1. EARLY INITIATIONOF BREAST FEEDINGAbla Al AlfyRCPCH Lead for EgyptSecretary General -ELCA
2. ANTENATAL PERIOD ANDEBF When Breast Milk Production start antenatal? Do we need any Nipple Massage? When should we start Breast Feeding? How we should Start Breast Feeding? When milk let down occur? What to do till mother get enough milk?
3. THE CARE A MOTHER‘RECEIVES DURING LABOURAND BIRTH CAN AFFECTBREASTFEEDING & HOWSHE CAN CARE FOR HERBABY’UNICEF-BFHI- 20 HOUR TRAINING
4. NEW INTERPRETATION OFSTEP 4 IN THE REVISEDBFHI GLOBAL CRITERIA(:(2006Place babies in skin-to-skin contact with their“ mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to .”breastfeed, offering help if needed Slide 4.4.2
5. WHAT ARE THE BENEFITS THIS?MOTHER AND BABY CAN GAIN
6. PRACTICES THAT HELPWOMEN FEEL CONTROL OFTHEIR LABOR Emotional support during labor Attention to the effect of pain medication on baby Offering light foods & fluids to mother in labor Freedom of movement Avoiding unnecessary C-section Early mother-baby contact Leaving baby skin-to-skin for at least an hour or until first feed (facilitating first feed)
7. SUPPORT AT BIRTH A companion can give Its effect on the birth:non medical support :outcome Emotional More alert baby Massages her back Less hypothermia Helps her to walk Less hypoglycemia Positive words More early frequent Offers foods feedings Reassures Easier bonding Builds her confidence
8. PAIN RELIEF Non medication methods of pain relief include: Walking around at labor Massage Warm water Verbal and physical reassurance Quiet environment
9. EFFECTS OF PAIN MEDICATION They increase risk of: Longer labor with its known complications Operative intervention Delayed first contact Separation/sleepy baby Decreased suckling Increased milk intake Extra time and assistance is needed if medications are used
11. FEEDBACK INHIBITOR OF( LACTATION (FIL To prevent the Feedback Inhibitor of Lactation from collecting and reducing milk production: -Make sure that the baby is well attached; -Encourage frequent breastfeeds; -Allow baby to feed for as long as she or he wants at each breast; -Let the baby finish the first breast before offering the second breast; -If baby does not suckle, express the milk so that milk production continues.
12. Goodattachment ?WHAT CAN YOU SEE Poor attachment 6/3 ,Breastfeeding Counselling: a training course WHO/CHD/93.4, UNICEF/NUT/93.2
13. HOW TO DECIDE IF ABABY IS WELL ORPOORLY ATTACHEDLooking from outside
14. Goodattachment ?WHAT CAN YOU SEE Poor attachment 6/4 ,Breastfeeding Counselling: a training course WHO/CHD/93.4, UNICEF/NUT/93.2
16. كيف تحققينهقربي الحلمة من أنف الطفل و اتركي رأسه يميل للخلف قليل ليفتح فمه لكبر اتساع و يخرج لسانه فيصبح لسانه مع فكه السفلي كالمغرفة.
17. كيف تحققينهبسرعة خذي الطفل عليك و ضعي ثديك على فكه السفلي و لسانه.
18. كيف تحققينهعندما يستقر ثديك على لسانه وهو مضموم إليك سيطبق شفته العليا علي الثدي و يبدأ المص. ستسمعين صوت البلع بعد قليل.
19. كيف تحققينهضعي كفك مفتوحا مع الربع أصابع تحت الثدي و سيف اليد مسنود على الضلوع ثم ضعي البهام فوق الثدي خلف الهالة السمراء.
20. يترك الطفل يمص حتى يكتفي و يترك الثدي بنفسهإذا أحسست بألم يمكنك وضع إصبعك الصغير في زاوية فمه ليترك ثديك برفق بين الثديين يمكنك تكريعه لينشط للرضاعة من الثدي الخر
21. THE ACTION OFSUCKLING• Rooting reflex When the breast touches the baby’s lips (or the baby smells the milk ), he or she puts their head back slightly, opens their mouth wide, and puts their tongue down and forward, to seek the breast.. The sucking reflex • When the baby is close enough to the breast, and takes a large enough mouthful, the baby can bring the nipple back until it touches the soft palate.. • The muscles then move the tongue in a wave from the front to the back of the mouth, expressing the milk from the ducts beneath the areola into the baby’s mouth. The oxytocin reflex makes the milk flow along the ducts. The swallowing reflex,The baby swallows when the back of the mouth fills with milk.
