Infant Feeding Policy

All pregnant women will have the opportunity to discuss feeding and caring for their baby with a health professional at every contact. This discussion will include the following topics:

• The value of connecting with their growing baby in-utero
• Feeding:
  1. An exploration of what parents already know about infant feeding
  2. The value of breastfeeding as food, for comfort, for stimulating and priming the gut biome and immune system.
  3. Getting breastfeeding off to a good start – giving information about positioning, attachment and signs of effective feeding
  4. Local and National breastfeeding support which is available to parents.
• The importance and value of skin contact for all mothers and
• The significance of responding to their baby's needs for comfort, closeness and feeding after birth and their role in establishing this.

An antenatal contact is now part of the Health Visiting and Family Nurse Partnership Pathways

The service recognises the significance of pregnancy as a time for building the foundations of future health and well-being of the family unit.  It acknowledges the role of health visitors to positively influence pregnant women and their families with evidence-based information. Staff will make every contact count to make the most of the opportunities available to them to share evidenced based information regarding the infant feeding, nurturing and building loving and close relationships.  This will include:

• Antenatal contacts with parents be used as an opportunity to discuss infant feeding and the importance of the early establishment of building a close and loving relationship with their baby.
• Members of the health visiting team proactively support and signpost to services provided by other organisations to mothers such as Breastfeeding in Borders, Antenatal classes facilitated by Maternity Services and Early Years Centres.
• The service works collaboratively to develop and support any locally operated antenatal interventions delivered with partner

It is recommended to start colostrum harvesting from 37 weeks. Gestation. This should be once or twice initially per day then building up to 3 times per day. It should only be carried out via hand and a pump should not be used until after birth. If the woman experiences regular uterine contractions the advice is to stop immediately, rest and if the uterine activity does not settle within 2 hours the women should contact her midwife for advice.

Antenatal Colostrum Harvesting is recommended for expectant mothers who have been informed that their baby is at increased risk of a low blood sugar or may be at risk of feeding difficulties following the birth.  Reasons for this may include but not exclusively:

• Women with diabetes in pregnancy (pre-existing or gestational)
• Infants diagnosed during the antenatal period with cleft lip and/or palate
• Infants diagnosed with congenital conditions
• Mothers having an elective caesarean section
• Infants diagnosed as small for gestational age
• Women who have had breast surgery
• Mothers taking beta blockers (e.g. labetalol)
• Mothers with a BMI of 37 or above
• Mothers expecting twins or triplets

Please see Antenatal Colostrum Harvesting & Hand Expressing Standard Operating Procedure for further information.

• All mothers will be offered the opportunity to have uninterrupted skin contact with their baby following delivery until after the first feed and for as long as they want to facilitate the instinctive behaviour of breast seeking by the baby if this is how the mother wishes to feed her baby and to promote the release of the nurturing hormone Oxytocin in the mother.
• All mothers will be encouraged to offer the first colostrum breastfeed in skin contact when the baby shows signs of readiness to

• If mothers choose to formula feed, they will be encouraged to offer the first feed of colostrum in skin-to-skin However, the personal informed choice of how they wish to feed their baby should always be respected.
• Those mothers who are unable or do not wish to have skin to skin contact immediately after birth, will be encouraged to commence skin to skin contact as soon as they are able to or when they wish to. Information should be shared by staff about the benefits for both the baby and mother of early skin to skin contact.
• Mothers will stay on labour ward for a minimum of 3 hours following delivery unless service demands dictate In this case, women will be transferred to the postnatal ward continuing skin to skin contact via wheelchair or bed.

Safety Considerations

Vigilance as to the baby’s well-being is a fundamental part of postnatal care in the first few hours after birth. For this reason, normal observations of the baby’s temperature, breathing, colour and tone should continue throughout the period of skin contact. Observations should also be made of the mother, with prompt removal of the baby if the health of either gives rise to concern. It is important to ensure that the baby cannot fall on to the floor or become trapped in bedding or by the mother’s body. Particular care should be taken with the position of the baby, ensuring the airway does not become obstructed.

Mothers can continue to hold their baby in skin-to-skin contact during perineal suturing. However, adequate pain relief is required, as a mother who is in pain is unlikely to be able to hold her baby comfortably or safely. Mothers should be discouraged from holding their baby if received analgesia has caused drowsiness (e.g. Morphine). 

