BREASTFEEDING MEDICINE

Volume 2, Number 3, 2007

Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2007.9990

ABM Protocols
ABM Clinical Protocol #2 (2007 Revision): Guidelines for
Hospital Discharge of the Breastfeeding Term Newborn
and Mother: The Going Home Protocol
THE ACADEMY OF BREASTFEEDING MEDICINE CLINICAL PROTOCOL COMMITTEE

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols
for managing common medical problems that may impact breastfeeding success. Theses protocols
serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an
exclusive course of treatment or serve as standards of medical care. Variations in treatment may
be appropriate according to the needs of an individual patient.

BACKGROUND
The ultimate success of breastfeeding is measured in part by both the duration of breastfeeding and the exclusivity of breastfeeding.
Anticipatory attention to the needs of the
mother and baby at the time of discharge from
the hospital is crucial to ensure successful,
long-term breastfeeding. The following principles and practices are recommended for consideration prior to sending a mother and her
full-term infant home.

GUIDELINES
1. Formal documented assessment of breastfeeding effectiveness should be performed
at least once during the last 8 hours preceding discharge of the mother and baby, by a
medical professional trained in formal assessment of breastfeeding. Similar assessments should have been performed during
the hospitalization, preferably at least once
every 8 to 12 hours. These should include

evaluation of positioning, latch, milk transfer, babys weight and percent weight loss,
clinical jaundice, and stool and urine output.
All problems raised by the mother such as
nipple pain, ability to hand express, perception of inadequate supply, and any perceived need to supplement must also be addressed.110
2. Prior to discharge, anticipation of breastfeeding problems should be assessed based
on the maternal and/or infant risk factors
(Tables 1 and 2): All problems with breastfeeding, whether observed by hospital staff
or raised by the mother should be attended
to and documented in the medical record
prior to discharge of mother and baby. A
plan of action that includes follow-up of the
problem after discharge must be in place.117
3. Physicians, midwives, nurses, and all other
staff should encourage the mother to practice exclusive breastfeeding for the first 6
months of the infants life and to continue
breastfeeding through at least the first year
of life, preferably to 2 years of life and beyond. The addition of appropriate comple-

158

ABM PROTOCOLS
TABLE 1.
FOR

MATERNAL RISK FACTORS

LACTATION PROBLEMS

History/social factors
Primiparity
Early intention to both breastfeed and bottle or
formula feed
Early intention to use pacifiers and/or artificial
nipples
Early intention/necessity to return to work or
school
History of previous breastfeeding problems or
breastfed infant with slow weight gain
History of infertility
Significant medical problems (e.g., untreated
hypothyroidism, diabetes, cystic fibrosis)
Maternal age (e.g., adolescent mother or advanced
age)
Psychosocial problems (e.g., depression, poor, or
negative support of breastfeeding)
Perinatal complications (e.g., hemorrhage,
hypertension, infection)
Intended use of any hormonal contraceptives
before breastfeeding is well established
Perceived inadequate milk supply
Maternal medication use (inappropriate advice
about compatibility with breastfeeding is common)
Anatomic/physiologic factors
Lack of noticeable breast enlargement during
pregnancy
Flat or inverted nipples
Variation in breast appearance (marked
asymmetry, hypoplastic, tubular)
Any previous breast surgery, including plastics
procedures
Previous breast abscess
Maternal obesity (BMI  29)
Extremely or persistently sore nipples
Failure of lactogenesis stage 2 (milk did not
noticeably come in. This may be difficult to
evaluatae prior to discharge that occurs in first
2448 hours.)
Mother unable to hand express colostrum
Discharge from hospital using a nipple shield or
any other appliance
Adapted with permission from Pediatr Clin North Am
2001;48:285, and AAP and ACOG: Breastfeeding Handbook for Physicians 2006, pp. 8283.

mentary food should occur after 6 months

of life.3,9 Mothers will benefit from education about the rationale for exclusive
breastfeeding. The medical, psychosocial,
and societal benefits for both mother and
baby and why artificial milk supplementation is discouraged should be emphasized.
Such education is a standard component of
anticipatory guidance that addresses individual beliefs and practices in a culturally
sensitive manner.3,9,10,1632 Special counsel-

159

ing is needed for those mothers planning

to return to outside employment or
school.3,9 (See #7.)
4. Families will benefit from appropriate, noncommercial educational materials on breastfeeding (as well as on other aspects of child
health care).3339 Discharge packs containing
infant formula, pacifiers, commercial advertising materials, and any materials not appropriate for a breastfeeding mother and baby
should not be distributed. These may encourage poor breastfeeding practices, which
may lead to premature weaning.3,9,3363
5. Breastfeeding mothers and appropriate others will benefit from simplified anticipatory
guidance prior to discharge regarding key
issues in the immediate future. Care must be
given not to overload mothers. Specific information should be provided in written
form to all parents regarding:
a) management of engorgement;
b) indicators of adequate intake (yellow
bowel movements by day 5, at least six
urinations per day and three to four
stools per day by the fourth day of life,
and regain birth weight by days 1014);
c) signs of excessive jaundice;

TABLE 2.

