Breastfeeding Lecture 14Dec2011 Dr Espos

7/26/2019 Breastfeeding Lecture 14Dec2011 Dr Espos

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BreastfeedingGetting Started

Roberto A. Espos Jr., MD,

FPPS, MHSA


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Challenges


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National BreastfeedingAwareness Campaign

Results

Babies Were Born To Be Breastfed!

Suzanne G. Haynes, Ph

Senior S!ien!e Ad"isor

#$!e on %omen&s Health '#%H(

)S epartment of Health and HumanSer"i!es


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Conclusions Respondents generall !nderstand the i"portan#e of

and re#o""endations abo!t breastfeeding, anda$areness and attit!des are i"pro%ing o%er ti"e.

A$areness of "essages abo!t breastfeeding rose fro"&'( to )'(

*hose $ho either #orre#tl identi+ed "onths as the

re#o""ended length to e-#l!si%el breastfeed a bab orsaid the re#o""ended d!ration $as longer than "onthsrose fro" &( to )(

*he n!"ber agreeing that babies sho!ld be e-#l!si%el

breastfed in the +rst "onths in#reased fro" pre/$a%e0)(1 to post/$a%e 0&(1

Signi+#antl "ore $o"en s!r%eed had breastfed a #hildin the 2342 st!d 05)(1 than in the 23423 st!d 0)(1


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*o breastfeed or not tobreastfeed6

7o"en $ho are !nable or #hoosenot to breastfeed #an still be$onderf!l "others. Breastfeedingad%o#ates "!st be #aref!l not toalienate or 8!dge s!#h $o"en.

*hat said, breastfeeding is abroadl bene+#ial pra#ti#e. 9tsho!ld be en#o!raged $hene%erpossible and safe, and "ade a"ore pra#ti#al and desirablepra#ti#e for $o"en e%er$here.

Ad%o#a# "!st be s!pple"ented$ith e"po$er"ent.:nderstanding and addressing#hallenges for breastfeeding$o"en at ho"e, $or;, and inso#iet #an in#rease the n!"bers

of $o"en #o"fortablbreastfeeding.

Artist< Mar Cassatt


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Bene+ts of Breastfeeding

N)*R+*+#N #ontaining ideal proportions of fats,%ita"ins, s!gar and $ater for infant de%elop"ent,h!"an breast "il; is the "ost #o"plete so!r#e

of n!trition for babies. 9t is easier to digest thanfor"!la and #a!ses less !nne#essar

$eight gain.

+--)N+* i""!noglob!lins fo!nd in breast "il; help prote#tagainst infe#tio!s diseases #a!sed b %ir!ses, ba#teria, andparasites !ntil the bab=s i""!ne sste" has "ore f!llde%eloped.

R/)C/ +S/AS/ R+S0 "a de#rease ris; of #hroni##hildhood diseases s!#h as tpes > and & diabetes, #elia#disease, in?a""ator bo$el disease, #hildhood #an#er, allergiesand asth"a.

BRA+N /1/2#P-/N* AN GR#%*H long/#hain

pol!nsat!rated fatt a#ids i"portant for brain de%elop"entand fo!nd in breast "il; "a lead to earl %is!al a#!it and


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Bene+ts of Breastfeeding -#*H/R&S H/A2*H breastfeeding in#reases o-to#in

le%els"ini"i@ing postpart!" blood loss and ind!#ing"ore rapid !terine in%ol!tion. 9t also #an fa#ilitate "other/#hild bonding.

/C#N#-+C h!ndreds of dollars #heaper per bab thanfor"!la. Breastfed babies tpi#all re!ire fe$er si#;"edi#al appoint"ents, hospitali@ations, and pres#riptions

than non/breastfed babies. Breastfeeding "others "!ststa ho"e $ith a si#; bab less often and th!s "iss less$or;.

erri a$nb

Pa!la Modersohn/Be#;er


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Ad%antages for the Bab

ess illnesses, diseases disorders

Antibodies in breast "il;

Al$as the right te"perat!re !rt!ring bene+ts fro" s;in to s;in

#onta#t

Aids in de%elop"ent of bab=s brainand ner%o!s sste"


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Ad%antages for Mother

De#reased postpart!" bleeding

Earlier ret!rn to pre/pregnan#

$eight Delaed res!"ption of o%!lation

Red!#ed ris; of o%arian #an#er

Red!#ed pre"enopa!sal breast#an#er


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Anato" Phsiolog

D!ring Pregnan#

Breast, areola, nipple in#rease insi@e

eins "a be "ore noti#eable

Mil; glands d!#ts in#rease

Colostr!" is prod!#ed in the se#ond

tri"ester Montgo"er glands be#o"e

n!"ero!s and pro"inent


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Ho$ Does a Breast

Prod!#e Mil;6

Mil; is "ade in grapeli;estr!#t!res deep in the breast

7hen "il; let=s do$n ittra%els o!t of the grapesdo$n the ste"s d!#ts and#olle#ts in the pools 0sin!ses1

!nder the dar; area 0areola1behind the nipple

Bab=s g!"s press areola torelease "il;


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*he Me#hani#s ofBreastfeeding

*he "other sho!ld be #o"fortable and s!pport the bab=sne#; and sho!lders $ith her ar"s or a pillo$.

