Support for breastfeeding during the antenatal and postpartum period

Breast milk is nutritionally complete for around the first 6 months for most babies. It is uniquely tailored to the infant and contains optimal proportions of macronutrients, micronutrients, enzymes, hormones, immune cells and more than 150 human milk oligosaccharides (HMOs) that support gut health and immunity (Walsh et al., 2020; Victora et al., 2016).

While it is acknowledged that breast feeding is best for baby (RCM 2018; WHO, 2018), healthcare professionals must do their diligence in offering alternatives where breastfeeding is not possible.

Infant and maternal outcomes to share with mothers and partners, both antenatally and postnatally, are outlined below:

Evidence consistently shows that breastfeeding leads to improved immune system development, reduces hospital admissions for respiratory and gastrointestinal infections (Branger et al., 2023), lowers the risk of Sudden Infant Death Syndrome (SIDS; Vennemann et al., 2009) and is associated with a reduction in type 2 diabetes (Horta et al., 2019).

For women, breastfeeding is associated with reduced risk of breast and ovarian cancer (Stordal et al., 2023), lower rates of type 2 diabetes (Gunderson et al., 2018) and improved postnatal weight regulation (Baker et al., 2008). Secondary benefits of breastfeeding that can be shared with parents include bonding, convenience and cost.

Health professional input to support antenatal breastfeeding preparation includes setting expectations, building skills and preventing early problems. Further, women from socioeconomically disadvantaged backgrounds are less likely to breastfeed and experience poorer health outcomes (RCM, 2018). Therefore, breastfeeding support from health professionals represents an opportunity to address existing health inequities (RCM, 2018).

After 28 weeks of pregnancy, it is recommended to discuss and give information on the baby’s feeding (NICE, 2021a). When discussing breastfeeding with new mums, a supportive and non-judgmental tone is encouraged, alongside informing them of the benefits of breastfeeding. It is important to explore the existing knowledge and understanding of the woman (and her partner) to individualise the discussion around breastfeeding or feeding choices. (NICE, 2021a).

Further, ensure that discussions include check that the woman (and partner) has understood the information that has been given, and how it relates to them. Provide regular opportunities to ask questions and set aside enough time to discuss any concerns. (NICE, 2021a).

Antenatal input improves confidence and reduces preventable early cessation, especially when it includes realistic feeding expectations and hands-on skill-building (Renuka et al., 2020; Ozturk et al., 2022).

Key Messages in the Antenatal period

The decline in both exclusive and partial breastfeeding with each month after birth (Office for Health Improvement & Disparities, 2023) has been attributed to pain, perceived insufficient milk supply, fatigue, societal attitudes, early return to work, and inconsistent professional support (RCM, 2018). This highlights the need for skilled care when it matters most. NICE frames postnatal care as structured assessment with attention to feeding and maternal wellbeing in the first 8 weeks (NICE, 2021b).

Midwives should make every possible effort to ensure uninterrupted skin-to-skin contact within the first hour after birth, as this significantly improves breastfeeding initiation and regulation (RCM, 2018; WHO, 2018).

Transfer of care from maternity care to community care should include handover of information about the baby’s Feeding, which should include a plan for feeding that baby and observing at least 1 effective feed (NICE, 2021a).

Effective breastfeeding positions and attachment underpin comfort, milk transfer and prevention of complications such as cracked nipples, engorgement and mastitis. Persistent pain should never be normalised and prompt skilled assessment with proactive, individualised infant-feeding support in routine postnatal care, including during pregnancy and early weeks (NICE, 2021a).

Breastfeeding mothers should be guided to understand the 4 most common breastfeeding positions, with the benefits of each. This includes:

By providing choice through guidance and education, mothers can choose the position that best addresses the problem e.g. their delivery, the time of day, supporting rest for the mother.

Share the criteria needed for an effective latch, regardless of which position is chosen. These include making sure baby’s head, neck and torso is aligned and baby’s is chin leading. Make sure the baby is close, with their nose opposite nipple before latching (NHS).

Check for a wide gape or an asymmetrical latch (more areola seen above top lip than below).

Listen and look for swallowing after initial quick sucks (NHS). Emphasise that the mother should be comfortable after the first initial seconds of discomfort and should not be in considerable pain.

HCPs may also need to support all feeding mothers and partners about how to effectively support their baby with winding or burping. Infants often vary in their requirements for winding and providing families with the tools to be responsive int their approach. NHS guidance suggests no strict rules; some babies need burping during feeds, some after and the baby’s cues should be followed.

Finally, health care professionals should provide mothers with important safety guidance such as never feeding the baby while they are in a sling or carrier.

For breastfeeding mothers in the UK, vitamin D supplementation is advised at 10 micrograms (400 IU) daily. For breastfed infants from birth to 1 year, 8.5–10 micrograms daily is recommended, unless taking ≥500 ml/day of formula. NICE’s maternal and child nutrition guidance also addresses improving uptake of vitamin supplements in line with government advice, including for pregnant and breastfeeding women (NICE, 2025).

The RCM (2018) is explicit that parents who choose to formula feed, exclusively or partially, must be supported without judgement. This includes providing clear, evidence-based guidance on preparation and sterilisation, encouragement of close physical contact and responsive feeding.

This article shares evidence-based guidance for health care professionals in supporting mothers and care partners in starting and maintaining breastfeeding. Our follow-up article considering how to “support problems during breastfeeding” is recommended to provide tailored and appropriate assessment in identifying and supporting common issues when breastfeeding.