INFANT RISK FACTORS

FOR

LACTATION PROBLEMS

Medical/anatomic/physiologic factors
Low birthweight or premature (37 weeks)
Multiples
Difficulty latching on to one or both breasts
Ineffective or unsustained suckling
Oral anatomic abnormalities (e.g., cleft lip/palate,
micrognathia, macroglossia, tight frenulum)
Medical problems (e.g., jaundice, hypoglycemia,
respiratory distress, infection)
Neurologic problems (e.g., genetic syndromes,
hypotonia, hypertonia)
Persistently sleepy infant
Excessive infant weight loss
Environmental factors
Motherbaby separation or breast pump
dependency
Formula supplementation
Effective breastfeeding not established by hospital
discharge
Early discharge from the hospital (48 hours of
age)
Early pacifier use
Adapted with permission from Pediatr Clin North Am
2001;48:285, and AAP and ACOG: Breastfeeding Handbook for Physicians 2006, pp. 8283.

160

6.

7.

8.

9.

d) sleep patterns of newborns, including

safe cosleeping practices; (see ABM Protocol #6: Guideline on cosleeping and
breastfeeding);
e) maternal medication use;
f) individual feeding patterns, including
normality of evening cluster feedings;
and
g) follow-up and contact information.3,9,6467
Every breastfeeding mother should receive
instruction on the technique of expressing
milk by hand (whether she uses a pump or
not), so she is able to alleviate engorgement,
increase her milk supply, or prepare to use
a pump. In addition, she may need to be
taught to use a breast pump so that she can
maintain her supply and obtain milk for
feeding to the infant should she and the infant be separated or if the infant is unable to
feed directly from the breast.3,9,6873
If a mother is planning on returning to outside employment or school soon after delivery, she would benefit from additional
written information. This should include
social support, possible milk supply issues,
expressing and storing milk away from
home, the possibility of direct nursing
breaks with the baby, and her local and/or
state laws regarding accommodations for
breastfeeding and milk expression in the
workplace.3,9,7398 It is prudent to provide
her with this information in written form,
so that she has resources when the time
comes for her to prepare for return to work
or school.
Every breastfeeding mother should be provided with names and phone numbers of
individuals and medical services that can
provide advice, counseling, and health assessments related to breastfeeding on a 24
hour-a-day basis if available, as well as on a
less intensive basis.3,9,10,99134
Mothers should be provided with lists of
various local peer support groups and services (e.g., La Leche League, hospital/clinic
based support groups, governmental supported groups, e.g., WIC [Women, Infants,
and Children] in the U.S.) with phone numbers, contact names, and addresses. They
should be encouraged to contact and consider joining one of them.3,910,99134

ABM PROTOCOLS

10. In countries where discharge is common

before or by 3 days of age, prior to discharge,
appointments should be made for (a) an office or home visit, within 35 days of age, by
a physician, midwife, or a physician-supervised breastfeeding trained licensed health
care provider and (b) the mothers 6-week
follow-up visit to the obstetrician or family
physician who participated in the delivery
of the baby. Infants discharged before 48
hours of age should be seen by 96 hours of
age.3,9,135 Additional visits for the mother
and the infant are recommended even if discharge occurs at greater than 5 days of age,
until all clinical issues such as adequate stool
and urine output, jaundice, and the baby attaining birth weight by 10 days of age are
resolved. (Note: a baby who is not back to
birth weight at day of life 10, but who has
demonstrated a steady, appropriate weight
gain for a number of days, is likely fine. This
baby may not need intervention, but continued close follow-up.) Any baby exhibiting a weight loss approaching 7% of his birth
weight by 56 days of life needs to be closely
monitored until weight gain is well established. Should 7% or more weight loss be
noted after 56 days of life, even more concern and careful follow-up must be pursued.
These babies require careful assessment, as
by 46 days the infant should be gaining
weight daily, so their % weight loss is actually more when that is taken into account.
In addition to attention to these issues,
babies with any of these concerns must
be specifically evaluated for problems
with breastfeeding and milk transfer.3,9,66,102,103,105,106,109,110,118,126,131,136142
11. If the mother is medically ready for discharge but the infant is not, every effort
should be made to allow the mother to remain in the hospital either as a continuing
patient or as a mother-in-residence with
access to the infant for exclusive breastfeeding promotion. Maintenance of a 24-hour
rooming-in relationship with the infant is
optimal during the infants extended
stay.143149
12. If the mother is discharged from the hospital before the infant is discharged (as in
the case of a sick infant), the mother should

ABM PROTOCOLS

be encouraged to spend as much time as

possible with the infant, practice skin-toskin technique and Kangaroo care with her
infant whenever possible, and to continue
regular breastfeeding.150156 During periods
when the mother is not in the hospital, she
should be encouraged to express and store
her milk, bringing it to the hospital for the
infant.

