Registered Nurses' Association of Ontario

Strategies to Support Breastfeeding Initiation

  • Encourage the breastfeeding person to approach breastfeeding initiation as an introduction with no expectations about whether the newborn latches, the length or timing of the feeding, or the volume of colostrum taken.
  • Provide a calming presence and help the breastfeeding person find a position that is comfortable.
  • Avoid unnecessary directions or interventions, such as manually attaching the newborn to the breast through the manipulation of the newborn’s position and the breast tissue.
  • Avoid swaddling or restraining the newborn’s hands in order to support normal newborn breast-seeking behaviour through hand movements (i.e., hand-to-hand or hand-to-mouth).
  • Educate the breastfeeding person on infant feeding cues as a sign of readiness to feed. This includes being in an alert state, bringing hands to mouth, making sucking sounds, moving towards the breast and finding the nipple, and opening the mouth wide.
  • Assess for situations involving the breastfeeding dyad where interventions are indicated, such as anatomical abnormalities, prematurity, or a history of breast surgery. In the absence of any factors complicating breastfeeding initiation, refrain from hands-on support or assistance unless requested by the breastfeeding person.
  • Provide support that empowers the breastfeeding person based on their needs. Offer clear information and directive assistance only as requested. Avoid statements that may seem confusing, judgmental, or disempowering to the breastfeeding person.
  • Suggest positions that avoid pressure on the abdomen for persons who have had a caesarean birth including football, side-lying, or cradle hold. Assistance may be required to support the infant’s weight or pillows may be used. 
  • Support the integration of doulas—such as relatives or friends selected by the breastfeeding person—during labour and postpartum. This is particularly important for primiparas, as doula support is positively associated with breastfeeding outcomes among this group, including increased initiation, exclusivity to six weeks, and fewer breastfeeding problems when compared to controls.   
Women and Children
Breastfeeding Best Practice Guidelines for Nurses
Point of Care Resources