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Maternal and Infant
Separation
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Assess Motivation
Discuss plans/reasons to continueDiscuss plans/reasons to continue
lactationlactation
Assess activities of daily livingAssess activities of daily living
Individual plan workable for eachIndividual plan workable for each
mothermother
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When mother-infant separation isWhen mother-infant separation is
necessary,necessary,
EARLY INTERVENTION IS IMPORTANT.EARLY INTERVENTION IS IMPORTANT.
Delays in expression :Delays in expression :
Lead to engorgementLead to engorgement
Cause irreversible involution ofCause irreversible involution of
the glandular tissue which canthe glandular tissue which canlead to a low supplylead to a low supply
Is associated with higher bacterialIs associated with higher bacterial
counts in the milkcounts in the milk
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Most common problems encounteredMost common problems encountered
by mothers separated from theirby mothers separated from their
infantsinfants
Inhibited milk ejection reflexInhibited milk ejection reflexLow milk supplyLow milk supply
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Methods to enhance Milk EjectionMethods to enhance Milk Ejection
ReflexReflex
Warm compressesWarm compresses
Gentle massageGentle massagePumping in pleasantPumping in pleasant
surroundingssurroundings
Looking at picture of babyLooking at picture of baby
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Methods to enhance MilkMethods to enhance Milk
Ejection ReflexEjection Reflex
Relaxation TechniquesRelaxation Techniques
LaMaze breathingLaMaze breathing Listening to musicListening to music
Imagining the milk flowingImagining the milk flowing
ReadingReading Talking with a friendTalking with a friend
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Milk Supply reducersMilk Supply reducers
Skipped pumping sessionsSkipped pumping sessions
Poor emptying ( ineffective pump)Poor emptying ( ineffective pump)
FatigueFatigue
Tension, worsening of babysTension, worsening of babys
conditioncondition
Illness, return to work or increasedIllness, return to work or increased
commitments inside or outside thecommitments inside or outside the
home, some medications and drugshome, some medications and drugs
Quick weight loss in momQuick weight loss in mom
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Milk SupplyMilk Supply EnhancersEnhancers
Frequent pumping sessionsFrequent pumping sessions
Complete emptying at each sessionComplete emptying at each session Rest and relaxationRest and relaxation
Improvement in babys conditionImprovement in babys condition
A nutritious diet of about 500 caloriesA nutritious diet of about 500 caloriesper day above pre-pregnantper day above pre-pregnant
requirementsrequirements
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SEPARATION OF MOTHER &SEPARATION OF MOTHER &
INFANTINFANT
I. Reason for Separation
Premature /sick hospitalizedinfant
Working mother /studying
Hospitalized mother
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Maintaining Milk SupplyMaintaining Milk Supply
A. Ideally =A. Ideally =
mother andmother and
child shouldchild should
stay togetherstay together
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B. If Mother is Separated fromB. If Mother is Separated from
InfantInfant
Encourage mother to visit /touch /care of infant.
Teach method of milk expression.
Emphasize hand washing and
hygiene.
Initiate expression before 12 hourspostpartum.
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If Mother is Separated from Infant
1.1. Frequent expression =Frequent expression =
> 8 times /day> 8 times /day
> 5 hours interval> 5 hours interval
Give take home handouts forGive take home handouts for
milk expression and storage.milk expression and storage.
Provide clean containers.Provide clean containers.
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C. If Mother is WorkingC. If Mother is Working
Plan ahead of timePlan ahead of time Individualize casesIndividualize cases
Flexi hoursFlexi hours
Employers supportEmployers support CrechesCreches
Express milk during office hoursExpress milk during office hours
Breastfeed just before leavingBreastfeed just before leaving Breastfeed on returning homeBreastfeed on returning home
Breastfeed more often at night andBreastfeed more often at night and
exclusively on weekendsexclusively on weekends
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MINI MILK BANKING
pasteurizerasteurizer
HUMAN
MIILK BANKING
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MILK STORAGEMILK STORAGE
Collection
Storage of milk
Distribution
SupportSupportEncouragement of successfulEncouragement of successful
PromotionPromotion lactationlactation
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WHENWHEN
As often as possibleAs often as possible
At workAt work
SOURCE OFSOURCE OF
BREASTMILKBREASTMILK
Own motherOwn motherWet nurseWet nurse
Other mothers pasteurizationOther mothers pasteurization
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HOWHOW
manualmanual
BreastmilkBreastmilk
expression pumpexpression pump
WHEREWHERE
Plastic containerPlastic container
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HOW TO
GIVE
Cup feeding
Dropper feeding
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MILK STORAGE
Container heavy plastic. Label as collected
Date / Time
PT FT Milk Store in small amounts Warm milk
Bowl of warm water (excessive heat =destroy enzymes and protein) Slow defrost is best Consume thawed milk
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STORING EXPRESSED BREASTMILK
When refrigerator is available Place container of Expressed Breastmilk in the
coldest part of the ref or freezer
Chill the milk well before adding to previously ref orfrozen milk.
Label container
- Bed # __________ Name ____________
- Date __________ Time ____________
Emphasize preterm or full term milkLeave space in container of milk to be frozen.
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STORAGE GUIDELINES:
4 hours
24 hours
3 months
8 hours
48 hours
3 months
1 year
Room Temperature
Refrigerator
Freezer (2 door ref)
Deep Freezer (- 20)
Preterm /Sick
Infants
Term InfantMethod of Storage
Put at the back of the fridge NOT IN THE DOORPut at the back of the fridge NOT IN THE DOOR
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FEEDING OPTIONS
Cup / Syringe
Readily available
Easy to use /clean
Safe if used properly Avoids nipple preference
Less chances of contamination
Bottles
Risk of nipple confusion
Readily contaminated
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WHEN REFRIGERATOR IS NOTWHEN REFRIGERATOR IS NOT
AVAILABLEAVAILABLE
In temperature climate ExpressedIn temperature climate Expressed
Breastmilk is safe in a clean containerBreastmilk is safe in a clean container
at room temperature for 8 10 hoursat room temperature for 8 10 hours
Use evaporative cooling container.Use evaporative cooling container.
