Breast feeding talk, adapted

1. SESSION 5
BIRTH PRACTICES AND
BREASTFEEDING - STEP 4
1
Breastfeeding Promotion and Support
A Training Course for Health Professionals
Adapted from Maryland Department of Health and Mental Hygiene

2. Objectives:
1.Describe how the actions during labour
and birth can support early breastfeeding.
2. Explain the importance of early contact for
mother and baby.
3. Explain ways to help initiate early
breastfeeding.
4. List ways to support breastfeeding after a
caesarean section.
5. Discuss how BFHI practices apply to
women who are not breastfeeding .
22

3. Actions in Labour and Birth can support
early Breastfeeding
3

4. • Step 4 of the 10 Steps to
Successful Breastfeeding :
“Help mothers to initiate
breastfeeding within half hour
of birth.”
4

5. Current implementation in Malaysia :
Place babies in skin to skin contact
with mothers immediately following birth
for at least 10 minutes, however longer
period up to one hour is recommended
and encourage mothers to recognise
when their babies are ready to
breastfeed, offering help if needed.
5

6. What practices may help a woman
to initiate breastfeeding soon after
birth?
6

7. Mother Friendly Birthing Room
7

8. Birth Practices That Support
Breastfeeding
Support person or doula during labor
Encourage comfortable birthing
positions and ambulation
Food or drink during EARLY labor
Encourage non-medicated births
Keep mother and baby together
8

9. Positions for resting during labour
9
Session 5 : Birth Practices and Breastfeeding
Ministry of Health Malaysia

10. Birth Practices That Hinder Breastfeeding
Pitocin use
 Lower Apgar scores
 Increased anxiety and pain
 Inhibits oxytocin release
 Fluid retention
Overhydration with IV fluids
 Breast edema
 Difficulty latching
 Increased newborn weight loss
10

11. Labour Pain Management
 All pain relief medications cross the
placenta
 Timing of analgesia is important
Non-medicated pain relief
11

12. Other Procedures That Can Interfere With BF
Forceps and vacuum extraction
Episiotomy
Gastric and vigorous suctioning
Eye prophylaxis before the first hour
Separating mother and baby
 Bathing newborn at delivery
 Swaddling and wrapping newborn
 Taking newborn to nursery for assessments/ procedures
12

13. Immediate Post Delivery
13

14. Skin-to-skin
Place babies skin-to-skin
Immediately following birth
Uninterrupted for first hour
No clothing between mother and baby
Dry infant while on mother’s chest
Until first breastfeeding completed
All infants, regardless of feeding plan
14

15. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
First Skin to Skin Contact
5/3
DrNilsBergman,Cape
Town,SouthAfrica
15First Skin to Skin Contact

16. Skin-to-skin contact: WHEN?
• Vaginal delivery
– Put the baby on mother’s abdomen while
delivering placenta and stitching epi
• LSCS
– If under epidural/spinal, skin-to skin and
breastfeeding initiated immediately after baby out
– If under GA – once mother able to
respond/recovery room
16

17. Skin-to-skin contact
All babies should be dried off as they are placed on
mother’s skin.
Baby does not need to be bathed immediately after birth.
Holding baby is not implicated in HIV transmission.
For mother with HIV
Babies, who are not stable immediately after
birth can receive skin-to-skin contact later
when they are stable.
17

18. Benefits of Skin To Skin Contact
Increases duration of breastfeeding
 Warms and colonizes baby
 More quickly stabilizes vital signs
 Provides antibody protection through
colostrum
Babies learn to suckle more effectively
Facilitate bonding
Improves developmental outcomes
18

19. What are barriers to early skin-to-skin
contact?
How could these barriers be overcome?
19

20. Barriers to skin-to-skin contact
 Concerns of cold
stress
 Baby needs
 Exam
 Bath
 Insufficient staff
 Mother needs
 Tired
 Perineum repair

21. Overcoming barriers
• Concern that baby will be cold
– Dry baby
– Place naked on mother’s chest
– Put dry cloth over both baby and
mother
– If room is cold, cover baby’s head
to reduce heat loss
– Skin to skin contact with mother
provides better heat regulation than heater
21

22. Overcoming barriers
• Baby needs to be examined
–Most examinations can be done with baby
on mother’s chest
• Baby likely to be lying quietly
–Weighing can be done later
22

23. Overcoming barriers
• Mother needs to be stitched
– baby can remain on mother’s chest for stitching of
epi/ LSCS
23

24. Overcoming barriers
• Baby needs to be bathed
–Delaying first bath allow vernix to soak into
baby’s skin
• Lubricating n Protecting
–Delaying first bath prevents temp loss
–Baby can be wiped dry after birth
24

25. Overcoming barriers
• Labour room is busy
– Transfer mother and baby to the ward in skin-to-
skin contact
– Continue contact in ward
• No staff available to stay with mother and
baby
– Family member/companion can stay
25