ACKNOWLEDGMENTS
Supported in part by a grant from the Maternal Child Health Bureau, Department of
Health and Human Services.
REFERENCES
1. Friedman MA, Spitzer AR. Discharge criteria for the
term newborn. Pediatr Clin N Am 2004;51:599618.
2. Langan RC. Discharge procedures for healthy newborns. Am Fam Physician 2006;73:849852.
3. American Academy of Pediatrics and the American
College of Obstetrics and Gynecologists. Breastfeeding Handbook for Physicians. Schanler RJ, ed. Elk
Grove Village, IL: American Academy of Pediatrics,
2006.
4. Johansson K. What type of information do parents
need after being discharged directly from the delivery ward? Upsala J Med Sci 2004;109:229238.
5. Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and
excess neonatal weight loss. Pediatrics 2003;112:
607619.
6. Sacco LM, Caulfield LE, Gittelsohn J, Martinez H.
The conceptualization of perceived insufficient milk
among Mexican mothers. J Hum Lact 2006;22(3):
277286.
7. Chapman DJ, Perez-Escamilla R. Does delayed perception of the onset of lactation shorten breastfeeding duration? J Hum Lact 1999;15:107111.
8. Ryan AS, Wysong JL, Martinez GA, Simon SD. Duration of breastfeeding patterns established in the
hospital. Clin Pediatr 1990;29:99107.
9. American Academy of Pediatrics Section on Breastfeeding. Policy statement: Breastfeeding and the use
of human milk. Pediatrics 2005;115:496506.
10. Kuan LW, Britto M, Decolongon J, Schoettker PJ,
Atherton HD, Kotagal UR. Health system factors
contributing to breastfeeding success. Pediatrics
1999;104:28.
11. Yanicki S, Hasselback P, Sandilands M, Jensen-Ross
C. The safety of Canadian early discharge guidelines.
Can J Public Health 2002;93:2630.

161
12. Ahluwalia IB, Morrow B, Hsia J. Why do women
stop breastfeeding? Findings from the pregnancy
risk assessment and monitoring system. Pediatrics
2005;116:14081412.
13. Weiss M. Length of stay after vaginal birth: sociodemographic and readiness-for-discharge factors.
Birth 2004;31:93101.
14. Britton JR, Baker A, Spino C, Bernstein HH. Postpartum discharge preferences of pediatricians: Results from a national survey. Pediatrics 2002;110:
5360.
15. Madden JM, Soumerai SB, Lieu TA, Mandl KD,
Zhang F, Ross-Degnan D. Effects on breastfeeding
of changes in maternity length-of-stay policy in a
large health maintenance organization. Pediatrics
2003;111:519524.
16. Taveras EM, Capra AM, Braveman PA, Jensvold
NG, Escobar GJ, Lieu TA. Clinician support and psychosocial risk factors associated with breastfeeding
discontinuation. Pediatrics 2003;112:108115.
17. Cernadas JM Noceda G, Barrera L, Martinez AM,
Garsd A. Maternal and perinatal factors influencing the duration of exclusive breastfeeding during
the first 6 months of life. J Hum Lact 2003;19:
136144.
18. Labbok MH, Wardlaw T, Blanc A, Clark D, Terreri
N. Trends in exclusive breastfeeding: Findings from
the 1990s. J Hum Lact 2006;22:272276.
19. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev
2002;1:CD003517.
20. Nelson AM. Toward a situation-specific theory of
breastfeeding. Res Theory Nurs Pract 2006;20:927.
21. Taveras EM, Li R, Grummer-Strawn L, et al. Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics
2004;113:e283e290.
22. Taveras EM, Scanlon KS, Birch L, Rifas-Shiman SL,
Rich-Edwards JW, Gillman MW. Association of
breastfeeding with maternal control of infant feeding at age 1 year. Pediatrics 2004;114:e577e583.
23. Scott JA, Binns CW, Oddy WH, Graham KI. Predictors of breastfeeding duration: Evidence from a cohort study. Pediatrics 2006;117:e646e655.
24. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding. In: Protecting Infants Through
Human Milk: Advancing the Scientific Evidence. Pickering LK, et al. eds. Kluwer Academic/Plenum Publishers, New York, 2004, pp. 6377.
25. James DC, Dobson B, American Dietetic Association.
Position of the American Dietetic Association: Promoting and supporting breastfeeding. J Am Diet Assoc 2005;105:810818.
26. Moreland J, Coombs J. Promoting and supporting
breastfeeding. Am Fam Physician 2000;61:20932100,
21032104.
27. Donath SM, Amir LH. Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study. Acta Paediatr
2003;92:352356.

