The Gift protects, promotes and supports breastfeeding in Louisiana through the Ten Steps to a Healthy, Breastfed Baby. Louisiana birthing facilities that implement the The Gift's Ten Steps are designated as "Gift Certified" and receive statewide recognition and breastfeeding support materials. 

One: Breastfeeding is the preferred method of newborn and infant feeding, and breastmilk is the optimal form of nutrition for the newborn and infant. All policies, interventions, and care plans directed towards the newborn, infant, or lactating woman will protect this valuable resource. The decision to interrupt breastfeeding or withhold breastmilk from a newborn or infant should be based on a physician's order. The hospital's policy should be communicated to all appropriate staff upon employment and on a regular basis.

Two: Hospital employees who care for mothers, newborns, and infants should receive breastfeeding education and training consistent with hospital policies upon employment, with updates provided on a regular basis. This education and training should include: the advantages of breastfeeding; anatomy and physiology of breastfeeding; correct positioning and latch; adequacy of intake; prevention and management of common problems; how to maintain a woman's milk supply if breastfeeding is interrupted; and the impact of introducing formula and artificial nipples or pacifiers before breastfeeding is established. Training should include supervised clinical experience, the process for referral to breastfeeding specialists after hospital discharge, and a list of community resources.

Three: The hospital should promote breastfeeding as the feeding method of choice to all mothers prior to birth, following birth, and after hospital discharge. Hospitals offering prenatal classes should include information about the benefits of breastfeeding, its management, and how to maintain lactation even if the mother is separated from her newborn or infant.

Four: The hospital policy should encourage mothers and newborns to breastfeed within the first two hours after birth, with the first hour being ideal. The hospital policy should address alterations to this time frame for mothers delivering by cesarean birth or with complications. Early skin-to-skin contact between mother and newborn is an important factor in the initiation of breastfeeding. Mothers should be given the opportunity to remain close to their newborns regardless of the type of delivery, as long as the health of the mother and newborn are not compromised.

Five: The hospital policy should address showing mothers how to breastfeed and how to maintain lactation, even if separated from their infants. Formal evaluation of breastfeeding, including observation of position, latch, and milk transfer, should occur within 6 hours of birth and at least once every shift while in the hospital. There should be staff with training beyond the basic level of lactation management who can assist mothers with unusual or difficult management concerns. These individuals include physicians, International Board Certified Lactation Consultants, or nurses with additional training. The hospital policy should also address maternal and newborn factors which require follow-up care after hospital discharge, the process for follow-up care, and the provision of appropriate community referral. La Leche League International and the International Lactation Consultant Association are two organizations with the resources to locate community referrals for lactation assistance. They can be accessed at www.lalecheleague.org and www.ilca.org.

Six: The hospital policy should support the decision of mothers to breastfeed. Complimentary or supplementary feedings of water or artificial infant formula will not be given to a breastfeeding infant unless specifically ordered by the physician for a clinical condition or upon parental request. Parents should be informed of the impact of introducing formula or water to the newborn prior to giving either to the breastfed newborn.

Seven: The hospital policy should encourage rooming-in both day and night. Mothers and newborns should be encouraged to remain together except for periods of up to one hour for hospital procedures which cannot be performed in the mother's room. The nurse should help the family plan for periods of rest and sleep. If, despite encouragement to room-in, the mother requests the newborn to stay in the nursery at night, the newborn should be brought to the mother to feed whenever hunger or comfort cues are evident.

Eight: The hospital policy should encourage mothers to breastfeed their newborns without restrictions. Breastfeeding should always take priority over other non-emergent events such as daily weights, baths, and pictures. Mothers should be instructed to recognize early hunger and comfort cues, to assess milk transfer, and to monitor wet and soiled diapers as indicators of adequate intake.

Nine: The hospital policy should discourage the use of artificial nipples for normal newborns. Pacifiers mask hunger cues and may adversely affect a mother's milk supply. Artificial nipples may interfere with the establishment of breastfeeding. If supplementary or complimentary feedings are needed, expressed breastmilk should be used. Breastfeeding mothers should not receive discharge packs that contain formula or formula advertisements, unless specifically requested by the mother or ordered by the physician for a clinical condition.

Ten: The hospital should address support for breastfeeding mothers following hospital discharge. This support may include: telephone follow-up, lactation clinics, in-home visitation, telephone hotline, space for breastfeeding mother-to-mother group meetings provided on a regular basis, and/or referral to community support groups, such as La Leche League or local WIC agencies. Mothers can call 1-800-LALECHE to locate a local support group. The hospital is encouraged to support staff who are breastfeeding by providing a place and time for them to pump.