Breast Feeding & Golden hour : Gynaecologists to support this Breast Feeding Mission : Dr Sharda Jain

1. Dr. Sharda Jain
Sec General DGF
Director : Lifecare Centre / Lifecare IVF
Breast Feeding & Golden hour :
Gynaecologists to support this
Breast Feeding Mission

3. बच्चे क
े लिए म ाँ क दू ध अमृत है

4. Importance of Counselling for breastfeeding is
Good obstetric practice
1. Breastfeeding is recognized as COMPLETE nutrition for infants,
providing numerous benefits to both mother and child such as:
 Makes them STRONG by giving Protection against child infections
., increases intelligence, and probable future reductions in NCD –
obesity , diabetes.& stroke
 Beside SHAPING her ,It gives protection against breast cancer and
improved birth spacing, and also protect against ovarian cancer
and type 2 diabetes.
1.https://pubmed.ncbi.nlm.nih.gov/26869575/ Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect Cesar G Victora 1, Rajiv Bahl 2, PMID: 26869575 DOI:
10.1016/S01406736(15)01024-7

5. Improved rated of breast feeding lead to…

7. The Golden hour of
Breast Feeding

8. Lessons learnt : Facts about Breastfeeding
 Breastfeeding for the first 6 months is crucial.
 Protects infants from childhood illnesses.
 Mothers should continue breastfeeding at work
 Benefits mothers as it reduces risks of breast and ovarian
cancer, type II diabetes, and postpartum depression..
 Infant formula does not contain the antibodies found in breast
milk  not to be promoted..
Breastfeeding (who.int) (https://www.who.int/health-topics/breastfeeding#tab=tab_1)
Dr Sharda Jain

9. Lessons learnt : Facts about Breastfeeding
 Transmission of HIV through breastfeeding can be reduced with
drugs (Antiretrovirals). Zero viral load is ideal.
 Solid foods should be phased in at six months or after.
 Long-term benefits for children such as the reduced risk of
obesity and type-II diabetes. Along with, better performance in
intelligence tests.
Breastfeeding (who.int) (https://www.who.int/health-topics/breastfeeding#tab=tab_1)
Dr Sharda Jain

10. The Golden hour
Defined as the first hour of post-natal
life.
BREAST FEEDING in this initial hours of
life can provide a healthy future for
newborns.
Sharma.: Neonatol Perinatol. 2017; 3: 16.

11. THE GOLDEN HOUR – GOLDEN RULE FOR
BABY NUTRITION
 SKIN –TO – SKIN contact + Breast Feeding to be initiated within
the GOLDEN HOUR
 Pasteurized Donor Human Milk to be used whenever
mother’s milk is not available
 Avoid formula feeds or bovine based feeds in the GOLDEN HOUR

12. Recommendation
Message

13. Message

14. GOI Emphasized: Golden Hour Nutrition is
CRITICAL for newborns
Ministry of Health

15. 16% of neonatal lives can be saved if all babies were breastfed
from day 1.
22% if breastfeeding were started within the first hour.
Neonatal mortality was also shown to increase markedly as
delay in initiation increased.
41.6% of new-born infants are receiving human milk feeding
within 1 hour of birth.(NFHS 4)
1. Edmond K et al Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics 2006;117:380-386
2. Ministry of Health and Family Welfare, Government of India. National Family Health Survey India IV. http://rchiips.org/NFHS/ nfhs4.shtml. Accessed January 8, 2018.

16. 1. http://data.unicef.org/nutrition/iycf
India
40%
100
%

17. Recap

18. 1. Reseach Benefits of the golden hour +S-T-S CONTACT + Rooming in 24/7
Research has shown that breastfeeding within the first hour after birth can
lead to:
 Improved infant bonding.
 Better lactation success.
 Reduced risk of infant mortality. & Morbidity.
2. Breastfeeding during the golden hour can also have long-term benefits,
such as decreased risk of obesity and chronic diseases for the infant.
Breastfeeding and Golden Hours
Breastfeeding and the use of human milk - PubMed (nih.gov) American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. doi: 10.1542/peds.2011-3552
Overview: Maternity Care Practices | Breastfeeding | CDC (https://www.cdc.gov/breastfeeding/data/mpinc/maternity-care-practices.htm)

19. 3. Encouraging skin-to-skin contact immediately after birth helps to
facilitate:
 Effective Breastfeeding.
 Promote infant bonding.
4. Doctors /nurses should encourage and support skin-to-skin
contact during the golden hour, even for infants who require medical
attention or procedures.
Breastfeeding in golden hours + S-T-S contact
Breastfeeding and the use of human milk - PubMed (nih.gov) American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. doi: 10.1542/peds.2011-3552
Overview: Maternity Care Practices | Breastfeeding | CDC (https://www.cdc.gov/breastfeeding/data/mpinc/maternity-care-practices.htm)

20. 5. Providing education and support includes ANTENATAL counselling
on:
 Proper breastfeeding techniques.
 Positioning and latch.
 Milk supply management.
6. Healthcare professionals should also be able to provide resources
and referrals to BFFH + breastfeeding support groups and lactation
consultants when needed during hospital stay or after.
Breastfeeding and golden hours
Breastfeeding and the use of human milk - PubMed (nih.gov) American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. doi: 10.1542/peds.2011-3552
Overview: Maternity Care Practices | Breastfeeding | CDC (https://www.cdc.gov/breastfeeding/data/mpinc/maternity-care-practices.htm)

