Any breastfeeding is valuable
Exclusive breastfeeding for the first six months ensures the best outcomes for babies. Right from birth, it’s important to ensure mothers and babies are supported to get breastfeeding off to the best possible start. However, there are some mothers who cannot or choose not to breastfeed exclusively. In these circumstances, any breastfeeding is valuable: babies benefit from receiving the maximum amount of breastmilk possible.
Managing supplementation rates
Evidence suggests that early supplementation is associated with an increased risk of stopping breastfeeding. This should therefore be avoided whilst feeding is being established. Ongoing sensitive support to ensure mothers can effectively attach their baby at their breast and know how to hand express if baby is reluctant to feed will reduce the need for supplementation.
Should a baby require supplementation for clinical reasons, this should be kept to a minimum, safe level and mothers should be encouraged to maintain their milk supply with a view to returning to full breastfeeding. Disruption to breastfeeding can also be minimised by choosing an alternative method of feeding which best supports the return to full breastfeeding when possible.
Local supplementation rates should be monitored and action taken if they appear to be increasing. There should be steady progress to reduce supplementation rates, especially for supplements given without medical indication or fully informed choice.
If a mother has decided to introduce formula milk for non-clinical reasons, ensure that she is aware that this may impact on her milk supply. It is important to adopt a gentle, non-judgemental approach when discussing this sensitive issue (see our guidance on conversations with mothers and our video on communication in pregnancy for tips). If she has made a fully informed decision to introduce formula milk, she can be supported to continue to provide breastmilk for her baby. You can work together on a plan to help her maximise her breastfeeding, thereby supporting her to see herself as a breastfeeding mother.
Some mothers may want to return to full breastfeeding. Providing practical support around gradually decreasing the amount of formula she gives, whilst increasing her own milk supply, will help her make the transition as safely as possible.
To meet this standard
- In maternity services – help mothers and babies get breastfeeding off to a good start with uninterrupted skin-to-skin contact and support with positioning, attachment and hand expressing
- Where possible avoid supplementation whilst breastfeeding is being established
- If supplements are given for clinical indication or as a result of fully informed maternal decision, keep the amount of formula to a minimum (whilst ensuring safety of the baby) and support mother and baby to return to full breastfeeding as soon as possible
- Monitor supplementation rates with a view to reduce the rates for non-clinical reasons
- If a mother has decided to combine breast and formula milk, ensure that she has information and support to continue to maximise the amount of breastmilk and breastfeeding the baby receives
- Revisit the mother’s goals, as she may want to return to full breastfeeding after the initial challenges faced in the difficult early weeks; work with her to develop a plan to increase her milk production and gradually decrease the amount of formula used
- Remember to praise mothers: however much breastfeeding they are doing, they remain breastfeeding mothers.
- Full details on achieving this standard are in the Baby Friendly Initiative Guide to the Standards
- Baby Friendly’s guide to having meaningful conversations with mothers talks through how to make the most of your time with a mother and how to provide effective, compassionate, mother-centred care
- For any persistent or complex problems, see our statement on additional and specialist support, as a requirement for the Baby Friendly standards
- The Baby Friendly maternity audit tool helps you to monitor supplementation rates in your unit. See also our dedicated supplementation form.
- The mother’s checklist for breastfeeding and breastfeeding assessment forms can be used to ensure that mothers are expressing their breastmilk effectively
- Sample infant feeding policies
- Videos on hand expression and communication with mothers
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