Staff Should Always Listen To Parents And Respond Immediately To Any Concerns Raises

•  Mothers will be encouraged and supported to start expressing milk as soon as possible after birth within two hours of birth.
• All mothers will be given a colostrum collection kit and the included information and instructions discussed, highlighting the benefits of the early administration of colostrum.
• Mothers will be supported to express colostrum and subsequent breast milk effectively through early demonstration of hand expressing.
• Mothers will be encouraged to have skin to skin contact as soon as possible and as frequently as the condition of both mother and baby
• Mothers with a baby on the neonatal unit will be supported to express as effectively as possible and encouraged to express at least 8 times in 24 hours including once during the They will be shown how to express by both hand and hospital grade electric breast pump.

Staff Considerations

It is the responsibility of midwifery staff to ensure that mothers who are separated from their baby receive this information.  Their ongoing support will enable mothers and their partners to establish and develop close and loving relationships to promote optimum outcomes for their baby and values parents as partners in care.

Mothers will be enabled to breastfeed effectively according to their needs.  Staff will complete a breastfeeding assessment to determine whether appropriate support with positioning and attachment, hand expression, understanding signs of effective feeding is required.  This will continue until the mother and baby are feeding confidently.

• Mothers will have the opportunity to discuss breastfeeding in the first few hours after birth as appropriate to their own needs and those of their Staff should always try to include early feeding cues, responsive feeding, positioning and attachment and how to recognize effective feeding within these conversations.
• A formal feeding assessment will be carried out using the UNICEF breastfeeding assessment form (UNICEF 2015 with amendments) as often as required in the first week with a minimum of one at discharge from hospital, one on or around day five and one at the HV first
• Before discharge home, breastfeeding mothers will be given information verbally and in writing about recognising effective
• All breastfeeding mothers will be informed about the local support groups available in each locality and will be offered Breastfeeding in the Borders (BiBs) peer
• For those mothers who require additional support for more complex breastfeeding challenges, onward referral to NHS Borders Infant Feeding Team or Specialist Service out with the area required for further assessment and/or treatment.
• Mothers will have the opportunity for discussion about their options for continued breastfeeding including responsive feeding, expression and storage of breastmilk and feeding when out and about or going back to work, according to individual need with a health care professional or other trained delegated person
• All services will work in collaboration to make sure that mothers have access to the most appropriate social support for breastfeeding

The term responsive feeding (previously referred to as ‘demand’ or ‘baby-led’ feeding) is used to describe a feeding relationship which is sensitive, reciprocal, and about more than nutrition.

Mothers will be offered the opportunity to discuss this aspect of feeding and reassure mothers that:

• Breastfeeding can be used to feed, comfort and calm babies, allowing them to relax if they have been overstimulated.
• Breastfeeds can be long or short
• Breastfed babies cannot be overfed or ‘spoiled’ by too much feeding. Breastfeeding promotes brain development and nurtures a close and loving relationship.
• Breastfeeding will not tire mothers anymore than caring for a new baby without breastfeeding.

• Mothers who breastfeed their babies will be provided with information about why exclusive breastfeeding leads to the best outcomes for their baby and why it is particularly important during the establishment of
• When exclusive breastfeeding is not possible, the value of continuing partial breastfeeding will be emphasised, and mothers will be supported to maximise the amount of breastmilk their baby
• Mothers who give other feeds in conjunction with breastfeeding will be enabled to do so as safely as possible and with the least possible disruption to This will include discussion regarding the potential impact of introducing a teat when a baby is learning to breastfeed.
• A full record will be made of all supplements given, including the rationale for supplementation and the discussion held with parents to ensure informed This should be documented on the baby’s feeding notes.

Supplementation rates will be audited continuously via the supplementation audit by the Infant Feeding Team.  These are submitted for BFI accreditation.

There are a number of clinical indications for a short term modified feeding regime in the early days after birth. This may include preterm or small for gestational age babies, babies of a diabetic mother, babies weighing over 4.5kg and those who are excessively sleepy after birth.

