Evidence-based Care for Breastfeeding

Mothers

Mapped to the UNICEF Baby Friendly Learning Outcomes, this new edition of Pollard’s
essential textbook ensures readers are equipped with the essential knowledge and skills
to efectively promote and support breastfeeding mothers.
Breastfeeding is a major public health issue. Not only does breastmilk provide all the
nutrients a baby needs for their first six months, but research shows it also helps to
protect infants from infection and reduce obesity, as well as helping to protect mothers
from some diseases in later life. Although many women want to breastfeed, rates drop
rapidly in the first days and weeks after giving birth. Women need the support of their
midwives and health visitors when establishing breastfeeding and throughout their
children’s infancy. This comprehensive and accessible text covers:

• anatomy and physiology;

• building relationships;
• essential skills and good practice guidance;
• dealing with common problems;
• public health considerations;
• mothers needing additional support;
• babies with special needs; and
• complementary feeding and weaning.

Suitable for midwifery and nursing students, as well as practitioners undertaking

continuing professional development, Evidence-based Care for Breastfeeding Mothers is
designed to aid learning. Each chapter begins with specific learning outcomes linked to
the Baby Friendly Learning Outcomes, key fact boxes, clinical scenarios and activities.

Maria Pollard is Deputy Director (Nursing, Midwifery and Allied Health Professions) at
NHS Education for Scotland, UK.
Evidence-based Care for
Breastfeeding Mothers
A Resource for Midwives and
Allied Healthcare Professionals
Third Edition

Maria Pollard
Designed cover image: Getty Images
Third edition published 2024
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2024 Maria Pollard
All rights reserved. No part of this book may be reprinted or reproduced or utilised
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent to
infringe.
First edition published by Routledge 2011
Second edition published by Routledge 2017
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library

ISBN: 978-1-032-25258-2 (hbk)

ISBN: 978-1-032-25240-7 (pbk)
ISBN: 978-1-003-28234-1 (ebk)
DOI: 10.4324/9781003282341

Typeset in Sabon
by Apex CoVantage, LLC
Contents

Preface vii
List of abbreviations x

1 Putting breastfeeding into context 1

2 Building relationships 20

3 Anatomy and physiology of lactation 28

4 Essential skills for practice 48

5 Good practice to promote, initiate and support breastfeeding 64

6 Management of common problems 80

7 Supporting mothers with special needs 96

8 Infants with special needs 117

9 Alternative methods of infant feeding when breastfeeding

is not possible 135

10 Introducing solid foods 153

11 Ongoing support for breastfeeding mothers 159

12 Developing knowledge and skills to support breastfeeding

mothers 172

Appendix 1: UNICEF UK Baby Friendly Initiative

University Standards 191
Appendix 2: Nursing and Midwifery Council Standards
for Proficiency for Midwives 195
vi Contents
Appendix 3: UNICEF UK BFI Neonatal Standards 197
Appendix 4: Answers to quizzes and scenarios 199
Glossary 204
References 206
Index 223
Preface

Healthcare professionals’ lack of knowledge and skills to support mothers to breastfeed

their infants has been identified as a major contributing factor to low rates of initiation
and duration of breastfeeding, leading to inconsistent and inaccurate advice (Renfrew
et al., 2005). This is a key public health problem for society and therefore has major
implications for service providers, as well as universities, in relation to how students are
taught about breastfeeding within the pre-registration curriculum and how midwives,
health visitors and other healthcare professionals keep themselves up to date.
Marks and O’Connor (2015) have suggested that midwives are exposed to similar
experiences of breastfeeding and cultural influences, as the mothers they care for, which
may therefore afect professional practice in both positive and negative ways. There have
been a number of studies carried out to identify the reasons for midwives’ lack of knowl-
edge and skill, most of which culminates in recommendations being made to improve
post-registration education related to breastfeeding (Renfrew et al., 2005; McFadden
et al., 2007). However, it was not until the introduction of the UNICEF UK Baby Friendly
Initiative (BFI) Best Practice Standards into Breastfeeding Education for Student Mid-
wives and Health Visitors (UNICEF UK BFI, 2002, updated 2014) and more recently the
UNICEF UK Baby Friendly Initiative University Standards (2019) – (see Appendix 1)
and the explicit inclusion of breastfeeding in the 2019 NMC Standards of proficiency
for midwives – (see Appendix 2) that the focus has moved to pre-registration education.
These initiatives have provided guidance and structure for pre-registration curricula
and for continuous professional development through a structured accreditation process
which includes education of staf.
Renfrew et al. recommended that:

Universities should be fundamental in providing opportunity for pre and post reg-
istration education for all health professionals, perhaps adopting the UNICEF
UK Baby Friendly Standards for Pre-registration Education . . . as a framework,
and developing self-study approaches and close links with clinical areas to enable
supervised practice.
(2005, p. 87)

In January 2022, 36 per cent of midwifery pre-registration programme and 15 per cent of
health visiting programmes had full UNICEF UK Baby Friendly accreditation.
Evidence-based Care for Breastfeeding Mothers: A Resource for Midwives and Allied
Healthcare Professionals is based on the UNICEF UK BFI University Standards, which
were updated in 2019. The standards continue to build on the ‘Ten steps to successful
viii Preface
breastfeeding’, including a number of changes particularly in relation to building strong
mother–baby and family relationships for all. This edition reflects the changes and ad-
dresses the following 5 themes and 16 learning outcomes detailed next to ensure that stu-
dents, midwives, health visitors and other related healthcare professionals are equipped
with essential knowledge and skills to enable them to support breastfeeding mothers
through the application of evidence-based knowledge to clinical situations.

Theme 1: Understanding breastfeeding

1 Have sufcient knowledge of anatomy of the breast and physiology of lactation to
enable them to support mothers to successfully establish and maintain breastfeeding.
2 Understand the importance of human milk and breastfeeding to the health and well-
being outcomes of mothers, babies and the wider family.

Theme 2: Support infant feeding

3 Have an understanding of infant feeding culture within the UK and the various influ-
ences and constraints which impact on women’s infant feeding decisions.
4 Be able to apply their knowledge and understanding of the physiology of lactation to
support women to get breastfeeding of to a good start.
5 Be able to apply their knowledge of physiology and the principle of reciprocity to
support mothers to keep their babies close and respond to their cues for feeding, love
and comfort.
6 Have the knowledge and skills to support mothers and babies to maximise breastmilk
and breastfeeding, to continue to breastfeed for as long as they wish and to introduce
solid foods at an appropriate time.
7 Be able to support parents who formula feed to do so responsively and as safely as
possible.
8 Understand the importance of the WHO International Code of Marketing of Breast-
milk Substitutes and subsequent WHA resolutions (the Code) and how it impacts on
practice.

Theme 3: Support close and loving relationships

9 Develop an understanding of the importance of secure mother-infant attachment and
the impact this has on their health and emotional wellbeing.
10 Be able to apply their knowledge of attachment theory to promote and encourage
close and loving relationships between babies, their mothers and families, irrespective
of their feeding method.

Theme 4: Manage the challenges

11 Be able to apply their knowledge of the physiology of lactation and infant feeding
to support efective management of challenges which may arise at any time during
breastfeeding.
12 Have an understanding of the special circumstances which can afect lactation and
breastfeeding (e.g. when mother and baby are separated, including preterm and sick
infants) and be able to support mothers to overcome the challenges.
 Preface ix
13 Draw on their knowledge and understanding of the wider social, cultural and po-
litical influences which undermine breastfeeding, to promote, support and protect
breastfeeding within their sphere of practice.

Theme 5: Promote positive communication

14 Have an understanding of the principles of efective communication and current
thinking around public health promotion strategies and approaches.
15 Be able to apply their knowledge of efective communication to initiate sensitive, com-
passionate, mother-centred conversations with pregnant women and new mothers.
16 Have the knowledge and skills to access the evidence-based information that under-
pins infant feeding practice and know how to keep up-to-date (e.g. e-alerts, research
summaries).

(Appendix 1 provides a breakdown and further explanation of the components of each

outcome.)
The book begins by putting breastfeeding into its socio-political context, leading to
a chapter focusing on building relationships and responsive feeding. This chapter is fol-
lowed by a chapter outlining the essential knowledge and skills required to promote,
initiate and support breastfeeding mothers in the early days. This leads on to the manage-
ment of common problems and supporting breastfeeding mothers and babies with special
needs, including alternative methods of infant feeding when breastfeeding is not pos-
sible. This is followed by a look at older babies, regarding when and how to commence
weaning, and ongoing support of mothers in the community. The book concludes with
a chapter on developing knowledge and skills to support breastfeeding mothers using a
trauma-informed approach and when required that reasonable adjustments are made to
share information in an understandable way for all mothers.
Each chapter is mapped to the appropriate UNICEF UK BFI (2019a) University Stand-
ards themes and learning outcomes, and the main text is evidence-based, relating the
theory to clinical practice. However, it is evident that in many areas of breastfeeding
management, there is still a lack of robust evidence. Each chapter includes key fact boxes,
clinical activities, diagrams and photographs when appropriate. Each chapter is consoli-
dated with a quiz, scenarios or reflective questions, and answers to these are found at
the end of the book. Useful resources are also listed at the end of each chapter with a
complete reference list and a glossary at the end of the book.
I would like to thank the following for giving permission to reproduce material: Me-
dela, Karen McKay NHS Highland, TIPS Lancet Series- Rollins et al, Oot et al and NHS
Education for Scotland and special thanks to the UNICEF UK BFI.
A special thank you to Tony, Thomas and Andrew for their encouragement through-
out my career and my Mum and Dad for giving me the best start to life.
Maria Pollard
Abbreviations

ABM Association of Breastfeeding Mothers

AED anti-epileptic drug
APGAR appearance, pulse, grimace, activity, respiration (from Apgar, its inventor)
ARV antiretroviral
BAPM British Association of Perinatal Medicine
BFI Baby Friendly Initiative
BFLG Baby Feeding Law Group
BFM Breastfeeding Manifesto
BFN Breastfeeding Network
BMA Baby Milk Action
BMI body mass index
BPA bisphenol-A
DH Department of Health
FIL feedback inhibitor of lactation
FSA Food Standards Agency
FSID Foundation for the Study of Infant Deaths
GP general practitioner
HCV hepatitis C virus
HE higher education
HEAT health improvement, efciency, access, treatment
HPL human placental lactogen
HSE Health and Safety Executive
IBFAN International Baby Food Action Network
IFAS Infant Feeding Attitude Scale
LAM lactational amenorrhoea method
NAS neonatal abstinence syndrome
NCT National Childbirth Trust
NICE National Institute for Health and Clinical Excellence
NMC Nursing and Midwifery Council
PCOS polycystic ovary syndrome
PIF prolactin-inhibiting factor
RCM Royal College of Midwifery
RCOG Royal College of Obstetricians & Gynaecologists
SACN Scientific Advisory Committee on Nutrition
SCBU special care baby unit
SG Scottish Government
 Abbreviations xi
SIDS sudden infant death syndrome
sIgA secretory immunoglobin A
SIGN Scottish Intercollegiate Guidelines Network
SPS Specialist Pharmacy Service
TAMBA Twins and Multiple Births Association
TB tuberculosis
UK United Kingdom
UKAMB United Kingdom Association for Milk Banking
UNICEF United Nations Children’s Fund
WABA World Alliance for Breastfeeding Action
WHA World Health Assembly
WHO World Health Organization
1 Putting breastfeeding into context

• Learning outcomes
• The benefits of breastfeeding
• Economic and environmental factors
• Who breastfeeds?
• UNICEF UK Baby Friendly Initiative
• Global and national strategies
• Breastfeeding in public
• Concluding comments
• Practice questions
• Resources

Breastfeeding cannot be considered as a standalone subject when culture, social support

and healthcare professionals’ knowledge and skills clearly have such a great impact on
initiation and duration of breastfeeding rates in the United Kingdom (UK) (Renfrew et al.,
2005, 2012; Victora et al., 2016; Rollins et al., 2016; Gavine et al., 2016). Breastfeed-
ing must be placed in the wider socio-political context to understand why mothers make
the choices they do with regard to infant feeding and to enable healthcare professionals
to adequately support them in practice. The Lancet Breastfeeding series (Rollins et al.,
2016, p. 492) describes the determinants of breastfeeding, using the conceptual model
in Figure 1.1, which afect women’s breastfeeding decisions and behaviours. In addition,
they highlight that most women are biologically capable of breastfeeding, but breastfeed-
ing practices are afected by historical, socioeconomic, cultural, and individual factors
that must be taken into consideration.
The aim of this chapter is to identify the role breastfeeding has in promoting pub-
lic health and reducing health inequalities for both mother and infant by exploring the
health benefits of breastfeeding and the dangers of not doing so. This chapter also in-
troduces some of the main global, national and local strategies to promote, support and
protect breastfeeding.

DOI: 10.4324/9781003282341-1
2 Putting breastfeeding into context

Determinants Interventions

Structural Sociocultural and market context

Social mobilisation and
mass media

+
Health systems Family and Workplace and
Settings Legislation, policy, financing,
and services community employment
monitoring, and enforcement

Counselling, support, and

Mother and Mother-infant
Individual lactation management
infant attributes relationship

Early Exclusive Continued

initiation breastfeeding breastfeeding

Figure 1.1 The components of an enabling environment for breastfeeding – a conceptual model
Source: Rollins et al. (2016, p. 492).

Mapping to UNICEF UK BFI Education learning outcomes (2019a)

By the end of the programme, students will:

Theme Learning outcomes

Theme 1: Understand 2. Understand the importance of human milk and

breastfeeding breastfeeding to the health and wellbeing outcomes
of mothers, babies and the wider family.
Theme 2: Support infant 3. Have an understanding of infant feeding culture
feeding within the UK and the various influences and
constraints which impact on women’s infant
feeding decisions.
8. Understand the importance of the WHO
International Code of Marketing of Breastmilk
Substitutes and subsequent WHA resolutions (the
Code) and how it impacts on practice.
Theme 4: Manage the 13. Draw on their knowledge and understanding of the
challenges wider social, cultural and political influences which
undermine breastfeeding, to promote, support and
protect breastfeeding within their sphere of practice.
Theme 5: Promote positive 14. Have an understanding of the principles of efective
communication communication and current thinking around public
health promotion strategies and approaches.

Learning outcomes
By the end of this chapter, you will be able to:

• identify the health benefits of breastfeeding for mother and infant;

• recognise the socio-economic characteristics of mothers who choose to breastfeed or not;
 Putting breastfeeding into context 3
• describe the BFI best practice standards for healthcare facilities and education; and
• discuss the importance of global, national and local policies and guidelines to encour-
age and support breastfeeding.

