breastfeeding6

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By: lyn87 (126 month(s) ago)

nice presentation....i like it....it would be nice if u can let me dwnload it for my reference on my presentation of breastfeeding.... thanx...

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Section 6: 

Section 6 We hope, you are enjoying this program. In this section, we shall discuss with you influence of health practices on breast feeding. You must be aware that most of the mothers, specially if they happen to be primi-gravidas, are very susceptible to influence of the health care practices. It is therefore important that due care should be given to these practices so that wrong signals are not sent to the mothers. Good luck.

Role of health care practices: 

Role of health care practices In 1989, WHO and UNICEF issued a joint statement to protect,promote and support breast feeding during maternity services. Based on this statement, ‘Ten steps’ to breast feeding were formulated. These ten steps are the basis of baby friendly hospital initiative.If a hospital wishes to be designated as baby friendly, it must follow all the ten steps. What are these ten steps?

The Ten steps: 

The Ten steps Every hospital providing maternity services and care of the newborns should- Have a written breast feeding policy which is communicated to all health care staff. Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about benefits and management of breast feeding. Help mothers initiate breast feeding within half an hour of birth.

The Ten steps ..: 

The Ten steps .. Show mothers how to breast feed and maintain lactation even when they are separated from their infants. Give newborns no food or drink other than breast milk unless medically indicated. Practice rooming in – allow mothers and infants to remain together 24 hours a day. Encourage breast feeding on demand. Give no artificial teats or pacifiers. Foster establishment of breast feeding support groups.

Ante-natal preparation: 

Ante-natal preparation All women who come to the ante-natal clinics should be informed about the advantages of breast feeding.This is specially true of young and first time mothers. They are the ones most likely to need help. You should discuss the advantages of breast feeding and dangers of artificial feeding. Give simple and relevant information on how to breast feed. Also make it a point to discuss mother’s questions and concerns related to breast feeding. Your aim should be to build her self confidence to breast feed.

Ante-natal preparation ..: 

Ante-natal preparation .. It is not essential to examine the breasts routinely.Often it can make a mother worry about them. If a mother has flat or inverted nipples, doing stretching exercises or wearing nipple shields does not help. Most nipples improve towards end of pregnancy. The important time to help a mother is after delivery. If a mother is worried about inverted nipples, explain that they will improve. Explain that a baby sucks from breast behind the nipple and not from the nipple itself.

Early contact: 

Early contact Allow the mother to hold her baby and to initiate skin to skin contact as soon as possible. In most cases, for first two hours after birth, it should happen as much as possible. This early contact helps a mother to bond to her baby. This also makes it likely that breast feeding will be initiated and maintained for longer period. A baby will generally show his readiness for breast feeding by signs such as opening the mouth and rooting for the breast.

The first breast feed: 

The first breast feed Babies normally become very alert and active within an hour of birth. Most babies want a feed during this time. If the first breast feed is delayed for more than an hour, breast feeding is less likely to be successful. You should make sure to avoid any pre-lacteal feeds as they replace colostrum as the first feed. We hope, you remember that colostrum contains IgA which coats the surface of baby’s intestines. Pre-lacteal feeds also interfere with suckling. The baby may also have nipple confusion, if he is given teats or pacifiers.

Rooming in: 

Rooming in Rooming in means allowing a mother and her baby to stay together and not separate them. In many hospitals, babies are kept in a nursery for a variable period of time after birth. This is more likely to result in bottle feeding and subsequent nipple confusion. This also interferes with bonding. The mother and the baby should be allowed to stay together as much as possible. Allowing a mother and her baby to stay together after birth is called rooming in.

Rooming in ..: 

Rooming in .. Rooming in has many advantages. It enables a mother to respond to her baby whenever he is hungry. This helps both bonding and breast feeding.Babies cry less and are less likely to be offered a bottle. It encourages the mothers to become more confident about breast feeding.Breast feeding is likely to continue even after discharge from hospital.

