5. Breastfeeding
Principles of breast feeding
• Breast feeding should be done in clean and safe manner.
• The mother and baby should be comfortable and relaxed at feeding
time.
• Breast feeding should be initiated within the first hour after birth.
• Burping should be done after the feeding in order to kick out the
swallowed air.
7. Contd.....
• The baby should be allowed to suckle from both the breast during
each feeding.
• It is desirable to feed the baby on demand it helps baby to gain
weight.
• The mother should be instructed to feed the child even when the
child is ill.
8. Management of breastfeeding
During pregnancy
• Mother is motivated as regard the benefits of breastfeeding since the
early pregnancy.
• Care and preparation of nipples.
• Teaching the mother how to take care of the crust formed on the
nipples.
9. Contd.....
Following delivery
• Early (½ – 1 hour) and exclusive breastfeeding in correct position is
encouraged
• To put the baby to the breast as soon as possible after delivery at 2–3
hours interval from the 1st day.
• Stimulation: An early practice of putting baby on the mother's breast
and encouraging it to suckle frequently e.g 2 hourly stimulates
prolactin and oxytocin production.
10. Contd.......
• Psycological: The expectant mother should be reassured,supported
and educated consistently about the benefits of breastfeeding. This
provide her mental relaxation and satisfaction and also prevents the
incident of depression and emotional disturbance later in life.
• Prohibit bottle feeding and encourage regular feeding.
• No prelacteal feeds (honey, water) are given to the infant.
11. Contd......
• Encourage mother to take nutritious diet with plenty of fluid and milk
intake.Food containing calcium e.g milk, cheese, high class protein
etc. should be given.
• Prevent the mother from any disease.
• Frequent breastfeeding to avoid breast engorgement.
12. Frequency of feeding
Feed the baby on demand
• Breast feed whenever the baby want to eat. Cues that the baby want
to eat include:
13. Contd.......
Most newborns will eat an average of 8-12 times in 24 hours/6-8 time
in a day, 3-4 time at night or about every 2-3 hours. This is important
because:
• A newborns stomach is small and needs to be filled often.
• Breast milk is easily digested and therefore passes quickly through the
baby.
• With demand feeding, the mother's milk production adjust to the
baby needs, so there is always enough milk. The more the baby
sucks,the more milk the mother makes.
14. Contd.....
Duration of each feeding
• There is no limitation how long a baby should suck. If the attachment,
suck and position are good, the baby can suck until she gets full.
• Use both breasts.
• The baby should finish emptying one breast to get the rich hind milk(
the last milk to come from a breast at a feeding )before starting on
the second breast.
• The baby should suck at least 15-20 minutes.
15. Advantages of breast feeding
To mother
• Breast feeding helps placenta seperation.
• Reduces anemia due to reduction in post partum bleeding and
delayed menstruation.
• Frequently sucking on the nipple helps contration of the mother
womb and reduces the bleeding.
• Its helps the uterus return to its normal size (involution).
• It helps the mother to regain her figure by early uterine involution.
16. Contd....
• Exclusive breast feeding helps suppress ovulation so it can delay
another pregnancy
• It has a protective effect against breast and ovarian cancers.
• Increases bonding with baby.
17. Contd....
• Breast feeding save money.The mother does not need to buy other
milk to feed the baby and pay for health care when her baby gets sick
more often.
• Improved maternal mood.
• Decreased maternal neuroendocrine response to stressors.
19. Contd.....
To babies
• Exclusive breastfeeding on demand provides all the nutrition ( perfect
nutrition) a baby needs in the first six months.
• Breastfeeding easily digested.
• Immediate skin to skin contact helps the baby maintain baby
temperature.
• Breast milk helps the baby's body and brain developand grow.
20. Contd...
• Breast milk is a clean source of food. Water used to mix formula and
to wash bottles may have germs that can cause diarrhoea.
• Breast milk is first immunization. It makes the immune system
stronger.
• Breast milk protects babies against allergies.
• If a baby is sick, breast milk help the baby get better faster.
• Breast milk provide adequate water for hydration.
21. Contd....
• Breast milk has laxative action.
• Better health and less risk of illness
• Breast milk contains vitamin A which increases appetite and decrease
eye problemand infections.
• It contains high level of lysozyme and IgA that protects baby from viral
and bacterial infections.
• Para amino Benzoic acid present in breast milk protects the baby from
malaria.