The benefits of breastfeeding

The World Health Organization (WHO, 2021a) recommends exclusive breastfeed-
ing for the first six months of life and to continue for two years and beyond because
breastmilk is perfectly balanced to meet the nutritional needs of newborns and is the
only food required until six months of age. Breastmilk has the advantage of being
readily available, at no cost, and delivered on demand and at the right tempera-
ture, and infants are able to regulate the amount required at each feed. The proper-
ties of breastmilk are exclusive, cannot be replicated by formula milk (see Chapter
3) and confer many benefits on both mother and infant. Despite this, the WHO
(2021a) estimates that only 44 per cent of infants are exclusively breastfed for six
months. It is widely accepted that breastfeeding protects against a range of adverse
health outcomes (Grummer-Strawn and Rollins, 2015) and supports the mother-baby
relationship.
In 2007, Ip et al. conducted a systematic review of the evidence on the efects of
breastfeeding on short- and long-term infant and maternal health in developed coun-
tries. For the infant, they suggested that breastfeeding reduces the risk of diarrhoea
and chest infections, atopic dermatitis and asthma, obesity and type I and II diabetes,
childhood leukaemia, sudden infant death syndrome (SIDS) and necrotising enterocol-
itis (NEC).
There have been a number of studies more recently that support Ip’s conclusions;
the following are a few examples. In a large prospective study of 1,105 children, Silvers
et al. (2012) found that breastfeeding protected against wheezing in children aged 2–6
years. A meta-analysis carried out by Amitay and Keinan-Boker in 2015 found that any
breastfeeding for six months or longer was associated with a lower risk of childhood leu-
kaemia. Colaizy et al. (2016) found that if extremely low birth weight infants were not
being fed breastmilk, they were at increased risk of NEC.
Kramer et al. (2008) suggest a link between intellectual and motor development and
‘dose-related’ breastfeeding. It is thought this could be due to the long-chain polyun-
saturated fatty acids in breastmilk as well as the psychosocial stimulation and bonding
conferred by breastfeeding. WHO (Horta and Victora, 2013) commissioned an update of
the 2007 systematic review (Horta et al., 2007) of the long-term impact of breastfeeding
on health. The evidence from this review could only establish a benefit in the protection
against overweight or obesity and an increase in performance in intelligence tests. Evi-
dence was inconclusive on the protection against high total cholesterol and high blood
pressure, and conflicting results were found on diabetes.
In 2016, the Lancet Series (Victora et al., 2016, and Rollins et al., 2016,.) ana-
lysed data from 28 systematic reviews and meta-analyses asserting that the deaths
of 823,000 children and 20,000 mothers’ breast cancer deaths could be prevented
through universal breastfeeding. They indicated that breastfeeding infants for longer
periods results in lower infectious morbidity, including diarrhoea and respiratory ill-
ness, and mortality, increased protection against child infections and malocclusion,
increases in intelligence and probable reductions in overweight and diabetes in later
life but it did not find associations with allergic disorders such as asthma, blood pres-
sure or cholesterol (Victora et al., 2016). Rollins et al. (2016, p. 1) suggested that ‘not
breastfeeding is associated with lower intelligence and economic losses of about $302
4 Putting breastfeeding into context
billion annually or 0·49 per cent of world gross national income’. Furthermore, they
state that ‘breastfeeding provides short-term and long-term health and economic and
environmental advantages to children, women, and society. To realise these gains, po-
litical support and financial investment are needed to protect, promote, and support
breastfeeding’.
The UK is facing an obesity epidemic that is predicted to increase. The Department
of Health and Social Care (DHSC) (2020) state that 63 per cent of adults are above a
healthy weight, and of them, half are obese; 1:3 children leaving primary school are
overweight, and 1:5 of them are obese. In England between 2006/7 and 2020/21, there
has been a disproportionate increase in obesity in children from low-income homes and
certain ethnicities (Nufeld Trust, 2022):

• Aged 4–5 years from most deprived (12.2 to 19.7 per cent, respectively) and least de-
prived (7.7 to 9.1 per cent, respectively).
• Aged 10–11 years from most deprived (21.5 to 32 per cent, respectively) and least
deprived (13 to 15 per cent, respectively).

Obesity is associated with an increased risk of hypertension, type II diabetes, heart

disease and some cancers. Numerous studies have found that prolonged or dose-related
breastfeeding reduces the risk of obesity and that breastfed children are leaner than those
who were never breastfed (Yan et al., 2014). The Childhood Obesity: A Plan for Action
(DHSC, 2016), updated in 2017, states that overweight and obesity-related conditions
across the UK cost the NHS £6.1 billion each year with almost 900,000 obesity-related
admissions in 2018–19. They suggest a range of initiatives to tackle this crisis, which
includes consultation on a proposal to ‘help parents of young children to make healthier
choices through more honest marketing and labelling of infant foods’ but does not in-
clude breastfeeding or appropriate weaning.
Breastfeeding also confers benefits on the mother by regulating fertility (Wambach and
Riordan, 2016) and reducing the risk of osteoporosis and ovarian and breast cancer in
later life, as well as type II diabetes (Ip et al., 2007; Grummer-Strawn and Rollins, 2015).
Ip et al. (2007) suggest that the protective factors of breastfeeding for mothers are also
dose-related; that is, the longer a mother breastfeeds, the better protection she receives,
particularly for breast cancer. Victora et al. (2016) also found evidence that breastfeeding
can prevent breast cancer and improve birth spacing and may reduce the risk of diabetes
and ovarian cancer. Ip et al. (2007) also suggested that early cessation of breastfeeding or
not breastfeeding at all increases the risk of postnatal depression.
In addition, breastfeeding helps mothers return to their pre-pregnancy weight more
quickly by utilising the fat laid down in pregnancy for energy. Oxytocin, the hormone
involved in the ‘let-down’ reflex, also causes contraction and involution of the uterus.
Breastfeeding immediately following birth assists contraction of the uterus, encouraging
placental separation and resulting in a possible reduction in postpartum blood loss (Al-
mutairi, 2021). A small study of 66 mothers in Sweden conducted by Jonas et al. (2008)
concluded that breastfeeding also reduced both systolic and diastolic maternal blood
pressure within two days of giving birth.
Many mothers are now aware that breastfeeding is associated with these benefits.
Research continues to identify other diseases that breastfeeding may ofer protection
against. For example, in a large study of 1 million women, Liu et al. (2009) identified that
the incidence of gall bladder disease increased by 8 per cent with each birth. However, the
 Putting breastfeeding into context 5
risk was reduced by 7 per cent for each year of breastfeeding. Pikwer et al. (2008) also
suggest that women who breastfed for longer than 13 months were 50 per cent less likely
to develop rheumatoid arthritis than those who had never breastfed and 25 per cent less
likely if they breastfed for 1–12 months.

Economic and environmental factors

As well as being safe and conferring health benefits, breastfeeding is free and environ-
mentally friendly. A UK All-Party Parliamentary Group (APPG, 2018) inquiry into the
financial impact of infant formula milk found that the cost on families was significant.
For a 2–3-month-old infant, this ranged from £6.44–£13.52 per week for powdered milk
and £24.47–£32.20 per week for ready prepared products. The inquiry collected lived
experience evidence from families across the UK in a variety of contexts and reported on
the following themes (APPG, p 2):

• The cost of infant formula significantly impacts on some family budgets.

• Families who cannot aford formula may resort to unsafe practices to feed their babies
(watering down feeds, adding cereal, early introduction of solids or cow’s milk, breast-
feeding when contraindicated; see Chapters 7 and 8).
• The small number of families where breastfeeding is contraindicated and who have
been advised to formula feed may be at particular risk of hardship.

In 2012, Renfrew et al. (2012) were commissioned by UNICEF UK Baby Friendly

Initiative (BFI) to undertake an economic analysis of diseases and conditions preventable
by breastfeeding. Illnesses that were reviewed included breast cancer in the mother, and
gastroenteritis, respiratory infections, middle ear infections and NEC in the baby. They
estimated that there could potentially be a saving of £40 million per year: the authors’
calculations show that moderate increases in breastfeeding could see millions in potential
annual savings to the NHS – and this figure might only be the tip of the iceberg. The re-
port suggested that if half of the mothers who currently do not breastfeed were to do so
for up to 18 months over their lives, there would be 865 fewer cases of breast cancer, with
cost savings to the NHS of over £21 million. If 45 per cent of babies were exclusively
breastfed for four months and if 75 per cent of babies in neonatal units were breastfed at
discharge, each year there would be:

• 3,285 fewer babies hospitalised with gastroenteritis and 10,637 fewer general practi-
tioner (GP) consultations, saving in excess of £3.6 million.
• 5,916 fewer babies hospitalised with respiratory illness and 22,248 fewer GP consul-
tations, saving approximately £6.7 million.
• 21,045 fewer GP visits for ear infection, saving approximately £750,000.
• 361 fewer cases of the potentially fatal disease NEC, saving over £6 million.

The key messages arising from the report were:

• Low breastfeeding rates in the UK lead to an increased incidence of illness that has a
significant cost to the health service.
• Investment in efective services to increase and sustain breastfeeding rates is likely to
provide a return within a few years, possibly as little as one year.
6 Putting breastfeeding into context
• Investing in supporting women to breastfeed will improve the quality of life for women
through the reduction in incidence of breast cancer and for children through reducing
acute and chronic diseases.
• Research into the extent of the burden of disease associated with low breastfeeding
rates is hampered by data collection methods; this can be addressed by investment in
good-quality research.
(Renfrew et al., 2012, p. 7)

Artificial feeding has a larger carbon footprint than breastfeeding. It has significant
detrimental efects on the environment and contributes to global warming through cattle
grazing and the consumption of fossil fuels in the production, distribution, disposal and
waste of formula milk and packaging (WABA, 2005; Linnecar et al., 2014; Palmer, 2017;
Karlsson et al., 2019), for example:

• Production of formula milk leads to deforestation of land required to graze cows,

which also leads to increased sewage polluting rivers and ground water. Cow flatu-
lence leads to approximately 20 per cent of global methane gas, which contributes to
greenhouse gases and global warming.
• Production processes of plastic bottles and teats and other infant feeding equipment
leads to increased carbon dioxide emissions and the plastics themselves contain toxins
such as bisphenol-A (BPA). It is estimated that they can take up to 450 years to break
down in landfill sites.
• Packaging of formula milk involves tins, paper and tetrapaks, most of which is not
recycled.
• Transportation of formula milk and feeding equipment to distributors and transporta-
tion of purchasers to buy the products use valuable resources.

Because breastfeeding is available at source and on demand, it uses none of the re-
sources listed and therefore does not create any pollution. Furthermore, lactational
amenorrhoea in breastfeeding mothers helps reduce family sizes, which improves wom-
en’s health, while reducing the production, distribution, disposal and waste of products
associated with menstruation, such as sanitary towels and tampons.
Oot et al. (2021) criticise the United Nations Food Systems Summit 2021 conceptual
framework of food systems for diets and nutrition because it does not include breastfeed-
ing as the first human food system. They suggest stakeholders must recognise the barriers
to breastfeeding within the food system and that breastfeeding must be recognised as a
critical first food (Figure 1.2).

Who breastfeeds?
Statistics provide healthcare professionals with important information about the charac-
teristics of those who choose to breastfeed and for how long. This information enables
the development of breastfeeding promotion programmes, policies and guidelines at na-
tional and local levels. On an individual level, they also provide healthcare practitioners
with an understanding of the reasons women make the choices they do. The last compre-
hensive UK survey was conducted in 2010. Prior to this, the Infant Feeding Survey was
conducted every five years to provide estimates on the incidence, prevalence and duration
 Aggressive marketing by the commercial formula milk industry has and impact on food
environments, consumer behaviour, and diets.
The commercial formula milk industry has an impact on climate
change with and estimated 4 kgs of greenhouse gases emitted Family-friendly policies, like paid maternity leave, influence consumer
for every kilogram of formula milk produced. behavior and play a key role in supporting breastfeeding practices.

Biophysical and Innovation, technology and Political and Socio-cultural Demographic

environmental drivers infrastructure drivers economic drivers drivers drivers
Natural resource capital Innovation Leadership Globalization and Culture Religions & Population growth
Ecosystem services Technology trade Conflicts and humanitarian rituals Changing age distribution
Climate change Infrastructure crises Food prices and Social traditions Urbanization
volatility Land tenure Women’s empowerment Migration & forced displacement

Food supply chains Food

environments

Production Farmers, indigenous peoples, agribusiness, land Food availability and

physical access (proximity) Nutrition
systems and plantation owners, fisheries, financial entites Consumer Diets
and health
Economic access behaviour
Storage and Transporters, agribusiness, Quantity outcomes
(affordability) Choosing where
distribution distributors Quality
Promotion, advertising and and what food to
acquire, prepare, Diversity
Processing Packing plants, food and beverage information
cook, store and eat Safety Impacts
and pacaging industry, small and medium enterprises Food quality and safety

Putting breastfeeding into context

Retail and Retailers, vendors, food outlet owners, Social
markets traders, restaurateurs, wholesalers Economic
Environmental

Political, programme and institutional actions

Sustainable Development Goals

AVAILABILITY ACCESS UTILIZATION

Figure 1.2 How the commercial milk formula industry and regulatory policies influence breastfeeding and the first food system

7
Source: Oot et al. (2021, p. 4).
8 Putting breastfeeding into context
of breastfeeding; however, the survey was discontinued. Alternative sources of informa-
tion can be found at:

England www.england.nhs.uk/statistics/statistical-work-areas/maternity-and-breastfeeding
Northern Ireland www.niassembly.gov.uk
Scotland https://publichealthscotland.scot
Wales https://statswales.gov.wales/Catalogue/Health-and-Social-Care/NHS-
Primary-and-Community-Activity/Breastfeeding

In 2017, the Scottish Government (SG) conducted the Scottish Maternal and Infant
Nutrition Survey to support the implementation of the Maternal and Infant Nutrition
Framework for Action (2011), which highlighted an increase in breastfeeding rates at
6 months from 32 per cent in 2010 to 43 per cent in 2017. Similar to The Infant Feed-
ing Survey 2010 (McAndrew et al., 2012), the Scottish Maternal and Infant Nutrition
Survey continues to demonstrate evidence of a relationship between breastfeeding and
socio-demographic characteristics and the need to focus support in areas of inequalities.
There were approximately 2,500 responses at each stage of the survey (antenatal, 8–12
weeks postnatal and 8–12 months postnatal). Although it did not fully replicate the UK
Infant Feeding Survey in the question wording, methodology and sampling strategy, it
is useful for comparison. It should also be noted that the demographic profile of women
giving birth in Scotland has changed since 2010, mothers tend to be older.
The Scottish Maternal and Infant Nutrition Survey (SG, 2017) demonstrated

• Three-quarters of respondents to both postnatal surveys had ‘ever’ breastfed and/or

expressed milk for their new baby (75 per cent of the 8–12-week survey and 76 per
cent of the 8–12-month survey).
• More than two-thirds of all respondents (69 per cent) were giving breastmilk to their
babies when they left the maternity unit.
• Three-quarters of respondents (75 per cent) who had stopped giving breastmilk re-
ported that they would have liked to have given breastmilk for longer. The most re-
ported reasons for stopping breastfeeding or expressing milk were feeding problems
(49 per cent), thinking the baby was not getting enough milk (45 per cent) and finding
it ‘too difcult’ (25 per cent).
• Around a quarter of respondents who had stopped breastfeeding or expressing milk
thought that access to certain types of support would have helped and encouraged
them to breastfeed or express milk for longer.
• 80 per cent of those aged 35 years or older stated that they had intended to give
breastmilk (65 per cent breastfeed or express only; 15 per cent mix feed) compared
with 57 per cent of 20–24 years (48 per cent breastfeed or express only; 10 per cent
mix feed).
• Younger respondents were more likely to have expressed an intention to formula feed
only – 35 per cent of respondents aged 20–24 years compared with 15 per cent for
those aged 35 years or older.
• Nearly two-thirds of respondents (65 per cent) who lived in the most deprived areas
had intended to give breastmilk to their babies compared with nearly 82 per cent of
those living in the least deprived areas. More than one in four respondents (28 per
cent) who lived in the most deprived areas intended to formula feed compared with
just over one in ten (12 per cent) who lived in the least deprived areas.
 Putting breastfeeding into context 9
The common situations that lead to early weaning

Early introduction of solid food increases the risk of ill health for infants and is not rec-
ommended until six months of age. Coinciding with changed advice from WHO and the
Department of Health regarding the timing of weaning from four to six months of age, the
Infant Feeding Survey 2010 (McAndrew et al., 2012) identified an improvement in the age
when parents introduced solid foods into their infants’ diet compared with 2005. Nearly
seven in ten (69 per cent) of all mothers in the UK introduced solids after four months,
and nearly all mothers introduced solids by six months (94 per cent, compared with 98
per cent in 2005) with only 5 per cent of mothers introducing solids after six months (2
per cent in 2005), suggesting mothers were not following guidance on weaning after six
months as three-quarters of mothers had already introduced solids by the time their babies
were five months old. McAndrew et al. (2012) also reported that early weaning was as-
sociated with younger age groups of mothers, lower social class groups and lower levels of
education. The Scottish Maternal and Infant Nutrition Survey (SG, 2017) demonstrated
further improvement with 96 per cent of respondents who did not introduce complemen-
tary feeding until their infant was at least four months, of whom 46 per cent waited until
six months or later. Only 3 per cent of respondents reported introducing solid foods before
their babies were four months old compared with 32 per cent in the 2010 survey.
McAndrew et al. (2012) reported that overall, the reasons for weaning were similar
to those in the 2005 survey (Bolling et al., 2007) in which 52 per cent were broadly in-
fluenced by the perception that babies are not satisfied by milk alone (52 per cent). The
Scottish Maternal and Infant Nutrition Survey (SG, 2017) reported a reduction to 30
per cent who chose this response. Other reasons for introducing complementary feeding
before four months and at six months of age or older can be found in Table 1.1:

Table 1.1 Reasons for starting to give complementary foods

(Question asked in survey: Why did you decide to start giving your baby foods other than milk at
this age?)

