Resources for Health Care Providers

The following links to resources are intended as a guide to overcoming barriers to implementation of the Ten Steps to Successful Breastfeeding. Every facility has obstacles to achieving full implementation of the Ten Steps, with the level of readiness for each facility varying around the state. The resources are listed under the step it helps to fulfill. If you are in a facility that has developed a resource that you would like to share with others, please e-mail it to

Step 1: Have a written breastfeeding policy that is routinely communicated to all health-care staff.

Model policies are available to assist facilities in developing maternity service policy that includes supportive breastfeeding practices. Facilities can use the model policies as a guide.

Watch the Step 1 video >>

Step 2: Train all health-care staff in the skills necessary to implement this policy.

The Texas Ten Step (TTS) program is guided by the Baby-Friendly hospital (BFHI) designation’s education recommendations. Education guidelines of BFHI should be followed when facilities are developing breastfeeding education for staff. The following documents and resources can be used as a guide to develop breastfeeding training for staff.

  • Texas Health Steps - Offers free CE’s through online training modules. Check out the NEW! Ten Steps to Successful Breastfeeding  or the general Breastfeeding modules.
  • The AAP Breastfeeding Residency curriculum
  • The Community Health Training Institute provides two online 1.5 hour tutorials, which together provide 3 hours of breastfeeding education that is aligned with the content expected for physicians providing care in Baby-Friendly Hospital facilities.
  • Stanford University – Breastfeeding page includes video demonstrations and resources.
  • Wellstart International - Free breastfeeding modules for physicians and nurses
  • ACOG Breastfeeding Toolkit for Healthcare Providers, 2016
  • AAP Breastfeeding Initiatives- archived breastfeeding webinars and more!
  • Maryland Hospital Policy Committee- This series of six recorded lectures contains insight on important strategies and practices related to promoting and supporting breastfeeding. Continuing Medical Education credits are available at no charge through June 2019 and were designed to help physicians and advanced care providers meet BFHI step 2 training requirements.
  • Step 2 BFHI Training- These instructional modules were developed as a collaboration between the Maryland Department of Health and the University of Maryland Upper Chesapeake Medical Center, under the guidance of the Maryland Department of Health Hospital Breastfeeding Policy Committee. These modules were developed to meet the requirements outlined in Step 2 of the Ten Steps to Successful Breastfeeding, developed by UNICEF/WHO.
  • The Breastfeeding University Developed through the Carolina Global Breastfeeding Institute (CGBI) by an interdisciplinary team of physicians, nurses, lactation consultants, public health professionals, educators and La Leche League leaders, these trainings will help learners to establish a working knowledge of the importance of breastfeeding and how to support mothers and families to meet their breastfeeding goals.
  • CHAMPS/CHEER Breastfeeding- courtesy of this initiative, free webinars on many important BFHI topics and the Ten Steps.

Texas DSHS – “Trained” Breastfeeding Educator Program

Birthing facilities often face challenges when staffing for onsite breastfeeding support. For some, the challenge is a lack of IBCLCs in the area. For others, providing a full- or part-time position for an IBCLC, or including weekend- or night-shift lactation support, are obstacles. The Breastfeeding Educator Program gives a staff member an opportunity to become qualified as a breastfeeding support resource person.  Interested staff can attend the two separate 2-day DSHS courses and use this designation for five years.

What is a DSHS-Trained Breastfeeding Educator (TBE)?

How do I sign up for the classes to become a Trained Breastfeeding Educator?

Is there a fee or test to become a Trained Breastfeeding Educator?

  • There is a $60 registration fee for each class but no other cost to receive a TBE certificate. There is no test.

What does the TBE designation allow me to do?

  • Having the TBE designation means you are knowledgeable about lactation and able to assist with basic breastfeeding education. Complex breastfeeding issues are not within this scope of practice, and referrals should be made to a health-care provider or an International Board Certified Lactation Consultant (IBCLC) for further evaluation and treatment.
  • In some cases, this designation may help you to initiate a lactation program in your facility.
  • Courses follow the IBLCE Exam Blueprint and may help you further your education in becoming an IBCLC.

Does my TBE certificate expire?

  • Yes. The TBE certificate will expire five (5) years from the date you completed the POLM course.
  • We encourage you to seek additional education and possibly pursue IBCLC certification within this five-year period. Our courses do not provide all of the education requirements to sit for the exam. See what is required to sit for the IBLCE exam.