21. 7. Addressing medical concerns: In some cases, medical
concerns may prevent breastfeeding during the golden hour,
such as:
 Infant respiratory distress.
 Maternal medical conditions.
8. Healthcare professionals should be able to provide appropriate
guidance and support to mothers in these situations to ensure
optimal breastfeeding success
Breastfeeding and golden hours
Breastfeeding and the use of human milk - PubMed (nih.gov) American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. doi: 10.1542/peds.2011-3552
Overview: Maternity Care Practices | Breastfeeding | CDC (https://www.cdc.gov/breastfeeding/data/mpinc/maternity-care-practices.htm)

22. Few More Facts

23. Source: NHFS-4, 2017
Rural ?
50%
Private Govt.
Urban
72%
Status of LSCS births in India :increasing
50%

24. INFANTS BORN BY CESAREAN SECTION
are four times less likely to receive breastfeeding
within first hour of birth than vaginally delivered
infants.
Source: NHFS-4, 2017
42%
58%
Newborns fed human milk
Within 1st hour Beyond 1st hour
LSCS: A persistent barrier to
early initiation of breastfeeding
Rowe-Murray HJ et al. Birth. 2002 Jun;29(2):124-31.

25. Babies delivered vaginally were enriched with
species of beneficial commensal genera
(68.3%)
Vs.
Gut microbiota of babies delivered by caesarean
section were dominated by genera associated with
hospital environment and hospitalized
preterm babies
Challenges for LSCS babies
Shao Y et. al, Nature. 2019 Sep 18
In the neonatal period, differential microbial colonization
clearly relates to
“Mode of Delivery”

26. Access to optimal volume of HM
 By day 6, only 20% in the CS group had
regained their birth weight compared
with 40% in the NVD group
 Formula-fed infants are subjected to excessive
loads of water and substrate

27. Donor Human milk
Breastfeeding
Right choice of feed

28. Choice of feeds
Bovine milk-based
formula
Human milk
(EBM / DHM)

29.  Feeding type significantly influenced the gut microbiota
 The formula microbial profile was distinct than those
observed in MOM and DHM, suggesting that DHM
favors an intestinal microbiome more similar to MOM.
Gut microbiota profile
Parra-Llorca et al. Front. Microbiol. 9:1376.

30. Benefits for baby of BF
Improved gut flora for stronger
immunity
Seamless transition to
breastfeedingBETTER BONDING
Higher neurocognitive
scores (IQ)

31. Benefits for parents
Reduced hospitalization expenses
Lower risk of re-hospitalisation
Lower risk of
developing metabolic
syndromeNCD

32. Benefits for Hospital of BF
Encourages breastfeeding
Compliance to recommendations
Improved
outcomes

33. GOLDEN HOUR Nutrition
Many names, same purpose
Trophic
Feeds
Gut
Stimulating
Feeds

34. Why trophic feeds???
Objective:
Maturation of gut (GUT Priming)
Breast feeding ,Breast feeding,
Breast feeding

35. Human Milk is
BEST &
LARGEST source
good bacteria
Human Milk is
PROTECTIVE
against these
infections
Microbiota in
GUTPROTECTIVE with BF

36. Human milk stimulates maturation of the
gut
Provides rich source of pre & pro biotics
Strong anti-infectious effects from
immunoglobulins
Protects against sepsis, NEC and death
Promotes post-natal growth and organ
development.
Importance of
trophic feeding with
human milk

37. Following are the risks if non-human milk
source is used as trophic feeds:
a. Emesis
b. Distended Abdomen
c. NEC
d. Longer days on IV nutrition
e. Infections/Sepsis
What not to use formula feeds
Bovine Milk
Based Feeds
Human Milk is always the safest and
strongest source of nutrition for newborns

38. Difference between human milk and bovine milk
Adapted from: Breastfeeding Counselling: A Training Course Geneva
EFA – Essential Fatty acids

39. The Golden hour – Nutrition क
े फ यदे
Ip S, Chung M et al.. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153
(Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022). AHRQ Publication No. 07-E007.
https://news.sanfordhealth.org/womens/pregnancy/the-golden-hour-giving-your-newborn-the-best-start/
Babies who are fed human milk within the
Golden Hour have LOWER RATES of
Ear Infection Asthma Diabetes
Childhood
Leukaemia
Sudden
Infant Death
Syndrome

40. Flaherman et al. Pediatrics. 2013 Jun; 131(6): 1059–1065.
Babies who are fed formula within the
Golden Hour have HIGHER RISKS of
Infections Gastroenteritis and
Diarrhea
Necrotizing Enterocolitis Obesity and Diabetes
Repeated hospital
admissions
Increased hospital
costs

41. 1
Mothers Own Milk
(MOM)
2
Donor Human Milk
(If MOM is not
available)
Recommendations for trophic feeds BF & Donor Human Milk

42. Points to be emphasized by
Gynaecologists + HF
Breastfeeding and golden hours :
Breastfeeding and the use of human milk - PubMed (nih.gov) American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. doi: 10.1542/peds.2011-3552
Overview: Maternity Care Practices | Breastfeeding | CDC (https://www.cdc.gov/breastfeeding/data/mpinc/maternity-care-practices.htm)

43. 1. Education and counselling session to patients
BF IN GOLDER HOUR
 Proper breastfeeding techniques.
 Positioning and latch.
 Milk supply management. – 4th – 10th day full milk
2. Healthcare professionals should also be able to provide resources and
referrals to breastfeeding support groups and lactation consultants when
needed.

44. 3. Addressing medical concerns: In some cases,
medical concerns may prevent breastfeeding during the
golden hour, such as:
 Infant respiratory distress.
 Maternal medical conditions.
4. Specialists should be able to provide appropriate
guidance and support to mothers in these situations to
ensure optimal breastfeeding success

45. THANK YOU