Demand feeding: 

Demand feeding Rooming in enables a mother to breast feed her baby on demand. A baby should get feeds whenever he wants it throughout the day and night and not just during specified timings only (this is called schedule feeding).A mother does not have to wait for a baby to cry. She can learn to respond to signs, for example rooting, which show that a baby is ready for feeding. There is no need to restrict the length of a feed. A baby should feed for as long as he wants. Advanced

Early breast feeding : 

Early breast feeding The most crucial time to give help to a mother to establish breast feeding is immediately after delivery. Many a times, the hospital staff are too busy or not trained to give such help. Many mothers do not need help.But a mother may not know if she needs help. It is therefore important that the person helping with the delivery should observe breast feeding and help the mother to position the baby if necessary. Advanced

Separation from infants: 

Separation from infants Sometimes, a mother may be separated from her infant because he is ill.In such a situation, a mother needs more help and support. Such a mother should be encouraged to express her milk so that it can be fed to the baby. This will also prevent ‘drying up’ of the milk due to inhibitors in the breast milk. A mother needs help to believe that her milk is important for the baby and that it will help in faster recovery of the baby. She also needs help to get her baby to suckle from her breast as soon as possible.

After a caesarian section: 

After a caesarian section It is usually possible for a mother to breast feed her baby within 4 hours of a caesarian section- or as soon as she regains her consciousness. A healthy term baby needs no food or drink till that time.A baby can room in with his mother and feed in ordinary way. Most mothers will however need help to find a comfortable position for the first few days.For the first day, most mothers may feed lying on their backs. For the next few days, feeding with lying on the sides may be more comfortable,after which a mother can sit up and feed.

Recapitulation 8: 

Recapitulation 8 Let us recall what we learnt so far. We learnt that- Health care practices have profound impact on breast feeding practices. Health care staff should be well trained to help a mother to successfully initiate breast feeding . Many mothers will need help, specially if they are young or first time mothers. Baby friendly hospital initiative aims at promoting breast feeding by better health care practices.

Quiz 23: 

Quiz 23 Treatment for flat nipples should begin during ante-natal period. True False

Quiz 24: 

Quiz 24 Till a mother recovers from rigors of labor, the baby should be given water to prevent dehydration. True False

Quiz 25: 

Quiz 25 A baby should be fed by the clock every 2 hours. True False

Have a break: 

Have a break

Foremilk and hind milk: 

Foremilk and hind milk Let us tell you about another feat of nature. The composition of milk secreted during early and later part of the feeding is not same. The milk during early part of feeding is high in carbohydrates and water; it is relatively low in fat. The color of this milk looks slightly bluish.The milk secreted during later part of feeding is rich in fats. The color of this milk looks slightly yellowish. What is the implication of this?

Slide21: 

Composition of milk Fat Proteins Sugar

Foremilk and hind milk ..: 

Foremilk and hind milk .. You must be aware that fats provide satiety. Since foremilk is low in fats, it encourages the baby to suck more vigorously. This promotes secretion of prolactin which helps in producing more milk. The high fat in the hind milk ensures that the baby is satisfied after a feed and won’t cry too early. If a mother takes a baby off the breast too early, he will not get hind milk. Not only he will have a deficit of calories but he is also likely to cry too soon after a feed due to hunger.

Foremilk and hind milk …: 

Foremilk and hind milk … This is also the reason to let the baby feed from a breast completely. If he is offered both the breasts at one feed, he is likely to get foremilk only, in which case his caloric needs may not be met. Further, during the next feed, he will get fat rich hind milk, which will give him satiety very early. However, since his intake will be less, he is likely to cry too soon after a feed. Remember, a baby crying too soon after a fed is the commonest reason for starting a baby on bottle.

Early breast feeding ..: 

Early breast feeding .. Here are some ways to help with an early breast feed- Avoid hurry and noise Ask the mother how she feels during feed Observe a breast feed Help with positioning if necessary. Give relevant information to the mother Answer mother’s questions.

Feeding patterns: 

Feeding patterns Babies differ very much in their feeding patterns – and all these are normal. During first 1-2 days, many babies may not want too many feeds. Some babies sleep for 8-12 after a good feed. If a baby has taken a good feed,is warm, well and not low birth weight, it is not necessary to wake him up for a feed. For the next one week, a baby may want to feed very often.Any baby may want to feed more on some days than others. It is important to make the mother aware of these different patterns.

Slide26: 

No, interventions during ante-natal period have not been shown to be helpful. On the other hand, they may undermine a mother’s confidence. Like to read it again?

Slide27: 

You are right. The intervention should start after delivery, when it has been shown to be most successful. Good.

Slide28: 

Sorry you are wrong. A baby can wait till the mother is fit to feed him. Fluids may be needed only in case of pre-terms or low birth weight babies.

