This document discusses the benefits of breastfeeding for babies, mothers, families, and communities. It provides details on 10 steps to successful breastfeeding including initiating breastfeeding within 30 minutes of birth, exclusive breastfeeding for the first 6 months, and rooming-in. Common breastfeeding problems like retracted nipples, cracked nipples, and mastitis are explained along with their treatments. Guidelines are provided for counseling breastfeeding mothers, managing special cases like working mothers and HIV-positive mothers, and the safety of medications during lactation.

1. AL Dr. AungBoBoWim
Department of Obstetric and Gynaecology
University of Medicine 1, Yangon

2. 1. Benefits of breastfeeding
1. Benefits to babies
a. Mother's milk fosters optimal growth
and development of a baby's
brain, immune system, and
general physiology.
b. Breast feeding is a vital factor
in preventing common
illness, especially diarrhoea and
respiratory tract infection.
c. Exclusive breast feeding reduces the
risk of environmental-born
illnesses, malnutrition,
food sensitization and
allergy. (infantile eczema)

3. 2. Benefits to mother
a. Lowers the risk of excessive post-partum
bleeding and anaemia.
b. Reduce a mother's stress by keeping her
infants and young children healthy and well
nourished.
c. Save the mother money, energy, and time:
nothing to buy, prepare or clean up.
d. Exclusive breast feeding can boost a
mother's own immune system.
e. Help delay a new pregnancy. (contraception)
f. Reduce the insulin needs of diabetic mother.
g. Help protect a mother from breast and ovarian
cancer and osteoporosis.

4. 3. Benefits to family
a. Economical
b. More time for other children
4. Health benefits to the country
a. Economical
b. Reduce child mortality
c. Promote health of future generation

5. 10 steps to successful Breast-feeding
1. Every health facility should have a written
breastfeeding policy that is routinely communicated
to all healthcare staff.
- All staff to adhere to this policy to avoid conflicting
advice
- New staff to be orientated to the policy.
- The policy should be available in all areas of the
maternity unit and children's
wards.
- The policy should also be accessible as audio or
videotapes in appropriate local
languages.

6. 2. Train all healthcare staff in the skills necessary to
implement the policy.
3. Inform all pregnant women about the benefits and
management of breastfeeding.
- Every pregnant woman should have an
opportunity to discuss infant feeding on a one-to-one
basis with a midwife or health visitor.
- Aim to give women confidence in their ability to
breastfeed.

7.  4. Help mothers initiate breastfeeding soon after
birth.
 - Encourage mothers to hold their babies in skin-to-
skin contact as soon as possible after delivery in an
unhurried environment, regardless of their
intended feeding method. (usually within 30
minutes after uncomplicated vaginal
delivery and Caesarean section)
 - Offer the first breastfeed when mother and baby
are ready.
 - Help must be available from a midwife if needed.

8. 5. Show mothers how to breastfeed and how to maintain
lactation, even if they are separated from their infants.
- Explain positioning and attachment of the baby to
the mother, who must be helped to acquire the skill
for herself.
- All breastfeeding, mother should be shown how to
hand express their milk.
If the baby is separated for medical reasons it is the shared
responsibility of the neonatal nurse and midwife to ensure
that the mother is given help to express her milk to maintain
lactation at least 6-8 times in a 24-hour period.

9. 6. Give newborn infants no food or drinks other
than breast milk unless medically indicated.
- No water or artificial feed should be given
to a breastfed baby unless prescribed by a
midwife or paediatrician in consultation
with parents and the reason explained to
them.
- Parents who request supplementation
should be made aware of its implications on
baby's health and breastfeeding. This will
allow them to make a fully informed choice.
- Supplements when prescribed should be
documented in the notes with the reasons.

10. 7. Practice rooming-in – allowing mothers and
infants to remain together 24 hours a day.
7. Encourage breastfeeding on demand.
7. Give no artificial teats or pacifiers (also called
dummies or soother) to breastfed infants
7. Foster the establishment of breastfeeding
support groups and refer mothers to them on
discharge from the hospital or clinic.

11. 3. Common problems in breast feeding
(1) Retracted nipple

12. Management
Antenatal management
Soon after delivery
- Build mother’s confidence
- Explain baby suckles BREAST not
nipple
- Let the baby explore breast, skin-to skin
contact
- Help mother to position baby early
- Try different positions
- Help her to make nipple stand out more
using fingers.
- Use pump, syringe
For first week or two
- Express breast milk and feed with cup, spoon.

13. (2) Crack Nipple

14. (1) Look for a cause
- Check position and attachment
- Examine breasts- engorgement, fissure,
candida infection.
- Check baby for candida infection and tongue-
tie
(2) Give appropriate treatment
- Build the mother’s confidence
- Improve the attachment and continue breast
feeding
- Reduce engorgement – suggest frequent
feeding , and express milk
- Treat for Candida if symptom indicate
(3) Advice the mother to:
- Wash breast only once a day, avoid soap
- Avoid medicated lotions and ointments
- Rub hindmilk on areola after feeds

15. (3) Blood Stained nipple discharge
- usually bilateral.
- due to epithelial proliferation.
- occurs in the second or third trimester of
pregnancy.
- does not persist beyond two months postpartum.
- self limiting and no treatment necessary,
reassurance only.
(4) Galactocele
- retension cyst of mammary ducts following
blockage by inspissated secretions.
- fluctuate swelling with minimal pain and
inflammation.
- resolve spontaneously, may be aspirated, surgical
excision may be necessary.

16. (5) Breast Engorgement
Begins by second or third postpartum day.
Can cause postpartum pyrexia.