22. Contd.....
To Family and nation
• Healthy mother and baby so healthy population.
• More bonding.
• Less stress.
• Population control
23. Contd.........
• Contributes to child survival
• Economic benefits
• breast feeeding lowers health care costs to family and society by
reducing the illness among children.
24. Contd.........
To the hospital
• Fewer neonatal infection.
• No nurseries, more hospital space.
• Less staff time needed.
• Improved hospital image and prestige
• decreases need for hospitalization
25. 13.3 Promotion of successful breast feeding
• Baby friendly hospital
• Exclusive breast feeding
• technique of breastfeeding
• Support and advice to mother
• Expressing and storing breast milk
• Cup and spoon feeding
27. Contd.........
The baby friendly Hospital initiative (BFHI) was lunched by WHO and
UNICEF in 1991, following the Innocenti Declaration of 1990.
The initiative is a global effort for improving the role of maternity
services to enable mother to breastfeed babies.
28. Contd.........
• Definition
A Baby Friendly Hospital (BFH) is a health care facility where the
practitioners who provides the care for women and babies adopt
practices that aim to protect, promote and support exclusive breast
feeding from birth.
29. Goals of Baby Friendly Hospital Initiative
The two goals of BFHI are:
• To transform hospital and maternity facilities through implementation
of the "ten steps" to successful breastfeeding.
• To end the practice of distribution of free and low cost supplies of
breast milk substitutes to hospitals and health care facilities.
30. Purpose of Baby Friendly Hospital Initiative
(BFHI)
• To actively protect, promote, encourage and support breastfeeding
through education of health care workers in maternity and neonatal
services.
• To accredit hospitals that demonstrate that they meet the
WHO/UNICEF criteria as a Baby Friendly Hospital.
40. Step 9 - Give no artificial teat or pacifiers to
breastfeeding infant.
41. 10. Foster the establishment of breastfeeding
support groups and refer mother to them on
discharge from the hospital or clinic.
42. 2. Exclusive breastfeeding
Definition:
Exclusive breast feeding means that the infant receives only
breast milk . No other liquids or solids are given not even water with
the exception of oral rehydration solution, or drops/syrups of vitamins,
minerals or medicines.
Exclusive breastfeeding is recommended for first 6 months of a baby's
life throught the world.
44. General principles of exclusive breastfeeding
• The mother should be encouraged for early and exclusive
breastfeeding when ever possible.
• Explain to the mother and her family the benefits of early and
exclusive breastfeeding.
• The mother is encouraged to breastfeed baby on demand, both day
and night(8-12 / 24 hours for as long as the baby wants.
• The baby should offer the second breast once the bay releases the
first breast on her / his own.
45. contd.........
• The mother should be advised for:
Not to force the baby to feed.
Not to interrupt a feed before the baby is done.
Not to use the artificial teats or pacifiers.
Not to gives the baby any other food such as pre-lacteal feeds or local
drink( water,glucose, honey, formula milk, lito, ghee)other than breast
milk for the first 6 month of life.
46. Contd......
• Ensure that the mother eat nutritious food and has enough to drink.
• Ensure that the mother can wash or shower daily.
• Mother is explain that most medication she may be given will not
harm her baby while she breast feed, however, if the mother is taking
Cotrimoxazole or the primethamine with sulpfadoxine, the baby is
monitor for jaundice.
47. Contd......
• If the mother is HIV positive, she need counselling to choose the most
suitable feeding method.
• If the mother is too ill, with breast problem, or if she chooses not to
breast feed;
• A breast milk substitute should be given to baby.
• Advice is given to mother on how to care for her breast.
48. Technique of breastfeeding
• Self attachment
place the baby on the mother's abdomen.
Support the baby's movement towards the breast.
Allow the baby to mouth the nipple before fully taking it into her
mouth.
Support the baby in her natural desire to take the full areola and
nipple and suck.
51. Contd.......
ii) Cross- cradle hold:
Useful for newborns and
small or weak babies and
premature baby or any
baby with a difficulty
attaching
52. Contd........
iii) Under arm hold
This position is best used:
After a Caesarean section
When the nipples are painful
For small babies
Breastfeeding twins
53. Contd....
iv)Side-Lying
It helps her to restwhile breastfeeding.
This position is best used for after
a Cesarean section.
The mother and infant are both
lying on their sides and facing each other.
55. Contd.......
Baby's position:
• The baby's head and body should be in a straight line.
