Breastfeeding and Lactation Support in Hospitals

The Hospital Infant Feeding Act requires all perinatal hospitals to have an infant-feeding policy that utilizes guidance provided by the Baby-Friendly Hospital Initiative or the California Dept. of Public Health (CDPH) Model Hospital Policy Recommendations.

All perinatal hospitals must implement the Ten Steps to Successful Breastfeeding as adopted by Baby-Friendly USA, per the Baby-Friendly Hospital Initiative, or an alternate process adopted by a health care service plan that includes evidence-based policies and practices and targeted outcomes, or the Model Hospital Policy Recommendations by January 1, 2025. The state shall also recommend training to improve breastfeeding rates among mothers and infants for general acute care hospitals that provide maternity care and have exclusive patient breast-feeding rates in the lowest 25 percent. HSC §1257

HSC §123360-123367 also requires CDPH to include the promotion of chest/breastfeeding in its public service campaigns, and develop a model eight-hour training course of hospital policies and recommendations promoting exclusive breastfeeding by 2025.

Independent of the California policies listed above, the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first 6 months of life and continued breastfeeding — along with complementary solid foods — to age 2 and beyond, so long as mutually desired by both parent and infant. AAP also recommends donor human milk for infants who are not breastfed.

What is the Baby-Friendly Hospital Initiative?

The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nation Children’s Fund (UNICEF), and implemented in the United States by Baby-Friendly USA, Inc. (BFUSA).

The Baby-Friendly Hospital Initiative recognizes and awards birthing facilities that successfully implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. The BFHI assists hospitals in giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding and choosing human milk for their babies or feeding formula safely, and gives special recognition to hospitals that have done so.

Hospitals play a critical role in a mother’s success in lactation initiation and in helping mothers continue to breastfeed and human milk feed after leaving their facilities. The BFHI focus is to make sure evidence-based maternity policies and practices are in place to support mothers who want to successfully initiate lactation and breastfeed their babies. Data shows that when the BFHI is implemented, exclusive breastfeeding rates increase overall, regardless of a mother’s race, ethnicity, and socioeconomic status.

The Baby-Friendly Hospital Initiative is a key strategy in meeting the Healthy People 2030 Objectives for Maternal, Infant, and Child Health related to breastfeeding:

  • Increase the proportion of infants who are breastfed exclusively through age 6 months (MICH‑15)
  • Increase the proportion of infants who are breastfed at 1 year (MICH‑16)

Why Does the California Breastfeeding Coalition Promote Baby-Friendly Designation?

Though the law allows perinatal hospitals and birth centers in California to choose an alternate process meeting the requirements above, the California Breastfeeding Coalition supports Baby-Friendly designation as the gold standard in infant-feeding policies and practices.

Unlike alternate processes using evidence-based policies and practices with targeted outcomes, Baby-Friendly designation is earned through objective third-party committee review. That review includes touring the hospital, interviewing staff and carefully assessing the facility’s policies and day-to-day practices. 

Self-assessment in any situation is never as thorough as third-party assessment.

Additionally, Baby-Friendly USA and the California Breastfeeding Coalition have intersecting beliefs:

1. Human milk fed through direct chest/breastfeeding is the optimal way for human infants to be nurtured and nourished.

Chest/breastfeeding is the optimal feeding and caring method for the health of both baby and lactating parent. Scientific evidence concludes that mothers and babies who breastfeed experience improved health outcomes and lower risks for certain diseases. Breastfeeding is the natural biological conclusion to pregnancy and an important mechanism in the natural development of the infant and the mother’s own mammary system. If chest/breastfeeding is not possible for any reason, we believe donor human milk should be offered to all parents in lieu of artificial substitutes.

2. The first days after birth are precious and should be protected as a time of bonding and support without the influence of commercial interests.

Hospitals and birthing centers wield enormous influence over the first days of life and play a critical role in determining breastfeeding success. Before the Baby-Friendly Health Initiative, commercial interests significantly influenced U.S. infant feeding practices in ways that undermined both breastfeeding and human milk feeding. Baby-Friendly facilities are centers of support in which evidenced-based care is provided, education is free from commercial interests, all infant feeding options are possible, and individual preferences are respected.

3. Every parent should be informed about the importance of chest/breastfeeding and respected to make their own decision.

The goal is for everyone to be fully informed of the importance of chest/breastfeeding and to receive the help needed to achieve their intentions when it comes to infant feeding. We respect that chest/breastfeeding is not possible for some families in certain situations, that supplementation is sometimes medically appropriate, and that some will decide not to breastfeed. Every person has the right to evidence-based information, free from commercial interests, to decide how to feed their baby and should be equally supported and treated with dignity and respect for their infant-feeding decisions.