Step 5 Standards
- All breastfeeding mothers should be offered help with a further breastfeed within six hours of delivery. (NB: The baby does not have to breastfeed again within six hours, but an offer of help should be made.)
- All breastfeeding mothers should be shown how to effectively position and attach their baby for breastfeeding.
- All breastfeeding mothers should be shown how to express their breastmilk by hand.
- All breastfeeding mothers should receive information, both verbally and in writing, prior to transfer home about how to recognise effective feeding. In addition, a breastfeeding assessment will be carried out at around day 5.
- All mothers with a baby on the neonatal unit should be offered help to initiate lactation as soon as possible after delivery, taught how to express by hand and by pump, and advised to do this at least 8 times in 24 hours, including at night.
- All mothers who are not breastfeeding should be able to correctly prepare a bottle of infant formula prior to discharge from hospital.
- All written materials intended for new mothers should be accurate and effective, and free from the promotion of breastmilk substitutes, bottles, teats and dummies.
- All health-care staff with primary responsibility for supporting breastfeeding mothers should have the necessary skills to teach mothers how to position and attach their baby for breastfeeding and how to hand express breastmilk.
Criteria measured at each stage of the assessment process for Step 5
Requirements at Stage 1:
- The method used for recording whether breastfeeding mothers have been given all relevant support and information.
- The mechanism for ensuring that all new breastfeeding mothers receive information, both verbally and in writing about how to recognise effective feeding.
- The mechanism for ensuring that a feeding assessment is carried out on or around day 5.
- The training curriculum for staff with primary responsibility for supporting breastfeeding mothers. This should show how these staff are educated to acquire the skills needed to teach mothers to position and attach their babies for breastfeeding and to hand express breastmilk.
- Written information for new mothers must be accurate and effective, and free from advertising of breastmilk substitutes, bottles, teats and dummies.
NB: In order for staff to acquire the skills to teach mothers how to position and attach their babies for breastfeeding and to hand express breastmilk, we recommend classroom teaching, role plays and supervised practical skills reviews. The curriculum should include details of the type and length of any skills-based training provided.
Requirements at Stage 2:
- Staff with primary responsibility for supporting breastfeeding mothers to demonstrate correctly how they would teach a mother to position and attach her baby for breastfeeding and to hand express breastmilk and give a satisfactory description of how they would assess the sufficiency of milk intake in a baby.
Requirements at Stage 3:
- All breastfeeding mothers to confirm that they have:
- been offered further help with breastfeeding within six hours of delivery
- been shown how to position and attach their baby effectively for breastfeeding
- been shown how to hand express breastmilk
- been given information, both verbal and in writing about how to recognise effective feeding
- had a breastfeeding assessment with a midwife or other member of staff (mothers of 5 days and above following the birth).
- All mothers with a baby on the neonatal unit to confirm that they have been:
- offered help to initiate lactation as soon as possible after delivery
- shown how to express breastmilk by hand and by pump
- advised to express at least 8 times in 24 hours including at night.
- All bottle feeding mothers to confirm that a staff member has ensured that they are able to make up a bottle of infant formula.
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