Mo%e nipple gentl ba#; and forth a#ross the bab=s"o!th !ntil the "o!th opens $ide. Mo%e the bab to$ardthe "other=s breast so the bab #an #lose "o!th aro!ndnipple.

Ma;e s!re the bab=s #hin 0not nose1 is in #onta#t $ith the"other=s breast to allo$ the bab to breath.

*he "other "a need to hold or s!pport her breast $hilen!rsing.

*he bab=s "o!th $ill !s!all deta#h a!to"ati#all $henbab is +nished.

9f the "other or bab are not #o"fortable or rela-ed, it=so;a to start o%er.

Reass!re the "other that it is o; to as; for helpIG!sta%li"t


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7hat is MBFH96


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3. %hat is -B4H+5

9t is a progra" transfor"inghospitals $ith "aternit andne$born ser%i#es and fa#ilities $hi#h

f!ll prote#t, pro"ote and s!pportbreastfeeding and roo"ing/inpra#ti#es.

M*HER/BABK FR9EDK HSP9*A

99*9A*9S 0MBFH91


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M*HER/BABK FR9EDK HSP9*A99*9A*9S 0MBFH91

%hat is a -other6Ba7y 4riendly Hospital5

A hospital that2 steps to s!##essf!lbreast feeding.


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M*HER/BABK FR9EDK HSP9*A99*9A*9S 0MBFH91

A. %hat are the goals of -B4H+5

>. Progra" Goal

All hospitals rendering "aternit and ne$bornser%i#es that are "other and bab friendl $illadopt the MBFH9 progra".

&. Mid/De#ade Goal

All hospitals rendering "aternit $ith ne$bornser%i#es and ha%ing at least >2 deli%eries $illbe a "other/bab friendl b the ear >LL.


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REP:B9C AC* 522


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An a!t pro"iding in!enti"es to all

go"ernment and pri"ate healthinstitutions with rooming6in and7reastfeeding pra!ti!es and forother purposes. *his a!t shall 7e8nown as the 9R##-+NG6+N ANBR/AS*4//+NG AC* #4 3::; $4o prior

appro%al.


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&.&.Gi%ing of sa"ples of "il;for"!la, other than "il;s!bstit!tes and related prod!#tsli;e feeding bottles and teats inthe fa#ilit.

&.&.Selling infant for"!la andbreast"il; s!bstit!tes andrelated prod!#ts in the hospitalphar"a#.

Rep!bli# A#t o. 522


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ENEC:*9E RDER . >


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E-e#!ti%e rder o. >

Mil; Code

C Prote#tion and pro"otion ofbreastfeeding to ens!re the safe,ade!ate n!trition of infants

thr! reg!lation of "ar;eting of infantfoods, related prod!#ts 0e.g. Breast"il;s!bstit!tes, infant for"!la, feedingbottles, teats et#.1


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C9"position of restri#ti%e !pon

health $or;ers, health #aresste", "an!fa#t!rers anddistrib!tors of reg!lated prod!#tsand the general p!bli#. *hese

details are e-a"ined b assessors$hen the assess the hospital for"other and bab friendliness.

E-e#!ti%e rder o. >

Mil; Code


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Adopting a national #ode of

"ar;eting of breast "il;s!bstit!tes, breas t"il;s!pple"ents and relatedprod!#ts, penali@ing %iolations

thereof and for other p!rposes.

E-e#!ti%e rder o. >

Mil; Code


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*his Code shall be ;no$n and

#ited as the ational Code ofMar;eting of Breast"il;S!bstit!tes, Breast"il;

S!pple"ent and ther RelatedProd!#ts.

E-e#!ti%e rder o. >

Mil; Code


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*he ai" of the Code is to #ontrib!te to

the pro%ision of safe and ade!aten!trition for infants b the prote#tionand pro"otion of breastfeeding and bens!ring the proper !se of breast"il;

s!bstit!tes and breast"il; s!pple"ents$hen these are ne#essar, on the basisof ade!ate infor"ation and thro!ghappropriate "ar;eting and distrib!tion.

E-e#!ti%e rder o. >

Mil; Code


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*en steps to s!##essf!lbreastfeeding

Step >.Ha%e a $ritten

breastfeeding poli#that is ro!tinel#o""!ni#ated to all

health #are staO.

A J9* 7H4:9CEF S*A*EME* 0>L'L1

Slide 3.>.)&


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Breastfeeding poli#

Why have a policy?