Reason for introducing food other than milk Age <4 months Age >6 months

Baby not satisfied with milk 70% 14%

Thought it was the right time 59% 63%
Previous experience with other baby 32% 35%
Baby waking up during the night 26% 7%
Partner/friend/relative advised me 17% 8%
Healthcare professional advised me 14% 59%
Baby able to sit up + hold food in hand 13% 52%
Fun First Foods booklet advised 5% 29%
Read leaflets/info that advised me 2% 41%
Baby not gaining enough weight 1% 2%
Other reason 8% 0
Source: SG (2017, p. 133)

The Scottish Maternal and Infant Nutrition Survey (SG, 2017) results are encourag-
ing with a high per centage of respondents taking professional advice and recognising
when the infant is ready at six months, but reasons for introducing solid food before four
months continue to be of concern. In addition, infant food labels continue to recommend
these products as suitable from the age of four months (Crawley and Westland, 2017).
10 Putting breastfeeding into context
As well as family and friends influencing decisions about weaning, understanding dif-
ferent information about introducing solid food can contribute to early weaning. In Eng-
land, the Ofce for Health Improvement and Disparities (OHID, 2022a) commissioned
a survey to inform the launch of the Better Health Start for Life Weaning Campaign
(DHSC, 2022) and found:

• 40 per cent of parents feel unsure as to what age to start introducing solid foods.
• 41 per cent of first-time mothers introduced solid foods by the time their babies were
5 months old even though experts recommend that solid food should be introduced
from the age of 6 months.
• 45 per cent said they found how much food to give their baby confusing.
• 43 per cent found when to progress from certain tastes and textures confusing.
• 64 per cent of parents received conflicting advice on what age to start introducing solid
foods.
• 73 per cent agree that there should be one ofcial source for weaning advice.
• 28 per cent of first-time mothers reported that their mother had the biggest influence
on their decision to start weaning.

Culture also plays an important role. Some ethnic minority mothers introduce solids
by two months of age for similar reasons as stated here but with additional cultural rea-
sons. For example, some mothers thicken breast or formula milk with cornmeal, maize,
cereal, rusks or semolina.
Introducing solid food is discussed further in Chapter 10.

UNICEF UK Baby Friendly Initiative

In 1989 the WHO/UNICEF published Protecting, Promoting and Supporting Breastfeed-
ing: the Special Role of Maternity Services, which included the Ten Steps to Successful
Breastfeeding (WHO/UNICEF, 1989) in response to concerns about hospital practices;
this was the forerunner to the BFI, 1992. The aim of this initiative was to ensure that
pregnant and breastfeeding women had access to high standards of care by supporting
healthcare settings to implement best practice standards. In 1998 the Seven Point Plan
for the Protection, Promotion and Support of Breastfeeding in Community Healthcare
Settings was published, reflecting the Ten Steps, and was later updated in 2008 and re-
named The Seven Point Plan for Sustaining Breastfeeding in the Community. In 2017,
WHO published Protecting, Promoting and Supporting Breastfeeding in Facilities Pro-
viding Maternity and Newborn Services as an update to the 1989 document, continu-
ing to build on the guidance of the Innocenti Declaration on the Protection, Promotion
and Support of Breastfeeding (WHO, 1990) and the Innocenti Declaration 2005 Infant
and Young Child Feeding and was followed by an update of the Ten Steps to Successful
Breastfeeding in 2018 (Table 1.2).
Over the years UNICEF UK BFI have updated the Baby Friendly Standards, building
on the Ten Steps to Successful Breastfeeding and Seven Point Plan for Sustaining Breast-
feeding in the Community. In 2017 they were further updated in line with emerging
evidence to include parent-infant relationships. UNICEF UK BFI provide an accredita-
tion programme for services to demonstrate achievement of the standards to support all
mothers with infant feeding. See Table 1.3 or www.unicef.org.uk/babyfriendlyfor further
detail.
 Putting breastfeeding into context 11
Table 1.2 The Ten Steps

Ten Steps
Critical management procedures
Step 1 a) Comply fully with the International Code of Marketing of Breast-milk
Substitutes and relevant World Health Assembly resolutions.
b) Have a written breastfeeding policy that is routinely communicated to
all healthcare staf.
c) Establish ongoing monitoring and data management systems.
Step 2 Ensure all staf sufcient knowledge, competence and skills to support
breastfeeding.
Key clinical practices
Step 3 Discuss the importance and management of breastfeeding with pregnant
women and families.
Step 4 Facilitate immediate and uninterrupted skin-to-skin contact and support
mothers to initiate breastfeeding as soon as possible after birth.
Step 5 Support mothers to initiate and maintain breastfeeding and manage
common difculties.
Step 6 Do not provide breastfed newborns any food or fluids other than
breastmilk, unless medically indicated.
Step 7 Enable mothers and their infants to remain together and to practise
rooming-in 24 hours a day.
Step 8 Support mothers to recognise and respond to their infants’ cues for feeding.
Step 9 Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
Step 10 Coordinate discharge so that parents and their infants have timely access to
ongoing support and care.
Source: WHO (2018); www.who.int/publications/i/item/9789241550086 (accessed 29 January 2023).

Table 1.3 UNICEF UK Baby Friendly Initiative Standards (2017a)

Building A Firm Foundation

Stage 1 Have written policies and guidelines to support the standards.
Plan an education programme that will allow staf to implement the
standards according to their role.
Have processes for implementing, auditing and evaluating the standards.
Ensure there is no promotion of breastmilk substitutes, bottles, teats or
dummies in any part of the facility or by any of the staf.
Stage 2 An Educated Workforce
Educate staf to implement the standards according to their role and the service
provided.
Stage 3 Parents’ Experiences of Maternity Services
Support pregnant women to recognise the importance of breastfeeding and
early relationships for the health and wellbeing of their baby.
Support all mothers and babies to initiate a close relationship and feeding
soon after birth.
Enable mothers to get breastfeeding of to a good start.
Support mothers to make informed decisions regarding the introduction of
food or fluids other than breastmilk.
Support parents to have a close and loving relationship with their baby.

(Continued)
12 Putting breastfeeding into context
Table 1.3 (Continued)
Parents’ Experiences of Neonatal Units
Support parents to have a close and loving relationship with their baby.
Enable babies to receive breastmilk and to breastfeed when possible.
Value parents as partners in care.
Parents’ Experiences of Health Visiting Services
Support pregnant women to recognise the importance of breastfeeding and
early relationships for the health and wellbeing of the baby.
Enable mothers to continue breastfeeding for as long as they wish.
Support mothers to make informed decisions regarding the introduction of
food or fluids other breastmilk.
Support parents to have a close and loving relationship with their baby.
Parents’ Experiences of Children’s Centres
Support pregnant women to recognise the importance of breastfeeding and
early relationships for the health and wellbeing of their baby.
Protect and support breastfeeding in all areas of the service.
Support parents to have a close and loving relationship with their baby.
Re-accreditation
Embed all the standards to support excellent practice for mothers, babies and
their families.
Source: www.unicef.org.uk/babyfriendly

Breastfeeding remains an important part of establishing strong relationships but is not

the sole aim of the standards; the focus is on communication styles and a mother-centred
approach. Whilst they incorporate the Ten steps to successful breastfeeding, there are a
number of changes particularly in relation to building strong mother-baby-family rela-
tionships for all. Previously debated topics such as skin-to-skin contact and rooming-in
are now part of routine practice, so the new standards reflect a broader approach and
respond to the importance of early care practices.
Implementation of the UNICEF UK BFI best practice standards has been identified as a
way to increase breastfeeding rates (Entwistle, 2013; Rollins et al., 2016; NICE, 2021a) and
has been implemented across the UK. In 2019 Northern Ireland and Scotland had 100 per
cent of births in BFI-accredited hospitals followed by Wales at 78 per cent and England at 58
per cent (www.statista.com). Across the UK this equates to 43 per cent of maternity services;
67 per cent of health visiting services and universities, 36 per cent of midwifery courses and
15 per cent health visitor courses (www.unicef.org.uk/babyfriendly, updated January 2022).
Despite the success of these initiatives, concern has been expressed about the level of
breastfeeding education for students in pre-registration programmes and why it is neces-
sary for employers to provide additional education for registered midwives and health
visitors. This led to the development of the Best Practice Standards for Higher Education
Institutions in 2002, revised in 2014 and more recently in 2019 (UNICEF UK BFI, 2019a).
The new education standards have five themes and 16 learning outcomes (Table 1.4)
to be introduced into the curriculum and successfully achieved at the point of registra-
tion as a midwife or health visitor. The intention is to equip students with the tools to
be able to communicate successfully with mothers, enable and support parents to make
informed choices about infant feeding and build good relationships to give their babies
the best start in life.
 Putting breastfeeding into context 13
Table 1.4 UNICEF UK BFI University learning outcomes (2019a) (further details can be found in
Appendix 1)

Theme Learning outcomes

By the end of the programme, students will:
Theme 1: 1. Have sufcient knowledge of anatomy of the breast
Understanding and physiology of lactation to enable them to support
breastfeeding mothers to successfully establish and maintain
breastfeeding.
2. Understand the importance of human milk and
breastfeeding to the health and wellbeing outcomes of
mothers, babies and the wider family.
Theme 2: Support 3. Have an understanding of infant feeding culture within
infant feeding the UK and the various influences and constraints which
impact on women’s infant feeding decisions.
4. Be able to apply their knowledge and understanding of
the physiology of lactation to support women to get
breastfeeding of to a good start.
5. Be able to apply their knowledge of physiology and the
principle of reciprocity to support mothers to keep their
babies close and respond to their cues for feeding, love
and comfort.
6. Have the knowledge and skills to support mothers and
babies to maximise breastmilk and breastfeeding, to
continue to breastfeed for as long as they wish and to
introduce solid foods at an appropriate time.
7. Be able to support parents who formula feed to do so
responsively and as safely as possible.
8. Understand the importance of the WHO International
Code of Marketing of Breastmilk Substitutes and
subsequent WHA resolutions (the Code) and how it
impacts on practice.
Theme 3: Support 9. Develop an understanding of the importance of secure
close and loving mother-infant attachment and the impact this has on
relationships their health and emotional wellbeing.
10. Be able to apply their knowledge of attachment theory to
promote and encourage close and loving relationships
between babies, their mothers and families, irrespective
of their feeding method.
Theme 4: Managing 11. Be able to apply their knowledge of the physiology
the challenges of lactation and infant feeding to support efective
management of challenges which may arise at any time
during breastfeeding.
12. Have an understanding of the special circumstances which
can afect lactation and breastfeeding (e.g. when mother
and baby are separated, including preterm and sick
infants) and be able to support mothers to overcome the
challenges.
13. Draw on their knowledge and understanding of the wider
social, cultural and political influences which undermine
breastfeeding, to promote, support and protect
breastfeeding within their sphere of practice.
Theme 5: Promote 14. Have an understanding of the principles of efective
positive communication and current thinking around public
communication health promotion strategies and approaches.

(Continued)
14 Putting breastfeeding into context
Table 1.4 (Continued)
Theme Learning outcomes

15. Be able to apply their knowledge of efective

communication to initiate sensitive, compassionate,
mother-centred conversations with pregnant women and
new mothers.
16. Have the knowledge and skills to access the evidence-based
information that underpins infant feeding practice and
know how to keep up-to-date (e.g. e-alerts, research
summaries).
Source: www.unicef.org.uk/babyfriendly

In addition to developing efective communication styles and supporting parents to

develop close and loving relationships, the education standards still include fundamental
and basic knowledge about the normal anatomy of the breast, the physiology of lacta-
tion and the practical skills of breastfeeding, incorporating research-based evidence and
consideration of the psycho-social factors that influence successful breastfeeding.
In a single-site case study in one of the first BFI-accredited pre-registration midwifery
programmes in the UK, Pollard (2010) stated that student midwives reported feeling theo-
retically prepared for practice-based placements for their level of education and graduates
of the programme also reported feeling confident at the point of registration to support
and advise breastfeeding mothers. She also found that the accreditation process promoted
a consistent approach to teaching and learning strategies, as well as content, within the
curriculum. Furthermore, students believed it enhanced their employability prospects.

Global and national strategies

The WHO Code

The WHO (1981) developed the International Code of Marketing of Breast-milk Substi-
tutes, known as the ‘Code’, to protect and promote breastfeeding and ensure the proper
use of breastmilk substitutes. It is a World Health Assembly (WHA) resolution aimed at
tackling a global health problem. Some of the requirements are:

• All formula milk labels should state the benefits of breastfeeding and the risks of for-
mula feeding.
• There should be no promotion of breastmilk substitutes (this includes follow-on formu-
las and any solid foods or drinks sold for infants younger than the age of six months).
• No free samples of breastmilk substitutes are to be given to pregnant women.
• No free samples or subsidised substitutes are to be given to health workers or health-
care facilities.
• There should be no gifts for healthcare workers.
• Labels on products should not idealise formula feeding and should be written in an
appropriate language.
• All information for healthcare workers should be factual and scientific.

It has been suggested that the Code removes choice from mothers, but instead the
Code aims to improve choice by ensuring that advertising provides factual informa-
tion for mothers on which to base their choices rather than biased information to sell
 Putting breastfeeding into context 15
a product. Although formula milk companies state on their products that breast milk
is best, they do not provide information on the dangers of not breastfeeding. They also
use persuasive language to suggest that formula milk is as ‘good’ as breastmilk when
this is not possible.
The aim of adhering to the Code is to provide mothers with evidence-based informa-
tion so they can make an informed choice about infant feeding and to protect against
misleading marketing. Marketing activities of artificial milk companies and hospital
practices have been identified as major reasons for the decline in breastfeeding. It is im-
portant that healthcare professionals do not accept gifts or samples from formula milk
companies (which often include pens, diary covers, calendars and obstetric calculators),
as these products are part of the marketing strategy, and accepting them suggests that
healthcare professionals are endorsing the product.
However, if a mother chooses to formula feed her infant, all healthcare professionals
should be equipped with up-to-date, factual and scientific information about the artificial
milks available. Material available in healthcare journals is often intended for marketing
purposes and therefore does not give all the facts. Healthcare workers must be objective
when supporting mothers with formula feeding, should ensure information provided is
evidence-based and should not promote one brand over another (NMC, 2015).
The Code was not fully adopted by the UK in law; instead, the government passed
the 1995 Infant Formula and Follow-on Formula Regulations. In 2007, the UK Minister
for Public Health established a review of the Infant Formula and Follow-on Formula
Regulations to reduce the confusion for parents between infant formula during the first
months of life and follow-on formula for infants aged six months and older. They made
the following recommendations:

• Manufacturers should make changes to advertising to make it clear that follow-on

formula is intended for infants older than six months by clearly representing the age
of the infants in the adverts.
• Any problems encountered with the enforcement of the regulations should be ad-
dressed accordingly.