162
28. Li R, Hsia J, Fridinger F, Hussain A, Benton-Davis
S, Grummer-Strawn L. Public beliefs about breastfeeding policies in various settings. J Am Diet Assoc
2004;104:11621168.
29. Hannan A, Li R, Benton-Davis S, Grummer-Strawn
L. Regional variation in public opinion about breastfeeding in the United States. J Hum Lact 2005;
21:284288.
30. Walker, M. Letter to the Editor. J Pediatr Health Care
1997;11:201.
31. Philipp BL, Merewood A. The Baby-Friendly way:
The best breastfeeding start. Pediatr Clin North Am
2004;51:761783.
32. Brady NC. The commitment to breastfeeding. Int J
Gynecol Obstet 1990;31:56.
33. Howard C Howard F, Lawrence R, Andresen E, DeBlieck E, Weitzman M. Office prenatal formula advertising and its effect on breast-feeding patterns.
Obstet Gynecol 2000;95:296303.
34. Frank DA, Wirtz SJ, Sorenson JR, Heeren T. Commercial discharge packs and breast-feeding counseling: Effects on infant-feeding practices in a randomized trial. Pediatrics 1987;80:845854.
35. Speer ME. Use of hospital discharge packs1995,
position statement of the Texas Pediatric Society
Committee on Fetus and Newborn. Tex Med 1996;
92:5657.
36. Howard CR, Howard FM, Weitzman M, Lawrence
R. Commentaries: Antenatal formula advertising:
Another potential threat to breast-feeding. Pediatrics
1994;94:102104.
37. Howard C, Howard FW. Commentary: Discharge
packs: How much do they matter? Birth 1997;24:
98101.
38. Neifert M, Gray J, Gary N, Camp B. Effect of two
types of hospital gift packs on duration of breastfeeding among adolescent mothers. J Adolesc Health
Care 1988;9:411413.
39. Valaitis RK, Shea E. An evaluation of breastfeeding
promotion literature: Does it really promote breastfeeding? Can J Public Health 1993;84:2427.
40. Donnelly A, Snowden HM, Renfrew MJ, Woolridge
MW. Commercial hospital discharge packs for
breastfeeding women. Cochrane Database Syst Rev
2000;2:CD002075
41. Wright A, Rice S, Wells S. Changing hospital practices to increase the duration of breastfeeding. Pediatrics 1996;97:669675.
42. Perez-Escamilla R, Pollitt E, Lonnerdal B, Dewey
KG. Infant feeding policies in maternity wards
and their effect on breast-feeding success: An
analytical overview. Am J Public Health 1994;84:
8997.
43. Snell BJ, Krantz M, Keeton R, Delgado K, Peckham
C. The association of formula samples given at hospital discharge with the early duration of breastfeeding. J Hum Lact 1992;8:6772.
44. Frank DA. Commentaries: Commercial discharge
packs and breastfeeding counseling: summary of a
study. J Hum Lact 1989;5:712.