17. (1) Causes
- Plenty of milk
- Delay starting to breastfeed
- Poor attachment to breast
- Infrequent expression
- Restriction of length of feeds
(2) Prevention
- Start breast feeding soon after delivery
- Ensure good attachment
- Encourage unrestricted breastfeeding
(3) Treatment
- Manual expression 6-8 times a day in the first two
weeks. Manual expression, firm support,
applying ice bag and breast pump.
- Allow baby easy access to breast is most effective
method of treatment and prevention.

18. (6) Mastitis

19. (a) Causes
- due to blocked 2 ducts obstructing the milk flow and
distended alveoli.
- If pressure persists, milk extravasates into perilobular
tissue initiating inflammatory process.
- Breast became painful, red and oedematous, flu like
symptoms, tachycardia and pyrexia develops.
- suppurative mastitis is usually unilateral.
- causal organisms - Staphylococcus aureus (40%),
Streptococcus viridans.
- source of infection - baby's nose or throat or from
infected breast.
- Infrequent or short breast feed
- Poor drainage of part or all of breast
- Damaged breast tissue
- Bacteria allowed entry

20. (b)Treatment
(1) Improve drainage of breast
- Check for and correct:
- Poor attachment
- Pressure from clothes
- Large breast drains poorly
(2) Advise:
- Frequent breastfeeding
- Gentle massage towards the nipple
- Warm compresses
- Start feed on unaffected side
If symptom severe or no improvement after
24 hours
- Antibiotics - Flucloxacillin 500 mg tds while
waiting for milk culture and sensitivity
results.
- Complete rest
- Analgesics

21. - 10% of women with mastitis develop breast
abscess and surgical incision and
drainage under general anaesthesia is
needed.
6. Suppression of lactation
- HIV infected women were counseled to avoid
breast feeding to prevent MCT of HIV of
formula feeding is an affordable, feasible
and available.
- If mother has stillbirth or neonatal death, milk
suppression may be needed.
- fluid restriction, breast binding with tight
brassier are equally effective as
bromocriptine or cabergoline,
these dopamine agonist inhibit
prolectin and suppress lactation.
- cabergoline 250 μg BD for two days is more
effective and has less side effect
compared to bromocriptine 2.5 mg

22. Counseling of breastfeeding mother and family
regarding benefits and management of breast feeding.
( Skill)
(1) Benefits of breast feeding
(2) Dangers of artificial feeding
– may interfere with bonding
- Artificially fed baby is more likely to become
ill with diarrhoea, respiratory and other
infection
- More likely to develop eczema
- More likely to develop chronic diseases such
as diabetes
- Lower intelligence
(3)Terms of breastfeeding
(a) Exclusive breastfeeding- means giving a
baby no other food apart from breast
feeding.
(b) Artificial feeding – means feeding a baby on

23. (4) Methods
- Breastfeeding usually within 30 minutes after delivery.
- Demand feeding, unrestricted or baby-led feedup,
feeding the baby without schedule, whenever
he is hungry and day and night.
- Exclusive breastfeeding at least first 6 month of life if
possible, continue for 2 years, weaning diet can
be introduced from 6 months onwards.
- Position of mother – lying or sitting
- Position of baby- attachment

24.  Good attachment
 The baby's head and body should be in straight
line
 His face should face the breast with his nose
opposite the nipple
 The mother should hold the body close to her
 The mother should support his bottom.
 The whole areola should be in the baby's mouth.
 The baby's check should be moving in and out
when he suckle.

26. 5. Counseling of infant feeding in special groups
(1) in HIV infected mother
- Explain risk of HIV transmission through
breastfeeding
- Recommend avoidance of all breastfeeding if
replacement feeding (Formula feeding) is
acceptable, feasible, affordable,
sustainable and safe.
- Recommend exclusive breast feeding during the
first six months if there is no safe
alternative and to discontinue as soon as
feasible and early weaning.
- Avoid mixed feeding it can increase the risk of
transmission of HIV.

27. (2) working mothers
- If the mother's work is near her home, she
should return home for breastfeeding.
- If her work is far from her home, she should
express milk at home before going to
work and feed the baby by spoon and
cup. The expressed milk can last for 8
hours.
- The mother should express milk at work to
prevent breast distension.
(3) maternal death- substitute feeding

28. 6. Manage common breast feeding problems
•feeding of insufficient feedup
•feeding water to baby
•feeding of ill baby , cleft palate

29. Breastfeeding contraindicated Anticancer drugs (antimetabolites)
Radioactive substances (stop
breastfeeding temporarily)
Continue breast feeding:
Side-effects possible
Monitor baby for drowsiness
Psychiatric drugs and anticonvulsants
Use alternative drug if possible Chloramphenicol, tetracycline,
metronidazole, quinolone antibiotics
(e.g. ciprofloxacin)
Monitor baby for jaundice Sulfonamides, dapsone
Sulfamethoxazole+trimethoprim
(cotrimoxazole)
7. Medications during lactation

30. Use alternative drug (may inhibit
lactation)
Estrogens, including estrogen-
containg contraceptives, thiazide
diuretics, ergometrine
Safe in usual dosage
Monitor baby
Most commonly used drugs:
analgesics and antipyretics: short
courses of paracetamol,
acetylsalicylic acid, ibuprofen;
occasional doses of morphine and
pethidine.
antibiotics: amoxicillin, cloxacillin
and other penicillins, erythromycin
anti-tuberculars, anti-leprotics (see
dapsone above)
antimalarials (except mefloquine,
fansidar), antihelminthics,
antifungals.
bronchodilators (e.g. salbutamol),
corticosteroids, antihistamines,
antacids, drugs for diabetes, most
antihypertensives, digoxin,
nutritional supplements of iodine,
iron, vitamins.