In 2020 regulations governing the composition and marketing of infant milks changed
and manufacturers of infant formula, follow-on formula and infant milks marketed as
foods for special medical purposes must comply. To date the UK only includes some of
the Code and does not cover inappropriate marketing of foods for use before age six
months even though the introduction of solid food is recommended from six months of
age (DHSC, 2022). There continues to be no regulations for the composition, marketing
and or labelling of milks marketed for children older than 12 months of age (‘growing
up’ or ‘toddler’ milks). Further detail can be accessed at www.bflg-uk.org.
Despite this, many healthcare settings that work to promote, protect and support
breastfeeding and reduce inappropriate breastmilk substitute marketing have adopted
the Code as part of their professional standards. Other professional and lay organisations
have done the same, for example:

• UNICEF UK Baby Friendly Initiative.

• Baby Milk Action (BMA).
• International Baby Food Action Network (IBFAN).
• Breastfeeding Manifesto (BFM).
• Baby Feeding Law Group (BFLG, n.d.).
16 Putting breastfeeding into context
In February 2023 The Lancet launched a series on breastfeeding focusing on the power,
reach and influence of commercial milk formula marketing practices. The three arti-
cles (Baker et al., 2023; Pérez-Escamilla et al., 2023; Rollins et al., 2023) explore how
normal infant feeding behaviours are framed as a reason to introduce formula milk
by formula milk companies playing on mothers’, families’ and professionals’ concerns
(such as insufcient breastmilk, crying, fussiness and poor sleep) and confidence, un-
dermining breastfeeding. The authors demonstrate a lack of evidence and unsubstan-
tiated claims by manufacturers on the benefits of formula milk as well as the impact
of the promotion of progression formula milk or products targeted at small babies
that builds brand loyalty but negatively impacts on lifelong health and development
and undermines the International Code of Breastmilk Substitutes. Instead of using the
term ‘breastmilk substitute’, the authors use the term ‘commercial milk formula’ to
clarify formula milk is artificial and a processed product to avoid the misconception
that there is equivalence. They describe the increase in sales of formula milk across the
world and the influence of marketing strategies on family health, policy and how it has
changed the infant feeding ‘ecosystem’. The authors identify breastfeeding success as a
collective responsibility, not just the responsibility of the mother, and is dependent on
multifaceted policy and society response. They call for governments to take action to
address the imbalance in power between commercial interests and the needs and health
of mothers and infants. A video of the launch of The Lancet series can be found on the
WHO’s website (www.who.int).

The Innocenti Declaration

The Innocenti Declaration on the Protection, Promotion and Support of Breastfeed-

ing (WHO, 1990) was developed by WHO and UNICEF policy makers in 1990 and
adopted in the UK and many other countries. It acknowledged the importance of exclu-
sive breastfeeding for the first six months of life and its continuance thereafter along-
side the introduction of solid foods. At the time it was apparent that there needed to
be a change in some countries away from a bottle-feeding culture to a breastfeeding
culture, which could only be achieved by removing obstacles to breastfeeding within
healthcare systems, the workplace and society in general and, in doing so, increasing
women’s confidence in their ability to breastfeed. The declaration made the following
recommendations:

• Women should be adequately nourished.

• Women should have access to family planning services to increase birth intervals and
improve their health.
• All governments should develop a national breastfeeding policy and set appropriate
targets that can be monitored.
• Breastfeeding policies should be integrated into other health and development policies.
• All governments should train healthcare staf to be able to implement the policies.
• National breastfeeding advisers should be appointed.
• Healthcare facilities should adhere to the WHO/UNICEF Ten Steps to Successful
Breastfeeding.
• All governments should take cognisance of the International Code of Marketing of
Breast-milk Substitutes and the WHA resolutions.
• All governments should enact legislation to protect breastfeeding mothers.
 Putting breastfeeding into context 17

Activity
It is interesting to see how far the UK has come since the Innocenti Declaration in
1990. Identify some of the more recent and relevant policy documents that have
recognised the need to promote breastfeeding to reduce health inequalities in your
country of practice.

The UNICEF UK BFI (2016a) put out a call for action for the UK and devolved gov-
ernments in UK to implement four key actions:

1 Develop a National Infant Feeding Board in each of the four nations to develop a Na-
tional Infant Feeding Strategy and implementation plan.
2 Include actions to promote, protect and support breastfeeding in all policy areas where
breastfeeding has an impact.
3 Implement evidence-based initiatives that support breastfeeding including UNICEF
UK BFI across all maternity, health visiting, neonatal and children’s centre services.
4 Protect the public from harmful commercial interests by adopting the Code.

The following year The Global Breastfeeding Collective (2017), a WHO and UNICEF
initiative, identified seven policy action priorities with an indicator and target to be
achieved by 2030 at national and global levels:

1 Funding: Increase investment in programmes that promote, protect and support

breastfeeding.
2 Fully implement the Code with legislation and efective enforcement.
3 Maternity protection in the workplace: Provide paid maternity leave and workplace
policies.
4 Implement the Ten Steps to Successful Breastfeeding in maternity facilities.
5 Improve access to skilled breastfeeding counselling in healthcare facilities.
6 Develop community support programmes.
7 Use monitoring systems to track progress on policies, programmes and funding.

Activity
Locate your local breastfeeding strategy and critically evaluate it to see if it reflects
the 2017 UNICEF UK BFI standards.

• Have local breastfeeding targets been set?

• How are breastfeeding rates monitored?

Breastfeeding in public
Women have consistently reported negative attitudes and sometimes abuse directed at
them when breastfeeding in public, and on occasion they have been removed from public
18 Putting breastfeeding into context
areas or transport. In 2005, The Breastfeeding (Scotland) Act was passed, which made
it an ofence to prevent a person feeding milk by bottle or breast to an infant in a public
place where the infant is legally entitled to be. Milk referred to breast, formula or cow’s
milk. Anyone who deliberately prevents a child being breast or bottle fed is guilty of an
ofence that could result in a fine. It was also intended that the Act would encourage, sup-
port and promote breastfeeding in Scotland by addressing negative attitudes.
Following this, in April 2009, the UK government presented an Equality Bill propos-
ing that it was unlawful to prevent a woman from breastfeeding her baby in public. It
was referred to as ‘maternity’ discrimination, which caused some confusion initially as
this may only relate to six months before or after the birth and would therefore possibly
not legally protect mothers breastfeeding for six months and beyond. It was amended to
clarify that it meant mothers breastfeeding at any time (The Equality Act, 2010).
Despite legislation, the Scottish Maternal and Infant Nutrition Survey (SG, 2017)
found 3 per cent of respondents reported being asked not to breastfeed or stop breast-
feeding in a variety places, including NHS facilities.

Concluding comments
It is clear from the evidence that breastfeeding is essential in reducing health inequali-
ties in mothers and infants in the UK. Despite this, mothers continue to face barriers
that either discourage them from commencing breastfeeding or lead to early cessation of
breastfeeding. Healthcare professionals need to be aware of the challenges mothers face
in society and be equipped with the knowledge and skills to support them to overcome
these barriers and confidently provide consistent information to manage these challenges
as they arise. There is a wealth of information available to both mothers and healthcare
professionals today, particularly online, and access is now available to most people. De-
veloping knowledge and skills to support breastfeeding mothers is discussed further in
Chapter 12.

Practice questions
1 In your area of practice, how and when do you inform mothers about the ben-
efits of breastfeeding and the dangers of not breastfeeding?
2 Are there services targeted at the socio-economic characteristics of mothers in
your area of practice? How do women find out about available services?
3 Go back and read the Ten Steps in Table 1.2 and the BFI Standards in Table 1.3.
Are these standards implemented in your area of practice? If not, why not?
4 In relation to marketing of formula milk, does your area of practice comply with
the WHO Code? How do you find out about new information on formula milk,
and how do you share it with mothers?
5 Has your university integrated the UNICEF UK BFI university learning out-
comes (see Table 1.3) into pre-registration programmes?
6 If yes, what diference do you think this has made to your practice?
7 If no, what advantages do you think accreditation would bring to the pro-
grammes and to practice?
 Putting breastfeeding into context 19