ABM PROTOCOLS
45. Cronenwett L, Stukel T, Kearney M, et al. Single
daily bottle use in the early weeks postpartum and
breast-feeding outcomes. Pediatrics 1992;90:760766.
46. Auerbach KG. Letter to the Editor: Infant formula
samples and breastfeeding. JOGNN 1987;March
April:8687.
47. Bliss MC, Wilkie J, Acredolo C, Berman S, Tebb KP.
The effect of discharge pack formula and breast
pumps on breastfeeding duration and choice of infant feeding method. Birth 1997;24:9097.
48. Victora CG, Behague DP, Barros FC, Olinto MT, Weiderpass E. Pacifier use and short breastfeeding duration: Cause, consequence, or coincidence? Pediatrics 1997;99:445453.
49. Howard CR, Howard FM, Lanphear B, et al. Randomized clinical trial of pacifier use and bottle-feeding or cup feeding and their effect on breastfeeding.
Pediatrics 2003;111:511518.
50. Howard CR, Howard FM, Lanphear B, deBlieck EA,
Eberly S, Lawrence RA. The effects of early pacifier
use on breastfeeding duration. Pediatrics 1999;103:
e33(16).
51. Aarts C, Hornell A, Kylberg E, Hofvander Y, GebreMedhin M. Breastfeeding patterns in relation to
thumb sucking and pacifier use. Pediatrics 1999;
104:e50(110).
52. Vogel AM, Hutchison BL, Mitchell EA. The impact
of pacifier use on breastfeeding: A prospective cohort study. J Paediatr Child Health 2001;37:5863.
53. Barros FC, Victora CG, Semer TC, Tonioli Filho S,
Tomasi E, Weiderpass E. Use of pacifiers is associated with decreased breast-feeding duration. Pediatrics 1995;95:497499.
54. Nelson EA, Yu LM, Williams S, International Child
Care Practices Study Group Members. International
child care practices study: Breastfeeding and pacifier use. J Hum Lact 2005;21:289295.
55. Gorbe E, Kohalmi B, Gaal G, et al. The relationship
between pacifier use, bottle-feeding and breastfeeding. J Matern-Fetal Neo M 2002;12:127131.
56. Barros FC, Victora CG, Morris SS, Halpern R, Horta
BL, Tomasi E. Breastfeeding, pacifier use and infant
development at 12 months of age: A birth cohort
study in Brazil. Paediatr Perinat Epidemiol 1997;11:
441450.
57. Kramer MS, Barr RG, Dagenais S, et al. Pacifier use,
early weaning, and cry/fuss behavior. JAMA
2001;286:322326.
58. Righard L. Are breastfeeding problems related to incorrect breastfeeding technique and the use of pacifiers and bottles? Birth 1998;25:4044.
59. Benis MM. Are pacifiers associated with early weaning from breastfeeding? Adv Neonat Care 2002;2:
259266.
60. Righard L, Alade MO. Breastfeeding and the use of
pacifiers. Birth 1997;24:116120.
61. Adair SM. Pacifier use in children: A review of recent literature. Pediatr Dent 2003;25:449458.
62. Binns CW, Scott JA. Using pacifiers: What are breastfeeding mothers doing? Breastfeed Rev 2002;10:2125.

ABM PROTOCOLS
63. Ullah S, Griffiths P. Does the use of pacifiers shorten
breastfeeding duration in infants? Br J Community
Nurs 2003;8:458463.
64. Neifert MR. Clinical aspects of lactation. Clin Perinatol 1999;26:281306.
65. American Academy of Pediatrics Subcommittee on
Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of
gestation. Pediatrics 2004;114:297316.
66. Neifert MR. Prevention of breastfeeding tragedies.
Pediatr Clin North Am 2001;48:273297.
67. Gartner LM, Herschel M. Jaundice and breastfeeding. Pediatr Clin North Am 2001;48:389399.
68. World Health Organization, United Nations Childrens Fund. Protecting, promoting and supporting
breastfeeding: The special role of maternity services
(A joint WHO/UNICEF statement). Int J Gynaecol
Obstet 1990;31:171183.
69. Schanler RJ. Post-discharge nutrition for the preterm
infant. Acta Paediatr 2005;94(Suppl 449):6873.
70. Nyqvist KH. Mothers advice about facilitating
breastfeeding in a neonatal intensive care unit. J Hum
Lact 1994;10:237243.
71. Auerbach KG, Walker M. When the mother of a
premature infant uses a breast pump: What every
NICU nurse needs to know. Neonatal Netw 1994;
13:2329.
72. Forte A, Mayberry LJ, Ferketich S. Breast milk collection and storage practices among mothers of hospitalized neonates. J Perinatol 1986;7:3539.
73. Chamberlain LB, McMahon M, Philipp BL, Merewood A. Breast pump access in the inner city: A hospital-based initiative to provide breast pumps for
low income women. J Hum Lact 2006;22:9498.
74. Killien MG. The role of social support in facilitating
postpartum womens return to employment. JOGNN
2005;34:639646.
75. Neilsen J. Return to work: Practical management of
breastfeeding. Clin Obstet Gynecol 2004;47:724733.
76. Eldridge S, Croker A. Breastfeeding friendly workplace accreditation. Creating supportive workplaces
for breastfeeding women. Breastfeed Rev 2005;13:
1722.
77. Rea MF, Morrow AL. Protecting, promoting, and
supporting breastfeeding among women in the labor force. In: Protecting Infants through Human
Milk: Advancing the Scientific Evidence. Pickering
LK, et al. eds. Kluwer Academic/Plenum Publishers, New York, 2004, pp. 121132.
78. Click ER. Developing a worksite lactation program.
MCN Am J Matern Child Nurs 2006;31:313317.
79. Ryan AS, Zhou W, Arensberg MB. The effect of employment status on breastfeeding in the United
States. Women Health Iss 2006;16:243251.
80. Kimbro RT. On-the-job moms: Work and breastfeeding initiation and duration for a sample of lowincome women. Matern Child Health J 2006;10:1926.
81. Dodgson JE, Chee Y, Yap TS. Workplace breastfeeding support for hospital employees. J Adv Nur
2004;47:91100.