22. SIGNS THAT A BABY ISSUCKLING EFFECTIVELY-The baby takes slow, deep sucks, sometimes pausing for a short time,-You can see or hear the baby swallowing.-The baby’s cheeks are full and not drawn inward during a feed.-The baby finishes the feed and releases the breast by himself or herself and looks contented.
23. SIGNS THAT A BABY IS NOTSUCKLING EFFECTIVELY -makes only rapid sucks; -makes smacking or clicking sounds; -has cheeks drawn in; -fusses or appears unsettled at the breast, and comes on and off the breast; -feeds very frequently - more often than every hour or so EVERY day; -feeds for a very long time - for more than an hour at EVERY feed, unless low birth weight; -is not contented at the end of a feed, Cluster feeding – when baby feeds very frequently for a few hours and then sleeps for a few hours, is norm
24. TEACH MOTHERS HOW THEYCAN KEEP MILK PRODUCTIONPLENTIFUL -Help the baby to breastfed soon after birth, -Make sure the baby is well attached at the breast and do not give any artificial dummies or teats that would confuse his or her suckling and reduce stimulation of the breast. -Breastfeed exclusively, -Feed the baby as frequently as he or she wants, usually every 1-3 hours, for aslong as he or she wants at a feed. -Feed the baby at night, when prolactin release in response to suckling is high.
25. TEACH MOTHERS HOW TO. CARE FOR THEIR BREASTS -Clean the breasts with water only. Soaps, lotions, oils, and Vaseline all interfere with the natural lubrication of the skin. -Washing the breasts once a day as part of general body hygiene is sufficient. It is not necessary to wash the breasts directly before feeds. This removes protective oils and alters the scent that the baby can identify as his or her mothers breasts. - Brassieres are not necessary, but can be used if desired. Choose a brassiere that fits well and is not too tight
26. SECOND DAY OF LIFE Baby is not feeding well Proper positioning and attachment Frequency of Nursing Mothers Diet Sleep Avoid engorgement Pain and cracking
27. MANAGEMENT OFRELUCTANCE TO FEED • Remove or treat the cause if possible: -Help the mother to position and attach the baby well, -Help the mother to express some milk before feeding if the milk is coming too fast or if the breast is too engorged. -Treat a sore mouth or thrush if you are able or refer the baby for medical help. -Provide pain relief if the baby is in pain, -Help the mother to hold the baby without causing pain, if the baby is bruised, -Avoid using artificial teats or pacifiers. If needed, give feeds by cup. -Stop using anything that is causing an unpleasant taste or smell to the breast. •
28. MANAGEMENT OFRELUCTANCE TO FEED Encourage skin-to-skin contact between mother and baby in a calm environment when the baby is not hungry. This helps both the mother and baby to see the breast as a pleasant place to be. Then the baby can explore the breast and attach when he or she is ready. This may be an hour or more and may not happen on the first occasion there is skin-to-skin contact. • Do not try to force the baby to the breast when the baby is crying. He or she needs to associate the breast with comfort. It may be necessary to express the milk and feed it by cup until the baby learns to breastfeed happil
29. PREVENTION OFRELUCTANCE TO FEED -Early and frequent skin-to-skin contact that helps the baby to learn that the breast is a safe place from the first few hours; -Helping the mother to learn the skill of positioning and attachment in a calm unhurried environment, -Being patient while the baby learns to breastfeed, -Caring for the baby in a gentle confident manner.
30. Contrary to popular belief,attaching the baby on the breast is not an ability with which amother is [born…]; rather it is a learned skill which she must acquire by observation and experience. .From: Woolridge M. The “anatomy” of infant sucking. Midwifery, 1986, 2:164-171 Slide 4.5.2
31. POSITIONS Supporte Close In line Facing d BREASTFEEDING 7/1,Breastfeeding Counselling: a training course WHO/CHD/93.4, UNICEF/NUT/93.2
32. في كل دقيقة احتاج لك ضميني اليك ولحتحرميني لبنك –ارضعيني متي اردت حتي اكتفي )8(
33. MOTHER’S POSITIONS There are many positions that a mother may use – for example, sitting on the floor or the ground, or sitting on a chair, lying down, standing up, or walking. If the mother is sitting or lying down, she should be: -Comfortable with back supported -Feet supported if sitting so that the legs are not hanging loose or uncomfortable, -Breast supported, if needed.
34. BABY’S POSITION The baby also can be in different positions, such as along the mother’s arm, under the mother’s arm, or along her side.Four key points are used to help the baby be comfortable.The baby’s body needs to be: -in line with ear, shoulder and hip in a straight line, so that the neck is neither twisted nor bent forward or far back; -close to the mother’s body so the baby is brought to the breast rather than the breast taken to the baby; -supported at the head, shoulders and if newborn, the whole body supported; and -facing the breast with the baby’s nose to the nipple as she or he comes to the breast.
