EARLY INITIATION OF BREASTFEEDING
DURING EMERGENCIES!

A guide for maternity service providers on supporting early initiation of breastfeeding

Essential tips
How can you support early initiation of breastfeeding?

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Warning1

During emergencies,breastfeeding saves lives

for successful breastfeeding in
the first days of life!

Always comply with theInternational Code of Marketing ofBreast-milk Substitutes, and yourfacility’s infant feeding policy.

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Delay bathing for the first few days.

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Avoid bottles and pacifiers, or giving
any foods and fluids other thanbreastmilk.

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During emergencies, mothers may
be more stressed than usual andtheir confidence may be shaken. This
may delay the onset of plentiful milk
production or slow down milk flow.
You can support a mother’s milk toflow by helping her to feel safe andsupported:

During pregnancy
Talk to mothers about:

Delaying the start of breastfeeding andwithholding skin-to-skin contact puts mothers
and babies at serious risk of:•ɖ Neonatal infection, dangerously low bodytemperature and blood sugar, less stable
heart rate and breathing, and death.

•ɖ Newborn stress, disrupted mother-baby
bonding, neglect and abandonment.

The importance of skin-to-skin, colostrum,exclusive breastfeeding and starting breastfeeding
within the first hour.
How to manage breastfeeding in the early days,
including how to position and attach the baby andhand express breastmilk.

For more, refer to:
Key conversations

ɖ Maternal mortality, postpartum haemorrhage,postpartum depression.
ɖ Breastfeeding difficulties, not breastfeedingexclusively, stopping breastfeeding too soon.

2

Immediately after birth
Place baby skin-to-skin with mother.
••••

Key conversations
Cover the following topics in pregnancy andthe first few days of life:

Place naked baby on mother’s bare chest.
Dry and assess baby on mother’s chest.
Cover mother and baby with a blanket.
Ensure baby’s mouth and nose are visible at all times.
WHO and UNICEF recommend that all mothers and newborns
have immediate, uninterrupted skin-to-skin contact.

Typical newborn feeding behaviours (e.g.
cluster feeding)
The importance of feeding frequently,
staying together (24h rooming-in) andskin-to-skin contact

In the first hour

Recognising and responding to baby’s cues
for feeding and comfort

Common infant behaviour during
emergencies and how to respond (calmingand soothing techniques)
Reassurance to continue breastfeeding,even when stressed or worried about dietMaternal nutrition and wellbeing

At all times – including during emergencies– women have the right to antenatal andpostnatal care from health workers who
are knowledgeable about and supportiveof breastfeeding.

••Day # of soiled diapers•

Share praise and encouragement•

Protect privacy and dignity•

Support skin to skin•Ask for consent before anynecessary touch or procedure

When temporary separation is
unavoidable, support mother toexpress breastmilk every 2-3 hours
into a clean container for cup feeding.

••for higher-risk mothers and babies

Early initiation of exclusive breastfeeding saves
lives. It should be prioritised during a humanitarian
response for both healthy and high-risk newborns.
Below is a list of special care scenarios and advice
for healthcare providers

Remember to record the number of children who were put tothe breast within one hour of birth.

Low-birth weight or premature babies
Provide Kangaroo Mother Care
(KMC) and patiently practicebreastfeeding.

4After a caesarean birth

Check
The most reliable way to tell if a newborn isgetting enough milk is to monitor newborn
weight, stool and urine output.

Provide respectful medical care

Special care

Support baby to crawl to nipple and start breastfeeding
using their instincts.
Share why suckling at the breast in the first hour isimportant and help mother recognise signs of readiness.
Avoid interruptions: delay non-urgent procedures (e.g.
weighing) and perform necessary procedures with the babyon the mother (e.g. newborn assessment and monitoring).
Follow protocol on mother and baby observation andexplain when to call for help.

On day one

Is the baby getting enough breastmilk?

•WHO and UNICEF recommend thatbabies should receive only breastmilk forthe first 6 months of life.

For at least one hour, maintain uninterrupted
skin-to-skin contact and support mothers toinitiate breastfeeding.

Family support for breastfeeding women
Safe sleeping and breastfeeding at night

Listen to mothers

3

Reliable signs that baby is getting enoughmilk (see ‘Check’ below)

Risks of using bottles, teats and pacifiers,of not breastfeeding, and of feeding babies
any foods or liquids other than breastmilk!

•Continue to support breastfeeding.
•••Offer practical and emotional support.
Point out signs of a good latch and milk transfer.
Help with breastfeeding difficulties.
For more, refer to:
Key conversations# of wet diapers

1

Try a laid-back, side-lying
or football-hold position.
Show birth companions
how to assist the motherto safely hold the babyskin-to-skin.
Mothers with a disability, or who are incapacitatedby illness or injury
Provide practical assistance for mother tobreastfeed or express breastmilk to cup feed.
Mothers who are survivors of sexual violence25

3At discharge

4Check how breastfeeding is going and review
mother’s knowledge.

Other reassuring signs:••

Infant feeds at least 8 times in 24 hours•

Infant has lost no more than 7 – 10% of their birth weight•

No signs of dehydration, e.g. depressed fontanel, darkand strong smelling urine.

•Baby is alert and active•••

Refer mother to a skilled counsellor if there arebreastfeeding challenges.
Describe a) newborn danger signs, b) signs ofundernourishment and c) how to get help.
Link mother to maternal and child health services
and breastfeeding support services.
Ensure the birth is registered within two weeks.

Part of the Infant Feeding in Emergencies Core Group infographicseries. Find out more at www.ennonline.net/ife

Understand breastfeeding may trigger difficult
memories and provide trauma-informed care.
Mother deceased
Provide donor human milk from a milk bankor find a healthy lactating woman who canbreastfeed the baby. As a last resort, provide
infant formula in accordance with the OG-IFE.
When supplementation is medically necessary
Supplements should only be given when
medically necessary, as determined bya breastfeeding-trained health worker.
Breastmilk is the preferred supplement.
Coordination tip:
During service planning, take into accountthat the number of higher-risk mothers andbabies often rises during emergencies.