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Bfhi revised section_3.3

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Bfhi revised section_3.3

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

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