Bfhi revised section_3.3

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  • 1. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    BABY-FRIENDLY HOSPITAL INITIATIVERevised, Updated and Expanded for Integrated Care
    “Maternity”, 1963, © 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York
  • 2. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Global Strategy for Infant and Young Child Feeding
    1/1
       The aim of the Global Strategy is to improve – through optimal feeding – the nutritional status, growth and development, health, and thus the survival of infants and young children.
    It supports exclusive breastfeeding for 6 months, with timely, adequate, safe and appropriate complementary feeding, while continuing breastfeeding for two years and beyond.
    It also supports maternal nutrition, and social and community support.
  • 3. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    The aim of the Baby Friendly Hospital Initiative
    1/2
    To implement the Ten Steps to Successful Breastfeeding and to end the distribution of free and low-cost supplies of breastmilk substitutes to health facilities.
  • 4. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Course Aims
    The aim of this course is that every staff member will confidently support mothers with early and exclusive breastfeeding,
    and that this facility moves towards achieving Baby-friendly designation.
    1/3
  • 5. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    3/1
    Original illustration by Jenny Corkery
  • 6. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Infant Feeding Recommendation for HIV-positive Women
    3/2
    When replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS), avoidance of all breastfeeding by HIV-infected mothers is recommended.
    Otherwise, exclusive breastfeeding is recommended during the first months of life and then should be discontinued as soon as it is feasible.
  • 7. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    4/1
    Original illustration by Jenny Corkery
  • 8. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    4/2
    The overall aim of the International Code of Marketing of Breastmilk Substitutes is the safe and adequate nutrition of all infants.
  • 9. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Skin to Skin Contact and Early Breastfeeding
    5/1
    ©UNICEF C107-2
  • 10. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    5/2
    Skin to Skin Contact and Early Breastfeeding
    UNICEF/HQ92-0369/ Roger Lemoyne, Thailand
  • 11. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    First Skin to Skin Contact
    5/3
    Dr Nils Bergman, Cape Town, South Africa
  • 12. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Parts of the Breast
    6/1
    Adapted from Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
  • 13. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Helping the Oxytocin Reflex
    6/2
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
  • 14. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    What can you see?
    6/3
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
    Good attachment
    Poor attachment
  • 15. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    What can you see?
    6/4
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
    Good attachment
    Poor attachment
  • 16. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Breastfeeding Positions
    7/1
    In line
    Close
    Supported
    Facing
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
  • 17. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    7/2
    BREASTFEED OBSERVATION AID
    Mother's name _______________________________ Date ___________________
    Baby's name _________________________________ Baby's age ______________
    Signs that breastfeeding is going well: Signs of possible difficulty:
    GENERAL
    Mother: Mother:
     Mother looks healthy  Mother looks ill or depressed
     Mother relaxed and comfortable  Mother looks tense and uncomfortable
     Signs of bonding between mother and baby  No mother/baby eye contact
    Baby: Baby:
     Baby looks healthy  Baby looks sleepy or ill
     Baby calm and relaxed  Baby is restless or crying
     Baby reaches or roots for breast if hungry  Baby does not reach or root
    BREASTS
     Breasts look healthy  Breasts look red, swollen, or sore
     No pain or discomfort  Breast or nipple painful
    Breast well supported with fingers away from nipple  Breasts held with fingers on areola
    BABY’S POSITION
     Baby’s head and body in line  Baby’s neck and head twisted to feed
     Baby held close to mother’s body  Baby not held close
     Baby’s whole body supported  Baby supported by head and neck only
     Baby approaches breast, nose to nipple  Baby approaches breast, lower lip/chin to nipple
    BABY’S ATTACHMENT
     More areola seen above baby’s top lip More areola seen below bottom lip
     Baby’s mouth open wide  Baby’s mouth not open wide
     Lower lip turned outwards  Lips pointing forward or turned in
     Baby’s chin touches breast  Baby’s chin not touching breast
    SUCKLING
     Slow, deep sucks with pauses  Rapid shallow sucks
     Cheeks round when suckling  Cheeks pulled in when suckling
     Baby releases breast when finished  Mother takes baby off the breast
    Mother notices signs of oxytocin reflex  No signs of oxytocin reflex noticed
    Notes:
  • 18. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Assess a Breastfeed
    7/3
    ©UNICEF C107-5
  • 19. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Wide Open Mouth
