Abstract Overview:
Human milk feeding rates remain suboptimal globally, although there are international and national recommendations for best practices, including early breastfeeding initiation, frequent and prolonged skin-to-skin contact, and regular breastfeeding. Prenatal, birth and infant-related factors can negatively affect lactation outcomes. These factors can hinder the early initiation of breastfeeding and skin-to-skin contact, vital for long-term lactation success.

Aims and Objectives:
The aim is to provide guidance regarding the identification and management of women and infants with risk factors associated with the impairment of the initiation and establishment of lactation. The objectives are to review the importance of breastfeeding and the physiology of lactation, to describe the critical window of time to optimize human milk supply, to list the risk factors which may affect milk production or breastfeeding and to outline proposed clinical pathways to manage those at risk.

Methods:
Key maternal, birth and infant risk factors that may impact lactation will be presented alongside an evidence-based perinatal operational breastfeeding plan with clinical pathways to guide healthcare professionals in providing individualized care for families with identified risks for lactation. Results By integrating the perinatal operational breastfeeding plan into clinical practice, midwives and other health care professionals will be able to proactively provide tailored education and interventions to families so that a delay in secretory activation does not lead to early breastfeeding cessation.

Conclusions:
The goal is to ensure timely secretory activation and adequate milk supply in the short and long term. This would enable more newborns to breastfeed longer and families to achieve their breastfeeding goals, hence contributing to improving maternal and child health outcomes.