ENCOuRAGE, SuPPORT AND PROMOTE BREASTFEEDING
95Guideline 4
Note: In the Australian version of the BFHI step 4 is phrased: ‘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’. These Guidelines refer to the original BFHI, as this version has
been extensively evaluated.897,935-937
Early contact improves breastfeeding outcomes.^33 Interventions aimed at either delaying or speeding up the
length of the first feed should be avoided.^ Hospital practices at the time of birth can be the first line of support for
a new mother. Difficulties encountered can be quickly resolved by staff with appropriate experience, and hospitals
can encourage rooming-in to facilitate frequent mother and child contact.^918 The use of prelacteal feeds or other
liquids while in hospital interferes with the establishment of lactation and is contrary to BFHI principles.
Community support
Successfully managing breastfeeding problems in the first weeks after birth has a major impact on breastfeeding
duration.^938 Sources of support for mothers in the first few weeks include family members, community health
nurses, voluntary organisations and GPs. Preparation and education before birth are very important in achieving
successful breastfeeding. Efforts to improve community acceptance of breastfeeding are also critical.
The legislative environment plays an important role in reducing discrimination against breastfeeding mothers. It is
legal to breastfeed in public in every state and territory of Australia. Most jurisdictions also have specific legislation
making it unlawful to discriminate against breastfeeding mothers.^873
4.3.3 Expressing breast milk
Many mothers find it convenient to express breast milk so that others can feed their baby if required. Appropriate
hygiene is essential for the expression and storage of breast milk. For details of methods of expression and the
safe storage of breast milk see the Infant Feeding Guidelines.^351
The use of a breast pump to express and measure breast milk production is not recommended as a way to assess
the adequacy of breastfeeding, because expression from the breast may not be as effective as an infant suckling.
Serial measurements of infant growth are the best way to assess nutritional adequacy.
4.3.4 Alcohol and breastfeeding
Alcohol is best avoided during breastfeeding. For more details, see Section 3.4 and the Infant Feeding
Guidelines.^351
4.3.5 When an infant is not receiving breast milk
When an infant is not breastfed or is partially breastfed, commercial infant formulas should be used as an
alternative to breast milk until 12 months of age. All formulas available in Australia are regulated by the Australia
New Zealand Food Standards Code and contain adequate nutrients for infants. A mother’s decision not to
breastfeed should be respected and support should be provided where needed. Cow’s milk should not be given
to infants under 12 months of age as a main drink. Complete details on the use of infant formula and the
introduction of solid foods are provided in the Infant Feeding Guidelines.^351