Maryland Hospital Breastfeeding Policy Recommendations

New breastfeeding training opportunities are coming up in the next few weeks!

Maryland Department of Health (MDH) encourages all birthing hospitals in the State to become “Maryland Best Practices Hospitals,” by either attaining Baby Friendly certification through the Baby Friendly Hospital Initiative (BFHI) the details of which are available at, or meeting the ten criteria contained in the Maryland Hospital Breastfeeding Policy Recommendations . A hospital may choose to implement none of these criteria, or, it may choose to fulfill one or more of these criteria. If a hospital chooses to satisfy all ten of the criteria in these policy recommendations, then the hospital will be considered a “Maryland Best Practices Hospital.”


While breastfeeding initiation is the essential first step, duration and exclusivity are key to obtaining the myriad of benefits to public health and society provided through breastfeeding. Babies who are fed formula or stop breastfeeding early have higher risks of obesity, diabetes, respiratory and ear infections, and sudden infant death syndrome (SIDS), and tend to require more doctor visits and hospitalizations.1,2

Breastfeeding decisions are influenced by many factors, including a mother’s initial breastfeeding experience, family support, challenges on returning to work or school, and community support. In the United States, most babies are born in a hospital, and mother and baby have their first feeding experience in that setting. A mother’s comfort with breastfeeding and her commitment to continue can be greatly influenced by hospital practices and staff support. First impressions have a lasting effect on subsequent behavior, making the birthing hospital stay a critical opportunity to impact breastfeeding success.

The Process

Recognizing the vital role that hospitals play in the success of breastfeeding, the Maryland Department of Health (MDH) formed a committee to develop breastfeeding policy recommendations that will strengthen and improve current maternity care practices. A stakeholders’ meeting was held in December 2011 to obtain input. The first edition recommendations were posted on the MDH website for public comment in February 2012. Over 130 comments were received in this first round. 56% of the respondents strongly agreed and 30% agreed that the policy recommendations focused on correct strategies to promote and support breastfeeding. The second edition recommendations were post on the MDH website for public comment in August 2012; 34 comments were received. 85% of the respondents agreed with the updated policy recommendations. In September 2012, the Committee finalized the policy recommendations and hospital self-assessment form. These policy recommendations, based on the WHO/UNICEF Ten Steps to Successful Breastfeeding​,​ include evidence-based hospital practices that increase rates of breastfeeding initiation, duration, and exclusivity for healthy, full term infants whose mothers have chosen to breastfeed them.


Next Steps

  • Posted and evaluated Maternity Staff Training Modules.  Edit, as possible, to meet participants’ requests of evaluation survey
  • Continue to offer physician webinars with CME at no cost to attendee
  • Continue to provide technical assistance educational opportunities
  • Work toward sending out Maryland Hospital Breastfeeding Policy self-evaluations in early 2018




  1. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.
  2. Hospital Support for Breastfeeding: Preventing Obesity Begins in Hospitals. CDC Vitalsigns; August 2011.