Re!ires a #o!rse of a#tion andpro%ides g!idan#e

Helps establish #onsistent #are for"others and babies

Pro%ides a standard that #an bee%al!ated

Slide 3.>.))


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Slide 3a


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Breastfeeding poli#

What should it cover?

At a "ini"!", it sho!ld in#l!de2 steps to s!##essf!l breastfeeding

An instit!tional ban on a##eptan#e of free orlo$ #ost s!pplies of breast/"il; s!bstit!tes,

bottles, and teats and its distrib!tion to"others

A fra"e$or; for assisting H9 positi%e "othersto "a;e infor"ed infant feeding de#isions that

"eet their indi%id!al #ir#!"stan#es and thens!pport for this de#ision

ther points #an be added

Slide 3.>.)


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Breastfeeding poli#

How should it be presented?

9t sho!ld be.

Fro"< CAH47H based on st!dies b Alberna@, Jaathila;a and Haider.

Ae

0Alberna@1 0Jaathila;a1

0Haider1

" wee#s after

diarrhoeatreat$ent

% $onths& $onths

12.&

5(.&

'

5'.(

&2 &5

0

20

40

60

80

100

Brazil '98 Sri Lanka '99 Bangladesh '96

E

xclusivereas!"e

eding#$%

&n!rl

&unselled


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7hi#h health professionalsother than perinatal staO

in?!en#e breastfeeding s!##ess6

Slide 3.&.


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Step ).9nfor" all pregnant

$o"en abo!t thebene+ts ofbreastfeeding.


Slide 3.).>


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Antenatal ed!#ation sho!ld in#l!de2


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Step )< Meta/analsis of st!diesof antenatal ed!#ation

and its eOe#ts on breastfeeding

Adapted fro"< G!ise et al. *he eOe#ti%eness of pri"ar #are/basedinter%entions to pro"ote breastfeeding< Sste"ati# e%iden#e re%ie$ and"eta/analsis Annals of )a$ily Medicine, &22), >0&1


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Step 3.Help "others initiate

breastfeeding $ithin ahalf/ho!r of birth.


Slide 3.3.>


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e$ interpretation of Step 3 in there%ised BFH9 Global Criteria 0&221L'L1

Slide 3..>


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6ontrary to popular belief,attachin the baby on the breast

is not an ability with which a$other is 7born89: rather it is alearned s#ill which she $ustac;uire by observation and

eL', &3/>5>.

Slide 3..&


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Slide 3;


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Slide 3l

EO t f tt h t


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EOe#t of proper atta#h"enton d!ration of breastfeeding

Adapted fro"< Righard , Alade . 0>LL&1 S!#;ing te#hni!e and its eOe#t ons!##ess of breastfeeding. Birth>L031'/>'L.

P34.445 P34.45 P34.45 P34.45

dase-#l!si%e

breastfeeding

> "onth & "onths ) "onths 3 "onths

An breastfeeding

Slide 3..)

0%

50%

100%

!ercenta

ge

&'rrec! sucking !echni6ue a! discharge4nc'rrec! sucking !echni6ue a! discharge

Step EOe#t of health pro%ider en#o!rage"ent of


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Step < EOe#t of health pro%ider en#o!rage"ent ofbreastfeeding in the hospital

on breastfeeding initiation rates

Adapted fro"< ! M, ange , Sl!sser 7 et al. Pro%ider en#o!rage"ent of breast/feeding

R9BFG, roo"ing/in $ithbreastfeedingg!idan#e, nT&&

:R signi+#antl

diOerent fro"R9 0p2.21 andR9BFG 0p2.21


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S!ppl and de"and

Mil; re"o%al sti"!lates "il;prod!#tion.

*he a"o!nt of breast "il; re"o%ed atea#hfeed deter"ines the rate of "il;prod!#tion in the ne-t fe$ ho!rs.

Mil; re"o%al "!st be #ontin!ed d!ring

separation to "aintain s!ppl.Slide 3..


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Slide 3"

*en steps to s!##essf!l


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Step .Gi%e ne$born infants

no food or drin; otherthan breast "il;!nless $edically

indi#ated.


Slide 3..>


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Slide 3n


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Slide 3o

t O t f h


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ong/ter" eOe#ts of a #hangein "aternit $ard feeding ro!tines

Adapted fro"< lander G et al. :ns!pple"ented breastfeeding in the "aternit$ard< positi%e long/ter" eOe#ts.Acta 'bstet (ynecol cand, >LL>, 52


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*he perfe#t "at#h

Adapted fro"< Pipes P. 0utrition in @nfancy and 6hildhood, )ourth =dition. St.o!is, *i"es Mirror4Mosb College P!blishing, >L'L.

Slide 3..)