Resources
• Baby Feeding Law Group (BFLG, n.d.)
www.bflg-uk.org/
• Baby Milk Action (BMA)
www.babymilkaction.org/
• Healthy Start
www.healthystart.nhs.uk/
• UNICEF UK Baby Friendly Initiative
www.unicef.org.uk/babyfriendly/
References
Abedi, P. , Jahanfar, S. , Namvar, F. , . (2016) Breastfeeding or nipple stimulation for reducing postpartum
haemorrhage in the third stage of labour, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD010845.pub2 (accessed 18 January 2023)
Adamson, J. (2004) Implementing informed choice on infant feeding, British Journal of Midwifery, 12(9):
586–690
Adsit, J. and Hewlings, S. (2022) Impact of bariatric surgery on breastfeeding: A systematic review, Surgery
for Obesity and Related Diseases, 18 (1): 117–122
The All-Party Parliamentary Group on Infant Feeding & Inequalities (APPG) (2018) Inquiry into the Cost of
Infant Formula in the United Kingdom. Available online at www.infantfeedingappg.uk/ (accessed 1 October
2022)
Alm, B. , Wennergren, G. , Möllberg, H. , . (2015) Breastfeeding and dummy use have a protective effect on
sudden infant death syndrome, Acta Paediatrica, 105(1): 31–38
Almutairi, W. (2021) Review literature review: Physiological management for preventing postpartum
hemorrhage, Healthcare, 9(658): 1–11
Almutairi, W. , Ludington, S. , Quinn Griffin, M. ,. (2020) The role of skin-to skin contact and breastfeeding on
atonic postpartum hemorrhage, Nursing Reports, 11: 1–11
Aloysius, A. and Lozano, S. (2007) Provision of nipple shields to preterm infants on a neonatal unit: A survey
of current practice, MIDIRS Midwifery Digest, 17(3): 419–522
Amitay, E.L. and Keinan-Boker, L. (2015) Breastfeeding and childhood leukaemia incidence: A meta-
analysis and systematic review, JAMA Pediatrics, 169(6): e151025–e151025. Available online at
http://archpedi.jamanetwork.com/article.aspx?articleid=2299705 (accessed 9 October 2022)
Anderson, J. , Held, N. and Wright, K. (2004) Raynaud’s phenomenon of the nipple: A treatable cause of
nipple pain, Pediatrics, 113(4): 360–364
Asztalos, E. , . (2019) Role of days post-delivery on breast milk production: A secondary analysis for the
EMPOWER trial, International Breastfeeding Journal, 14(21). Available online at
https://doi.org/10.1186%2Fs13006-019-0215-z (accessed 19 October 2022)
Avici, M. , Sanlikan, F. , Celik, M. , . (2014) Effects of maternal obesity on antenatal, peri-natal and neonatal
outcomes, The Journal of Maternal-Fetal & Neonatal Medicine, 28(17): 2080–2083
Baby Feeding Law Group-UK (n.d.) Current UK Laws. Available online at www.bflg-uk.org/ (accessed 9
October 2022)
Baker, P. , Smith, J. , Garde, A. , . (2023) The political economy of infant and young child feeding:
Confronting corporate power, overcoming structural barriers, and accelerating progress, The Lancet,
401(10375): 503–524
Ball, H. (2002) Reasons to bed-share: Why parents sleep with their infants, Journal of Reproductive and
Infant Psychology, 20(4): 207–321
Ball, H. (2003) Breastfeeding, bed-sharing, and infant sleep, Birth, 30(3): 181–188
Ball, H. (2009) Bed-sharing and co-sleeping, Perspective NCT, 5: 10–12
Ball, H. , Howel, D. , Bryant, A. , . (2016) Bed-sharing by breastfeeding mothers: Who bed-shares and what
is the relationship with breastfeeding duration? Acta Paediatrica, 105: 628–634
Ball, H. , Ward-Platt, M. , Heslop, E. , . (2006) Randomised trial of infant sleep location on the postnatal
ward, Archive of Disease in Childhood, 91(12): 1005–1010
Ballard, O. and Morrow, A. (2013) Human milk composition: Nutrients and bioactive factors, Pediatric Clinics
of North America, 60(1): 49–74. Available online at www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783
(accessed 9 October 2022)
Balogun, O. , O'Sullivan, E. , McFadden, A. , . (2016) Interventions for promoting the initiation of
breastfeeding, Cochrane Database of Systematic Review. Available online at
https://doi.org/10.1002/14651858.CD001688.pub3 (accessed 28 January 2023)
Banta-Wright, S. , Shelton, K. , Lowe, N. , . (2012) Breast-feeding success among infants with
phenylketonuria, Journal of Paediatric Nursing, 27(4): 319–327
Barrett, M. , Heller, M. , Fullerton Stone, H. , . (2013) Raynaud phenomenon of the nipple in breastfeeding
mothers, JAMA Dermatology, 149(3): 300–306
Battersby, S. (2014) The role of the midwife in breastfeeding: Dichotomies and dissonance, British Journal of
Midwifery, 22(8): 551–556
Baxter, J. (2006) Women’s experience of infant feeding following birth by caesarean section, British Journal
of Midwifery, 14(5): 290–295
Beake, S. , Pellowe, C. , Dykes, F. , . (2011) A Systematic review of structured compared with non-
structured breastfeeding programmes to support the initiation and duration of exclusive and any
breastfeeding in acute and primary health care settings, Maternal and Child Nutrition, 8: 141–161
Bergman, J. and Bergman, N. (2014) Whose choice? Advocating birthing practices according to baby’s
biological needs, The Journal of Perinatal Education, 22(1): 8–13
Bergman, N. (2019) Birth Practices: Maternal-Neonate Separation as a Source of Toxic Stress, Birth Defects
Research. Available Online at www.kangaroula.com/wp-content/uploads/2020/02/Bergman-2019-separation-
source-toxic-stress.pdf (accessed 16 October 2022)
Bergman, N. , Linley, L. and Fawcus, S. (2004) Randomised control trial of skin-to-skin contact from birth
versus conventional incubator for physiological stabilisation in 1200–2199 gram newborns, Acta Paediatrica,
93(6): 779–885
Bergman, N. , Ludwig, R. , Westrup, B. , . (2019) Nurturescience versus neuroscience: A case for rethinking
mother-infant behaviours and relationship, Birth Defects Research, 1–18
Berlo, D.K. (1960) The Process of Communication, New York: Holt, Rinehart and Winston
Berry, C. , Thomas, E. , Piper, K. , . (2007) The histology and cytology of the human mammary gland and
breastmilk, in T. Hale and P. Hartman (eds) Textbook of Human Lactation, Amarillo, TX: Hale Publishing.
35–47
Biloš, L. (2017) Polycystic ovarian syndrome and low milk supply: Is insulin resistance the missing link?
Endocrine Oncology & Metabolism, 3(2): 49–55
Blair, P. , Sidebotham, P. , Evason-Coombe, C. , . (2009) Hazardous co-sleeping environments and risk
factors amenable to change: Case-control study of SIDS in Southwest England, British Medical Journal, 339:
3666. Available online at www.bmj.com/content/339/bmj.b3666.full (accessed 9 October 2022)
Blixt, I. , Johansson, M. , Hildingsson, I. , . (2019) Women’s advice to healthcare professionals regarding
breastfeeding: ‘Offer sensitive individualized breastfeeding support’ – an interview study, International
Breastfeeding Journal, 14(1): 51–51
Bolling, K. , Grant, C. , Hamlyn, B. , . (2007) Infant Feeding Survey 2005, London: The Information Centre
Bompy, L. , Gerenton, B. , Chrisofari, S. , . (2019) Impact of breastfeeding according to implant features in
breast augmentation: A multicentric retrospective study, Annals of Plastic Surgery, 82(1): 11–14
Bortoli, J. and Amir, L. (2021) Is onset of lactation delayed in women with diabetes in pregnancy? A
systematic review, Diabetic Medicine, 33(1): 17–24
Boswell, N. (2021) Complimentary feeding methods: A review of the benefits and risk, International Journal
of Environmental Research and Public Health, 18(13): 7165
Boud, D. , Keogh, R. and Walker, D. (eds) (1985) Reflection: Turning Experience into Learning, London:
Kogan Page
Bowlby, J. (1982) Attachment and Loss. Vol. 1: Attachment (2nd edn), New York: Basic Books
Breastfeeding Network (BFN) (2014) Breastfeeding if You Are on the Autistic Spectrum. Available online at
www.breastfeedingnetwork.org.uk/breastfeeding-on-autistic-spectrum/ (accessed 11 December 2022)
Breastfeeding Network (BFN) (2019a) Expressing and Storing Breast Milk. Available online at
https://www.breastfeedingnetwork.org.uk/ (accessed 9 October 2022)
Breastfeeding Network (BFN) (2019b) Creams and Ointments Applied to the Skin of Breastfeeding Mothers.
Available online at www.breastfeedingnetwork.org.uk/creams/ (accessed 9 October 2022)
Breastfeeding Network (BFN) (2019c) Smoking, Smoking Cessation and Breastfeeding. Available online at
www.breastfeedingnetwork.org.uk (accessed 9 October 2022).
Breastfeeding Network (BFN) (2019d) Increasing Milk Supply- Use of Galactagogues. Available online at
www.breastfeedingnetwork.org.uk (accessed 18 October 2022)
Breastfeeding Network (BFN) (2020) Thrush and Breastfeeding. Available online at
https://www.breastfeedingnetwork.org.uk (accessed 9 October 2022)
Breastfeeding Network (BFN) (2021) Alcohol and Breastfeeding. Available online at www.breast-
feedingnetwork.org.uk (accessed 9 October 2022)
Breastfeeding Network (BFN) (2022) Mastitis and Breastfeeding. Available online at www.breast-
feedingnetwork.org.uk (accessed 12 January 2023)
Bridges, N. (2016) The faces of breastfeeding support: Experiences of mothers seeking breastfeeding
support online, Breastfeeding Review, 24(1): 11–20
British Association of Perinatal Medicine (BAPM) (2017) Identification and Management of Neonatal
Hypoglycaemia in the Full Term Infant: A BAPM Framework for Practice. Available online at www.bapm.org
(accessed 16 October 2022)
British Association of Perinatal Medicine (BAPM) (2022) Covid-19 Pandemic Frequently Asked Questions
Within Neonatal Services. Available online www.bapm.org (accessed 14 January 2023)
Buckley, K. (2009) A double-edged sword: Lactation consultants’ perceptions of the impact of breast pumps
on the practice of breastfeeding, Journal of Perinatal Education, 18(2): 13–22
Caldwell, K. , Turner-Maffei, C. , Blair, A. , . (2004) Pain reduction and treatment of sore nipples in nursing
mothers, Journal of Perinatal Education, 13(1): 29–35
Campbell-Yeo, M. , Disher, T. , Benoit, B. , . (2015) Understanding kangaroo care and its benefits to preterm
infants, Paediatric Health Medicine, 6: 15–32
Care Quality Commission (CQC) (2022) Experiences of Being in Hospital for People with Learning Disability
and Autistic People. Available Online at www.cqc.org.uk (accessed 13 November 2022)
Carper, B.A. (1978) Fundamental patterns of knowing in nursing, Advances in Nursing Science, 1(1): 13–23
Cawse-Lucas, J. , Waterman, S. and Leilani, A. (2015) Does frenotomy help infants with tongue-tie
overcome breastfeeding difficulties? Journal of Family Practice, 64(2): 126–127
Channell Doig, A. , Jasczynski, M. , Fleishman, J.L. , . (2020) Breastfeeding among mothers who have
experienced childhood maltreatment: A review, Journal of Human Lactation, 36(4): 710–722
Charpak, N. , Gabriel Ruiz, J. , Zupan, J. , . (2005) Kangaroo mother care: 25 years after, Acta Paediatrica,
94(5): 514–522
Chertok, I. (2009) Re-examination of ultra-thin nipple shield use, infant growth and maternal satisfaction,
Journal of Clinical Nursing, 18(21): 2049–2155
Chertok, I. , Raz, I. , Shoham, I. , . (2009) Effects of early breastfeeding on neonatal glucose levels of term
infants born to women with gestational diabetes, Journal of Human Nutrition and Dietetics, 22(2): 166–169
Coentro, V. , Perrella, S. , Lai, C. , . (2021) Impact of nipple shield use on milk transfer and maternal nipple
pain, Breastfeeding Medicine, 16(3): 222–229
Colaizy, T. , Bartick, M. , Jeiger, B. , . (2016) Impact of optimised breastfeeding on the costs of necrotizing
enterocolitis in extremely low birthweight infants, Journal of Pediatrics, 175: 100–105
Colson, S. (2015) Biological Nurturing: Laid Back Breastfeeding. Available online at
www.biologicalnurturing.com/our-beliefs/ (accessed 9 October 2022)
Conde-Agudelo, A. and Díaz-Rossello, J. (2016) Kangaroo mother care to reduce morbidity and mortality in
low birthweight infants, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD002771.pub4 (accessed 19 January 2023)
Coppa, G. , Bruni, S. , Morelli, L. , . (2004) The first prebiotics in humans: Human milk oligosaccharides,
Journal of Clinical Gastroenterology, 38: 80–83
Cox, D. , Owens, R. and Hartmann, P. (1996) Blood and milk prolactin and the rate of milk synthesis in
women, Experimental Physiology, 81: 1007–1120
Crawley, H. and Westland, S. (2017) Baby Foods in the UK A Review of Commercially Produced Jars and
Pouches of Baby Foods Marketed in the UK, London: First Steps Nutrition Trust
Cregan, M. , Mitoulas, L. and Hartmann, P. (2002) Milk prolactin, feed volume and duration between feeds in
women breastfeeding their full-term infants over a 24h period, Experimental Physiology, 87(2): 207–214.
Available online at http://onlinelibrary.wiley.com/doi/10.1113/eph8702327/epdf (accessed 6 January 2023)
Crepinsek, M. , Taylor, E. , Michener, K. , . (2020) Interventions for preventing mastitis after childbirth,
Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD007239.pub4 (accessed 8 January 2023)
Czank, C. , Henderson, J. , Kent, J. , . (2007a) Hormonal control of the lactation cycle, in T. Hale and P.
Hartmann (eds) Textbook of Human Lactation, Amarillo, TX: Hale Publishing. 89–112
Czank, C. , Mitoulas, L.R. and Hartmann, P. (2007b) Human milk composition: Fat, in T. Hale and P.
Hartmann (eds) Textbook of Human Lactation, Amarillo, TX: Hale Publishing. 49–68
D'Andrea, M. and Spatz, D. (2019) Maintaining breastfeeding during severe infant and maternal HSV-1
infection: A case report, Journal of Human Lactation, 35(4). Available online at https://doi-
org.knowledge.idm.oclc.org/10.1177/0890334419830994 (accessed 13 January 2023)
Dayal, D. , Soni, V. , Jayaraman, D. , . (2016) Cultural gynecomastia in the 21st century India: ‘Witch’s milk
revisited’. Pediatria Polska 91: 472–475
Dennis, C. , Jackson, K. and Watson, J. (2014) Interventions for treating painful nipples among
breastfeeding women, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD007366.pub2 (accessed 12 January 2023)
Department of Health and Social Care (DHSC) (2016) Childhood Obesity: A Plan for Action. Available online
at www.gov.uk (accessed 1 October 2022)
Department of Health and Social Care (DHSC) (2017) Drug Misuse and Dependence: UK Guidelines on
Clinical Management. Available online at www.gov.uk (accessed 15 January 2023)
Department of Health and Social Care (DHSC) (2020) Tackling Obesity: Empowering Adults and Children to
Live Healthier Lives. Available online at www.gov.uk (accessed 1 October 2022)
Department of Health and Social Care (DHSC) (2022) New Campaign Promotes Advice to Introduce Babies
to Solid Food. Available online at www.gov.uk (accessed 9 October 2022)
Dewey, K. , Nommsen-Rivers, L. and Heinig, J. (2005) Risk factors for suboptimal infant breast-feeding
behaviour, delayed onset of lactogenesis, and excessive neonatal weight loss, Pediatrics, 112: 607–619
Dickens, V. (2008) Learning on the job: Influences on the initiation and duration of breastfeeding, MIDIRS
Midwifery Digest, 18(2): 243–247
Dixon, K. , Ferris, R. , Marikar, D. , . (2017) Definition and monitoring of neonatal hypoglycaemia: A
nationwide survey of NHS England neonatal units, Archives of Disease in Childhood, 102(1): 92–93
Dogan, E. , Yilmaz, C. , Turgut, M. , . (2018) Baby-led complementary feeding: Randomised controlled study,
Pediatrics International, 60(12): 1073–1080
Dorea, J. (2007) Maternal smoking and infant feeding: Breastfeeding is better and safer, Maternal and Child
Health, 11: 287–391
Doughty, K. and Taylor, S. (2021) Barriers and benefits to breastfeeding with gestational diabetes, Seminars
in Perinatology, 45(2). Available online at https://doi-
org.knowledge.idm.oclc.org/10.1016/j.semperi.2020.151385 (accessed 12 January 2023)
Douglas, P. (2022) Re-thinking benign inflammation of the lactating breast: Classification, prevention and
management, Women’s Health, 18. Available online at https://doi.org/10.1177/17455057221091349
(accessed 13 January 2023)
Dryden, C. , Young, D ., Hepburn, M. , . (2009) Maternal methadone use in pregnancy: Factors associated
with the development of neonatal abstinence syndrome and implications for health-care resources, British
Journal of Obstetrics and Gynaecology, 116: 665–671
Dykes, F. (2003) Protecting and supporting breastfeeding, British Journal of Midwifery, 11(10): 24–48
Dyson, L. , Renfrew, M. , McFadden, A. , . (2006) Promotion of Initiation and Duration of Breastfeeding:
Evidence into Practice Briefing, London: NICE
