When to Start Breastfeeding

Breastfeeding should be initiated within the first hour after birth through immediate skin-to-skin contact between mother and infant. 1, 2

Immediate Postpartum Period

Early skin-to-skin contact immediately after birth (as soon as the mother is medically stable, awake, and able to respond to her newborn) should be implemented to facilitate breastfeeding initiation within the first hour of life 1
Common nursery routines such as weighing the infant, administration of vitamin K, and application of ocular antibiotics can be safely delayed until after the initial breastfeeding 2
The American Academy of Pediatrics (AAP) recommends that vitamin K administration and ophthalmic prophylaxis can be delayed for at least 1 hour and up to 4 hours after delivery 1
Allow the infant to root and latch on spontaneously within the first hour of life whenever possible 2

Early initiation of breastfeeding decreases the risk of hypoglycemia in newborns 1
Timely initiation of breastfeeding ensures infants receive colostrum, which contains protective antibodies 3
Breastfeeding within the first hour of life helps prevent newborn death due to sepsis, pneumonia, diarrhea, and hypothermia 3
Early breastfeeding is associated with higher rates of exclusive breastfeeding at hospital discharge and at 8 weeks postpartum 1

Implementation of breastfeeding-supportive hospital practices, including breastfeeding in the first hour after birth, exclusive breastfeeding, rooming-in, and breastfeeding on demand, enable mothers to be more successful at meeting their breastfeeding goals 1
Continuous rooming-in with frequent, exclusive breastfeeding is recommended to establish successful breastfeeding 1
Avoid recommending breast milk supplements unless breastfeeding technique and frequency have been optimized first or when supplementation is medically necessary 1

Frequent feeding on demand, at least 8-10 times in 24 hours, decreases newborn weight loss, the need for supplements, and the risk of clinically significant hyperbilirubinemia 1, 4
Breastfeeding 9-10 times per day is associated with lower bilirubin concentrations, while breastfeeding fewer than 7 times per day is associated with higher bilirubin concentrations 4
Newborns (0-1 month) should feed 8-12 times per 24 hours (approximately every 2-3 hours) 4

Mode of delivery: Mothers who deliver in a health facility are more likely to initiate breastfeeding within the first hour of birth (OR 1.67; 95% CI: 1.25,2.23) 5
High-risk pregnancy status and cesarean delivery may delay early breastfeeding initiation 6
Maternal education: Mothers with higher education are more likely to initiate early breastfeeding (OR 2.56; 95% CI: 1.26,5.21) 5
Prelacteal feeding (giving foods other than breast milk before initiating breastfeeding) negatively impacts early breastfeeding initiation 6

The AAP recommends exclusive breastfeeding for approximately 6 months after birth 1, 7
The AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond 7
These recommendations are consistent with those of the World Health Organization (WHO) 7

Avoid unnecessary separation of mother and infant in the immediate postpartum period 1
Don't delay breastfeeding for routine procedures that can be performed while the infant is being held skin-to-skin or can be delayed 1
Avoid supplementing with formula unless medically necessary, as this can interfere with establishing breastfeeding 4
Avoid prelacteal feeding, which can negatively impact early breastfeeding initiation 6