this lecture is one of my lectures to the students of Benha Lactation specialist Diploma this lecture involves simple and easy explanation for lactation management in the postpartum period early practices during postpartum period that support breast feeding Post-neonatal or Post-puerperal period practices to support breast feeding technique of breast feeding good positioning for breast feeding Correct positioning benefits bad positioning for breast feeding good attachment for breast feeding bad attachment for breast feeding Maternal instructions for good attachment Duration of the breastfeed Preventing Inadequacy of Milk Supply Criteria for sufficient breast milk Danger signs for insufficient breast milk Mothers' instruction about signs of sufficient & poor breast feeding Precipitating factors for inadequate breast feeding Management of inadequate Breast feeding

1. Lactation Management in the Postpartum Period
By
Dr. Ahmed Mohamed Amin Nasef
Assistant lecturer of Obstetrics & gynecology
Benha University

2. Objectives
Lactation Management in the Postpartum
Period
Early postpartum period practices to
support breast feeding
Post-neonatal or Post-puerperal period
practices to support breast feeding
Technique of breast feeding
Preventing Inadequacy of Milk Supply

3. Lactation
Management in the
Postpartum Period

4. Lactation management
The art of how mothers practice breastfeeding and use special skills to solve
related difficulties and conditions that would otherwise lead to breastfeeding
failure and discontinuation
This includes:
• Early postpartum period practices
• How to deal with Poor maternal confidence?
• Post-neonatal or Post-puerperal period practices
• Technique of breast feeding

5. Early postpartum
period practices
Maternal fatigue, anxiety and pain
should be avoided by avoiding
unnecessary episiotomy and by creating a
relaxed atmosphere of encouragement by
relatives and health personnel
Excessive maternal medications and
anesthesia during delivery should be
avoided (because of its prolonged
sedative effect on the newly born baby,
thus interfering with early and good
suckling)

6. How to deal with
Poor maternal
confidence?
Raising mother's confidence by mastering counseling skills
(include active listening to mother, accept how mother feels,
empathize (reflect her feelings) with mothers, praise her good
practice and her milk, inform and suggest alternative and
avoid commands or criticism)

7. Post-neonatal or
Post-puerperal
period practices
• Early initiation in first hour through SSC (or as soon as the
mother can respond to her baby) and adherence with EBF
should be mandated. EBF starts from birth to the end of 6
months
• Complementary feeding should be started immediately after 6
months should be adequately provided with continued
breastfeeding. Foods are given by spoon and drinks by cup
never by bottle, to promote palatability and chewing
• Breastfeeding should not be stopped before two years
• When infants are unable to suckle because of illness or
weakness or maternal illness, HBM should be expressed
several times per day to ensure maintenance of milk secretion
and fed to baby by nasogastric tube then by spoon or cup
whilst offering breast
• For working mothers, expressed HBM (EBM) can be sealed and
stored in safe place (refrigerator for 24-48 hours or deep freeze
for 3 months) and given by cup and spoon to the baby

8. Technique of
breastfeeding

9. Technique of
breastfeeding
Breastfeeding should be observed and
assessed for correct positioning, reflexes,
emotional bonding, breast condition,
attachment and suckling efficacy and timing
(BREAST)

10. Correct positioning
When positioning is comfortable, and the
infant is well aligned with the breast, a
deep and effective latch is more likely
Signs of good positioning include
Baby close, facing mother, aligned (head
and body in straight line) and supported
at buttocks
Mother sits in comfortable with her back
supported and shoulders upright. She
brings her baby to her breast without
leaning forward

14. Correct & false mother positions

15. Correct positioning benefits
Effective positioning and latching are essential for successful breastfeeding and
can:
• Help the infant to suck effectively
• Ensure effective breastmilk transfer to assist with optimal growth of the infant
• Stimulate, build, and maintain a mother’s breastmilk production
• Help prevent many breastfeeding problems such as sore nipples, mastitis, low
breastmilk supply, and poor infant weight gain

16. Correct attachment
Signs of good attachment include baby's
mouth wide open, all areola inside mouth
as baby attached from below to above, lips
averted with tongue cupping the breast, full
cheeks and chin touching the breast,
gulping sounds

17. Maternal instructions for good attachment

18. Correct attachment

19. Poor attachment
Signs of poor attachment include Dimpling of the
cheeks or pursed lips, not wide pen mouth, more
areola is seen below, smacking sounds at breast

20. Poor attachment

21. Duration of the breastfeed
let the baby decide when to take himself off the breast, to ensure baby takes
more "hind milk" that is rich in fat and essential for weight gain and brain
maturation

22. Preventing Inadequacy
of Milk Supply

23. Criteria for sufficient breast milk
• Immediate SSC and suckling within the first hour of birth
• Feeding frequently in response to needs
• The mother’s first feeds were observed, and baby is well latched at the breast and
effectively suckling
• Proper rooming-in
• Breastfeeding frequently (8-12 times) without supplements
• The infant has passed meconium and is voiding (urine and stools) at least six wet diapers per
day (provided no supplements are given)

24. Danger signs for insufficient breast milk
• The mother was sedated at birth and the newborn had depressed reflexes
• The newborn was taken away from her to the observation nursery or the
neonatal care unit
• The newborn was given milk feeds other than HBM
• The infant fails to gain weight satisfactorily after the 7th day
• The infant has decreased number of urine output

25. Mothers' instruction about signs of sufficient &
poor breast feeding

26. Precipitating factors for inadequate breast
feeding
• Errors in breastfeeding practices or
technique: infrequent breastfeeding,
use of bottles or teats, short
breastfeeds, incorrect positioning or
attachment at breast
• Maternal psychological factors, low of
self-esteem, drug intake as diuretics or
estrogen
• Infant problems (interfering with
proper suckling and or decreasing HBM
production)

27. Management of
inadequate BF
• Correction of any technical error and
treatment of any observed maternal
or infant problem using counseling
skills to increase her confidence and
self esteem
• Increase frequency of breastfeeding,
mother infant content
• Stimulation of prolactin secretion by
administering small doses of
chlorpromazine or metoclopramide
for few days or by devices (breast
feeding aids)
• If HBM supply in not increased (i.e.,
scanty HBM) refer for further
investigation. The baby may need to
be given expressed HBM or donor
HBM until the problem is resolved