Eagen-Torkko, M. , Low, L. , Zielinski, R. , . (2017) Prevalence and predictors of breastfeeding after
childhood abuse, Journal of Obstetric, Gynecologic, & Neonatal Nursing, 46(3): 465–479
East, C. , Dolan, W. and Forster, D. (2014) Antenatal breast milk expression by women with diabetes for
improving infant outcomes, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD010408.pub2 (accessed 15 January 2023)
Eglash, A. (2014) Treatment of maternal hypergalactia, Breastfeeding Medicine, 9(9): 423–425
Employment Rights Act (1996) London: HMSO. Available online at
https://www.legislation.gov.uk/ukpga/1996/18/contents (accessed 16 April 2023)
Entwistle, F. (2013) The Evidence and Rationale for the UNICEF UK Baby Friendly Initiative Standards,
London: UNICEF Baby Friendly UK Equality Act (2010) London: HMSO. Available online at
https://www.legislation.gov.uk/ukpga/2010/15/contents (accessed 13 April 2023)
Fangupo, L. , Heath, A. , Williams, S. , . (2016) A baby-led approach to eating solids and risk of choking,
Pediatrics, 138(4): e20160772
Fawcett, J. , Watson, J. , Neuman, B. , . (2001) On nursing theories and evidence, Journal of Nursing
Scholarship, 33: 115–119. Available online at https://doi.org/10.1111/j.1547-5069.2001.00115.x (accessed
24 January 2023)
Finigan, V. (2009) ‘It’s on the tip of my tongue’: Evaluation of a new frenulotomy service in northern England,
MIDIRS Midwifery Digest, 19(3): 395–400
Fitzgerald, E. , Hor, K. and Drake, A. (2020) Maternal influences on fetal brain development: The role of
nutrition, infection and stress, and the potential for intergenerational consequences, Early Human
Development, 50. Available online at www.sciencedirect.com/science/article/pii/S0378378220306514
(accessed 9 October 2022)
Flint, A. , New, K. and Davies, M. (2016) Cup feeding versus other forms of supplemental enteral feeding for
newborn infants unable to fully breastfeed, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD005092.pub3 (accessed 22 January 2023)
Food Standards Agency (FSA) (2013) Committee on Toxicity of Chemicals in Food, Consumer Products and
the Environment. Available online at https://cot.food.gov.uk/sites/default/files/cot/tox201315.pdf (accessed 22
January 2023)
Food Standards Agency (FSA) (2018) An Investigation into the Attitudes and Behaviours of Consumers and
Caregivers in the Preparation, Handling and Storage and Feeding of Powdered Infant Formula Inside and
Outside the Home. Available online at www.food.gov.uk/ (accessed 28 October 2022)
Food Standards Agency (FSA) (2021) Committee on Toxicity of Chemicals in Food, Consumer Products and
the Environment. Overarching Statement on Consumption of Plant-based Drinks in Children Aged 6 Months
to 5 Years. Available online at https://cot.food.gov.uk/2021-statementsandpositionpapers (accessed 28
October 2022)
Foong, S. , Marasco, L. , Ho, J. , . (2020) Oral galactagogues (natural therapies or drugs) for increasing
breastmilk production in mothers of non-hospitalised term infants,Cochrane Database of Systematic
Reviews. Available online at https://doi.org/10.1002/14651858.CD011505.pub2 (accessed 18 October 2022)
Forster, D. , Moorhead, A. , Jacobs, S. , . (2017) Advising women with diabetes in pregnancy to express
breastmilk in late pregnancy (diabetes and antenatal milk expressing [DAME]): A multi-centre, unblinded,
randomised control trial, Lancet, 389: 2204–2213
Foster, J. , Psaila, K. and Patterson, T. (2016) Non-nutritive sucking for increasing physiologic stability and
nutrition in preterm infants, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD001071.pub3 (accessed 19 January 2022)
Frazier, D. , Allgeier, C. , Homer, C. , . (2014) Nutrition management guideline for maple syrup urine disease:
An evidence- and consensus-based approach, Molecular Genetics and Metabolism, 112(3): 210–217
Gavine, A. , MacGillivray, S. , Renfrew, M. , . (2016) Education and training of healthcare staff in the
knowledge, attitudes and skills needed to work effectively with breastfeeding women: A systematic review,
International Breastfeeding Journal, 12 (6). Available online at
www.ncbi.nlm.nih.gov/pmc/articles/PMC5288894 (accessed 9 October 2022)
Gavine, A. , Shimwell ., Bucchan, P. , . (2022) Support for healthy breastfeeding mothers with healthy term
babies, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD001141.pub6 (accessed 4 January 2023)
Geddes, D. (2007a) Inside the lactating breast: The latest anatomy research, Journal of Midwifery and
Women’s Health, 52(6): 556–663
Geddes, D. (2007b) Gross anatomy of the lactating breast, in T. Hale and P. Hartmann (eds) Textbook of
Human Lactation, Amarillo, TX: Hale Publishing. 19–34
Geddes, D. , Gridneva, Z. , Perella, S. , . (2021) 25 Years of research in human lactation: From discovery to
translation, Nutrients, 8 (12). Available online at www.mdpi.com/2072-6643/13/9/3071/htm (accessed 10
October 2022)
Geddes, D. , Langton, D. and Gallow, I. (2008) Frenulotomy for breastfeeding infants with ankyloglossia:
Effect on milk removal and sucking mechanism as imaged by ultrasound, Pediatrics, 122(1): 188–294
Gibbs, G. (1998) Learning by Doing: A Guide to Teaching and Learning Methods, London: Further Education
Unit
Giglia, R. , Binns, C. and Alfonso, H. (2006) Maternal cigarette smoking and breastfeeding duration, Acta
Paediatrica, 95: 1370–1374
The Global Breastfeeding Collective (2017) Global Breastfeeding Scorecard, The Global Breast-feeding
Collective. Available online at www.globalbreastfeedingcollective.org/ (accessed 9 October 2022)
Graignic-Philippe, R. , Dayan, J. , Chokron, S. , . (2014) Effects of prenatal stress on fetal and child
development: A critical literature review, Neuroscience & Biobehavioral Reviews, 43: 137–162
Gray, J. (2001) Evidence-Based Health Care (2nd edn), London: Churchill Livingstone.
Gregson, S. , Meadows, J. , Teakle, P. , . (2016) Skin-to-skin contact after elective caesarean section:
Investigating the effect on breastfeeding rates. British Journal of Midwifery, 24(1): 18–25
Grove, S. , Gray, J. and Burns, N. (2014) Understanding Nursing Research: Building an Evidence-Based
Practice (6th edn), Missouri: Elsevier Saunders.
Grummer-Strawn, L. and Rollins, N. (2015) Summarising the health effects of breastfeeding, ACTA
Paediatrica, 104 (S467): 1–2
Güemes, M. , Rahman, S. and Hussain, K. (2016) What is normal blood glucose? Archives of Disease in
Childhood, 101 (6): 569–574
Habron, J. , Booley, S. , Najaar, B. , . (2013) Responsive feeding: Establishing healthy eating behaviour
early on in life, South African Journal of Clinical Nutrition, 26(3): 141–149
Hake-Brooks, S. and Anderson, G. (2008) Kangaroo care and breastfeeding of mother – preterm infant
dyads 0–18 months: A randomised controlled trial, Neonatal Network, 27: 151–159
Han, S. and Hong, Y. (1999) The inverted nipple: Its grading and surgical correction, Plastic Reconstructive
Surgery, 104: 389–395
Handlin, L. , Jonas, W. , Peterson, M. , . (2009) Effects of sucking and skin-to-skin contact on maternal
ACTH and cortisol levels during the second day postpartum: influence of epidural analgesia and oxytocin in
the perinatal period, Breastfeed Med, 4(4): 207–220
Harding, C. (2009) An evaluation of the benefits of non-nutritive sucking for premature infants as described
in the literature, Archives of Disease in Childhood, 94(8): 636–740
Hartmann, P. and Ramsay, D. (2006) Mammary anatomy and physiology, in E. Jones and C. King (eds)
Feeding and Nutrition in the Preterm Infant, London: Elsevier
Heath, H. (1998) Reflection and patterns of knowing in nursing, Journal of Advanced Nursing, 27:
1054–1059
Henderson, J. , Hartmann, P. and Newham, J. (2008) Effects of preterm birth and antenatal corticosteroid
treatment on lactogenesis II in women, Pediatrics, 121: 92–100
Henry, L. and Britz, S. (2013) Loss of blood= loss of breastmilk? The effect of postpartum hemorrhage on
breastfeeding success, Journal of Obstetric, Gynecological & Neonatal Nursing, 42 (1). Available online at
https://doi.org/10.1111/1552-6909.12198 (accessed 18 January 2023)
Hepatitis B Foundation (2020) Pregnancy and Hepatitis B. Available online at www.hepb.org (accessed 29
January 2023)
Herron, M. , Sinclair, M. , Kernohan, W.G. , . (2015) Tapping into authentic presence: Key components
arising from a concept analysis of online breastfeeding support, Evidence Based Midwifery, 13(3): 76–83
Hersh, C. , Sorbo, J. , Moreno, J. , . (2022) Aspiration does not mean the end of breastfeeding relationship,
International Journal of Pediatric Otorhinolaryngology, 161. Available online
https://doi.org/10.1016/j.ijporl.2022.111263 (accessed 25 October 2022)
Hewitt, H. (2008) Peer influence, MIDIRS Midwifery Digest, 18(2): 260–262
Hilton, S. (2008) Milk production during pregnancy and beyond, British Journal of Midwifery, 16(8): 544–548
Hogan, M. , Westcott, C. and Griffiths, M. (2005) Randomised control trial of division of tongue-tie in infants
with feeding problems, Journal of Paediatrics and Child Health, 41(5–6): 246–350
Homeyard, C. and Patelarou, E. (2018) To what extent are midwives adapting antenatal information for
pregnant women with intellectual disabilities? A survey of NHS trusts in England, Public Health, 158: 25–30
Horta, B. , Matrinés, J. , Victora, C. , . (2007) Evidence on the Long-Term Effects of Breastfeeding, Geneva:
WHO
Horta, B. and Victora, C. (2013) Long-Term Effects of Breastfeeding: A Systematic Review, Geneva: WHO
Howatson-Jones, L. (2016) Reflective Practice in Nursing, London: Sage Publications
Hurley, K. , Cross, M. and Hughes, S. (2011) A systematic review of responsive feeding and child obesity in
high-income countries, Journal of Nutrition, 141(3): 1–7
Hurst, N. (2007) Recognising and treating delayed or failed lactogenesis II, Journal of Midwifery & Women’s
Health, 52(6): 588–694
Ingram, J. , Johnson, D. and Condon, L. (2011) The effects of Baby Friendly Initiative training on
breastfeeding attitudes, knowledge and self-efficacy of community healthcare staff, Primary Health Care
Research & Development, 12: 266–275
Ingram, J. , Thomson, G. , Johnson, D. , . (2020) Women’s and peer supporters’ experiences of an assets-
based peer support intervention for increasing breastfeeding initiation and continuation: A qualitative study,
Health Expectations, 23 (3): 622–631
Inherited Metabolic Disorders in Scotland (IMD Scotland) (2017) Metabolic Conditions. Available online at
www.imd.scot.nhs.uk (accessed 25 October 2022)
Ip, S. , Raman, G. , Chew, P. , . (2007) Breastfeeding and Maternal Health Outcomes in Developed
Countries: Evidence Report/Technology Assessment No. 153, Agency for Healthcare Research and Quality.
Available online at http://archive.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf (accessed 9 October
2022)
Islam, M. (2016) Why are ‘hard-to-reach’ women not engaging in breastfeeding support programmes?
Community Practitioner, 89(2): 36–41
Iyer, N. , Srinivasan, R. , Evans, K. , . (2008) Impact of early weighing policy on neonatal hypernatraemic
dehydration and breastfeeding, Archives of Childhood Disease, 93(4): 297–299
Jaafar, S. , Ho, J. , Jahanfar, S. , . (2016a) Effect of restricted pacifier use in breastfeeding term infants for
increasing duration of breastfeeding, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD007202.pub4 (accessed 22 January 2023)
Jaafar, S. , Ho, J. and Lee, K. (2016b) Rooming-in for new mother and infant versus separate care for
increasing the duration of breastfeeding, Cochrane Library, Cochrane Database of Systematic Reviews.
Available online at https://doi.org/10.1002/14651858.CD006641.pub3 (accessed 29 January 2023)
Jackson, W. (2004) Breastfeeding and type 1 diabetes mellitus, British Journal of Midwifery, 12(3): 158–265
Jambert-Gray, R. , Lucas, K. and Hall, V. (2009) Methadone-treated mothers: Pregnancy and breastfeeding,
British Journal of Midwifery, 17(10): 654–657
Januszewski, A. (2001) Educational Technology: The Development of a Concept, Santa Barbara, CA:
Libraries Unlimited Inc
Joham, A. , Nanayakkara, N. , Ranasinha, S. , . (2016) Obesity, polycystic ovary syndrome and
breastfeeding: An observational study, Acta Obstetrica et Gynecologica Scandinavica, 95 (4): 458–466.
Available online at https://doi.org/10.1111/aogs.12850 (accessed 18 January 2023)
Johns, C. (1995) Framing learning through reflection within Carper’s fundamental ways of knowing in
nursing, Journal of Advanced Nursing, 22: 226–334
Johnson, C. , . (2021) Supporting women with learning disabilities in infant feeding decisions: A scoping
review, Maternal & Child Nutrition, 18: e13318
Johnston, C. , Filion, F. and Campbell-Yeo, M. (2008) Kangaroo mother care diminishes pain from heel
lance in very preterm infants: A cross-over trial, MIDIRS Midwifery Digest, 18(4): 574–575
Jonas, W. , Nissen, E. , Ransjö-Arvidson, A. , . (2008) Short- and long-term decrease of blood pressure in
women during breastfeeding, Breastfeed Medicine, 3: 103–109
Jones, E. and Spencer, S. (2008) Optimising the provision of human milk in preterm infants, MIDIRS
Midwifery Digest, 18(1): 118–221
Karlsson, J. , Garnett, T. , Rollins, N. , . (2019) The carbon footprint of breastmilk substitutes in comparison
with breastmilk, Journal of Cleaner Production, 222: 436–445
Katz, J. , Lee, A. and Kozuki, N. (2013) Mortality risk in preterm and small-for-gestational-age infants in low-
income and middle-income countries: A pooled country analysis, The Lancet, 382(9890): 417–525
Kaunonen, M. , Hannula, L. and Tarkka, M.J. (2012) A systematic review of peer support interventions for
breastfeeding, Journal of Clinical Nursing, 21: 1943–1954
Keely, A. , Lawton, J. , Swanson, V. , . (2015) Barriers to breastfeeding in obese women: A qualitative
exploration, Midwifery, 31 (5): 532–539
Kendall-Tackett, K. (2017) Why trauma-informed care needs to be the standard of care for IB CLCs, Clinical
Lactation, 8 (4): 150–152
Kent, J. (2007) How breastfeeding works, Journal of Midwifery & Women’s Health, 52(6): 564–670
Kent, J. , Ashton, E. , Hardwick, C. , . (2015) Nipple pain in breastfeeding mothers: Incidence, causes and
treatments, International Journal of Environmental Research and Public Health, 12 (10): 12247–12263
Kent, J. , Gardner, H. and Geddes, D. (2016) Breastmilk production in the first 4 weeks after birth of term
infants, Nutrients, 8 (12): 756
Kent, J. , Mitoulas, L. , Cregan, M. , . (2006) Volume and frequency of breastfeeding and fat content of
breastmilk throughout the day, Pediatrics, 117(3): 387–395
Kent, J. , Mitoulas, L. , Cregan, M. , . (2008) Importance of vacuum for breastmilk expression, Breastfeed
Medicine, 3: 11–19
Khajehei, M. , Doherty, M. , Tilley, P.J. , . (2015) Prevalence and risk factors of sexual dysfunction in
postpartum Australian women, The Journal of Sexual Medicine, 12 (6): 1415–1426
Kim, S. and Yi, D. (2020) Components of human breast milk: From macronutrient to microbiome and
microRNA, Pediatrics, 63 (8): 301–309
Knight, C. , Peaker, M. and Wilde, C. (1998) Local control of mammary development and function, Reviews
of Reproduction, 3: 104–212
Kramer, M. , Aboud, F. and Mironova, E. (2008) Breastfeeding and child cognitive development: New
evidence from a large randomised trial, Archives of General Psychiatry, 65: 578–684
Krogstad, P. , Contreras, D. , Ng, H. , . (2022) No infectious SARS-CoV-2 in breast milk from a cohort of 110
lactating women, Pediatric Research, 92: 1140–1145
Kronborg, H. , Vaeth, M. , Olsen, O. , . (2007) Health visitors and breastfeeding support: Influence of
knowledge and self-efficacy, European Journal of Public Health, 18(3): 283–288
Kruger, E. , Kritzinger, A. and Pottas, L. (2019) Oropharyngeal dysplasia in breastfeeding neonates with
hypoxic-ischaemic encephalopathy on therapeutic hypothermia, Breastfeed Med, 14 (10): 718–723
Ladhani, S. , Srinivasan, L. , Buchanan, C. , . (2004) Presentation of vitamin D deficiency, Archives of
Disease in Childhood, 89: 781–784
Law, C. , Wolfenden, L. , Sperlich, M. , . (2021) A Good Practice Guide to Support Implementation of
Trauma-informed Care in the Perinatal Period, Blackpool: The Centre for Early Child Development
Letourneau, N. , Waton, B. , Duffet-Legger, L. , . (2011) Cortisol patterns of depressed mothers and their