Slide29: 

You are right. A baby does not need any fluids till his mother recovers from rigors of labor. Well done.

Slide30: 

No. A baby should be fed on demand, meaning that his requirements should guide the timings of feed rather than the clock. Will you like to read the advantages of demand feeding?

Slide31: 

You are right. The baby should be fed on demand rather than by the clock. Good answer.

Expressed breast milk : 

Expressed breast milk Expressing breast milk is useful in many situations.These include – Relieving engorgement Feeding a baby while he learns to suckle Feeding a Low- birth- weight baby Feeding a sick baby Keep up supply of milk while the baby or the mother is sick. Leaving milk for the baby while mother goes to work.

Expressing breast milk : 

Expressing breast milk The breast milk can either be expressed by hand or by use of mechanical devices. Before you start expressing milk, it may be useful to stimulate mother’s oxytocin reflex so that the milk can come out easily. Stimulating the nipples,massaging the breasts lightly or rubbing the back are some of the simple ways to stimulate the oxytocin reflex.Also keep handy a clean or sterile container to collect the expressed breast milk.

Slide34: 

Stimulating the oxytocin reflex

Expressing by hands: 

Expressing by hands You should teach the mother to express her milk using the following steps. She should wash her hands thoroughly. She should put her thumb above the nipples and areola and first finger below them. She must press her breast with the thumb and finger on the lactiferous sinuses. Pressing and releasing will generally bring out milk.Squeezing the nipple should be avoided as it is painful and does not result in expulsion of milk. Each breast should be expressed for at least 3-5 minutes.

Slide36: 

Manual expression of breast milk

Expressing by devices: 

Expressing by devices If a mother finds it uncomfortable to express breast milk by hands, she can use a breast pump. The breast pumps are either in the form of a rubber bulb or in the form of a syringe. Both work on the principles of generating negative pressure to promote flow of milk. The pumps are however difficult to clean and milk expressed by pumps is generally not suitable for feeding the baby. They are useful to relieve engorgement in situations where the expressed breast milk is to be discarded.

Slide38: 

Rubber bulb pump

Slide39: 

Syringe pump

Ante-natal preparation ..: 

Ante-natal preparation .. It is not essential to examine the breasts routinely.Often it can make a mother worry about them. If a mother has flat or inverted nipples, doing stretching exercises or wearing nipple shields does not help. Most nipples improve towards end of pregnancy. The important time to help a mother is after delivery. If a mother is worried about inverted nipples, explain that they will improve. Explain that a baby sucks from breast behind the nipple and not from the nipple itself. Back to Quiz

Nipple confusion: 

Nipple confusion The action of sucking from the bottle is very different from suckling at the breast. In bottle feeding, the baby sucks at the nipple and uses his tongue to stop the flow of milk, whereas in breast feeding, the baby uses the tongue to express milk from the breast. Babies who have been put on bottle try to suck at the mother’s nipple rather than suckle. This happens because a small baby can’t master two skills at a time. This is what is called nipple confusion.

Slide42: 

Breast feeding Bottle feeding Tongue used to express milk Tongue used to stop milk

Colostrum …: 

Colostrum … What important differences we see in the composition? We see that the colostrum is rich in proteins as compared to mature milk. This high protein content is made of up antibodies (mainly Ig A type) from the mother which help to protect the baby from many kinds of infection.No vaccine or immunizing agent known so far has the capacity to protect the baby against so many infections. By not giving colostrum to the baby, we deprive him of this rich source of protective material.

Inhibitor in the breast milk: 

Inhibitor in the breast milk You would be surprised to know that there is a substance in the breast milk itself, which can inhibit milk production. If a lot of milk is left in the breast tissue, this inhibitor comes into play.By pressing on the walls of the alveoli, it causes them to stop producing milk. This is a nature’s way of stopping milk production in case it is not needed (e.g. after death of a baby).

Demand feeding: 

Demand feeding Rooming in enables a mother to breast feed her baby on demand. A baby should get feeds whenever he wants it throughout the day and night and not just during specified timings only (this is called schedule feeding).A mother does not have to wait for a baby to cry. She can learn to respond to signs, for example rooting, which show that a baby is ready for feeding. There is no need to restrict the length of a feed. A baby should feed for as long as he wants. Back

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