Water soaked earthen jar, cover withWater soaked earthen jar, cover withcloth that reaches down the water.cloth that reaches down the water.
Place in coolest part of the house.Place in coolest part of the house.
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METHODS OF COLLECTIONMETHODS OF COLLECTION
Manual expressionManual expression
Simple MethodSimple Method
Position thumb above areola,Position thumb above areola,forefingers belowforefingers below
Push . . . Press . . . . Release -Push . . . Press . . . . Release -
Push . . Press . . . ReleasePush . . Press . . . Release Massage all around, avoidingMassage all around, avoiding
sliding of the fingerssliding of the fingers
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Manual Expression
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Stimulating milk flow
(let -down or oxytocin reflex)
Breast or back massage
Nipple massage
Warm bath / shower Photo of baby
Babys clothing / smell
music
How to rub a mothers back
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Practice
>Rolling of fingers on the breast
> Breastmilk expression on yourself
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Milk Collection (colostrum)Milk Collection (colostrum)
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THE WARM BOTTLE METHOD OFTHE WARM BOTTLE METHOD OF
EXPRESSING MILKEXPRESSING MILK
a. Putting hot water into a bottle.
b. Pouring the hot water out.
c. A mother putting the heated bottle over her nipple.c. A mother putting the heated bottle over her nipple.
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Kaneson Pumpaneson Pump Lloyd B Pumployd B Pump
Elec tr ic Pumplec tr ic Pump
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QUALIFICATION OF Breastmilk DONOR
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Had normal pregnancy and delivery.Had normal pregnancy and delivery.
Is serogically negative for syphilis and hepa-Is serogically negative for syphilis and hepa-b surface antigen.b surface antigen.
Has no infection acute or chronic.Has no infection acute or chronic.
Not taking medications, smoking or usingNot taking medications, smoking or usingexcessive alcohol.excessive alcohol.
Is capable of carrying out sterile technique orIs capable of carrying out sterile technique orneat personally.neat personally.
If donating for other infant, own child isIf donating for other infant, own child ishealthy without jaundice.healthy without jaundice.
QUA LIF IC AT IO N OF Brea st mil k DONORUA LIF IC AT IO N OF Brea st mil k DONOR
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The lower the temperature the longer theThe lower the temperature the longer thestorage!storage!
3 days in a refrigerator running below3 days in a refrigerator running below
10C.10C.
4 and 8 days in a refrigerator running4 and 8 days in a refrigerator running
between 0 and 4C.between 0 and 4C. If the temperature rises above 4C duringIf the temperature rises above 4C during
this time the milk should be usedthis time the milk should be used
within 8 hours or thrown awaywithin 8 hours or thrown away
Saf e St ora geaf e St ora ge (Sandra Lang 2007)
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If a refrigerator running at 4C is notIf a refrigerator running at 4C is notavailable - a cool bag with frozen iceavailable - a cool bag with frozen ice
packs (changed every 24 hours) can bepacks (changed every 24 hours) can be
used. The milk should beused. The milk should be protectedprotectedfrom freezingfrom freezing
If milk is to be kept for longerIf milk is to be kept for longerthan 8than 8
days it should be frozendays it should be frozen as soon afteras soon after
expression as possibleexpression as possible
Safe Stor ageafe Stor age
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REMEMBER
The more often a refrigerator door is
opened the more likely the temperature
is to rise.
Check the temperature with a fridge
thermometer of ANY refrigerator (or
cool bag) where human milk is beingstored.
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Using Stored Frozen Breastmilk
Defrost frozen breastmilk in a refrigeratoror if needed quickly defrost under cool
and then warm running water - dry
container thoroughly
DO NOT HEAT BREASTMILK IN A
MICROWAVE
Use defrosted breastmilk immediately
and throw away any unused milk
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IF the milk smells SOUR - DO NOTIF the milk smells SOUR - DO NOT
USEUSE
When stored the milk will separate,When stored the milk will separate,
gently shake the milk to mix it.gently shake the milk to mix it.
Give expressed breastmilk byGive expressed breastmilk by cup orcup or
spoon or breastfeedingspoon or breastfeeding supplementersupplementernot a bottle if the baby is less than 7not a bottle if the baby is less than 7
weeks old or if the bottle cannot beweeks old or if the bottle cannot be
cleaned properly.cleaned properly.
Using Stored Frozen BreastmilkUsing Stored Frozen Breastmilk
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Safe Storage of Breastmilk in the HomeSafe Storage of Breastmilk in the Home
Use immediatelyUse immediatelyDefrosted in fridgeDefrosted in fridge
12 hours12 hoursDefrosted in fridgeDefrosted in fridge
Previously frozen milkPreviously frozen milk6 months6 monthsFreezer: -18C or lowerFreezer: -18C or lower
If temperature goes above 4C after 3 days use within 6If temperature goes above 4C after 3 days use within 6hours or throw awayhours or throw away
8 days8 daysFridge: 0 to 4CFridge: 0 to 4C
3 days3 daysFridge: 5 to 10CFridge: 5 to 10C
6 hours6 hoursRoom:Room:
Fresh breastmilk kept at homeFresh breastmilk kept at home
Maximum timeMaximum timePlacePlace
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