Google Translate Disclaimer

Translation on this website is provided by Google Translate, a third-party automated translator tool. The Simcoe Muskoka District Health Unit assumes no responsibility for the accuracy of translations performed by Google Translate, or for any issues or damages resulting from its use.

Infant Feeding banner_Prenatal
pregnant mom and toddler
print header


Prenatal Considerations

Most parents decide how they plan to feed their baby before or during pregnancy and the earlier the decision to breastfeed is made, the more likely a parent is to breastfeed.1 This means every interaction with parents during the prenatal period offers an opportunity to share information to support parents to make an informed decision about infant feeding. Interventions that support exclusive breastfeeding for six months begin in the prenatal period and incorporate a combination of education, counselling and support.2,3 Best practices to support prenatal informed decision-making are outlined in Step 3 of the Baby-Friendly Initiative.4

Interventions that support exclusive breastfeeding for six months incorporate a combination of education, counselling and support and a seamless continuum of care from prenatal to postpartum.2,3 Another critical practice that supports breastfeeding is to reduce conflicting advice as much as possible.5,6

Feeding Babies in Simcoe Muskoka: Prenatal Considerations Infographic

In Simcoe Muskoka:

  • Over 90% (92.3% [91.5%–93.0%]) of parents plan to breastfeed, including over 85% (86.6% [85.6%–87.5%]) who plan to breastfeed exclusively.
    • More expectant parents in Simcoe Muskoka plan to exclusively breastfeed compared to the provincial average (79.8% [79.6% - 80.0%]).7
  • How parents plan to feed their baby is associated with how they begin feeding their babies.
    • In particular, 75% to 85% of parents, both those who plan to provide exclusive breastmilk and those who plan to provide no breastmilk, follow through with their intentions, emphasizing the importance of the prenatal period in infant feeding decision making.7

    Infant Feeding Intention and Initiation Rates,

Prenatal care and education offer opportunities to provide prospective parents with knowledge, skills and identification of resources and sources of support to prepare for early parenting, including feeding their baby.

Prenatal care/education that describes the importance of skin-to-skin contact meets best practice recommendations (as per Step 3 of the BFI). In Simcoe Muskoka, 75% (95% Confidence Interval: 71.0% - 78.4%) of pregnant parents report they were provided with information about the importance of skin-to-skin contact by a health care provider.8

There is an association between prenatal class attendance and breastfeeding initiation and duration rates9, however attending prenatal class may have underlying social and economic influences. In Simcoe Muskoka, previous prenatal class attendance (in the past five years) is associated with higher ‘any’ breastfeeding rates at two, four and six months.

Duration of Any Breastfeeding by Past 5 Year Prenatal Class Attendance SMDHU 2015-2016

Data about pregnant parents in Simcoe Muskoka indicate some parents may need extra support to plan to breastfeed exclusively if they:

  • Are under 25 years of age;
  • Use tobacco or other substances;
  • Have given birth previously (parity)*; and or
    • (*Despite their lower intention rates, second-time parents have higher exclusive breastfeeding rates at initiation and up to 2 months compared to first time parents, likely because intention is informed by the breastfeeding experience with the previous baby and is a more accurate predictor of duration for those parents).
  • Were underweight or obese pre-pregnancy (according to their body mass index [BMI]).7
These factors are likely not the cause of lower intention rates, but rather are the result of underlying social and economic (SES) factors. Factors such as housing status, income and social support are not available to analyze with intention data so they cannot be assessed for association with breastfeeding intention.

In addition to the factors identified through local data, other factors that may influence how parents plan to feed their babies include:

  • Parent demographics (e.g. ethnicity, immigration status, language, income, education);
  • Parent health status (e.g. diabetes, hypertensive disorders);
  • Parent social support (e.g. without a partner); and
  • Parent confidence, attitudes, knowledge and beliefs.10,11,12

Along with standard prenatal best practices (e.g. informed decision-making conversations, informing parents of the importance of skin-to-skin contact), parents with lower breastfeeding intention rates may benefit from additional support to address barriers to breastfeeding such as addressing breastfeeding self-efficacy, limited social support, poverty, housing and food insecurity, or other SES factors.

Health care providers can:

1. Assess prenatal parents for barriers and risk factors that may impact their decisions about feeding their babies.

This includes assessing:

  • Breastfeeding knowledge, attitudes and beliefs;
  • Breastfeeding confidence/self-efficacy (including previous breastfeeding experience);
  • Available supports;
  • Pre-pregnancy body mass index;
  • Perinatal mood disorder;
  • Tobacco, alcohol and/or other substance use; and
  • Social and economic determinants of health (SDOH).


