Support for mothers to initiate and establish breastfeeding after childbirth

Intervention | Last updated: 9 August 2023

Breastfeeding has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits, such as reducing the risk of overweight and obesity in childhood and adolescence.

Early initiation of breastfeeding refers to initiation of breastfeeding within one hour after birth and ensures that the infant receives the colostrum, or “first milk”, which is rich in protective factors.

Current evidence indicates that skin-to-skin contact between mother and infant immediately after birth helps to initiate early breastfeeding and increases the likelihood of exclusive breastfeeding in the first months of life as well as the overall duration of breastfeeding. Infants placed in early skin-to-skin contact with their mother also appear to interact more with their mothers and cry less. In addition, evidence indicates that initiation of breastfeeding within 1 hour of birth reduces the risk of neonatal mortality and improves infant survival, compared to initiation of breastfeeding at timepoints greater than 1 hour after birth.

WHO Recommendations

Early and uninterrupted skin-to-skin contact between mothers and infants should be facilitated and encouraged as soon as possible after birth.

All mothers should be supported to initiate breastfeeding as soon as possible after birth, within the first hour after delivery.

Mothers should receive practical support to enable them to initiate and establish breastfeeding and manage common breastfeeding difficulties.

Mothers should be coached on how to express breast milk as a means of maintaining lactation in the event of their being separated temporarily from their infants.

Mothers should be supported to practise responsive feeding as part of nurturing care.

Mothers should be supported to recognize their infants’ cues for feeding, closeness and comfort, and enabled to respond accordingly to these cues with a variety of options, during their stay at the facility providing maternity and newborn services.

Mothers should be discouraged from giving any food or fluids other than breast milk to their infants unless medically indicated.

Guidelines and guidance documents Learn More

GRC-approved guidelines

Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services

Implementation guidance: protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018

Baby-friendly hospital initiative: revised, updated and expanded for integrated care

Global strategy for infant and young child feeding

Innocenti Declaration on the protection, promotion and support of breastfeedingpdf, 1.65Mb

Innocenti Declaration 2005 on infant and young child feeding

Evidence

Systematic reviews used to develop the guidelines

Delayed breastfeeding initiation and infant survival: a systematic review and meta-analysis

Smith ER, Hurt L, Chowdhury R, Sinha B, Fawzi W, Edmond KM; Neovita Study Group. PLoS One. 2017;12(7):e0180722.

Early additional food and fluids for healthy breastfed full-term infants

Smith HA, Becker GE. Cochrane Database of Systematic Reviews. 2016; Issue 8. Art. No.: CD006462.

Methods of milk expression for lactating women

Becker GE, Smith HA, Cooney F.Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD006170.

Summary of this review

Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation

Crowe L, Chang A, Wallace K.Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD005586.

Summary of this review

Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding

Jaafar SH, Ho JJ, Lee KS.Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD006641.

Summary of this review

Support for healthy breastfeeding mothers with healthy term babies

McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S.Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001141.

Summary of this review

Responsive versus scheduled feeding for preterm infants

Watson J, McGuire W.Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD005255.

Summary of this review

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants

Conde-Agudelo A, Díaz-Rossello JL.Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD002771.

Summary of this review

Early skin-to-skin contact for mothers and their healthy newborn infants

Moore ER, Bergman N, Anderson GC, Medley N.Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD003519.

Summary of this review

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding.Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD009067.

Summary of this review

Related systematic reviews

Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity--a systematic review and meta-analysis

Khan J, Vesel L, Bahl R, Martines JC. Matern Child Health J. 2015;19(3):468-79.

Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review

Debes AK, Kohli A, Walker N, Edmond K and Mullany LC. BMC Public Health. 2013; 13(Suppl 3):S19.

Cost-effectivenеss Learn More

Relevant cost-effectiveness analyses have not yet been identified.

e-Library of Evidence for Nutrition Actions (eLENA)