9"pa#t of ro!tine for"!la


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De#reased fre!en# or eOe#ti%eness of

s!#;ling

De#reased a"o!nt of "il; re"o%ed fro"

breasts

Delaed "il; prod!#tion or red!#ed "il;

s!ppl

So"e infants ha%e di#!lt atta#hing tobreast if for"!la gi%en b bottle

9"pa#t of ro!tine for"!las!pple"entation

Slide 3..3

Deter"inants of la#tation perfor"an#e


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e e a s o a# a o pe o a #ea#ross ti"e in an !rban pop!lation fro"

Me-i#o

Mil; #a"e in earlier in the hospital $ithroo"ing/in $here for"!la $as not allo$ed

Mil; #a"e in later in the hospital $ithn!rser 0p2.21

Breastfeeding $as positi%el asso#iated$ith earl "il; arri%al and in%erselasso#iated $ith earl introd!#tion ofs!pple"entar bottles, "aternal

e"plo"ent, "aternal bod "ass inde-,and infant age.

Adapted fro"< Pere@/Es#a"illa et al. Deter"inants of la#tation perfor"an#ea#ross ti"e in an !rban pop!lation fro" Me-i#o. oc ci Med, >LL),0'12L/5'.

Slide 3..

S!""ar of st!dies on the $ater


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S!""ar of st!dies on the $aterre!ire"ents of e-#l!si%el breastfed

infants

ote< or"al range for !rine os"olarit is fro" 2 to >322"s"4;g.Fro"< Breastfeedin and the use of water and teas. Di%ision of Child Health andDe%elop"ent :pdate o. L, Gene%a, 7orld Health rgani@ation, reiss!ed, o%. >LL5.

Slide 3..

&'un!r,/e)era!ure

:&;ela!ive

s)?l%

5rgen!ina 20*.9 60*80 10+*199

ndia 23*42 10*60 66*12.4

@a)aica 24*28 62*90 10.*468

Aeru 24*.0 4+*96 .0*+44


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Medi#all indi#ated

*here are rare e-#eptions d!ring$hi#h the infant "a re!ireother ?!ids or food in addition to,

or in pla#e of, breast "il;. *hefeeding progra""e of thesebabies sho!ld be deter"ined b!ali+ed health professionals onan indi%id!al basis.

Slide 3..5

A bl di l f l i l


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A##eptable "edi#al reasons for s!pple"entation or repla#e"ent

+nfant !onditions

9nfants $ho #annot be BF b!t #an re#ei%e BMin#l!de those $ho are %er $ea;, ha%e s!#;ingdi#!lties or oral abnor"alities or are separatedfro" their "others.

9nfants $ho "a need other n!trition in additionto BM in#l!de %er lo$ birth $eight or preter"infants, infants at ris; of hpogl#ae"ia, orthose $ho are dehdrated or "alno!rished,

$hen BM alone is not eno!gh. 9nfants $ith gala#tose"ia sho!ld not re#ei%e BM

or the !s!al BMS. *he $ill need a gala#tosefree for"!la.

9nfants $ith phenl;eton!ria "a be BF andSlide 3..':9CEF, re%ised BFH9 #o!rse and assess"ent tools,


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-aternal !onditions

BF sho!ld stop d!ring therap if a "other is

ta;ing anti/"etabolites, radioa#ti%e iodine, orso"e anti/throid "edi#ations.

So"e "edi#ations "a #a!se dro$siness orother side eOe#ts in infants and sho!ld bes!bstit!ted d!ring BF.

BF re"ains the feeding #hoi#e for the "a8orit ofinfants e%en $ith toba##o, al#ohol and dr!g !se.9f the "other is an intra%eno!s dr!g !ser BF isnot indi#ated.

A%oidan#e of all BF b H9Q "others isre#o""ended $hen repla#e"ent feeding isa##eptable, feasible, aOordable, s!stainable andsafe. ther$ise EBF is re#o""ended d!ring the+rst "onths, $ith BF dis#ontin!ed $hen

#onditions are "et. Mi-ed feeding is not Slide 3..L


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-aternal !onditions '!ontinued(

9f a "other is $ea;, she "a be assisted toposition her bab so she #an BF.

BF is not re#o""ended $hen a "other has abreast abs#ess, b!t BM sho!ld be e-pressed andBF res!"ed on#e the breast is drained and

antibioti#s ha%e #o""en#ed. BF #an #ontin!e onthe !naOe#ted breast.

Mothers $ith herpes lesions on their breastssho!ld refrain fro" BF !ntil a#ti%e lesions ha%ebeen resol%ed.

BF is not en#o!raged for "others $ith H!"an */#ell le!;ae"ia %ir!s, if safe and feasible optionsare a%ailable.

BF #an be #ontin!ed $hen "others ha%ehepatitis B, *B and "astitis, $ith appropriatetreat"ents !nderta;en. Slide 3..>2


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Step 5.Pra#ti#e roo"ing/in U

allo$ "others andinfants to re"aintogether U

&3 ho!rs a da.