Clinical Resources:

2. Provide tailored education, counselling and support

  • Support parents to make informed decisions by providing information about:
  • Infant feeding recommendations;
  • The importance of breastfeeding;
  • The importance of exclusivity;
  • The risks of non-medically indicated supplementation;
  • Health risks of not breastfeeding for both parent and child; and
  • The risks and costs of formula feeding.
  • Talk to parents often throughout their pregnancies about how they plan to feed their babies and educate prenatal parents about feeding their babies
  • Educate parents who plan to breastfeed about position and latch, and how to tell if their baby is getting enough.
  • Educate parents who plan to breastfeed and formula-feed on how to protect their breastmilk supply.
  • Educate and support parents who plan to provide any infant formula to:
  • choose a formula that is acceptable, feasible, affordable, sustainable, and safe (AFASS); and
  • safely prepare, feed and store formula.
  • Educate all prenatal parents about:
  • The importance of early and ongoing skin-to-skin contact (including skin-to-skin contact/breastfeeding during painful procedures, e.g. blood draws, immunizations);
  • Rooming in;
  • Hand expression;
  • Cue-based feeding;
  • Ways to calm their babies;
  • The rights of breastfeeding parents, and
  • Breastfeeding help and support and other social supports in the community.

Clinical Resources:

Patient Resources

Programs and Services

3. Refer to prenatal classes/programs and community service supports

  • Refer clients to contact Health Connection for information about prenatal classes or programs offering additional support.
  • Call or visit 211 to refer clients to additional community social supports.

Health care organizations can:

1.  Create an organizational environment supportive of breastfeeding

    • Family-Centred Maternity and Newborn Care: National Guidelines,
    • Best Practice Guideline: Breastfeeding – Promoting and Supporting the Initiation, Exclusivity and Continuation of Breastfeeding for Newborns, Infants and Young Children,
    • Baby-Friendly Initiative,
    • International Code of Marketing of Breast-milk Substitutes, and
    • Breastfeeding friendly workplaces and spaces policies.

2.  Collaborate with community partners to:

  • Protect, promote and support breastfeeding

More local prenatal data is available from SMDHU’s HealthSTATS webpages including:

  • Pregnancy outcomes (e.g. pregnancy rate, fertility rates, multiple birth rate, preterm birth rate, small and large for gestational age rate, infant mortality rate, stillbirth rate)
  • Health during pregnancy (e.g. folic acid supplementation, smoking, alcohol, and drug use during pregnancy, maternal mental health, hypertension, gestational weight gain)
  • Prenatal preparation (e.g. first trimester visits, prenatal class attendance and primary care provider)
  • Parental characteristics (e.g. social determinants of health, parental age, and parity)
  1. Best Start Resource Centre. Prenatal Education Key Messages for Ontario [Internet]. 2015. Available from:
  2. Kim SK, Park S, Oh J, Kim J, Ahn S. Interventions promoting exclusive breastfeeding up to six months after birth: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud. 2018; 80: 132-137
  3. Registered Nurses’ Association of Ontario (RNAO). Best Practice Guideline: Breastfeeding – Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding in Newborns, Infants and Young Children. 3rd ed. [Internet]. Toronto, ON. 2018. Available from:
  4. Breastfeeding Committee for Canada. The BFI 10 Steps and WHO Code Outcome Indicators for Hospitals and Community Health Services. 2017. Available from:
  5. MacVicar S, Kirkpatrick P. The effectiveness and maternal satisfaction of breast-feeding support for women from disadvantaged groups: a comprehensive systematic review. JBI Database of Systematic Reviews & Implementation Reports. 2014; 12(6), 420-476.
  6. Schmied V, Sheehan A, McCourt C, Dykes F, Beake S, Bick D. Women’s perceptions and experiences of breastfeeding support. Birth. 2011; 38(1) 49-60.
  7. BORN, 2019
  8. SMDHU IFS, 2015-2016
  9. Best Start Resource Centre. The Delivery of Prenatal Education in Ontario: A Summary of Research Findings [Internet]. 2019. Available from:
  10. Baby-Friendly Initiative Strategy for Ontario. BFI Implementation Toolkit [Internet]. 2018. Available from:
  11. Best Start Resource Centre. Populations with Lower Rates of Breastfeeding: A Summary of Findings [Internet]. Toronto, ON. 2015. Available from:
  12. Best Start Resource Centre. Targeted Support for Ontario Populations with Lower Rates of Breastfeeding: 2013-2016 [Internet]. Toronto, ON. 2017. Available from:

Maternal & Child section of Health Professional Portal button

Did you find what you were looking for today?
What did you like about this page?
How can we improve this page?

If you have any questions or concerns that require a response, please contact Health Connection directly.

Thanks for your feedback.
Failed to submit comment. Please try submitting again or contact us at the Health Unit.
Comment already submitted ...