10 STEPS
to support breastfeeding mothers
QUOTES FROM PROFESSIONALS
“As a neonatologist I have always strongly
encouraged the mothers of all of my patients
to provide their breastmilk for their babies.
A mother’s own milk is always the best
feeding option.”
Susan Sward-Comunelli, MD
Founder of the Mothers’ Milk Bank of North Texas
THE TEXAS TEN STEP PROGRAM

Recognizes hospitals and birth centers
that provide optimal breastfeeding support
to new mothers
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Offers trainings and updates
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Supports facilities in reaching the
Healthy People 2020 goals.
THE HEALTHY PEOPLE 2020 GOALS

Increase Texas breastfeeding initiation rates to 82%

Increase the percent of Texas infants
breastfeeding at 6 months to 61%

Increase the percent of Texas infants
breastfeeding at 12 months to 34%

Increase the percent of Texas infants exclusively
breastfeeding at 3 months to 44%

Increase the percent of Texas infants exclusively
breastfeeding at 6 months to 24%
THE HEALTHY PEOPLE 2020 GOALS
• Reduce the proportion of breastfed newborns who receive
formula supplementation within the first 2 days of life to 16%
• Increase the proportion of live births that occur in facilities
that provide recommended care for lactating mothers and
their babies to 8%
• Increase the proportion of employers that have worksite
lactation support programs to 38%
WHY SHOULD WE BECOME
A TEXAS TEN STEP FACILITY?


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Over 75% of women in the state of Texas are
choosing to breastfeed their infants
These women are seeking medical care that
will support them in this decision
The Texas Ten Step designation will help you
advertise as a breastfeeding friendly facility
QUOTES FROM PROFESSIONALS
Enthusiastic support and involvement of pediatricians in the promotion
and practice of breastfeeding is essential to the achievement of optimal
infant and child health, growth, and development.
– AAP
The American College of Obstetricians and Gynecologists strongly supports
breastfeeding and calls upon its Fellows, other health professionals caring
for women and their infants, hospitals and employers to support women in
choosing to breastfeed their infants.
All should work to facilitate the continuation of breastfeeding in the
work place and public facilities. Breastfeeding is the preferred method of
feeding for newborns and infants. Health professionals have a wide range of
opportunities to serve as a primary resource to the public and their patients
regarding the benefits of breastfeeding and the knowledge, skills and
support needed for successful breastfeeding. – ACOG
HOW WILL MY FACILITY BENEFIT
FROM RECEIVING THE DESIGNATION?

The TTS designation can be used to advertise
the expert care your facility provides to
breastfeeding women

Your facility will be provided with a variety of items
to advertise your commitment to offering
infants the very best care. The Texas Department of State
Health Services will provide you a unique log-in that will
allow you to order breastfeeding materials for your patients
free of charge.
HOW DO I APPLY?


Create policies that protect and promote breastfeeding
Applications are located at:
www.texastenstep.org/apply
DSHS WILL SUPPORT EFFORTS TO MEET THE TTS CRITERIA BY
PROVIDING:

Free on-site breastfeeding trainings

Free breastfeeding materials for patient education

Additional training for staff off-site
STEP 1
Make breastfeeding
the preferred method
of infant feeding.
DEVELOP POLICIES THAT PROMOTE BREASTFEEDING AS THE
PREFERRED METHOD OF INFANT NUTRITION



All interventions and care plans should
protect this valuable resource
Decisions to interrupt breastfeeding or withhold
human milk should be evidence based
Policies should be communicated to staff upon
employment and updated on a regular basis
Sample Policies can be found at
http://bfmed.org/ace-files/protocol/mhpolicy_ABM.pdf.
STEP 2
Employees who care for
mothers and infants should
receive breastfeeding
training within six months
of employment, with
updates provided on a
regular basis.
Training can be offered in house by the Department
of State Health Services at no charge.
CE’s are available for:
-Breastfeeding Management
-Breastfeeding the Compromised Infant
-Managing Breastfeeding Complications
To schedule a training through DSHS please contact:
Hellen Sullivan
Hellen.Sullivan@dshs.state.tx.us
(512) 341-4591
STEP 3
Breastfeeding is presented
as the feeding choice for
all mothers, including those
that must be separated
from their infant.
PRENATAL CLASSES AND HOSPITAL
TEACHINGS SHOULD INCLUDE:

