P) be given no foods or fluids other than breast milk unless medically indicated (I), compared to giving early additional food or fluids (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any newborn infant born with no medical indication for not breastfeeding
InterventionComparator
No foods or fluids other than breast milk given to infantsGiving early additional foods or fluids
Subgroups:
By timing of additional food/fluid: before first milk feed, within 1 day after birth, within 3 days after birth, throughout the stay in the facility
Outcomes
Early initiation of breastfeeding within 1 hour after birth
Early initiation of breastfeeding within 1 day after birth
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)
Morbidity (respiratory infections, diarrhoea, others)
Onset of lactation

Avoidance of pacifiers or dummies

Should infants (P) not be allowed to use pacifiers or dummies (I), compared to allowing use of pacifiers or dummies (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any infant
InterventionComparator
Not allowing pacifier useAllowing pacifier use
Outcomes
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)
Duration of any breastfeeding (in months)
Morbidity (respiratory infections, diarrhoea, others)

Avoidance of feeding bottles and teats

Should infants who are or will be breastfed (P) not be fed supplements with bottles and teats but only by cup, dropper, gavage, finger, spoon or other methods not involving artificial teats (I), compared to using feeding bottles and teats (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any infant born who is or will be breastfed or given breast milk other than from the breast
InterventionComparator
Artificial teats are not used (instead use a cup, dropper, gavage, finger, spoon, other methods not involving artificial teats) when not on the breastUse of artificial teats (bottle feeding) when not on the breast
Outcomes
Exclusive breastfeeding during the stay at the facility
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)
Neonatal, infant or child mortality (all-cause)
Onset of lactation

C. Creating an enabling environment

Breastfeeding policy of facilities providing maternity and newborn services

Should hospitals and facilities providing maternity and newborn services (P) have a written breastfeeding policy that is routinely communicated to staff (I), compared to those without a written breastfeeding policy (C), in order to increase rates of early initiation of breastfeeding (O)?

Population
Hospitals or facilities providing maternity and newborn services
Subgroups
By type of hospital or facilities providing maternity and newborn services: tertiary hospital, referral hospital, primary care hospital, teaching hospital
InterventionComparator
Having a written infant feeding policy
Subgroups:
By content of the policy: with all the nine other steps of the Ten Steps to Successful Breastfeeding specified, with some (not all) of the nine other steps specified, with none of the nine other steps specified
By inclusion of the International Code of Marketing of Breast-milk Substitutes (26): yes/no
By frequency of communication to old and new staff: annual, every 2 years, less often
Having no written infant feeding policy
Outcomes
Early initiation of breastfeeding
Exclusive breastfeeding during the stay in the facility
Duration of exclusive breastfeeding (in months)
Awareness of staff of the infant feeding policy of the hospital
Implementation of the provisions of the International Code of Marketing of Breast-milk Substitutes (26)

Training of health workers

Should health-facility staff (P) be trained on breastfeeding and supportive feeding practices (I), compared to not being trained (C), in order to increase rates of early initiation of breastfeeding (O)?

Population
Health-facility staff
Subgroups
By kind of staff: clinical role, come in contact with mother and infant but have limited role in infant feeding support, specialist role in infant feeding support
InterventionComparator
Training of health workers on breastfeeding and supportive feeding practices
Subgroups:
By frequency of training: 1×, 2×, at least 3×
No training of health workers on breastfeeding and supportive feeding practices
Outcomes
Early initiation of breastfeeding
Exclusive breastfeeding during the stay in the facility
Duration of exclusive breastfeeding (in months)
Knowledge of health-care workers on infant feeding
Quality of skills of health-facility staff in improving practices of mothers in optimal infant feeding
Attitudes on infant feeding
Adherence to the provisions of the International Code of Marketing of Breast-milk Substitutes (26)

Antenatal breastfeeding education for mothers

Should mothers giving birth (P) be given antenatal breastfeeding education (I), compared to not having antenatal breastfeeding education (C), in order to increase rates of exclusive breastfeeding during the stay at the facility (O)?

Population
Any mother giving birth with antenatal care
InterventionComparator
Antenatal breastfeeding education to mothers
Subgroups:
By type of promotion: face-to-face counselling, distribution of printed material, group sessions
By frequency: 1×, 2×, 3×, at least 4×
No antenatal breastfeeding education to mothers
Outcomes
Exclusive breastfeeding during the stay at the facility
Early initiation of breastfeeding within 1 hour after birth
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 3 months
Exclusive breastfeeding at 6 months
Duration of exclusive breastfeeding (in months)
Onset of lactation

Discharge planning and linkage to continuing support

Should mothers giving birth in hospitals or facilities providing maternity and newborn services (P) be given linkage to continuing breastfeeding support after discharge from the facilities providing maternity and newborn services (I), compared to not providing an linkage to continuing breastfeeding support after facility discharge (C), in order to increase rates of exclusive breastfeeding at 1 month (O)?

Population
Any mother giving birth in a hospital or facility providing maternity and newborn services
InterventionComparator
Provision of linkage to breastfeeding support after discharge from facility
Subgroups:
By type of support: active reaching out to mothers (e.g. home visits or phone calls), passive (e.g. scheduling of visits, referral to peer support, sharing of information, providing a phone number)
By quality of support based on background or training of support provider: no training, with lactation support training
No linkage to breastfeeding support after discharge from facility
Outcomes
Exclusive breastfeeding at 1 month
Exclusive breastfeeding at 6 months
Exclusive breastfeeding at 3 months
Duration of exclusive breastfeeding (in months)
Duration of any breastfeeding (in months)
Morbidity (respiratory infections, diarrhoea, others)
Copyright © World Health Organization 2017.

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “The translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization.

Bookshelf ID: NBK487817

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (1.0M)

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...