Watch the Step 2 video >>

Step 3: Inform all pregnant women about the benefits and management of breastfeeding.

This step assures that consistent prenatal breastfeeding messages are included in all aspects of prenatal care. Facilities are encouraged to provide prenatal breastfeeding education courses and work with their prenatal health-care providers to recommend attendance in these community classes. Local WIC agencies and other community breastfeeding resource organizations can be invited to provide education if the facility has limited staff.

Prenatal education topics that should be covered include: the benefits of breastfeeding, the importance of exclusive breastfeeding, basics of breastfeeding management, possible effect of analgesia/ anesthesia on infant behavior, rationale for care practices such as skin-to-skin contact, rooming-in, and infant feeding cues. All materials and education should be presented without messages promoting artificial feeding or sponsorship.

Watch the Step 3 video >>

Step 4: Help mothers initiate breastfeeding within an hour of birth. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to recognize when their babies are ready to breastfeed and offer help if needed.

Watch the Step 4 video >>

Step 5: Shows mothers how to breastfeed and how to maintain lactation, even if they should become separated from their infants.

A mother should be assessed within six hours after her delivery and once per shift throughout her stay. Infant feeding cues; correct latch and position; hand-expression and pumping; safe preparation, handling, and storage of formula for the non-breastfeeding mother; and signs of satiety and output are topics for breastfeeding reinforcement.

Watch the Step 5 video >>

Step 6: Give infants no food or drink other than breastmilk unless medically indicated.

Healthy babies should not be routinely supplemented with any food or drink other than human milk unless medical indications for supplementation exist. In addition, parents should be protected from the marketing of breastmilk substitutes.

For mothers who have made the informed decision to provide breastmilk substitutes for their infants, separate education should be provided to them which discusses the risks of using this form of supplementation, how to properly prepare/ bottle feed their infant and newborn stomach capacity.

Watch the Step 6 video >>

Step 7: Practice rooming-in to allow mothers and infants to remain together 24 hours a day.

Rooming-in should be practiced by all mothers regardless of feeding method to ensure that ample opportunities are available for skin-to-skin contact and early learning of infant feeding cues. A mother who requests to be separated from her infant should receive counseling on the importance and benefits to rooming-in, and staff should explore reasons for the request and provide solutions. Healthy mothers and infants should not be separated during their stay, with the exception of no more than one hour a day to allow for any medically necessary procedures that cannot be conducted at the bedside.

Watch the Step 7 video >>

Step 8: Encourage breastfeeding on demand. Teach mothers cue-based feeding regardless of feeding method.

Mothers and their families should be educated about infant feeding cues and normal infant transitional behavior. They should be supported and provided unlimited opportunities to respond to infant feeding cues.

Watch the Step 8 video >>

Step 9:  Give no artificial nipples or pacifiers to breastfeeding infants.

Health-care providers should not offer healthy breastfed infants pacifiers or artificial nipples. Supplementation, when required, should be offered using alternative measures such as a cup, tube or syringe.

Watch the Step 9 video >>

Step 10: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic.

Discharge support and follow-up for breastfeeding mothers is imperative to their success in breastfeeding duration and exclusivity. Refer all mothers  to the appropriate resources and be aware of the community resources available prior to discharge. Individual care plans should be developed by the health-care team to guide the mother to continued success and achievement of her goals.

Watch the Step 10 video >>

WIC Lactation Support Centers – breastfeeding support for the WIC-enrolled breastfeeding mother.

**Health-care providers have access to breastfeeding management support via the Texas Lactation Support Hotline.

Mom’s Place- Austin
8701-B Research Blvd
Austin, TX 78758
512-972-6700, Facebook Page

Lactation Foundation- Houston
2636 South Loop West #135
Houston, TX 77054
713-500-2800, Facebook Page

Lactation Care Center of Dallas
2600 North Stemmons Freeway, Suite 188
Dallas, TX 75207
1-855-550-6667 (Texas Lactation Support Hotline), Facebook Page

Lactation Care Center Rio Grande Valley- McAllen
3001 B, 23rd Street, Suite 2
McAllen, TX 7850
956-292-7711 Facebook Page

Baby Café – Mom-to-mom breastfeeding support located in drop-in cafés around Texas: