Breastfeeding Recommendations

Start breastfeeding within hour 1hr of birth Breastfeed exclusively from 0 4month of age Complementary foods can begin between 46mths Give complementary foods to all children from 6mths Continue breastfeeding up to 2 yrs of age or beyond Why must all mothers breastfeed their baby?

Protection from allergy

A mother s milk is especially suited for her own baby. Colostrum is the perfect first for baby food Is thick, sticky and yellowish in color. Has laxative properties which helps baby pass meconium therefore prevents jaundice. Contains immunonoglobulins which provide an anti-infective protection to baby

Benefits of exclusive breastfeeding for 6 months

Protection against infection Overall, there is less illness requiring health care Provides the best infant nutrition and growth Protection against infection; bifidus factor helps special bacteria to grow in baby s intestine and prevents other harmful bacteria from growing Has antibodies - protect baby against diseases mother has been exposed to.

 The amount of protein is perfect for growth and brain development The foremilk contains more protein whereas the hindmilk contains more fat The GI tract develops more quickly when breastfed preventing foreign proteins from entering his system Emotional bonding results in less child neglect and abuse

 Lower incidence of cot death and lower risk of childhood diabetes, cancer and ear infection Better psychomotor, emotional and social development Mother oxytocin released during brestfeeding contracts the uterus- helps stops the bleeding after birth - frequent feeding delays the return of menses

- post partum depression is reduced - safe, no preparation needed, and ??? What else - Benefits to society - ???

Teach mothers how to keep prolactin level high

Assist baby to attach effectively at the breast never give dummies or teats Baby breastfeed as frequently as he wants (every 1-3hrs) and as long as he wants Offer night feeds

Release of oxytocin can be temporarily inhibited by: extreme pain Stress hormones resulting from doubt, embarrassment, anxiety Nicotine and alcohol

Mother can reduce inhibition of oxytocin by: Relaxing and getting comfortable for feeds Avoid embarrassing or stressful situations Express a little milk and gently stimulate the nipple Ask someone to massage her upper back

Identifying women at risk for breastfeeding difficulties

* Previous feeding practices Family difficulties Age, social status or state of mind Regular separation from their babies

Dealing with sleepy babies

Remove blankets and let the arms and legs move Breastfeed baby in a more upright position Gently massage the body and talk to him Wait 1/2hr and try again Allow baby to suckle until he releases the breast.

Help mothers learn how to respond to baby s need

Keep baby and mother day and night (rooming in) Show them how to watch for feeding signs rather than waiting for baby s cry Explain that frequent suckling and milk removal keeps milk production high

 Inform them to allow baby determine the frequency and length of breastfeed Relieve overfull or uncomfortable breasts by breastfeeding or expressing milk

Suckling and Attachment

Hold the baby close and facing the mother s breast The baby needs a large mouthful of breast in order to remove milk effectively The nipple, areola and breast tissue form a teat within the baby s mouth The tongue cups along the sides of the teat, and a wave of compression moves along the tongue towards the back of the mouth The baby swallows when the back of his mouth is full Artificial teats can cause sucking confusion

Positioning and Attachment

Positioning Baby s whole body to be turned towards mother, with buttocks well supported Attachment Elicit the rooting reflex by touching baby s lip with the breast. Wait until baby has a wide-open mouth Bring baby to the breast, not the breast to the breast

 Move the whole of baby s body to the breast; do not push his head Make sure baby gets a large mouthful of breast. Support the breast during the feed to help with attachment Feed until baby releases the breast spontaneously. If baby is not attached well, or if mother feels pain, she should break sucking, remove baby from breast and start again.

Causes of Poor Attachment

Use of feeding bottle before breastfeeding established - for later supplements *Inexperienced mother first baby, previous bottle feeder Functional difficulty small or weak baby - breast poorly protractile - engorgement, late start

Signs of good attachment

Baby s mouth is open wide Chin is touching the breast Lower lip is curled outward Slow deep sucks Mother may hear baby swallowing

Signs that a newborn is receiving sufficient milk

Breastfeed at least 8 times in 24hrs During a feed swallowing and gulping may be heard Baby is alert, has good muscle tone and healthy skin

 Baby is contented between feeds Uses 6 or more diapers in 24hrs Has 3-8 bowel movements in 24hrs but becomes less as they grow older Consistent weight gain 18-30gm in 24hrs

Reasons why a baby may not get enough breastmilk

These are Common Breastfeeding factors Delayed start Infrequent feeds No night feeds Short feeds Poor attachment Bottles pacifiers, complementary feeds

Common: Mother psychological factors Lack of confidence Worry, stress Dislike of breastfeeding Tiredness Rejection of baby

These are not common Mother s: physical condition eg Contraceptive pills, diuretics Pregnancy Severe malnutrition Alcohol, smoking, retained piece of placenta(rare) Baby s condition Illness deformity

Premature babies can breastfeed:

When * they are able to coordinate suckle and swallow Putting their fist to their mouth Feeding with only occasional disruptions in breathing and heart rhythm

Skills for building confidence and giving support

accept what a mother thinks and feels Recognize and praise what a mother and baby are doing right Give practical help Give a little, relevant information Use simple language Make 1 or 2 suggestions, not commands

Treating breast engorgement

Correct any problems with attachment Breastfeed more frequently Gently express some milk to soften the areola, help the baby s attachment Apply cold compress to the breasts after a breastfeed for comfort

Treating sore nipples Check for poor attachment Massage the breasts gently towards the nipples. Express milk to stimulate milk flow Begin each breastfeed on the least sore breast Avoid limitations on the frequency of feeds Apply EBM to the nipples after a breast feed Expose the breasts to air and sun

If the mother has thrush on her nipples

Apply medication to the mother s nipple, baby s mouth and diaper area Expose nipple to air and sunlight after feeds Take special care in washing clothing Check for vaginal infection and treat

Medication for breastfeeding mothers

Most medication pass through breastmilk in very small amounts. For possible side effects; monitor the baby for abnormal sleepiness, unwillingness to feed, jaundice The following drugs may reduce milk supply; oestrogen, thiazide diuretics (use alternative drugs)

Preparation for discharge

Refer to a mother to mother support group Give written or verbal advice for breastfeeding at home Identify where mothers can receive help and support

Roles of staff in upholding the International Code

Breast-milk substitutes in the health facility should be kept out of the sight of pregnant women and mothers Health facilities should not allow sample gift packs with breast milk substitutes or related supplies be distributed to pregnant women or mothers

 Financial or material inducements to promote products within the scope of the Code should not be accepted by health workers Manufacturers and distributors of products within the scope of the Code should disclose to the institution any contributions made to health workers such as fellowships, study tours, research grants conference. Similar disclosures should be made by the recipient

Ten steps to successful breastfeeding

Every facility providing maternity services and care for newborn infants should: 1. Have a written breastfeeding policy that is routinely communicated to all health care staff 2. Train all health care staff in skills necessary to implement this policy

3. inform all pregnant women about the benefits and management of breastfeeding 4. Help mothers initiate breastfeeding within a half-hour of birth 5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants

6. Give newborn infants no food or drink other than breast milk unless medically indicated 7. Practice rooming in allow mothers and infants to remain together 24hrs a day 8. Encourage breastfeeding on demand, give no artificial teats or pacifiers to breastfeeding infants

9. Give no artificial teats or pacifiers to breastfeeding infants 10. Forster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.

References

Palmer, G.(1998) The Politics of Breastfeeding. 3rd ed. London. A Division of Harper Collins Publishers. Chetley, A. Allain, A. (1987) Protecting Infant Health, a health workers guide to the International Code of Marketing Breastmilk Susbtitutes. 3rd ed. Penang * Protecting, Promoting, and Supporting Breastfeeding: the special role of maternity services. A Joint WHO/UNICEF Statement, Geneva: WHO/UNICEF, 1989.