infants are related to maternal – infant interactive behaviours, Journal of Reproductive and Infant
Psychology, 29(5): 439–459
Levene, M. , Tudehope, D. and Sinha, S. (2008) Essential Neonatal Medicine (4th edn), London: Blackwell
LGBT Foundation (2022) Trans and Non-Binary Experiences of Maternity Services. Available online at
www.lgbt.foundation/ (accessed 15 July 2022)
Li, L. , Wan, W. and Zhu, C. (2021) Breastfeeding after a caesarean section: A literature review, Midwifery,
103. Available online at https://doi.org/10.1016/j.midw.2021.103117 (accessed 29 November 2022)
Linnecar, A. , Gupta, A. , Dadhich, J. , . (2014) Formula for Disaster: Weighing the Impact of Formula
Feeding vs Breastfeeding on Environment, Delhi: BPNI/IBFAN
Liu, B. , Beral, V. and Balkwall, A. (2009) Childbearing, breastfeeding, other reproductive factors and the
subsequent risk of hospitalization for gallbladder disease, International Journal of Epidemiology, 38(1):
312–318. Available online at http://ije.oxfordjournals.org/content/early/2008/09/04/ije.dyn174.short (accessed
9 October 2022)
Livingstone, V. (1996) Too much of a good thing: Maternal and infant hyperlactation syndromes, Canadian
Family Physician, 42: 89–99
Livingstone, V. , Willis, C. , Abdel-Wareth, L. , . (2000) Neonatal hypernatraemic dehydration, Canadian
Medical Association Journal, 162(5): 647–652
Lommens, A. , Brown, B. and Hollist, D. (2013) Experiential perceptions of relactation. A phenomenological
study, Journal of Human Lactation, 21(3): 109–112
Lubbe, W. and ten Ham-Baloyi, W. (2017) When is the use of pacifiers justifiable in the baby-friendly hospital
initiative context? A clinician’s guide, BMC Pregnancy & Childbirth, 17: 130
Lubbers, C. (1990) Communication skills for continuing education in nursing, Journal of Continuing
Education in Nursing, 21(3): 109–212
Lullaby Trust (2022) How to Reduce the Risk of SIDS. Available online at www.lullabytrust.org.uk (accessed
29 January 2023)
Lumbiganon, P. , Martis, R. , Laopaiboon, M. , . (2016) Antenatal breastfeeding education for increasing
breastfeeding duration, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD006425.pub4 (accessed 5 January 2023)
Mansoori, M. and Salmani, N. (2020) Effect of breast milk expression during kangaroo mother care on milk
volume in mothers with premature infants admitted to neonatal intensive care unit, Evidence Based Care
Journal, 10 (1): 44–50
Marks, D. and O'Connor, R. (2015) Health professionals’ attitudes towards the promotion of breastfeeding,
British Journal of Midwifery, 23(1): 854–962
Martin, C. , Ling, P.R. and Blackburn, G. (2016) Review of infant feeding: Key features of breast-milk and
infant formula, Nutrients, 8 (5): 279
Martyn, T. (2003) Infant feeding, Midwives, 6(5): 215
Matthiesen, A. , Ransjö-Arvidson, A. , Nissen, E. , . (2001) Postpartum maternal oxytocin release by
newborns: effects of infant hand massage and sucking, Birth, 28(1): 20–21
McAndrew, F. , Thomson, J. , Fellows, L. , . (2012) Infant Feeding Survey 2010, Leeds: Health and Social
Care Information Centre
McCrory, F. and Richens, Y. (2007) Pregnancy, parenting and substance misuse, in Y. Richens (ed)
Challenges for Midwives Volume II, London: Quay Books. 201–213
McFadden, A. , Renfrew, M.J. , Wallace, L. , . (2007) Does breastfeeding really matter? A National
multidisciplinary breastfeeding knowledge and skills assessment, MIDIRS Midwifery Digest, 17(1): 85–88
McGrath, J. and Braescu, A. (2004) State of the science feeding readiness in the preterm infant, Journal of
Perinatal and Neonatal Nursing, 18(4): 353–470
McInnes, R. and Chambers, J. (2006) Breastfeeding in Neonatal Units: A Review of Breast-feeding
Publications between 1990–2005, Edinburgh: NHS Health Scotland/Scottish Executive.
McInnes, R. and Chambers, J. (2008a) Infants admitted to neonatal units – interventions to improve
breastfeeding outcomes: A systematic review 1990–2007, Maternal and Child Health, 4: 235–363
McInnes, R. and Chambers, J. (2008b) Supporting breastfeeding mothers: Qualitative synthesis, Journal of
Advanced Nursing, 62(4): 407–527
McKinney, C. , Glass, R. and Coffey, P. (2016) Feeding neonates by cup: A systematic review of the
literature, Maternal and Child Health Journal, 20(8): 1620–1633
Mencap (2022) How Common is Learning Disability? Available Online at www.mencap.org.uk/learning-
disability-explained (accessed 13 November 2022)
Menella, J. and Pepino, M. (2008) Biphasic effects of moderate drinking on prolactin during lactation,
Alcoholism: Clinical and Experimental Research, 32(11): 1899–1908
Mitchell, J. , Jones, W. , Winkley, E. , . (2020) Guideline on anaesthesia and sedation in breast-feeding
women, Anaesthesia, 75 (11): 1482–1493
Moberg, K. (2003) The Oxytocin Factor: Tapping the Hormone of Calm, Loving and Healing, Cambridge,
MA: Da Capo Press
Mohd Hassan, S. , Sulaiman, Z. and Tengku Ismail, T. (2021) Experienced of women who underwent
induced lactation: A literature review, Malaysian Family Physician, 16 (1): 18–30
Moore, E. , Anderson, G. , Bergman, N. , . (2012) Early skin-to-skin contact for mothers and their healthy
newborn infants, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD003519.pub3 (accessed 19 January 2023)
Moore, E. , Anderson, G. , Bergman, N. , . (2016) Early skin-to-skin contact for mothers and their healthy
newborn infants, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD003519.pub4 (accessed 5 January 2023)
Moser, K. , Whittle, C. and Hicks, C. (2003) Social inequalities in low birth weight in England and Wales:
Trends and implications for future population health, Journal of Epidemiology and Community Health, 57:
687–791
Napierala, M. , Mazela, J. , Merritt, T. , . (2016) Tobacco smoking and breastfeeding: Effect on the lactation
process, breast milk composition and infant development. A critical review, Environmental Research, 151:
321–338
National Institute for Health and Clinical Excellence (NICE) (2010) Donor Milk Banks: Nice Clinical Guideline
CG93. Available online at www.nice.org.uk/guidance/cg93 (accessed 22 January 2023)
National Institute for Health and Clinical Excellence (NICE) (2011) Division of Ankyloglossia (Tongue-Tie) for
Breastfeeding (Shared Learning Database), London: NICE
National Institute for Health and Clinical Excellence (NICE) (2016) Jaundice in the Newborn, London: NICE
National Institute for Health and Clinical Excellence (NICE) (2017) Faltering Growth: Recognition and
Management of Faltering Growth in Children: Nice Clinical Guideline 75, London: NICE
National Institute for Health and Clinical Excellence (NICE) (2018a) Social and Emotional Well-being: Early
Years (updated from 2012), London: NICE
National Institute for Health and Clinical Excellence (NICE) (2018b) Faltering Growth: Weight Loss in the
First Few Days after Birth, London: NICE. Available online at https://cks.nice.org.uk/topics/faltering-
growth/management/weight-loss-in-the-first-few-days-after-birth/ (accessed 29 November 2022)
National Institute for Health and Clinical Excellence (NICE) (2021a) Postnatal Care, NCGUNI CEUNICEF
194, London: NICE
National Institute for Health and Clinical Excellence (NICE) (2021b) Mastitis and Breast Abscess. Available
online at https://cks.nice.org.uk/topics/mastitis-breast-abscess/management/management-lactating-women
(accessed 9 October 2022)
National Institute for Health and Clinical Excellence (NICE) (2022a) Scenario: Breastfeeding Problems-
Management. Available online at Scenario: Breastfeeding problems – management | Management |
Breastfeeding problems | CKS | NICE (accessed 12 January 2023)
National Institute for Health and Clinical Excellence (NICE) (2022b) Epilepsy. Available online at
https://bnf.nice.org.uk/treatment-summaries/epilepsy (accessed 18 January 2023)
National Institute on Drug Abuse (NIDA) (2020) Substance Use While Pregnant and Breastfeeding. Available
online at www.drugabuse.gov/publications/research-reports/substance-use-in-women/substance-use-while-
pregnant-breastfeeding (accessed 9 October 2022)
NHS (2018) Drinks and Cups for Babies and Young Children. Available online at www.nhs.uk (accessed 18
September 2022)
NHS (2019a) Types of Formula. Available online at www.nhs.uk (accessed 18 September 2022)
NHS (2019b) Weaning and Feeding. Available online at www.nhs.uk (accessed 8 August 2022)
NHS (2020) Vitamin D: Vitamins and Minerals. Available online at www.nhs.uk/ (accessed 27 October 2022)
NHS (2022) Breastfeeding and Drinking Alcohol. Available online at www.nhs.uk/ (accessed 15 January
2023)
NHS Health Scotland (2016) Breastfeeding and Returning to Work, Edinburgh: Health Scotland
Nickell, W. and Skelton, J. (2005) Breast fat and fallacies, Journal of Human Lactation, 21(2): 126–230
Nissen, E. , Uvnas-Moberg, K. , Svensson, K. , . (1996) Different patterns of oxytocin, prolactin but not
cortisol release during breastfeeding in women delivered by Caesarean section or by the vaginal route, Early
Human Development, 45: 103–118
Noble, L. and Rosen-Carole, C. (2022) Breastfeeding infants with problems, in R. Lawrence and R.
Lawrence (eds) Breastfeeding: A Guide for the Medical Profession (9th edn), Philadelphia: Elsevier
Nommsen-Rivers, L. , Heinig, M. , Cohen, R. , . (2008) Newborn wet and soiled diaper counts and timing of
onset of lactation as indicators of breastfeeding inadequacy, Journal of Human Lactation, 24: 27–33.
Nuffield Trust (2022) Evidence for Better Health. Available online at
www.nuffieldtrust.org.uk/resource/obesity (accessed 1 October 2022)
Nursing and Midwifery Council (NMC) (2015) The Code: Professional Standards of Practice and Behaviour
for Nurses and Midwives (Updated 2018), London: NMC
Nursing and Midwifery Council (NMC) (2018) Future Nurse: Standards of Proficiency for Registered Nurses,
London: NMC
Nursing and Midwifery Council (NMC) (2019) Standards of Proficiency for Midwives, London: NMC
O'Brien, M. , Buikstra, E. , Fallon, T. , . (2009) Strategies for success: A toolbox of coping strategies used by
breastfeeding women, Journal of Clinical Nursing, 18: 1574–1582
Office for Health Improvement Disparities (OHID) (2022a) Better Health Start for Life Weaning Campaign.
London: OHID
Office for Health Improvement Disparities (OHID) (2022b) Small Area Associations between Breastfeeding
and Obesity, London: OHID
Oot, L. , Mason, F. and Lapping, K. (2021) The first food system: The importance of breastfeeding in global
systems discussions. Global Policy Brief. Available online at http://resource-
centreuploads.s3.amazonaws.com/uploads/sc_fhi_solutions_alivethrive_breastfeeding_and_food_systems_
brief.pdf (accessed 29 May 2022)
Osborn, D. and Sinn, J. (2013) Prebiotics in infants for prevention of allergy, Cochrane Database of
Systematic Reviews. Available online at https://doi.org/10.1002/14651858.CD006474.pub3 (accessed 27
October 2022)
O'Shea, J. , Foster, J. , O'Donnell, C. , . (2017) Frenotomy for tongue-tie in newborn infants, Cochrane
Database of Systematic Reviews. Available online at https://doi.org/10.1002/14651858.CD011065.pub2
(accessed 27 October 2022)
Osman, A. , Celik, M. and Samanci, S. (2021) Evaluation of term newborn patients with hypernatremic
dehydration, Turkish Archives of Pediatrics, 56 (4): 344–349
Paley, J. , Cheyne, H. , Dalgleish, L. , . (2007) Nursing’s ways of knowing and dual process theories of
cognition, Journal of Advanced Nursing, 60(6): 692–701
Palmer, G. (2017) Why the of Politics Breastfeeding Matter, London: Pinter and Martin
Parahoo, K. (2014) Nursing Research: Principles, Process and Issues (3rd edn), Basingstoke: Pal-grave
MacMillan
Parker, L. , Sullivan., Mueller, M. , . (2012) Effect of early breast milk expression on milk volume and timing
of lactogenesis stage II among mothers of very low birth weight infants: A pilot study, Journal of
Perinatology, 32: 205–209
Penny, F. , Judge, M. , Brownell, E. , . (2018) Cup feeding as a supplemental, alternative feeding method for
preterm breastfed infants: An integrative review, Maternal and Child Health Journal, 22: 1568–1579
Pérez-Escamilla, R. , Tomori, C. , Hernández-Cordero, S. , . (2023) Breastfeeding: Crucially important, but
increasingly challenged in a market-driven world, The Lancet, 401 (10375): 472–485
Pikwer, M. , Bergström, U. , Nilsson, J. , . (2008) Breastfeeding, but not oral contraceptives, is associated
with a reduced risk of rheumatoid arthritis, Annals of the Rheumatic Diseases, 68: 526–530. Available online
at http://ard.bmj.com/content/early/2008/05/13/ard.2007.084707.abstract (accessed 27 October 2022)
Pollard, M. (2010) Learning about Breastfeeding in a Baby Friendly Accredited Pre-Registration Midwifery
Programme, unpublished EdD thesis, University of Strathclyde
Pollard, M. (2023 in press) The breasts and lactation, in: J. Rankin (ed) Physiology in Childbearing (4th edn),
London: Elsevier
Preusting, I. , Brumley, J. and Louis, J. (2017) Obesity as a predictor of delayed lactogenesis ll, Journal of
Human Lactation, 33 (4), 684–691
Price, E. , Weaver, G. , Hoffman, P. , . (2016) Decontamination of breast pump milk collection kits and
related items at home and in hospital: Guidance from a joint working group of the healthcare infection society
and infection prevention society. Journal of Hospital Infection, 92: 213–221
Prior, V. and Glaser, D. (2006) Understanding Attachment and Attachment Disorders: Theory, Evidence and
Practice, London: Jessica Kingsley Publishers
Public Health Agency (PHA) (2022) Off to a Good Start, Belfast: PHA
Public Health England (PHE) (2019) Pregnancy and Tuberculosis. Information for Clinicians, London: PHE
Public Health Scotland (PHS) (2021) Formula Feeding. How to Feed Your Baby Safely. Available online at
www.healthscotland.com/ (accessed 28 October 2022)
Public Health Scotland (PHS) (2022) Fun First Foods. Available online at www.healthscotland.com/
(accessed 28 October 2022)
Quigley, M. , Embleton, N. and McGuire, W. (2019) Formula versus donor breast milk for feeding preterm or
low birth weight infants, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD002971.pub5 (accessed 22 January 2023)
Raina, A. and Preston, N. (2014) Human immunodeficiency virus and infant feeding, Infant, 10(1): 5–8
Ramsay, D. , Kent, J. , Hartmann, R. , . (2005) Anatomy of the lactating breast redefined with ultrasound
imaging, Journal of Anatomy, 206(6): 525–534
Rapley, G. (2008) Baby-led Weaning. Available online at www.rapleyweaning.com/leaflets.php (accessed 22
January 2023)
Rapley, G. (2011) Baby-led weaning: Transitioning to solid foods at baby’s own pace, Community
Practitioner, 84(6): 20–23
Rasmussen, K. and Kjolhede, C. (2004) Pre-pregnant overweight and obesity diminish the prolactin
response to suckling in the first week postpartum, Pediatrics, 113: 465–571.
RCPCH UK-WHO (2013) UK-WHO Growth Charts-0–4 Years. Available online at
www.rcpch.ac.uk/resources/uk-who-growth-charts-0-4-years (accessed 1 May 2022)
Regan, S. and Brown, A. (2019) Experiences of online breastfeeding support: Support and reassurance
versus judgement and misinformation, Maternal & Child Nutrition, 15: e12874. Available online at
https://doi.org/10.1111/mcn.12874 (accessed 1 January 2023)
Renfrew, M. , Ansell, P. and MacLeod, K. (2003) Formula feed preparation – helping reduce the risks: A
systematic review, Archives of Disease in Childhood, 88(10): 855–858
Renfrew, M. , Dyson, L. , McCormick, E. , . (2009) Breastfeeding promotion for infants in neonatal units: A
systematic review, Child: Care, Health and Development, 36(2): 165–178
Renfrew, M. , Dyson, L. , Wallace, L. , . (2005) The Effectiveness of Public Health Interventions to Promote
the Duration of Breastfeeding: Systematic Review, London: NICE
Renfrew, M. , McLoughlin, M. and McFadden, A. (2008) Cleaning and sterilisation of infant feeding
equipment: A systematic review, Public Health Nutrition, 11(11): 1188–1199
Renfrew, M. , Pokhrel, S. , Quigley, M. , . (2012) Preventing Disease and Saving Resources: The Potential
Contribution of Increasing Breastfeeding Rates in the UK, London: UNICEF UK. Available online at The
Baby Friendly Initiative | Resources | Preventing disease and saving resources (unicef.org.uk) (accessed 1
October 2022)
Renfrew, M. , Woolridge, M. and McGill, H. (2000) Enabling Women to Breastfeed: A Review of Practices
