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Writing Hospital Policy to Implement Step 3 for Baby-Friendly

Autumn maternity photo. Step 3 is an important part of writing hospital policy.

While writing your breastfeeding policy, maybe you sailed through Steps 1 and 2 of the Ten Steps. But, if you’re like many of my clients, maybe you came to a grinding halt when you started writing hospital policy to implement Step 3. 

Step 3, to review, is this: Inform all pregnant women about the benefits and management of breastfeeding.

Those from hospitals without a prenatal clinic might protest: “We can’t write anything for this! We don’t see patients until they walk through the doors of our labor and delivery suites!”

But even those hospitals with prenatal clinics can object: “We have a prenatal clinic and we ask them if they plan to breastfeed or formula-feed. We wrote that into our policy. We’re done with Step 3, right?”

Actually, no one is done here. With or without a hospital-based prenatal clinic, you have plenty more work to do writing Step 3.

Keep in mind that a policy is more a “rule book” than a “how to” manual. Write the “rules” for 5 questions: who, what, where, when, and how.

Who is responsible for prenatal education?

Whether your hospital does or doesn’t have a prenatal clinic, state who is responsible for providing, facilitating or coordinating prenatal information about breastfeeding. The aim is for the hospital and the primary care provider to deliver consistent messages to the mother.

The teaching responsibility will likely fall on a discipline (e.g., “midwives”) or a department (“lactation department” or “childbirth education department.”) Just state that.

What content must you teach prenatally?

When writing Step 3, state the existence of a prenatal teaching curriculum that includes content on World Health Organization’s topic list. Skip the whys-and-wherefores. Just stick to the list.

Content for prenatal teaching

  • benefits of breastfeeding
  • the importance of exclusive breastfeeding
  • listing options for non-pharmacologic labor pain relief as it relates to early breastfeeding
  • early initiation of skin-to-skin contact
  • 24-hour rooming-in
  • baby-led feeding
  • frequency of feeding as a means to establish and maintain milk supply
  • why effective positioning and latch techniques are a critical part of good breastfeeding, exclusivity
  • continuation of breastfeeding after introduction of complementary foods

Where will such teaching occur? Hospital-based prenatal clinic or outside of the hospital?

This is where it gets tricky. Your policy must state whether the hospital does or does not have an associated prenatal clinic.

If your hospital does have a prenatal clinic, OR if it offers prenatal classes (even in the absence of a prenatal clinic), include pertinent information in the policy. State that you have a written curriculum. Further, include in the policy a statement that the curriculum specifies

  • the content to teach
  • who teaches it
  • the characteristics of the teaching materials (e.g., no formula logos), and
  • where the teaching must be documented.

Write details in the curriculum, not in the policy.

When must the topics be taught?

Does your hospital have a prenatal clinic? If so, specify that all of the prenatal teaching topics listed will be taught before 32 weeks’ gestation. Since the number of visits a mother makes can vary substantially, “pre-assigning” of a topic to a particular all “generic” visits is unrealistic.

Instead, specify the date or month or week for discussion of a particular topic for each individual client.

When the Assessors do a site survey, they ask questions. They might ask when you’ll discuss Topic X with Ms. A. Or, they might  look in the medical record to verify if Ms. B.’s topic was discussed on the date it was scheduled.

How? What methods will you use? How will you foster community-based programs?

Here, “how” means the rules or restrictions about the “how to,” not the steps for “how to.” Handle the “how to” details of the instruction in the curriculum, not in the policy.

Will teaching occur on a one-to-one basis, or in groups, or both? Will you provide some sort of written material, such as a pamphlet? Is there are statement that prohibits handouts with formula-company logos?

If your hospital does not provide prenatal education, you need to show that you interface with community-based programs that do.

Here’s an example of a statement that would work.


“We foster development of community-based programs that (state how the education is offered, either through individual or group education or both).


Hospital personnel interact with outside community-based programs; the aim of such interaction is to provide non-conflicting messages to the expectant family. To achieve that aim, we provide outside organizations with a copy of our curriculum.”

I recommend NOT mentioning less structured methods for interactions (e.g., meetings at a local coalition or scheduled teleconferences). It’s difficult to prove that such interactions occurred.

In summary, include the “rules” for the who-what-where-when-how breastfeeding information you plan to deliver to the hospital’s clients.

For more posts on the Baby-Friendly Hospital Initiative, click here

What have you been most confused about when writing your policy related to Step 3? Leave me a comment below, I’d love to know — or help!

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