163
82. Brown CA, Poag S, Kasprzycki C. Exploring large
employers and small employers knowledge, attitudes, and practices on breastfeeding support in the
workplace. J Hum Lact 2001;17:3946.
83. Bromberg Bar Yam N. Workplace lactation support,
Part II: Working with the workplace. J Hum Lact
1998;14:321325.
84. Slusser W, Lange L, Dickson V, Hawkes C, Cohen
R. Breastmilk expression in the workplace: A look at
frequency and time. J Hum Lact 2004;20:164169.
85. American Academy of Family Physicians. Information from your family doctor: Returning to work
while breastfeeding. Am Fam Physician 2003;
68:22012208.
86. Stevens KV, Janke J. Breastfeeding experiences of active duty military women. Mil Med 2003;168:380384.
87. Bocar DL. Combining breastfeeding and employment: increasing success. J Perinat Neonat Nurs
1997;11:2343.
88. Greiner, T. Breastfeeding and maternal employment:
another perspective. J Hum Lact 1993;9:214215.
89. Bridges CB, Frank D. Curtin J. Employer attitudes
toward breastfeeding in the workplace. J Hum Lact
1997;13:215219.
90. Bromberg Bar Yam N. Workplace lactation support,
Part I: A return-to-work breastfeeding assessment
tool. J Hum Lact 1998;14:249254.
91. OGara C, Canahuati J, Moore Martin A. Every
mother is a working mother: Breastfeeding and
womens work. Int J Gynecol Obstet 1994;47(Suppl.):
S33S39.
92. Biagoli F. Returning to work while breastfeeding.
Am Fam Physician 2003;68:22012208.
93. Cohen R, Mrtek MB, Mrtek, RG. Comparison of maternal absenteeism and infant illness rates among
breastfeeding and formula-feeding women in two
corporations. Am J Health Promot 1995;10:148153.
94. Corbett-Dick P, Bezek SK. Breastfeeding promotion
for the employed mother. J Pediatr Health Care 1997;
11:1219.
95. Gielen AC, Faden RR, OCampo P, Brown CH, Paige
DM. Maternal employment during the early postpartum period: Effects on initiation and continuation
of breastfeeding. Pediatrics 1991;87:298305.
96. Greenberg CS, Smith K. Anticipatory guidance for
the employed breastfeeding mother. J Pediatr Health
Care 1991;5:204209.
97. Meek JY. Breastfeeding in the workplace. Pediatr Clin
North Am 2001;48:461474.
98. Pantazi M, Jaeger MC, Lawsin M. Staff support for
mothers to provide breastmilk in pediatric hospital
and neonatal units. J Hum Lact 1998;14:291296.
99. Philipp BL. Every call is an opportunity. Supporting
breastfeeding mothers over the telephone. Pediatr
Clin North Am 2001;48:525532.
100. Philipp BL, Caldwell K. Fielding questions about
breastfeeding. Contemp Pediatr 1999;16:149164.
101. Phillipp BL, Merewood A, OBrien S. Physicians and
breastfeeding promotion in the United States: A call
for action. Pediatrics 2001;107:584587.

164
102. Chen CH. Effects of home visits and telephone contacts on breastfeeding compliance in Taiwan. Matern
Child Nurs J 1993;21:8290.
103. Houston MJ, Howie PW, Cook A, McNeilly AS. Do
breastfeeding mothers get the home support they
need? Health Bull (Edinb.) 1981;39:166172.
104. Long DG, Funk-Archuleta MA, Geiger CJ, Mozar AJ,
Heins JN. Peer counselor program increases breastfeeding rates in Utah Native American WIC population. J Hum Lact 1995;11:279284.
105. Bonuck KA, et al. Randomized, controlled trial of a
prenatal and postnatal lactation consultant intervention on duration and intensity of breastfeeding
up to 12 months. Pediatrics 2005;116:14131426.
106. Labarere J, Gelbert-Baudino N, Ayral AS, et al. Efficacy of breastfeeding support provided by trained
clinicians during an early, routine, preventive visit:
A prospective, randomized, open trial of 226 motherinfant pairs. Pediatrics 2005;115:e139146.
107. Nankunda J, Tumwine JK, Soltvedt A, Semiyaga N,
Ndeezi G, Tylleskr T. Community based peer counselors for support of exclusive breastfeeding: Experiences from rural Uganda. Int Breastfeed J 2006;1:19.
http://www.internationalbreastfeedingjournal.com
/content/1/1/19 (Last accessed 5/31/07).
108. Chapman DJ, Damio G, Young S, Perez-Escamilla R.
Effectiveness of breastfeeding peer counseling in a
low-income, predominantly Latina population: A
randomized controlled trial. Arch Pediatr Adolesc Med
2004;158:897902.
109. Fetrick A, Christensen M, Mitchell C. Does public
health nurse home visitation make a difference in the
health outcomes of pregnant clients and their offspring? Public Health Nurs 2003;20:184189.
110. Martens PJ. Increasing breastfeeding initiation and
duration at a community level: An evaluation of Sagkeeng first nations community health nurse and
peer counselor programs. J Hum Lact 2002;18:
236246.
111. Merewood A, Philipp BL. Peer counselors for breastfeeding mothers in the hospital setting: trials, training, tributes, and tribulations. J Hum Lact 2003;19:
7276.
112. Heinig MJ, Follett JR, Ishii KD, Kavanagh-Prochaska
K, Cohen R, Panchula J. Barriers to compliance with
infant-feeding recommendations among low-income women. J Hum Lact 2006;22:2738.
113. Anderson AK, Damio G, Young S, Chapman DJ,
Perez-Escamilla R. A randomized trial assessing
the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income
community. Arch Pediatr Adolesc Med 2005;159:
836841.
114. Gross SM, Caulfield LE, Bentley ME, et al. Counseling and motivational videotapes increase duration
of breastfeeding in AfricaAmerican WIC participants who initiate breastfeeding. J Am Diet Assoc
1998;98:143148.
115. Stremler J, Lovera D. Insight from a breastfeeding
peer support pilot program for husbands and fathers