Slide 3.5.>


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Roo"ing/inA hospital arrange"ent $here a

"other4bab pair sta in the sa"eroo" da and night, allo$ing

!nli"ited #onta#t bet$een "other

and infant

Slide 3.5.&


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Slide 3p


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Slide 3

Roo"ing/in


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Roo"ing in

Why?

Red!#es #osts

Re!ires "ini"al e!ip"ent

Re!ires no additional personnel

Red!#es infe#tion

Helps establish and "aintainbreastfeeding

Fa#ilitates the bonding pro#ess

Slide 3.5.)

M bidit f b b bi t S l h


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Morbidit of ne$born babies at SanglahHospital before and after roo"ing/in

Adapted fro"< Soet8iningsih, S!raat"a8a S. *he ad%antages of roo"ing/in.Pediatrica @ndonesia,>L', &.

Slide 3.5.3

nT&2

nT>5

nT55

nT>>

nT>

nT>5nT&

nT30$

2$

4$

6$

8$

10$

12$

5cu!e !i!is

)edia

iarrhea Cena!al sesis (eningi!is

$'

"ne9'rnaies

6 )'n!hs e"'re r'')ing*in

6 )'n!hs a"!er r'')ing*in


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EOe#t of roo"ing/in on fre!en#of breastfeeding per &3 ho!rs

Adapted fro"< Ka"a!#hi K, Ka"ano!#hi 9 . *he relationship bet$een roo"ing/in4notroo"ing/in and breastfeeding %ariables.Acta Paediatr cand, >LL2, 5L2>L.

Slide 3.5.

*en steps to s!##essf!l


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pbreastfeeding

Step '.En#o!rage

breastfeeding onde"and.


Slide 3.'.>


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Breastfeeding onde"andLL2, '0&15>/>5.

L)&

>&3L

))

&>5

2L

Slide 3.'.3

2(.1%

24.5%

15.2%

11.(%

0.0%0$

10$

20$

.0$

0)2 3)4 5)' &)( 9)11

re8uency o breasteeding24 hours

ncid

ence

Mean feeding fre!en# d!ring the


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Mean feeding fre!en# d!ring the+rst ) das of life and ser!" bilir!bin

Fro"< DeCar%alho et al.A$ J >is 6hild,>L'&>)


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pbreastfeeding

Step L.Gi%e no arti+#ial teatsor pa#i+ers 0also#alled d!""ies andsoothers1 to

breastfeeding infants.


Slide 3.L.>


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Slide 3t


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Slide 3!

Alternati%es to arti+#ial


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Alternati%es to arti+#ialteats

#!p

spoon

dropper Sringe

Slide 3.L.&

C!p/feeding a


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C!p/feeding abab

Slide 3.L.)


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Slide 3%

Proportion of infants $ho $ere breastfed !p to th f di t f f i+


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"onths of age a##ording to fre!en# of pa#i+er!se at > "onth

on/!sers %spart/ti"e !sers

on/!sers %s.f!ll/ti"e !sers

Fro"< i#tora CG et al. Pa#i+er !se and short breastfeeding d!ration< #a!se,#onse!en#e or #oin#iden#e6 Pediatrics, >LL5, LL


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breastfeeding

Step >2. Foster theestablish"ent ofbreastfeeding s!pportgro!ps and refer

"others to the" ondis#harge fro" thehospital or #lini#.A J9* 7H4:9CEF S*A*EME* 0>L'L1

Slide 3.>2.>


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The #ey to best breastfeedinpractices is continued day+to+day support for the

breastfeedin $other withinher ho$e and co$$unity.

Fro"< Saadeh RJ, editor. Breast+feedin the Technical Basis and

eco$$endations for Action.Gene%a, 7orld Health rgani@ation, pp.LL).

Slide 3.>2.&

S!pport #an in#l!de


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S!pport #an in#l!deL'), &L2.3


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Slide 3$


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Slide 3-


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Slide 3Photo< Joan S#h!bert


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Slide 3@

Step >2< EOe#t of trained peer #o!nsellorsth d ti f l i b tf di


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on the d!ration of e-#l!si%e breastfeeding

Adapted fro"< Haider R, abir 9, H!ttl S, Ash$orth A. *raining peer #o!nselors topro"ote and s!pport e-#l!si%e breastfeeding in Bangladesh.J Hu$ 1act,&22&>'0>1&.

Slide 3.>2.

&0%

'%

0%

10%

20%

30%40%

50%

'0%

&0%(0%

!ro;ect


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pe-#l!si%e breastfeeding

Fro"< Morro$ A, G!errereo M, Sh!ltis J, et al. E#a# of ho"e/based peer#o!nselling to pro"ote e-#l!si%e breastfeeding< a rando"ised #ontrolled trial.1ancet,>LLL, ))&&/)>

Slide 3.>2.

(0%

'&%'2%

50%

24%12%

0%

10%

20%30%

40%

50%

'0%

&0%

(0%90%

2 wee6s 3 months

nant=s age

"#clusi$ereasteeding

1%2

i#)$isit group

>hree)$isit group

-ontrol group

Co"bined Steps< *he i"pa#t of bab/friendl pra#ti#es,

&')/3&2.

Slide 3.>>.>

DiOeren#es follo$ing the inter%ention


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Co""!ni#ation fro" Chal"ers and ra"er 0&22)1

Slide 3.>>.&

EOe#t of bab/friendl #hanges


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on breastfeeding at ) "onths

Adapted fro"< ra"er et al. 0&22>1

Slide 3.>>.)

43.3%

&.9%'.4%

0.'%0%

10%

20%

30%

40%

50%

"#clusi$e B 3 months "#clusi$e B ' months

!ercen

tage

"#perimental ?roup n (('5

-ontrol ?roup n (1(1

9"pa#t of bab/friendl #hangeson sele#ted health #onditions


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on sele#ted health #onditions

Adapted fro"< ra"er et al. 0&22>1

ote< DiOeren#es bet$een e-peri"ental and #ontrol gro!ps for%ario!s respirator tra#t infe#tions $ere s"all and statisti#allnon/signi+#ant.

Slide 3.>>.3

9.1%

3.3%

13.2%

'.3%

0%

5%

10%

15%

20%

25%

?astro)intestinal tract inections


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p g

Data $as anal@ed for &'> infants aged 2 to>>"onths in >3 health fa#ilities.

Breastfeeding data $as #o"pared $ith both theprogress to$ards Bab/friendl stat!s of ea#hhospital and the degree to $hi#h designatedhospitals $ere s!##essf!ll "aintaining the Bab/

friendl standards.

Adapted fro"< Merten S et al. Do Bab/Friendl Hospitals 9n?!en#e BreastfeedingD!ration on a ational e%el6 Pediatrics,&22, >>< e52& V e52'.

Slide 3.>>.

Proportion of babies e-#l!si%el breastfed for


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the +rst +%e "onths of life // S$it@erland

.Adapted fro"< Merten S et al. Do Bab/Friendl Hospitals 9n?!en#e BreastfeedingD!ration on a ational e%el6 Pediatrics,&22, >>< e52& V e52'.

Slide 3.>>.

Median d!ration of e-#l!si%e breastfeedingfor babies born in Bab/friendl hospitals //


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for babies born in Bab friendl hospitals S$it@erland

.Adapted fro"< Merten S et al. Do Bab/Friendl Hospitals 9n?!en#e BreastfeedingD!ration on a ational e%el6 Pediatrics, &22, >>< e52& V e52'.

Slide 3.>>.5

BREAS*FEED9G AD CH9D S:R9AP9CK


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P9CK

>. *he instit!tion shall in#orporate the breastfeedingpoli# $ith the orientation, #ontin!ing "edi#aled!#ation progra"s, on/going staO de%elop"enta#ti%ities, as $ell as the e%al!ation and pro"otion#riteria.

&. *he instit!tion shall #ontin!e to attra#t and gi%epriorit to health personnel $ho shall en#o!rage,pro"ote, prote#t, and s!stain breastfeeding.

). Breastfeeding, the breastfeeding poli#, as $ell as

the other +%e s!r%i%al progra"s, shall beintegrated into the "edi#al, n!rsing, "id$ifer, andother para"edi#al #!rri#!la of the De a Salle:ni%ersit Health S#ien#es Ca"p!s.



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P9CK

3. *he appoint"ents of all health personnel shall onl bea$arded after the appli#ant4s has4ha%e !ndergonetraining in la#tation "anage"ent and after ha%ingde"onstrated satisfa#tor ;no$ledge, attit!de and s;illsin the pro"otion, prote#tion and s!pport of breastfeeding.

. *he $aiting roo" of the Pre/natal Clini# of the !t/PatientDepart"ent shall be pro%ided $ith all the ne#essara!dio/%is!al e!ip"ents, reading "aterials and the li;e toens!re that all pregnant "others are properl infor"ed ofthe ad%antages and "anage"ent of breastfeeding.

. All B/Gne and Pediatri#s Cons!ltants shall pro%ide theirpatients $ith a"ple and appropriate reading "aterialsand lea?ets $hi#h pro"ote, prote#t and s!stainbreastfeeding.



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P9CK

5. A Mothers= Class shall be held dail b either theresidents, interns, #lini#al #ler;s, or the n!rse atthe PD.

'. *he h!sband and an other person4s $ho are in

#lose #onta#t $ith the pregnant "other and $hopla4s a signi+#ant role in the pro"otion,prote#tion and s!pport of breastfeeding areen#o!raged to a#ti%el intera#t d!ring the pre/natal %isit.

