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There is available guidance to help establish an adequate milk supply for healthy individuals experiencing a physiologic labor and birth, and there are robust recommendations for the lactating parents of small, sick, and preterm newborns to ensure that these newborns can receive human milk. Missing from the literature are clinical practice guidelines that address the preexisting health, pregnancy, birth, or newborn\u2010related risk factors for suboptimal lactation. This can include risk factors that impact secretory activation or newborns who may not attach and suckle effectively to provide the stimulation and removal necessary to reach full milk volume. Secretory activation can only occur after the birth of the newborn and the placenta, with milk volume being established during the first weeks of breastfeeding. Recognizing this gap, over the past 2 years, an international group of midwives led by a doctoral nurse scientist in lactation conducted an extensive literature review to identify the most significant risk factors that can disrupt normal physiologic lactation. Our group sought to establish proactive lactation management strategies to ensure long\u2010term milk production. We developed an evidence\u2010based perinatal operational breastfeeding plan alongside clinical pathways to guide health care professionals in assessment, care, and necessary education for families who present with risk. Our goal is for midwives and other health care professionals to integrate the perinatal operational breastfeeding plan into practice and use these pathways to ensure (1) timely and effective secretory activation, (2) building a milk supply as robust as feasible for personal situations and conditions, (3) more newborns receiving more human milk and (4) more families achieving their personal breastfeeding goals.<\/jats:p>","DOI":"10.1111\/jmwh.13726","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T00:38:08Z","timestamp":1735259888000},"page":"343-349","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Proactive Management of Lactation in the Birth Hospital to Ensure Long\u2010Term Milk Production and Sustainable Breastfeeding"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7316-6616","authenticated-orcid":false,"given":"Diane L.","family":"Spatz","sequence":"first","affiliation":[{"name":"University of Pennsylvania School of Nursing  Philadelphia Pennsylvania"},{"name":"Center for Pediatric Nursing Research and Evidence Based Practice Children's Hospital of Philadelphia  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salom\u00e9","family":"\u00c1lvarez Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Central de Asturias  Oviedo Spain"},{"name":"Federaci\u00f3n de Asociaciones de Matronas de Espa\u00f1a  Oviedo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Benjilany","sequence":"additional","affiliation":[{"name":"Enghienles Bains France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Finderle","sequence":"additional","affiliation":[{"name":"Croatian Chamber of Midwives  Rijeka Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleyd","family":"von Gartzen","sequence":"additional","affiliation":[{"name":"German Midwives Association, Karlsruhe  Germany"},{"name":"German National Breastfeeding Committee  Hanover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Yates","sequence":"additional","affiliation":[{"name":"International Confederation of Midwives  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Brumley","sequence":"additional","affiliation":[{"name":"Midwifery Practice at Tampa General Hospital  Tampa Florida"},{"name":"American College of Nurse\u2010Midwives  Washington District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003519.pub4"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2013.9979"},{"key":"e_1_2_9_4_1","unstructured":"UNICEF;World Health Organization.Implementation Guidance: Protecting Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services: The Revised Baby\u2010Friendly Hospital Initiative.World Health Organization;2018."},{"key":"e_1_2_9_5_1","unstructured":"UNICEF;World Health Organization.Protecting Promoting and Supporting Breastfeeding. 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