Supporting Breastfeeding after Discharge ABM Protocol #2 Highlight:
For hospital discharge within 72 hours of birth "appointments where breastfeeding can be assessed should be made before discharge for the newborn and mother… Providers should be aware that many newborns who are discharged within 48 hours of birth do not receive early follow-up as recommended. Barriers to newborn postbirth hospitalization checkup can be maternal illness, lack of reliable transportation, and lack of understanding of the importance of follow-up in healthy newborns.” This excerpt from Academy of Breastfeeding Medicine (ABM) Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyad, is our protocol highlight for February.
Protocol #2 lists 19 recommendations, which include: recommendation #16 (above) and #18 that “visits with a lactation professional should be part of regular follow-up.”
Primary care provider visits after hospital discharge provide an important touch point for assessing and supporting breastfeeding. Given the barriers to newborn follow-up, and the need to maximize lactation support in this critical window, an integrated model of team-based lactation consultant/primary care provider visits is an option that concretely addresses obstacles to breastfeeding support.
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Research Updates
Experiences of Healthcare Professionals in a Breastfeeding Training Program
- Breastfeeding education is lacking in med school & residencies.
- Providers highlighted need for more hands-on training, such as instruction on milk expression and pain relief.
- Researchers note need for further discussion about when hands-on support is appropriate and when it may disrupt the dyad.
- Interprofessional training opportunities improve learning, and can encourage interprofessional clinical collaboration.
- from International Breastfeeding Journal, 2025
Survey of Breastfeeding & Lactation Medicine Providers (BFLM) explores barriers/facilitators
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The survey of 138 US practioners, with median of 8 years of clinical BFLM experience, found institutional leadership could be a barrier(51.5%) or facilitator(48.5%) to developing BFLM services.
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94.8% of participants identified that breastfeeding and lactation medicine care addressed critical gaps in standard health care.
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Over 40% of respondents described their health care system/practice as unable to provide BFLM care to all families in need.
Factors in Delayed Lactogenesis
- Highlights from a systematic review and meta-analysis including 35 studies identified the incidence of delayed lactogenesis (onset of milk production > 72 hours) to be 30% in China and 34% in the United States.
- Maternal risk factors include: Primiparous delivery, emergent csection, gestational diabetes, hypertensive and thyroid disease of pregnancy.
- Infant risk factors include: gestational age <37 weeks & birthweight <2.5 kg.
- Receiving breastfeeding guidance is protective against delayed lactogenesis, reinforcing the importance of early breastfeeding support for those families at risk of delayed lactogenesis.
- From International Breastfeeding Journal August 22, 2024
Helpful Resources
- VIDEO from Breastfeeding Medicine of Northeast Ohio: The Basics of Breast Massage & Hand Expression in English and Spanish
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Baby-friendly Hospital Initiative monitoring manual, 2025: with tools & strategies for monitoring BFHI adherence.
- Baby-friendly Hospital Initiative competency verification toolkit, 2020: assess staff competency to implement the BFHI 10 steps. Includes a Competency Verification Tool with performance indicators.
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