L. All #lini#s and other strategi# pla#es in thisinstit!tion shall displa at least one poster that

pro"otes breastfeeding.



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P9CK

>2.All posters and other si"ilar "aterials$hi#h pro"ote the #ontrar shalltherefore be re"o%ed.

>>.*he se#!rit g!ard shall perfor" ro!tineand thoro!gh inspe#tion of all personsentering the hospital. *he follo$ing arebeing banned fro" being ta;en into thehospital&.Patients= %isiting ti"e for the B 7ard shall beli"ited to L


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P9CK

>3.*he hospital shall stri#tl i"ple"ent theroo"ing/in pra#ti#e.a. *he !rser shall be #on%erted into eonatal

9ntensi%e Care :nit onl.b. bstetri#ians shall infor" all their patients abo!t

this poli# and roo"ing/in pra#ti#e at all ti"esd!ring the pre/natal #ons!ltation.#. *he B/Gne#ologi#al $ard shall be i"pro%ed.d. All pregnant $o"en ad"itted to the hospital are

ro!tinel and ade!atel infor"ed of thebreastfeeding and roo"ing/in poli#ies.

>.A breastfeeding roo" shall be pro%ided at the9C:.



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P9CK

>.*he 9C: staO shall al$as ens!re that the"others are #onstantl re"inded of thead%antages, properl ta!ght and professionalls!pported abo!t breastfeeding.

>5.A properl e!ipped and f!n#tioning breast "il;ban; shall be a%ailable at the 9C:.

>'.*he hospital phar"a# shall no longer displa,dispense or sell arti+#ial for"!la, "il;

s!bstit!tes, teats and soothers and other si"ilaror related "aterials.

BREAS*FEED9G AD CH9DS:R9A P9CK


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S:R9A P9CK

>L.All health personnel shall see to it that thebabies are fed on de"and.

&2.A lin;age shall be established $ith G=s and

G=s $ho pro"ote and prote#t breastfeeding.

&>.bstetri#ians and Pediatri#ians are en#o!ragedto ro!tinel #he#; and follo$/!p the stat!s ofbreastfeeding d!ring the post/part!" period for

at least 3/ "onths.

&&.*he instit!tion shall establish its o$nbreastfeeding s!pport gro!p in the near f!t!re.

BREAS*FEED9G AD CH9DS:R9A P9CK


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S:R9A P9CK

&).*he hospital shall pro%ide a breastfeedingroo" for the personnel4e"ploees, $herethe #an breastfeed e%en d!ring $or;ingho!rs.

&3.bstetri#ians and Pediatri#ians, and"e"bers of the health staO shallen#o!rage their patients to as; !estionsabo!t breastfeeding and "a;ethe"sel%es a%ailable at an ti"e forsi"ilar !eries.

&.Mothers $ho ha%e stopped breastfeedingshall be "oti%ated to rela#tate.



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&.Proble"s rele%ant to the poli# shall bedis#!ssed d!ring the "onthl "edi#al staO"eeting.

&5.Mothers shall be en#o!raged to gi%e their

opinions and s!ggestions on ho$ the hospital#an i"pro%e the pra#ti#e of breastfeeding androo"ing/in.

&'.on/#o"plian#e of an "e"ber of the staO of

this poli# shall "a;e the" s!b8e#t toappropriate dis#iplinar a#tion.

*ips and *ro!bleshootingI


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/P+)RA2Srather than general anestheti#s allo$ "others to be"ore alert i""ediatel after gi%ing birth. *pi#all the pain

"edi#ations and antibioti#s gi%en after !ndergoing a C/SAR/ANS/C*+#Nare #o"patible $ith breastfeeding.

PAR*N/RS, -+%+1/S #R #)2AS#an help P#S+*+#N"other tobreastfeed after birth. 0ote< doula< person e-perien#ed in #hildbirth$ho pro%ides ad%i#e, infor"ation, and e"otional s!pport to a "otherbefore, d!ring, and 8!st after #hildbirth midwife< person s;illed inassisting $o"en d!ring #hildbirth and s;illed deli%ering babies.1

C#2#S*R)- thi#;, ello$ish "il; prod!#ed initiall d!ringbreastfeedinglo$ in fat and high in #arbohdrates, proteins, andantibodies. 9t is eas to digest and helps ?!sh o!t bab=s stool,pre%enting 8a!ndi#e. Most "others sho!ld sa%e #olostr!" and feed itindire#tl to infants if dire#t breastfeeding not s!##essf!l. *hin, pale,nor"al breast "il; seen after a fe$ das.

SCH/)2/S"other sho!ld $at#h for signs of h!nger in bab, s!#has #ring or the rooting re?e- 0s!#;ing on hands4+ngers1, rather than$at#hing the #lo#;. Health babies sho!ld feed e%er &/) ho!rs.4R/D)/N* 4//+NGS;eep bab health and breasts sti"!lated toprod!#e an ade!ate "il; s!ppl. As bab ages and bab=s sto"a#hro$s feedin s nat!rall be#o"e less fre !ent.

*ips and *ro!bleshootingI 2/A0+NGSo"eti"es "il; lea;s fro" one breast $hile a bab feeds


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fro" the other. A n!rsing pad or to$el #an be !sed to #lean !p.ea;ing #an be "ini"i@ed b not "issing a feeding. 9f a "other feels alea; b!t #annot n!rse at the "o"ent, appl slight press!re 0i.e., b#rossing ar"s1, to help stop "il; e8e#tion.

4)22N/SS7hen "other=s "il; s!ppl ad8!sts to bab=s needs, thefeeling of f!llness "a de#rease 0b!t does * indi#ate inade!ateprod!#tion1.

9t is nor"al to ha%e one breast that prod!#es "ore "il; than theother it is also nor"al for the bab to prefer one breast o%er theother.

So"e $o"en ne%er feel or #ease to feel a 2/*6#%N0"il;/e8e#tion1re?e-. *he #an tell $hen their "il; is e8e#ted b $at#hing to see$hen the bab s!#;s and s$allo$s.

Mothers $ith +N1/R*/ or 42A* N+PP2/S #an still breastfeed.

A CR#SS6B# S2+NG is re#o""ended to #arr the bab.9t pro%ides #onstant ta#tile #onta#t, pro"otes health

#hild de%elop"ent, helps bab transition fro"#al" $o"b to o!tside en%iron"ent, en#o!rages non/%erbal #o""!ni#ation and bondin , often #al"s babies,

*ips and *ro!bleshootingI

Breastfeeding SH#)2N#* H)R* if done safel and#orre#tl S#R/N/SS is !s!all #a!sed b i"proper

Mastitis.

atl ibrar of Medi#ine,9H.


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#orre#tl. S#R/N/SS is !s!all #a!sed b i"properpositioning, blo#;ed "il; ?o$, stress or infe#tion.

Changing position, appling hot $ater bottle for

$ar"th, getting rest, and fre!ent feedings#an red!#e pain.

-AS*+*+S< breast infe#tion $ith tender breast0s1, in $hi#h"other "a feel a#h, tired and fe%erish "a or "a

re!ire antibioti# treat"ent. See abo%e for initial#are. C#N*+N)/ *# BR/AS*4// BABthe

antiba#terial properties of h!"an "il; prote#t bab fro" infe#tion andspeed re#o%er of "other. 9f s"pto"s persist after &3 ho!rs, "othersho!ld #onta#t phsi#ian. Pres#ribed "edi#ation sho!ld be #o"patible$ith breastfeeding. En#o!rage "others to ta;e entire antibioti##o!rse to help a%oid infe#tion re#!rren#e.http


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:se of lotionEsoap or towel to 9rough up< of nipples aspreparation for a feeding is no longer re#o""ended. *he breastsprod!#e prote#ti%e s!bstan#es that "a be re"o%ed b thesesntheti# "aterials. Patients $ith s;in #onditions sho!ld #ons!lt ado#tor.

*hinning "il;, less fre!ent feeding, de#reasing stool, and slo$ingof bab gro$th after +rst fe$ $ee;s are nor"al #hanges andtpi#all # N#* +N+CA*/ +NA/D)A*/ -+20 S)PP2.

B+*+NG< often o##!rs $hen babies are teething and does *ne#essaril "ean that the $ant4need to be $eaned. Prote#tnipple fro" biting b sliding +nger into bab=s "o!th. 9f a babbites $hile n!rsing, lightl lat#h on to o!r nipple and positioningbab #loser to the breast.

S!dden #hanges in bab=s feeding beha%ior "a indi#ate illness orrea#tion to so"ething the "other ate. Mothers sho!ld paattention to *H/+R +/*S$hile breastfeeding.

R/42)Fret!rn of sto"a#h #ontents into the esophag!s.Breastfed babies ha%e less se%ere re?!- at night. Contin!e tobreastfeed babies $ith re?!-. See the a e#he eag!e arti#le for

"ore info< http


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Preparing for Breastfeeding

Massage breasts and r!b nipplesgentl

A%oid !sing soap on nipples E-pose nipples to air and brie? to

s!nlight

et nipples r!b against #lothing

Flat or 9n%erted ipples
http://www.lalecheleague.org/FAQ/ger.html


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Begin treat"entlate in pregnan# Stop if #a!ses

!terine #ontra#tions

Breast shells 7ear > ho!r a da

and grad!allin#rease to se%eralho!rs

Dr area !ndernipple often

Breastfeeding2/> on ea#h breast per feeding

Ade!ate $et diapers Ade!ate stools

Bab is gaining $eight

!rsing Mothers

Documents

Breastfeeding Lecture 14Dec2011 Dr Espos