For these babies, this policy should be used in conjunction with the following documents:

• Transitional care Nursing and Medical pathways and including the hypoglycaemia
• NeoSIFAN Infant Feeding Policy - Neonatal
• The use of Breastmilk Fortifier on Neonatal Units guidelines
• NG Feeding Guidelines
• The Management of Reluctant Feeders Policy

Midwives, Health Visitors and their support staff will ensure that mothers who formula feed will be enabled to do so safely through discussion and the offer of a demonstration on safe preparation of formula milk on a one-to-one basis. Staff should be mindful that this information may have been previously learned therefore revisiting or reinforcing may be required but to be sensitive to a mother’s previous experience.

Staff must be confident that mothers who chose to formula feed:

• Have the evidence-based information they need to enable them to formula feed
• Are encouraged to hold their baby close and in a semi upright position during feeding and to offer most of the feeds to their baby
• Understand the importance of responsive feeding and be encouraged to respond to cues when their baby is hungry, thirsty and needing to be close to their mother for reassurance.
• Invite their baby to draw in the teat rather than forcing the teat into their baby’s
• Pace the feed so that their baby is not forced to feed more than they want to
• Recognise when their baby’s cues that they have had enough milk

Representatives from formula companies will not be received in NHS borders premises. 

Furthermore, if staff wish to attend study days provided by infant formula companies they must do so in their own time.

Skin-to-skin contact will be encouraged throughout the postnatal period regardless of feeding choice. All parents will therefore be supported to understand a baby’s needs through:

• encouraging frequent touch
• sensitive verbal and visual communication
• responding to social cues
• keeping babies close
• responsive feeding to early feeding cues.
• safe sleeping practice as per the current guidance from the Scottish Government and Lullaby Trust. Safer-sleep-guide-for-parents.pdf
• Parents will be given information about local parenting support that is

All Health Professionals should be familiar with safe bed sharing guidelines

Co-sleeping guide for health professionals | The Baby Friendly Initiative

Caring for your baby at night leaflet - Baby Friendly Initiative

Professionals hub | The Lullaby Trust

Advice about bed sharing should be included at every opportunity when feeding is being discussed. Highlighting the following key messages:

• The safest place for your baby to sleep is in a cot/crib beside your bed
•  Always put your baby on their back to sleep in a clear flat space.
•  Sleeping with your baby on the sofa puts your baby at a much higher risk from cot death.

Your baby should never share a bed with anyone who:

• Is ingesting any nicotine products such as smoking cigarettes; vaping or using nicotine pouches
• Has been drinking any alcohol
• Has been taking any medication or drugs that makes them excessively drowsy
• Is excessively tired
• Your baby was born prematurely (before 37 weeks of pregnancy) or weighed under 2.50kgs / 5.8lbs

Parents within these groups will need more face-to-face discussion to ensure that these key messages are explored and understood. They may need some practical help and support to enable them to put them into practice therefore liaison with other agencies may be required.

Babies need a sober carer to respond to their needs

All parents will have a timely discussion about when and how to introduce solid food including:

• that solid food should be started at around six months as per Public Health Scotland Guidelines. Fun first foods: An easy guide to introducing solid foods - Publications - Public Health Scotland
• babies’ signs of developmental readiness for solid food What is weaning? | Parent Club
• How to introduce solid food to babies
• Highlighting appropriate first foods for babies
• Signposting to local practical weaning workshops run by Community Food Worker as appropriate

NHS Borders requires that compliance with this policy is audited at least annually using the UNICEF UK Baby Friendly Initiative audit tool. Staff involved in carrying out this audit require training on the use of this tool. Audit results will be reported to the Director of Nursing and Midwifery and the local Breastfeeding Champions, and an action plan will be agreed with the BFI Lead to address any areas of non-compliance that have been identified

Monitoring outcomes

 Outcomes will be monitored by:

• Monitoring breastfeeding rates at initiation, Health Visitor first visit and 6-8wk review
• Audit and evaluation of care and advice given to a convenience sample of ante and postnatal clients
• Analysis of readmission data from Ward 16 and SCBU via Inphase reporting tool.
• Qualitative data collected through patient Outcomes will be reported to:

The Maternity and Paediatric Clinical Management Teams, the Director of Nursing and Midwifery and the Chief Executive of NHS Borders.

Development Group

Infant Feeding Team/Maternity Care Planning Group 09/2015

Review Groups

Infant Feeding Team 06/2025

Young G

Robson J

Fraser J 

Infant Feeding Team 09/2019

Corbishley A

Hassing I

Jessop B

Hunter M

Infant Feeding Team 01/2018

Hassing I

Jessop B

Hunter M