ABM PROTOCOLS

116.

117.

118.

119.

120.

121.

122.

123.

124.

125.

126.

127.

128.

129.

130.

131.

of Texas WIC participants. J Hum Lact 2004;20:

417422.
Kistin N, Abramson R, Dublin P. Effect of peer counselors on breastfeeding initiation, exclusivity, and
duration among low-income urban women. J Hum
Lact 1994;10:1115.
Cohen R, Lange L, Slusser W. A description of a
male-focused breastfeeding promotion corporate
lactation program. J Hum Lact 2002;18:6165.
Graffy J, Taylor J. What information, advice, and
support do women want with breastfeeding? Birth
2005;32:179186.
Chapman DJ, Damio G, Perez-Escamilla R. Differential response to breastfeeding peer counseling
within a low-income, predominantly Latina population. J Hum Lact 2004;20:389396.
Bronner Y, Barber T, Miele L. Breastfeeding peer
counseling: rationale for the national WIC survey. J
Hum Lact 2001;17:135139.
Bronner Y, Barber T, Vogelhut J, Resnik AK. Breastfeeding peer counseling: Results from the national
WIC survey. J Hum Lact 2001;17:119168.
Bronner Y, Barber T, Davis S. Breastfeeding peer
counseling: Policy implications. J Hum Lact 2001;17:
105109.
McInnes R, Love JG, Stone DH. Evaluation of a community-based intervention to increase breastfeeding
prevalence. J Public Health Med 2000;22:138145.
Ahluwalia IB, Tessaro I, Grummer-Strawn LM, MacGowan C, Benton-Davis S. Georgias breastfeeding
promotion program for low-income women. Pediatrics 2000;105:e85e91.
Shaw E, Kazorowski J. The effect of a peer counseling program on breastfeeding initiation and longevity
in a low-income rural population. J Hum Lact
1999;15:1925.
Morrow AL, Guerrero ML, Shults J, et al. Efficacy of
home-based peer counseling to promote exclusive
breastfeeding: A randomized controlled trial. Lancet
1999;353:2261231.
Arlotti JP, Cottrell BH, Lee SH, Curtin JJ. Breastfeeding among low-income women with and without peer support. J Community Health Nur
1998;15:163178.
Schafer E, Vogel MK, Viegas S, Hausafus C. Volunteer peer counselors increase breastfeeding duration
among rural low-income women. Birth 1998;25:
101106.
Grummer-Strawn LM, Rice SP, Dugas K, Clark LD,
Benton-Davis S. An evaluation of breastfeeding promotion through peer counseling in Mississippi WIC
clinics. Matern Child Health J 1997;1:3542.
Milligan RA, et al. Breastfeeding duration among
low income women. J Midwifery Wom Heal 2000;45:
246252.
Caulfield LE, Gross SM, Bentley ME, et al. WICbased interventions to promote breastfeeding
among AfricanAmerican women in Baltimore: Effects on breastfeeding initiation and continuation. J
Hum Lact 1998;14:1522.