35. POSITIONS Supporte Close In line Facing d BREASTFEEDING 7/1,Breastfeeding Counselling: a training course WHO/CHD/93.4, UNICEF/NUT/93.2
40. ED BREASTFE 7/6UNICEF/HQ91-0168/ Betty Press, Kenya
41. 9/1 8/1Original illustration by Jenny Corkery
42. JUST ONE BOTTLE
43. X Slide 4o
44. أمي الحبيبة –أرضعيني لبنك لاريد ماء ولأي شي آخر يحرمني لبنك.ماذلت صغيرا وجسدي لم يكتمل بعد (6(
45. لاريد لهايات وليبيبرونات . طعمها مختلف عن لبنك وكلها امراض. لحتتسببي فيضرري ياحبيبتي لولكتكذبي علي من يومي اللول. أنا اريد لبنك لو كل دة يبيلخبطني وانا لسه صغير ومحتاج اركز لواحتعلم الرضاعة علي ثدييك فقط )9(
47. MY MILK IS NOT ENOUGHMy Milk is Too Much
48. التناسب المثالي لكمية اللبن مع حجم معدة الرضيع معدة رضيع عمره سنة معدة رضيع عمره يوم أو 2 02 002 مل مل ملعقة شاي ملعقة شاي
49. الممارسات المثالية لنجاح الرضاعة الطبيعيةعلمات الرغبة في الرضاعة يحرك الرضيع رأسه من جانب إلى آخر. • يفتح فمه. • يخرج لسانه. • يضع أصايبعه و كفه في فمه. • يقوم يببعض الصوات الهادئة أو المص. • يحرك شفتيه و كأنه يرضع. • يحك أنفه في صدر الم أثناء حملها له. • إذا لمس أي شئ خده يلتفت لنفس الحتجاه. •
50. OXYTOCIN .Oxytocin reflex, or milk ejection reflex, or letdown • Oxytocin causes the muscle cells around the alveoli to . contract and makes milk flow down the ducts .This is essential to enable the baby to get the milk It may happen several times during a feed. The reflex may . feel different or be less noticeable as time goes by Soon after a baby is born, the mother may experience • : certain signs of the oxytocin reflex. These include,painful uterine contractions, sometimes with a rush of blood - , a sudden thirst- milk spraying from her breast, or leaking from the breast - , which is not being suckled . feeling a squeezing sensation in her breast-
51. When the milk ejects, the rhythm of the babys suckling •changes from rapid to slow deep, sucks (about one per . second) and swallows Seeing, hearing, touching and thinking lovingly about • .the baby, helps the oxytocin reflex :The mother can assist the oxytocin to work by Feeling pleased about her baby and confident that her - , milk is best . Relaxing and getting comfortable for feeds- Expressing a little milk and gently stimulating the - . nipple Keeping her baby near so she can see, smell, touch and - . respond to her baby If necessary, asking someone to massage her upper- . back, especially along the sides of the backbone
52. HELPING THE OXYTOCIN REFLEX 6/2,Breastfeeding Counselling: a training course WHO/CHD/93.4, UNICEF/NUT/93.2
53. Slide 4m
54. CASE Case study 9/2 2 weeks oldSTUDY Healthy at birth Discharged Day 2 “Sleeping all the time” “Refusing” the breast Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 3 stools in week UNICEF/HQ91-0168/ Betty Press, Kenya 12% under birth weight Bottle with honey and water twice yesterday
55. Dr Nils Bergman, Cape Town, South Africa O CARE MOTHER 10/2
56. TRIPLET-I HAVETWINSI am pregnant
57. I AM SICK –HAVE COLD- HAVEDIARRHEAOn Drugs
58. MY BABY IS VOMITINGMy Baby Have frequent watery stool My Baby is constipated
59. SUCCESSFULBREASTFEEDINGStep 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. A JOINT WHO/UNICEF STATEMENT (1989)
60. HOW TO IMPLEMENT STEP 10 It is the responsibility of the BFHI maternity hospital to be linked to a support group or health unit that can provide adequate skilled support to breastfeeding mothers. These health facilities or support groups should be ‘Baby Friendly’ i.e. comply to the Ten Steps and the International Code for prohibiting marketing inside health facilities or permitting free supplies..
61. The key to best breastfeeding practices is continued day-to-day support for the breastfeeding mother within her home and community. From: Saadeh RJ, editor. Breast-feeding: the Technical Basis and Recommendations for Action. Geneva, World Health Organization, pp.:62-74, 1993. Slide 4.10.2