• The baby's face should face the breast, with his nose opposite the
nipple.
• Mother should hold babies close to hers body.
• She should support his/ her buttock , whole body and not just his
head and shoulders.
56. Contd........
C) Attachment and suck
• The mother should hold her breast in a " C-hold " ( thumb on
top and other fingers with below) with fingers away from the
nipple.
• Baby's lips are touched with the nipple.
• Wait for the signs of readiness.
• Once the mouth is opened wide, the baby is moved on to
the breast with baby's lower lip below the nipple.
57. Contd......
Signs of good attachment
• Baby’s mouth wide open
• Lower lip turned outwards
• Baby’s chin touches breast
• More of the areola is visible above than below the mouth.
59. Contd......
Sign of good sucking
• Slow and deep suck.
• Some pauses during sucking.
• Can hear sound of swallow.
60. Contd.......
Sign of getting enough milk
• Regular frequency of urine at least 6 times per day.
• Weight gain.
• Mouth is full of milk.
• Baby satisfied with calm and quiet sleep.
• Suckling present, breast feel soft.
62. Contd....
Results of poor attachment
• Pain and damage to nipples eg. sore nipple / fissures.
• Breast engorgement.
• Apparent poor milk supply.
• Baby frustrated refused to suckle.
• Poor milk supply hence baby is not satisfied after feeding leading to
poor weight gain.
63. 4. Support and advice to mother
• The following advices can be given to mother:
Initiate breastfeeding immediately after birth as earlier as possible.
Give only breast milk in the first 6 month ( exclusive breastfeeding).
The baby who takes other liquid or foods before 6 months gets sick
more often and has bigger chance of getting diarrhea or an infection
such as pneumonia.
64. Contd......
Feed the baby on demand.
Alternate which breast is used to start feeding.
Use both breasts at every feed.
Empty first breast before starting on other. This provide hind milk.
65. Contd.......
Continue breastfeeding when the baby is sick.
Recognize baby is getting enough milk or not.
Teach mother about good positioning and attachment.
Use comfortable and different position.
66. Contd....
Feed baby more often during period of rapid growth.( during first 3
month of life).
Baby should be kept with the mother all the time.
Get enough rest
67. Contd.....
Drink a large glass of fluid with every breast feeding.
Eat one extra meal a day
Take one vitamin A capsule as sson as possible after delivery ( can be
taken to 6 weeks post partum ).
68.
69. Post test
Write 'T' for True and 'F' for false in the box for following statement.
a)Frequently sucking on the nipple helps contration of the mother
womb and reduces the bleeding.
b) More of the areola is visible below than above the mouth is one of
the sign of good attachment.
70. Contd.....
Choose the best answer from the given alternatives and circle (O) it.
a) Exclusive breastfeeding is recommended for .........
• First 7 month
• First 6 month
• First 8 month
• First 5 month
71. Contd.......
b ) The baby friendly Hospital initiative (BFHI) was lunched by WHO and
UNICEF in .....................
• 1994
• 1987
• 1991
• 1996
74. Plan for next class
Expressing and storing breast milk.
75. References
• Prasai( Subedi) P.,"Textbook of Midwifery Nursing(Postpartum
care)part III",Akshav Publication,Kathmandu, 1st edition,2018,page
no. 142-149
• Prof. Ranabhat R.D,Assist.Prof.Niraula(Mahat) H,"A Text Book of
Midwifery and Reproductive Health"National Center for Health
Professions Education, IOM,TU,1st edition,2017,page no. 452-454.
• Datta's,"Textbook of Obstetrics,"The health sciences publisher,8th
edition, page no. 172-174
• Ashalatha PR, Deepa G," Textbook of Anatomy and Physiology for
Nurses", The health sciences publisher,New delhi,4th
edition,2015,page no. 486-487.
76. Contd....
• Tuitui R." Manual of Midwifery-C (postnatal)",Vidyarthi Pustak
Bhandar,bhotahity, kathmandu,8th edition,2012,page no.63-69
• Chamberlain G,"Obstetrics by Ten Teachers",unabridged of British
publishers,16th edition,reprinted 1997,page no.260-263
• Gaur.S,Razia.R, Textbook of "Child Health Nursing" The health
sciences publisher,1st edition,2016,page no.176
• Retrive from https://www.cdc.gov/nutrition/Infanta on 2076/11/17.
