Session 8

Session Objectives

Describe their role in practices that assist rooming-in.

Describe their role in practices that assist baby-led (demand)

feeding.

Suggest ways to awaken a sleepy baby and to settle a crying

baby,

List the risks of unnecessary supplements.

Describe why it is important to avoid the use of bottles and

teats.

Discuss removing barriers to early breastfeeding.

Step 7
Practice rooming in allow mothers and infants
to remain together 24 hours a day.

What can you say to explain

the importance of rooming-in ?

Benefits of Rooming-in

Babies sleep better, cry less

Continuation of sleep/awake rhythm

developed before birth,

BF is well established, continues longer,

baby gains weight quickly,

Feeding on cues is easier, develops good

milk supply,

Mother becomes confident in caring,

Baby exposed to fewer infection,

Promotes bonding,

Barriers to rooming-in and

possible solutions
1.

Concerns that mothers are tired.

2.

Taking the baby to nursery for

procedures.

3.

Beliefs that newborn babies need

to be observed.
Cont.

Barriers to rooming-in and possible solutions

4.

No space in the ward for babys cot,

5.

Staff do not know how to assist

mothers in learning to care for their
babies,

6.

Mothers ask for their babies to be

taken to the nursery,

Step 8
Encourage breastfeeding on
demand
demand feeding - baby-led feeding
This means that the frequency and
length of feeding is determined by
the babys needs and signs.

Importance of baby-led feeding

1.
2.
3.
4.

Baby gets more immune rich

colostrum,
Faster development of milk
supply,
Faster weight gain,
Less neonatal jaundice,

Importance of baby-led feeding

6. Less breast engorgement.

7. Mothers learn to respond to her
baby.
8. Breastfeeding established faster.
9. Less crying, less temptation to
supplement.
10. Longer breastfeeding duration.

Signs of hunger
The baby:
- Increases eye movements or opens
eyes.
- Opens his mouth, stretches out the
tongue
- Makes soft whimper sounds.
- Sucks or chews on hands.
Cont.

Signs of hunger

If the baby is crying loudly, arches his or

her back.
Some babies are very calm and wait or
go back to sleep if not noticed.
Other babies wake quickly and become
very annoyed.

What are the signs that a baby

has finished feeding?
Signs of Satiety :
As they get full, their body relaxes.
Let go of the breast.
Take small gentle sucks until they are
asleep.
Finish one breast before she offers
the other breast.

Feeding Pattern
feed for a short time at frequent intervals.
feed for a long time and then wait a few
hours.
Very long feeds - more than 40 minutes,
very short feeds - less than 10 minutes,
very frequent feeds - more than 12 feeds/24
hrs,
Sore nipples are the result of poor attachment,
not the result of feeding too often.

The typical feeding pattern for a full term healthy

newborn:

Every 1-3 hours in the first 2-7 days.

Night feeds are important.
Once lactation is established 8-12 times /
24 hrs.
During periods of rapid growth, a baby may be
hungrier.
Let babies feed whenever they want.

Special Situations
Baby is very sleepy due to
prematurity, jaundice, or the effects of
labor medication,
o

Mothers breasts are overfull and

uncomfortable
o

Babies who are on replacement feed

Ways to wake a sleepy baby

If the baby seems too sleepy to feed,
suggest that the mother:
Remove blankets and heavy clothing.
Breastfeed in a more upright position.
Gently massage and talk to her baby.
Wait half an hour and try again.
Avoid hurting the baby.

Settle a crying baby

Baby is crying.

Baby who is crying too much.

Baby is crying frequently.

Build the mothers confidence

cont

Build the mothers confidence in her ability to

care for her baby and give her support:
- Listen and accept what the mother is
feeling.
- Reinforce what the mother and baby are
doing right / what is normal.
- Give relevant information.
- Make one or two suggestions.
- Give practical help
cont

Suggestions and practical help to settle a

crying baby can include:

Make the baby comfortable.

Put the baby to the breast.

Put baby on the mothers chest, skin to

skin.

Talk, sing and rock the baby while holding

close.

Gently stroke or massage.

cont

Suggestions and practical help

Give one breast at each feed; if overfull,

express.
Reduce the mothers coffee and other
caffeine drinks.
Do not smoke.
Have someone else carry.
Involve other family members.
Pressure to give unnecessary supplemental
feedings.
Hold the baby in a manner that wraps around
him.

Step 6
Give newborn infants no food or drink
other than breastmilk unless
medically indicated.
Healthy full term babies rarely have a
medical need for supplements or
prelacteal feeds.
They do not require water to prevent
dehydration.

Dangers of supplements
Exclusive breastfeeding is recommended
for the first six months.
Supplements can:
- Overfill a babys stomach,
- Reduce milk supply,
- Can cause insufficient weight gains,
- Reduce protective effect of breastfeeding,
- Reduce the mothers confidence,
- Be an unnecessary expense.
cont

May indicate that mother is having

difficulties feeding and caring for her
baby.

A health worker may lack of knowledge

and skill in supporting BF

May indicate an overall stressful

atmosphere
cont

Prelacteal feeding or offering formula to

an infant of an HIV positive woman who
will breastfeed may alter the GI mucosa
and allow the transmission of the virus.
When we cannot test the HIV status of
mother, it is important to emphasize
that exclusive breastfeeding reduces
the risk of HIV transmission during
breastfeeding.

If a mother has been counseled, tested and

found to be HIV-positive and has decided
not to breastfeed, this is an acceptable
medical reason for giving her infant other
milks in place of breastmilk.
Even if many mothers are giving
replacement feeds, this does not prevent a
hospital from being designated as babyfriendly if those mothers have all been
counseled, tested, and made genuine
informed choices.

Step 9
Give no artificial teats or pacifiers (also
called dummies or soothers) to
breastfeeding infants

Why is it recommended to avoid using

bottles and teats?

Baby may develop preference for it.

Pacifiers given instead of feed for
hungry baby.
May carry infection.

Discussion Removing Barriers to early

breastfeeding
Case study :
Read the Case Study aloud in class.
Ask participants to note practices that
may help and those which may
interfere with establishing
breastfeeding. What might be the effect
of this situation on breastfeeding?
Distribute Case Study

Possible answers:

No support during labor - longer labor - more

tired, stressed.
No skin-to-skin contact did not get the time to
be with her baby to notices his birthmark,
which worries her.
Carolina and her baby are separated for many
hours - formula.
Did not get colostrum - no breast stimulation
to make milk.
Not given any help to breastfeed - sleepy,
-refuse to suckle. The nurse worries her about
sore nipples.
cont

It is painful to sit down when feeding the baby.

- inhibit the oxytocin release.
Carolina could be helped to feed lying down.
Carolina feels alone and this caused her
stress.
Nurse frightens Carolina to feed her baby or
she will not be able to go home.

The result is that Carolina is worried, sore,

frightened and lonely as well as not knowing
how to feed her baby. She is likely to go home
thinking that she is not able to make milk and
will feed her baby a breastmilk substitute.

Summary
Rooming in and baby-led feeding help
breastfeeding and bonding.
Help mothers to learn skills of mothering.
Prelacteal and supplemental feeds are
dangerous.
Artificial teats can cause problems.