Supporting Maternal Efforts to Provide Optimal Infant Nutrition in the Post-Partum Setting.

Supporting optimal newborn nutrition and the positive maternal-infant relationship, while encouraging safe sleep practices, are essential components of maternal and newborn care in the hospital setting following birth. Breastfeeding is widely recognized as best practice to support the nutritional needs and well-being of the infant, and recommendations have been developed by the World Health Organization (WHO), the American Academy of Pediatrics (AAP) and the US Centers for Disease Control (CDC) to encourage and successfully support breastfeeding efforts prior to hospital discharge. The 10 Steps to Successful Breastfeeding, developed and promoted by the WHO, form the basis of the Baby Friendly Hospital Initiative (BFHI) and have become the international framework for public health initiatives to promote breastfeeding. An evaluation of hospital performance implementing the 10 Steps through the process of "Baby Friendly Designation" (BFD) has been suggested by many breastfeeding advocates as the optimal pathway to attain the goals of the BFHI. However, the WHO has recognized that BFD may not be an appropriate goal in all settings, and indicated, as part of their updated 2018 Guidance, that "Facilities may make changes in their policies and procedures to obtain the designation, but these changes are not always sustainable, especially when there are no regular monitoring systems in place" (1). In addition, unintended associated issues regarding newborn safety and maternal dissatisfaction with certain of the 10 Steps have emerged. This perspective will discuss the challenges facing hospitals attempting to implement the BFHI 10 Steps and suggest potential solutions to make progress in those efforts with or without BFD, as well as the efforts needed to support formula feedings when appropriate.