    7/4
    ©UNICEF C107-7
  • 20. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Assess a Breastfeed
    7/5
    ©UNICEF C107-9
  • 21. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Assess a Breastfeed
    7/6
    UNICEF/HQ91-0168/ Betty Press, Kenya
  • 22. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    8/1 9/1
    Original illustration by Jenny Corkery
  • 23. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Case study
    9/2
    Case study
    2 weeks old
    Healthy at birth Discharged Day 2
    “Sleeping all the time”
    “Refusing” the breast
    3 stools in week
    12% under birth weight
    Bottle with honey and water twice yesterday
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
    UNICEF/HQ91-0168/ Betty Press, Kenya
  • 24. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    10/1
    Kangaroo Mother Care
    Dr Nils Bergman, Cape Town, South Africa
  • 25. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    10/2
    Kangaroo Mother Care
    Dr Nils Bergman, Cape Town, South Africa
  • 26. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Positioning a preterminfant
    10/3
    UNICEF/HQ93-0287/ Roger Lemoyne, China
  • 27. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Twins Grow Well on Breastmilk
    10/4
    UNICEF/HQ92-0260/ Lauren Goodsmith, Mauritania
  • 28. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    DANCER Hand Position
    10/5
    ©UNICEF C107-21
  • 29. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Chin Support
    10/6
    Kay Hoover and Barbara Wilson-Clay, from The Breastfeeding Atlas
  • 30. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    11/1
    Hand Expression
    ©UNICEF 910164F
  • 31. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Cup Feeding
    11/2
    Promoting breastfeeding in health facilities:
    A short course for administrators and policy makers WHO/NUT/96.3, Wellstart International
  • 32. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    11/3
    Supplementer
    Dr Ruskhana Haider, Dhaka, Bangladesh
  • 33. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    12/1
    Size and Shape
    There are many different shapes and sizes of breast and nipple.
    Babies can breastfeed from almost all of them.
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
  • 34. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Full Breast
    12/2
    UNICEF C-107-19
  • 35. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    12/3
    Engorged Breast
    © UNICEF C-10-25
  • 36. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Mastitis
    12/4
    ©UNICEF C107-39
  • 37. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Sore Nipple
    12/5
    ©UNICEF C107-31
  • 38. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    12/6
    Sore Nipple
    ©UNICEF C107-32
  • 39. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Syringe method for inverted nipples
    12/7
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
  • 40. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    12/8
    Candida on the nipple
    ©UNICEF C107-34
  • 41. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    12/9
    Candida on the nipple
    ©UNICEF C107- 33
  • 42. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Tongue-tie
    12/10
    ©UNICEF C107-35
  • 43. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    13/1
    Lactational Amenorrhea Method (LAM)
    Ask the mother or advise her to ask herself these three questions:
    YES
    1. Have your menses returned?
    When the answer to ANY one of these questions becomes YESThe mother’s chance of pregnancy is increased.
    For continued protection, and to achieve child spacing, a complementary family planning method needs to be used, and breastfeeding continue.
    NO
    2. Are you giving supplements or are there long periods without breastfeeding either day or night?
    YES
    NO
    3. Is your baby more than six months old?
    YES
    NO
    There is only a 1-2% chance of pregnancy at this time.
    Institute for Reproductive Health, Georgetown, Washington, DC
  • 44. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    UNICEF/WHO/UNAIDS Infant Feeding Recommendation for HIV-positive Women
    13/2
    When replacement feeding is acceptable, feasible, affordable, sustainable and safe, (AFASS)avoidance of all breastfeeding by HIV-infected mothers is recommended.
    Otherwise, exclusive breastfeeding is recommended during the first months of life and should be then discontinued as soon as it is feasible.
  • 45. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    14/1
    Original illustration by Jenny Corkery
  • 46. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Course Aims
    The aim of this course is that every staff member will confidently support mothers to succeed with early and exclusive breastfeeding,
    and that this facility moves towards achieving Baby-Friendly designation.
    15/1
  • 47. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Developing a Plan:
    Step One
    15/2
    Where are we now?
  • 48. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    Developing a Plan:
    Step Two
    15/3
    Where do we want to be?
  • 49. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    15/4
    Developing a Plan:Step Three
    How will we get there?
  • 50. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    15/5
    Developing a Plan:Step Four
    How will we know if we are there?
  • 51. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
    15/6
    Developing a Plan:Step Five
    How will we sustain it?