26. Overcoming barriers
• Baby is not alert
– More important to have contact
– Sleepy baby due to pain
medication needs extra support
to bond and feed
• Mother is tired
– Mother rarely so tired, does not want to hold baby
– Contact with baby helps mother relax
– Review practices of withholding food/fluids
26

27. Overcoming barriers
• Mother does not want to hold baby
– If mother unwilling to hold baby
• Indication mother is depressed
• Greater risk of abandonment/neglect/abuse
–Encouraging contact increases bonding
potential
• Reduce risk of harm to baby
27

28. Overcoming barriers
• Twins
– interval between births varies.
– the first infant can have skin to skin contact until
mother starts to labour for second birth.
– First twin can be held in skin to skin contact by a
family member for warmth and contact while
second twin is born.
– Then the two infants are held by mother in skin to
skin contact and assisted to breastfeed when
ready.
28

29. Skin To Skin
29
Session 5 : Birth Practices and Breastfeeding
Ministry of Health Malaysia

30. Helping to Initiate Breastfeeding
30

31. Initiating Breast Feeding
Assist the first feeding
Pre-feeding behaviors
Short rest periods
Recognises feeding cues
Hands to mouth
Licking
Sucking motions
Touching nipple
Moving towards breast
 Finding nipple
31

32. Helping to Initiate breastfeeding
• Help mother to recognise pre-feeding
behaviours or cues.
– When mother and baby are kept quietly in skin-to-
skin contact, baby typically works through a series
of pre-feeding behaviours.
– may be a few minutes or an hour
or more.
32

33. 33
Session 5 : Birth Practices and Breastfeeding
Ministry of Health Malaysia

34. Further advantage
Skin to skin and eye contact :
•optimise oxytocin release
•Coordinate suckling, swallowing and breathing
34

35. Helping to initiate breastfeeding
• There should be no pressure on mother
or baby
– how soon first feed takes place,
– how long first feed lasts, how well
– Consider as an introduction to breast rather
than a feed.
35

36. Role of health care worker
• Provide time and a calm atmosphere
• Help mother to find comfortable
position
• Build mother’s confidence
• Avoid rushing baby to breast or
pushing breast into baby’s mouth.
36

37. Supporting breastfeeding after
Caesarean Section
37

38. Caesarean Section
Maternal disappointment in birthing process
Unexpected or unplanned
 Separation from newborn
 Impact on breastfeeding
 Delay in Lactogenesis II
 Newborn lethargic
 Suctioning of infant
 Delay in early contact
 Separation
38

39. Supporting BF after Caesarean Section
Assist mother with skin-to-skin as soon
after delivery as possible
Assist mother to find comfortable
positions
 Laid-back (biological nurturing)
 Side lying
 Clutch/football
39

40. 40

41. Supporting BF after Caesarean Section
• Presence of supportive health worker
Help initiate /Encourage skin to skin asap
Spinal/epidural - immediate
GA- contact in recovery room if mother
responsive
Skin to skin by father /family member while
waiting for mother to return from OT
Prem/unstable baby – contact when stable
41

42. Infants Who Do Not Self Attach
 Observe infants closely for feeding cues
 Assessment of infant by physician
 Limit visitors
42

43. BFHI practices and women who are not
breastfeeding
All mothers should be encouraged to let baby
suckle at breast unless:
– there is a known medical reason for not
breastfeeding, (e.g HIV-positive woman )
– If a mother has a strong personal desire
not to breastfeed
43

44. Summary
Baby-friendly practices support women whether
or not they are breastfeeding
Support during labor
 Skin-to-skin
Limiting invasive interventions & pain relief
Offering light food and fluids
Respect a mother wishes
 Replacement feedings, if applicable
44
SUMMARY SESSION 5
BIRTH PRACTICES AND BREASTFEEDING - STEP 4

45. Session 5 Knowledge Check
1. Name three possible barriers to early skin-to-
skin contact and how each might be
overcome
2. List four labour or birth practices that can
help mother and baby get a good start with
breastfeeding.
3. List three ways to assist a mother following a
caesarean section with breastfeeding.
45

46. Barriers to skin-to-skin contact
 Concerns of cold
stress
 Baby needs
 Exam
 Bath
 Insufficient staff
 Mother needs
 Tired
 Perineum repair

47. Birth Practices That Support
Breastfeeding
Support person or doula during labor
Encourage comfortable birthing
positions and ambulation
Food or drink during EARLY labor
Encourage non-medicated births
Keep mother and baby together
47

48. Supporting BF after Caesarean Section
Presence of supportive health worker
Assist mother with skin-to-skin as soon
after delivery as possible
Assist mother to find comfortable
positions
 Laid-back (biological nurturing)
 Side lying
 Clutch/football
48

49. THANK YOU
49