Which Promote or Inhibit Breastfeeding – With Evidence-Based Guidance for Practice, London: The
Stationery Office
Riddle, S. and Nommsen-Rivers, L. (2016) A case control study of diabetes during pregnancy and low milk
supply, Breastfeed Med, 11 (2): 80–85
Roller, C. (2005) Getting to know mothers’ experiences of kangaroo care, Journal of Obstetrics,
Gynaecology and Neonatal Nursing, 34: 210–217
Rollins, N. , Bhandari, N. , Hajeebhoy, N. , . (2016) Why invest and what will it take to improve breastfeeding
practices? The Lancet, 387 (10017), 491–504
Rollins, N. , Piwoz, E. , Baker., P. , . (2023) Marketing of commercial milk formula: A system to capture
parents, communities, science, and policy, The Lancet, 401 (10375): 486–502
Rollnick, S. , Miller, W. and Butler, C. (2008) Motivational Interviewing in Healthcare; Helping Patients
Change Behaviour, New York: The Guildford Press
Rosenthal, P. (2014) Another explanation for breast milk jaundice, The Journal of Pediatrics, 165 (1): 10–11
Royal College of Midwives (RCM) (2009) Infant Feeding: A Resource for Health Care Professionals and
Parents, London: RCM Trust
Royal College of Midwives (RCM) (2020) Parental Emotional Wellbeing and Infant Development, London:
RCM
Royal College of Obstetricians and Gynaecologist (RCOG) (2018) Care of Women with Obesity in
Pregnancy (Green Top Guideline No. 72). Available online at www.rcog.org.uk (accessed 19 January 2023)
Royal College of Obstetricians and Gynaecologist (RCOG) (2022) Coronavirus (Covid-19), Infection and
Pregnancy FAQs. Available online at www.rcog.org.uk (accessed 14 January 2023)
Rozga, M. , Kerver, J. and Olson, B. (2014) Self-reported reasons for breastfeeding cessation among low
income women enrolled in a peer counselling breastfeeding support program, Journal of Human Lactation,
31 (1). Available online at https://doi-org.knowledge.idm.oclc.org/10.1177/0890334414548070 (accessed 12
January 2023)
Sackett, D. , Rosenberg, W. , Gray, J. , . (1996) Evidence based medicine: What it is and what it isn’t, British
Medical Journal, 312: 71–72
Schaal, B. , Doucet, S. , Sagot, P. , . (2005) Human breast areolae as scent organs: Morphological data and
possible involvement in maternal – neonatal condition, Developmental Psychobiology, 48: 100–110
Schiff, M. , Algert, C. , Ampt, A. , . (2014) The impact of cosmetic breast implants on breastfeeding: A
systematic review and meta-analysis, International Breastfeeding Journal, 9: 17. Available online at
www.ncbi.nlm.nih.gov/pmc/articles/PMC4203468 (accessed 19 January 2023)
Schön, D. (1983) The Reflective Practitioner, New York: Basic Books
Schore, A. (2001) dysregulation of the right brain: A fundamental mechanism of traumatic attachment and
the psychopathogenesis of posttraumatic stress disorder, Australian and New Zealand Journal of Psychiatry,
36: 9–30
Scientific Advisory Committee on Nutrition (SACN) (2008) Consideration of the Place of ‘Good Night’ Milk
Products in the Diet of Infants Aged 6 Months. Available online at
www.gov.uk/government/publications/sacn-statement-on-good-night-milks-2008 (accessed 22 January
2023)
Scientific Advisory Committee on Nutrition (SACN) (2016) Vitamin D and Health. Available online at
www.gov.uk/government/publications/sacn-vitamin-d-and-health-report (accessed 12 October 2022)
Scientific Advisory Committee on Nutrition (SACN) (2018) Feeding in the First Year of Life. Available online
at https://www.gov.uk/government/publications/sacn-report-on-feeding-in-the-first-year-of-life (accessed 14
August 2022)
Scottish Government (SG) (2017) Scottish Maternal and Infant Nutrition Survey. Available online at
www.gov.scot (accessed 05 August 2022)
Scottish Government (SG) (2021) Trauma-Informed Practice: A Toolkit for Scotland. Available online at
www.gov.scot/publications/trauma-informed-practice-toolkit-scotland/ (accessed 24 January 2023)
Shaker, C. (2013) Cue-based co-regulated feeding in the neonatal intensive care unit: Supporting parents in
learning to feed their preterm infant. Newborn and Infant Nursing Reviews, 13(1): 51–55
Sheriff, N. , Hall, V. and Pickin, M. (2009) Fathers’ perspectives on breastfeeding: Ideas for intervention,
British Journal of Midwifery, 17(4): 223–227
Sheriff, N. , Panton, C. and Hall, V. (2014) A new model of father support to promote breastfeeding,
Community Practitioner, 87(5): 20–24
Sihota, H. , Oliffes, J. , Jelly, M. , . (2019) Father’s experiences and perspectives of breastfeeding: A scoping
review, American Journal of Men’s Health, 13 (3): 1–12
Silvers, K. , Frampton, C. , Wickens, K. , . (2012) breastfeeding protects against current asthma up to 6
years of age, The Journal of Pediatrics, 160(6): 991–996
Simmer, K. , Patole, S. and Rao, S. (2017) Longchain polyunsaturated fatty acid supplementation in infants
born at term, Cochrane Database of Systematic Reviews. Available online at
https://doi.org/10.1002/14651858.CD000376.pub4 (accessed 22 January 2023)
Sinkiewicz-Darol, E. , Bernatowicz-Lojko, U. , Lubiech, K. , . (2021) Tandem breastfeeding: A descriptive
analysis of the nutritional value of milk when feeding a younger and older child, Nutrients, 13 (1): 277
Specialist Pharmacy Service (SPS) (2020) Safety in Lactation: Viral Hepatitis, Specialist Pharmacy Service,
NHS. Available online at www.sps.nhs.uk (accessed 13 January 2023)
Spencer, J. (2008) Management of mastitis in breastfeeding women, American Family Physician, 78(6):
727–833
Stenhouse, E. (2018) Breastfeeding and diabetes, in D. McCance , M. Maresh and D. Sacks (eds) A
Practical Manual of Diabetes in Pregnancy (2nd edn), Chichester: John Wiley & Sons
Stevens, J. , Schmied, V. , Burns, E. and Dahlen, H. (2014) Immediate or early skin-to-skin contact after a
caesarean section: A review of the literature, Maternal and Child Nutrition, 10: 456–473
Stiles, J. and Jernigan, T. (2010) The basics of brain development, Neuropsychology Review, 20(4):
327–348. Available online at www.ncbi.nlm.nih.gov/pmc/articles/PMC2989000/ (accessed 27 October 2022)
Svensson, K. , Velandia, M. , Matthiesen, A. , . (2013) Effects of mother-infant skin-to-skin contact on severe
latch-on problems in older infants: A randomized trial. International Breastfeeding Journal, 8: 1. Available
online at https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-8-1#citeas
(accessed 6 January 2023)
Taylor, C. , Tully, K. and Ball, H. (2015) Night-time on a postnatal ward: Experiences of mothers, infants, and
staff, in Ethnographic Research in Maternal and Child Health, Abingdon, Oxon: Routledge, 117–140
Teplica, D. , Cooney, E. , Jeffers, E. , . (2022) There is no ‘Axillary Tail’: Rethinking the assumption of James
Spence, Plastic Reconstruction Surgery Global Open, 10 (2): e4086. Available online at
www.ncbi.nlm.nih.gov/pmc/articles/PMC8830835/ (accessed 6 January 2023)
Thompson, J. , Heal, L. , Roberts, C. , . (2010) Women’s breastfeeding experiences following a significant
primary postpartum haemorrhage: A multicentre cohort study, International Breast-feeding Journal. Available
online at https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-5-5
(accessed 18 January 2023)
Thomson, G. and Crossland, N. (2019) Using the behaviour change wheel to explore infant feeding peer
support provision; insights from a North West UK evaluation, International Breastfeeding Journal, 14 (41).
Available online at https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-019-
0236-7 (accessed 4 January 2023)
Toscano, M. , De Grandi, R. , Peroni, D. , . (2017) Impact of delivery mode on the colostrum microbiota
composition, BMC Microbiology. Available online at https://bmcmicrobiol.biomed-
central.com/articles/10.1186/s12866-017-1109-0 (accessed 12 October 2022)
Trimeloni, L. and Spencer, J. (2016) Diagnosis and management of breast milk oversupply, Journal of the
American Board of Family Medicine, 29(1): 139–242
Trotter, S. (2010) Raising awareness amongst parents of treatments for tongue-tie, MIDIRS Midwifery
Digest, 20(1): 83–85
Turcksin, R. , Bel, S. , Galjaard, S. , . (2013) Maternal obesity and breastfeeding intention, initiation, intensity
and duration: A systematic review, Maternal and Child Nutrition, 10(2): 1–18.
UNICEF UK BFI (2002) Introducing the Baby Friendly Best Practice Standards into Breastfeeding Education
for Student Midwives and Health Visitors, London: UNICEF UK Baby Friendly Initiative
UNICEF UK BFI (2014) A Guide to Infant Formula for Parents Who Are Bottle Feeding: The Health
Professionals’. Available online at www.unicef.org.uk/babyfriendly/wp-
content/uploads/sites/2/2016/12/Health-professionals-guide-to-infant-formula.pdf (accessed 15th August
2022)
UNICEF UK BFI (2016a) Protecting Health and Saving Lives: A Call to Action, Chap 1. Available online at
www.unicef.org.uk/babyfriendly (accessed 9 October 2022)
UNICEF UK BFI (2016b) Responsive Feeding: Supporting Close and Loving Relationships. Available online
at www.unicef.org.uk/babyfriendly (accessed 18 October 2022)
UNICEF UK BFI (2017a) Guide to the UNICEF UK Baby Friendly Initiative Standards. Available online at
www.unicef.org.uk/babyfriendly (accessed 30 April 2022)
UNICEF UK BFI (2017b) Assessment of Breastmilk Expression. Available online at
www.unicef.org.uk/babyfriendly (accessed 18 October 2022)
UNICEF UK BFI (2019a) Guide to the UNICEF UK Baby Friendly Initiative University Standards. Available
online at www.unicef.org.uk/babyfriendly (accessed 30 April 2022)
UNICEF UK BFI (2019b) Responsive Bottle Feeding. Available online at www.unicef.org.uk/baby-friendly
(accessed 18 October 2022)
UNICEF UK BFI (2021) Building a Happy Baby. A Guide for Parents, London: UNICEF UK
UNICEF UK BFI (2022) Guide to the UNICEF UK Baby Friendly Initiative Neonatal Standards for Neonatal
Units, London: UNICEF UK
UNICEF UK BFI (n.d.) Guidance for Antenatal and Postnatal Conversations. London: UNICEF UK. Available
online at www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-
resources/guidance-for-antenatal-and-postnatal-conversations/ (accessed 12 December 2022)
Uvnäs-Moberg, K. , Ekström-Bergstöm, A. , Buckley, S. , . (2020) Maternal plasma levels of oxytocin during
breastfeeding: A systematic review, PLoS ONE, 15 (8): e0235806. Available online at
https://doi.org/10.1371/journal.pone.0235806 (accessed 17 October 2022)
Van der Wijden, C. and Manion, C. (2015) Lactational amenorrhoea method for family planning, Cochrane
Database of Systematic Reviews. Available online at https://doi.org/10.1002%2F14651858.CD001329.pub2
(accessed 4 January 2023)
van Veldhuizen-Staas, C. (2007) Overabundant milk supply: An alternative way to intervene by full drainage
and block feeding, International Breastfeeding Journal, 2(11). Available online at
www.ncbi.nlm.nih.gov/pmc/articles/PMC2075483 (accessed 6 January 2023)
Verret-Chalifour, J. , Giguère, Y. , Forest, J.C. , . (2015) Breastfeeding initiation: Impact of obesity in a large
Canadian perinatal cohort study, PLoS ONE, 10 (2): e0117512
Victora, C. , Bahl, R. , Barros, A. , . (2016) Breastfeeding in the 21st century: Epidemiology, mechanisms,
and lifelong effect, The Lancet, 387 (10017): 475–490
Wambach, K. and Riordan, J. (2016) Breastfeeding and Human Lactation, Burlington, MA: Jones and
Bartlett Publishers
Wang, S. , Guendelman, S. , Harley, K. , . (2018) When fathers are perceived to share in the maternal
decision to breastfeed: Outcomes from the infant feeding practices survey II, Maternal & Child Health
Journal, 22: 1676–1684
Watson, J. and McGuire, W. (2016) Responsive versus scheduled feeding for pre-term infants, Cochrane
Database of Systematic Reviews. Available online at https://doi.org/10.1002/14651858.CD005255.pub5
(accessed 5 January 2023)
Watson-Genna, C. and Rabin, J. (2022) Breastfeeding: Normal sucking and swallowing, in C. Watson-
Genna (eds) Supporting Sucking Skills in Breastfeeding Infants (4th edn), Burlington, MA: Jones and Bartlett
Publishers.
White, J. (1995) Patterns of knowing: Review, critique, and update, Advances in Nursing Science, 17(4):
73–86
Widström, A. , Lija, G. , Aaltomaa-Michalias, P. , . (2011) Newborn behaviour to locate the breast when skin-
to-skin: A possible method for enabling early self-regulation, Acta Paediatrica, 100 (1): 79–85
Wilde, C. , Addey, C. , Boddy, L. , . (1995) Autocrine regulation of milk secretion by a protein in milk,
Biochemistry Journal, 1(305): 51–58
Wilson, C. , Finch, E. , Kerr, C. , (2020) Alcohol, smoking and other substance use in the peri-natal period,
British Medical Journal, 369: 1627. Available online at https://doi.org/10.1136/bmj.m1627 (accessed 15
January 2023)
World Alliance for Breastfeeding Action (WABA) (2005) Towards Healthy Environments for Children: FAQs
about Breastfeeding in a Contaminated Environment. Available online at
www.waba.org.my/whatwedo/environment/pdf/faq2005_eng.pdf (accessed 27 October 2022)
World Health Organization (WHO) (1981) International Code of Marketing of Breast Milk Substitutes,
Geneva: WHO
World Health Organization (WHO) (1990) Innocenti Declaration on the Protection, Promotion and Support of
Breastfeeding, Florence: WHO
World Health Organization (WHO) (1998a) Evidence for the Ten Steps to Successful Breastfeeding,
Geneva: WHO
World Health Organization (WHO) (1998b) Relactation: Review of Experience and Recommendations for
Practice, Geneva: WHO
World Health Organization (WHO) (2010) Guidelines on HIV and Infant Feeding: Principles and
Recommendations for Infant Feeding in the Context of HIV and a Summary of Evidence, Geneva: WHO.
World Health Organization (WHO) (2014a) Global Nutrition Targets 2025. Breastfeeding Policy Brief 5.
Available online at www.who.int/publications/i/item/WHO-NMH-NHD-14.7 (accessed 28 October 2022)
World Health Organization (WHO) (2014b) Guideline for the Identification and Management of Substance
Use and Substance Use Disorders in Pregnancy, Geneva: WHO
World Health Organization (WHO) (2016) Guideline Updates on HIV and Breastfeeding. The Duration of
Breastfeeding and Support from Health Services to Improve Feeding Practices Among Mothers Living with
HIV, Geneva: WHO
World Health Organization (WHO) (2018) Ten Steps to Successful Breastfeeding. Available online at
www.who.int/teams/nutrition-and-food-safety/food-and-nutrition-actions-in-health-systems/ten-steps-to-
successful-breastfeeding (accessed 25 January 2023)
World Health Organization (WHO) (2020) Breastfeeding and Covid-19: Scientific Brief, Geneva: WHO
World Health Organization (WHO) (2021a) Infant and Young Child Feeding, Geneva: WHO Available online
at Infant and young child feeding (who.int) (accessed 18 October 2022)
World Health Organization (WHO) (2021b) Immediate ‘Kangaroo Mother Care’ and Survival of Infants with
Low Birth Wight, Geneva: WHO. Available online at www.who.int/news/item/26-05-2021-kangaroo-mother-
care-started-immediately-after-birth-critical-for-saving-lives-new-research-shows (accessed 5 January 2023)
World Health Organization (WHO) (2023) Nutrition, Breastfeeding. Available online at
https://apps.who.int/nutrition/topics/exclusive_breastfeeding/en/ (accessed 4 January 2023)
World Health Organization (WHO)/UNICEF (1989) Ten Steps to Successful Breastfeeding, Geneva: WHO.
Available online at Nutrition and Food Safety (who.int) (accessed 27 October 2022)
World Health Organization (WHO)/UNICEF (2009) Acceptable Medical Reasons for the Use of Breast-Milk
Substitutes, Geneva: WHO
World Health Organization (WHO)/UNICEF (2021) Global Breastfeeding Scorecard 2021. Available online at
https://apps.who.int/iris/bitstream/handle/10665/348546/WHO-HEP-NFS-21.45-eng.pdf?sequence=1
(accessed 4 January 2023)
Yan, J. , Liu, L. , Zhu, Y. , . (2014) The Association between breastfeeding and childhood obesity: A meta-
analysis, BMC Public Health, 14(1): 1267
Young, C. , Kingma, S. and Neu, J. (2011) Ischemia-reperfusion and neonatal intestinal injury, The Journal
of Pediatrics, 158(2): 25–28
Zakarija-Grkovic, I. and Stewart, F. (2020) Treatments for breast engorgement, Cochrane Database of
Systematic Reviews. Available online at https://doi.org/10.1002/14651858.CD006946.pub4 (accessed 12
January 2023)
Zimmerman, E. and Thompson, K. (2015) Clarifying nipple confusion, Journal of Perinatology, 35: 895–899