The Role of the Nurse
In the United States, 98% of all births occur in
hospitals where nurses are the primary health
care providers supporting women from labor and
birth through discharge. Nurses play a vital role
in preparing, educating, encouraging, and supporting
women to breastfeed and are instrumental
in facilitating initiation and continuation of breastfeeding.
Nurses and other health care professionals who
care for mother-infant dyads should acquire the
knowledge and demonstrate the competence
needed to provide consistent and evidencebased
breastfeeding information and support
throughout the preconception, prenatal, and postpartum
periods. If the health care professional
does not possess the knowledge and skills
needed to provide support, consultation with or
referral to a lactation specialist or other clinical expert
should be offered for all mother-infant dyads.
The USBC has developed core competencies
that detail the knowledge, skills, and attitudes
that health professionals should possess in order
to help women prepare for, initiate, and sustain
breastfeeding (USBC, 2010). Academic education
programs for all health care professionals
should include content on lactation.
All women have the right to expect culturally sensitive
breastfeeding promotion and support. Health
care providers should strive to understand and
be prepared to address cultural issues in all aspects
of breastfeeding promotion and support for
the population of women they serve. Breastfeeding
has different meanings and levels of acceptance
in different cultures; therefore, it is essential
that providers explore the specific breastfeeding
concerns of the individuals with whom they are
working. All women have the right to obtain information
about the benefits of breastfeeding so that
they are able to make informed decisions.
Nurses and other health care providers should
support each woman’s choice of infant nutrition by
providing women with information about the risks
and benefits of various feeding options to facilitate
informed decision making. There may be certain
rare instances when a woman wants to breastfeed,
but is unable to or should avoid doing so, including
some women who have had breast surgery,
women with HIV infection, certain substance use
disorders, untreated tuberculosis, or who are taking
medications contraindicated in breastfeeding.
In these situations, women should be given information
by their nurses and encouraged to further
consult with their health care providers to
help them make infant feeding decisions. There
may be other instances where women erroneously
think that breastfeeding is contraindicated (e.g.,
smoking cigarettes), and nurses should provide
correct information regarding these misconceptions.
Nurses should encourage women to discuss
their medications and herbal and other nutritional
supplements with a health care provider who has
expertise in breastfeeding and is knowledgeable
about the interactions of prescription and overthe-
counter medications and supplements with
breastfeeding.
If a woman chooses to or is required to formula
feed instead of breastfeed, nurses should help her,
her family, and other support persons understand
how to safely prepare, feed, and store formula and
bottles. Education and resources should also include
information about the risks of contamination
of formula, feeding systems, and/or water supply.
Women should be advised to monitor whether
a particular feeding system and/or formula is recalled
for safety or other reasons.
International Code of Marketing of
Breast-milk Substitutes
AWHONN supports the goals the World Health
Organization (WHO) set forth in the International
Code of Marketing of Breast-milk Substitutes
released in 1981 in an effort to improve