Intended for healthcare professionals

Rapid response to:


Breastfeeding programmes “should be targeted”

BMJ 2000; 321 doi: (Published 19 August 2000) Cite this as: BMJ 2000;321:467

Rapid Response:

Breastfeeding initiation: benefits of the Hands Off Technique

Dear Editor,

The paper 'Promoting the initiation of breastfeeding' (Effective
Health Care
2000;6:2) points to static breastfeeding rates over the past 20 years.

However, breastfeeding support may be just as important as promotion.
Targeting specific groups in order to encourage them to breastfeed is only
part of the story. At present, women who already want to breastfeed stop
sooner than they had planned to, often because of setbacks or
misunderstandings which can be avoided, or quickly corrected, with the
information and support. More than 80% of women who stop breastfeeding
before four months would have liked to have continued for
longer (1).

There has been little research into the finer points of how new
initiate breastfeeding, but recent work has shown it could make a real
difference between 'trying to breastfeed' and 'breastfeeding'. At the
Women's Hospital in Australia, which is Baby Friendly (2) accredited, the
'Hands-Off Technique' Program (HOT) has been implemented (3). Midwifery
staff have been taught to teach mothers about effective positioning and
attachment 'Hands Off' - so the mothers learn to do it for themselves
from the start. Fletcher and Harris acknowledge that it is a challenge to
alter midwifery culture but that it is worthwhile and has brought benefits
for mothers and babies, and for staff (increased professionalism and
back injuries). There are occasions when 'hands on' is more appropriate,
the authors are now convinced that they are in the minority.

A recent survey of infant feeding across one county in the UK (4)
that, of 95 first-time mothers who had decided antenatally to fully
breastfeed, only 46% were still fully breastfeeding at around six weeks.
Interestingly, those who had put their own babies to the breast for the
first feed ('Hands Off') were much more likely to still be breastfeeding
(71%) than those who had someone else put the baby on for them (38%).
However, as only about one third of the new mothers put their own babies
the breast for the first feed, further research is needed to check whether
the differences are statistically significant.

In the UK as a whole, the majority of mothers are no longer giving
breastmilk by six weeks (1). It is likely that only a minority of mothers
are getting positive breastfeeding experiences in this country. This
needs to be addressed before more women are encouraged to 'try

Di Napier

lay breastfeeding counsellor

1. Foster K, Lader D, Cheesbrough S., Infant feeding 1995, The
Office, London 1997.

2. Information on the international WHO/UNICEF Baby Friendly
Initiative can
be found at

3. Fletcher, D, Harris, H, The implementation of the HOT program at
Royal Women's Hospital Breastfeeding Review 2000, 8 (1): 19-23

4. Benjamin, M, Survey of Infant Feeding Practices in Warwickshire
Clinical Effectiveness Department, Warwick, 1999

Competing interests: No competing interests

24 August 2000
Di Napier
lay breastfeeding counsellor
Warwickshire, UK