The health risks associated with not breastfeeding

Principles of milk establishment and supply

Importance of skin-to skin contact

Maintaining lactation if mother and infant are separated
STEP 4
Mothers are encouraged
to breastfeed their
newborn within
one hour of birth,
within 30 minutes
is ideal.
SKIN-TO-SKIN CONTACT


Mothers with c-sections or complications should
be assisted to breastfeed as soon as possible
Mothers should have the opportunity for early
skin-to-skin contact regardless of type of delivery
*Protocols for skin-to-skin after birth and research
supporting this contact can be found at:
http://bfmed.org/ace-files/protocol/peripartum.pdf
STEP 5
Breastfeeding should
be assessed within
six hours after birth
and at least once
per shift.

There should be staff with training beyond the
basics of breastfeeding to assist with unusual
management concerns (IBCLC, nurses or
physicians with additional training).
Additional training could include staff that have attended Principles
of Lactation Management and Lactation Counseling and Problem
Solving (Trained Breastfeeding Educators) or staff that have
clinical breastfeeding training. Staff can register for these trainings at:
http://www.dshs.state.tx.us/wichd/lactate/courses.shtm.
STEP 6
Newborns should be given
artificial human milk
only if it is medically
indicated and ordered
by the physician or
requested by the parent.

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Policy should state that the parents are advised
on the impact of introducing formula prior to
establishing breastfeeding
If infant needs supplementation staff should protect
breastfeeding while offering the supplement
Protocols on supplementation and methods of
supplementation can be found at:
http://bfmed.org/ace-files/protocol/supplementation.pdf
STEP 7
Mothers and newborns
should be encouraged
to room-in unless
separation is medically
indicated.

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Limit time away from mother for
medical procedures
Nurses should help families plan for
periods of rest during their hospital stay.
If the mother requests newborn be brought
to the nursery, the infant should be brought
to the mother when hunger cues are evident.
Additional information on peripartum breastfeeding management
can be found at: http://bfmed.org/ace-files/protocol/peripartum.pdf
STEP 8
Mothers should be
encouraged to breastfeed
their newborns without
restriction and
breastfeeding should
take priority over
non-emergent events.

Mothers should be instructed to:
•
•
•
•
•
Recognize early hunger cues
Assess latch and adequate feed
Monitor wet and soiled diapers
Recognize normal feeding patterns
of a newborn
Recognize changes in the infants
feeding patterns as the infant goes
through growth spurts and starts solids
STEP 9
Artificial Nipples
should be
discouraged for
the healthy newborn.

Alternate feeding methods should be used
if supplementation is necessary.

Expressed breastmilk should be the first choice
if supplementation is necessary.

Mothers should not be given discharge packs
that include formula or formula advertisements.
Protocols for supplementing a breastfeeding infant can be found
at the Academy of Breastfeeding Medicine’s website:
http://bfmed.org/ace-files/protocol/supplementation.pdf
STEP 10
Breastfeeding mothers
should receive support
following discharge.

Follow up should include a list of resources including:
-

Online resources such as www.breastmilkcounts.com
Telephone hotlines
Area Mother-to-Mother support meetings
IBCLCs’ in the area
Hospitals can provide a lactation clinic, in-home
visitation or follow-up phone calls to support
breastfeeding moms.
WIC Peer Counselors can be a great resource for breastfeeding families
and hospital staff. For information on this program please contact:
Jewell Stremler
Jewell.Stremler@dshs.state.tx.us
(512) 341-4593
MOTHER FRIENDLY WORKSITE
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Texas Ten Step facilities must be designated as a MotherFriendly Worksite.
This designation shows that you support
your staff in giving their infants the very best.
Information on applying to become a Mother Friendly Worksite can
be found at: http://www.dshs.state.tx.us/wichd/lactate/mother.shtm