Evidence for the Ten Steps to Successful Breastfeeding: Document Produced by the WHO Division of Child Health

Contents
Introduction
Methods used in the review
Presentation of information
The Ten Steps to Successful Breastfeeding
1. Step 1: Policies
1.1 Criteria
1.2 Introduction
1.3 Effectiveness of breastfeeding policies
1.4 Results of weak policies
1.5 Policies which discourage or interfere with breastfeeding
1.6 Effectiveness of strong policies
1.7 Elements of a policy
1.8 Process of policy development
2. Step 2: Training
2.1 Criteria
2.2 Introduction
2.3 Knowledge, attitudes and practices of health care staff
2.4 Effectiveness of training
2.5 Length of training courses
2.6 Conclusions
3. Step 3: Antenatal preparation
3.1 Criteria
3.2 Introduction
3.3 Influences on breastfeeding intentions
3.4 Evidence for the benefits of antenatal education
3.5 Evidence for the benefits of nipple preparation
3.6 Conclusions
4. Step 4: Early contact
4.1 Criteria
4.2 Introduction
4.3 Effect of early contact on breastfeeding
4.4 Other outcomes
4.5 Analgesia during labour and delivery
4.6 Conclusions
5. Step 5: Guidance
5.1 Criteria
5.2 Introduction
5.3 Showing mothers how to breastfeed
5.4 Helping mothers who are separated from their infants in hospital
5.5 Conclusions
6. Step 6: Use of supplements
6.1 Criteria
6.2 Introduction
6.3 Effect of in-hospital prelacteal feeds and supplements on
breastfeeding
6.4 Effects of supplements after discharge on breastfeeding
6.5 Other outcomes
6.6 Effect of commercial samples of breastmilk substitutes on
breastfeeding
6.7 Impact and cost-effectiveness of restricting formula in maternity
wards
6.8 Conclusions
7. Step 7: Rooming-in
7.1 Criteria
7.2 Introduction
7.3 Effect of rooming-in on breastfeeding
7.4 Other outcomes
7.5 Validity of reasons for not rooming-in
7.6 Effect of co-sleeping on breastfeeding and other outcomes
7.7 Conclusions
8. Step 8: Feeding on demand
8.1 Criteria
8.2 Introduction
8.3 Frequency and length of suckling soon after birth
8.4 The effect of unrestricted breastfeeding
8.5 Other outcomes
8.6 Conclusions
9. Step 9: Teats and pacifiers
9.1 Criteria
9.2 Introduction
9.3 Effect of artificial teats on breastfeeding
9.4 Effect of pacifiers on breastfeeding
9.5 Other effects of artificial teats and pacifiers
9.6 Conclusions
10. Step 10: Continuing support
10.1 Criteria
10.2 Introduction
10.3 Effect of post-discharge support on breastfeeding: Health services
10.4 Effect of post-discharge support on breastfeeding: Mother-to-mother support groups
10.5 Effect of post-discharge support on breastfeeding: Community-based peer counsellors
10.6 Conclusions
11. Combined interventions
11.1 Introduction
11.2 Effect on breastfeeding practices
11.3 Effect of combined interventions on cost-effectiveness and morbidity
Conclusions and recommendations
References
List of abbreviations
List of methodological limitations