ABM PROTOCOLS
132. Chapman D, Damio, G, Young, S, Prez-Escamilla,
R. Association of degree and timing of exposure to
breastfeeding peer counseling services with breastfeeding duration. Adv Exp Med Biol 2004;554:303306.
133. Perez-Escamilla R, Guerro ML. Epidemiology of
breastfeeding: Advances and multidisciplinary applications. In Protecting Infants through Human
Milk: Advancing the Scientific Evidence. Pickering
LK, et al. eds. Kluwer Academic/Plenum Publishers, New York, 2004, pp. 4559.
134. Agrasada GV, Gustafsson J, Kylberg E, Ewald U.
Postnatal peer counseling on exclusive breastfeeding of low-birthweight infants: A randomized, controlled trial. Acta Paediatr 2005;94:11091115.
135. American Academy of Pediatrics, Subcommittee on
Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of
gestation. Pediatrics 2004;114:297316.
136. Casiday RE, Wright CM, Panter-Brick C, Parkinson
KN. Do early infant feeding patterns relate to breastfeeding continuation and weight gain? Data from a
longitudinal cohort study. Eur J Clin Nutr 2004;
58:12901296.
137. Svedulf CI, Bergbom Engberg IL, Berthold H,
Hoglund IE. A comparison of the incidence of breastfeeding two and four months after delivery in mothers discharged within 72 hours and after 72 hours
post delivery. Midwifery 1998;14:3747.
138. Madden JM, Soumerai SB, Lieu TA, Mandl KD,
Zhang F, Ross-Degnan D. Length-of-stay policies
and ascertainment of postdischarge problems in
newborns. Pediatrics 2004;113:4249.
139. Madlon-Kay DJ, DeFor TA, Egerter S. Newborn
length of stay, health care utilization, and the effect
of Minnesota legislation. Arch Pediatr Adolesc Med
2003;157:579583.
140. Galbraith AA, Egerter SA, Marchi KS, Chavez G,
Braveman PA. Newborn early discharge revisited:
Are California newborns receiving recommended
postnatal services? Pediatrics 2003;111:364371.
141. Winterburn S, Fraser R. Does the duration of postnatal stay influence breastfeeding rates at one month
in women giving birth for the first time? A randomized control trial. J Adv Nurs 2000;32:11521157.
142. Margolis LH, Schwartz JB. The relationship between
the timing of maternal postpartum hospital
discharge and breastfeeding. J Hum Lact 2000;
16:121128.
143. Rapley G. Keeping mothers and babies together
Breastfeeding and bonding. RCM Midwives 2002;5:
332334.
144. Waldenstrom U, Swenson A. Rooming-in at night in
the postpartum ward. Midwifery 1991;7:8291.
145. Yamauchi Y, Yamanouchi I. The relationship between rooming-in/not rooming-in and breastfeeding variables. Acta Paediatr Scand 1990;79:10171022.

165
146. Keefe MR. The impact of infant rooming-in on maternal sleep at night. J Obstet Gynecol Neonat Nurs
1988;17:122126.
147. Keefe MR. Comparison of neonatal nighttime
sleepwake patterns in nursery versus rooming-in
environments. Nurs Res 1987;36:140144.
148. Procianoy RS, Fernandes-Filho PH, Lazaro L, Sartori
NC, Drebes S. The influence of rooming-in on breastfeeding. J Trop Pediatr 1983;29:112114.
149. Lindenberg CS, Atroloa RC, Jimenez V. The effect of
early postpartum motherinfant contact and breastfeeding promotion on the incidence and continuation of breastfeeding. Int J Nurs Stud 1990;27:179186.
150. Hurst NM, Valentine CJ, Renfro L, Burns P, Ferlic L.
Skin-to-skin holding in the neonatal intensive care
unit influences maternal milk volume. J Perinatol
1997;17:213217.
151. Browne JV. Early relationship environments: Physiology of skin-to-skin contact for parents and their
preterm infants. Clin Perinatol 2004;31287298.
152. Carfoot S, Williamson PR Dickson R. A systematic
review of randomized controlled trials evaluating
the effect of mother/baby skin-to-skin care on successful breastfeeding. Midwifery 2003;19:148155.
153. Anderson GC, Moore E, Hepworth J, Bergman N.
Early skin-to-skin contact for mothers and their
healthy newborn infants. Cochrane Database Syst Rev
2003;2:CD003519.
154. Bier JA, Ferguson AE, Morales Y, et al. Comparison
of skin-to-skin contact with standard contact in lowbirth-weight infants who are breastfed. Arch Pediatr
Adolesc Med 1996;150:12651269.
155. Wallace H, Marshall D. Skin-to-skin contact. Pract
Midwife 2001;4:3032.
156. Kirsten GF, Bergman NJ, Hann FM. Kangaroo
mother care in the nursery. Pediatr Clin North Am
2001;48:443452.

Contributor
*Amy Evans, M.D.
Protocol Committee
Caroline J. Chantry, M.D., FABM,
Co-Chairperson
Cynthia R. Howard M.D., MPH, FABM,
Co-Chairperson
Ruth A. Lawrence, M.D., FABM
Kathleen A. Marinelli, M.D., FABM,
Co-Chairperson
Nancy G. Powers, M.D., FABM
*Lead author.

For reprint requests: [email protected]