Every facility providing maternity services and care for newborn infants should:
Step 4: Help mothers initiate breastfeeding within a half-hour of birth.
Mothers in the maternity ward who have had normal vaginal deliveries should confirm that within a half-hour of birth
they were given their babies to hold with skin contact, for at least 30 minutes, and offered help by a staff member to
initiate breastfeeding...At least 50% of mothers who have had caesarean deliveries should confirm that within a half-hour
of being able to respond, they were given their babies to hold with skin contact.
Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed.
It is now well established that mothers who are supported to initiate breastfeeding soon after the baby is born are more likely to
have a successful breastfeeding experience. So the fourth step is to initiate breastfeeding within a half–hour of birth.
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see Initiation of Breastfeeding by Breast Crawl video here
What You Can Do.
 Step 4: WABA Action Chart
What You or Your Organisation Can Do >> click here
World Breastfeeding Week Action Folders  >>
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- General
This step now means, for all healthy newborns, skin-to-skin contact from immediately after delivery for at least one hour or until the baby has attached and fed at the breast if this takes longer.
- Health System
Advocate for training of all birth attendants to give skilled support to mothers for skin-to-skin contact immediately after delivery, allowing the baby to attach to the breast when he or she is ready.
- Community
Work to increase community awareness of the importance of early initiation of breastfeeding. Show the video breastfeeding crawl so people see what newborns can do.
- National / Global
Inform health professional organisations about new research on implementation of this and other Ten Steps, and ask them to support the new practice.
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Key Points:
Why initiate so soon?
- Allows for skin to skin contact between mother and child, providing emotional support.
- Provides colostrum as the baby's first immunization.
- Takes advantage of the first hour of alertness.
How to initiate within 30 minutes:
- Keep mother and baby together.
- Place baby on mother's chest
- Let the baby start suckling when ready. Do not hurry or interrupt the process.
Early Initiation can also:
- Increase duration of breastfeeding
- Babies learn to suckle more effectively
- Help mothers learn to breastfeed on cue
- Facilitate proper positioning during feedings with the help of a health care professional nearby
- Enforce education on the risk of artificial feeding and bottle-feeding
Mothers with c-section or complications should be assisted to breastfeed as soon as possible
Mothers should have the opportunity for early skin-to-skin contact regardless of type of delivery
HIV Issues to Consider
Step 4: Help mothers initiate breastfeeding within a half-hour of birth.
Issues to consider while implementing this step in relation to feeding recommendations for children of HIV-infected mothers and for settings with high HIV prevalence.
- All babies should be well dried, given to their mothers to hold skin-to-skin and covered, whether or not they have decided to breastfeed.
- Staff may assume that babies of HIV infected mothers must be bathed and even separated from their mothers at birth.
- They need to understand that HIV is not transmitted by mothers while they are holding their newborns - mothers need to be encouraged to hold and feel close and affectionate towards their newborn babies.
- HIV-positive mothers should be supported in using the feeding option of their choice. They shouldn't be forced to breastfeed, as they may have chosen to replacement feed without knowledge of the delivery room staff.
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