BFHI Slides

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2009

BABY-FRIENDLY HOSPITAL INITIATIVERevised, Updated and Expanded for Integrated Care

“Mat

erni

ty”,

1963

, ©20

03 E

stat

e of

Pab

lo P

icas

so/A

rtist

s R

ight

s S

ocie

ty (A

RS

), N

ew Y

ork


Global Strategy for Infant and Young Child Feeding

The aim of the Global Strategy is to improve – through optimal feeding – the nutritional

status, growth and development, health, and thus the survival of infants and young children.

It supports exclusive breastfeeding for 6 months, with timely, adequate, safe and appropriate complementary feeding, while continuing breastfeeding for two years and beyond.

It also supports maternal nutrition, and social and community support.

1/1


The aim of the Baby Friendly Hospital Initiative

To implement the Ten Steps to Successful Breastfeeding

and to end the distribution of free and low-cost

supplies of breastmilk substitutes to health facilities.

1/2


Course Aims

The aim of this course is that every staff member will confidently

support mothers with early and exclusive breastfeeding,

and that this facility moves towards achieving Baby-friendly designation.

1/3


3/1

Orig

inal

illu

stra

tion

by J

enny

Cor

kery


Infant Feeding Recommendation for HIV-positive Women

Exclusive breastfeeding is recommended for HIV-infected mothers for the first six months of life

unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for

them and their infants before that time.

When replacement feeding is acceptable, feasible, affordable, sustainable and safe avoidance of all

breastfeeding by HIV-infected mothers is recommended.

3/2


4/1

Orig

inal

illu

stra

tion

by J

enny

Cor

kery


The overall aim of the International Code of Marketing

of Breast-milk Substitutes is the safe and adequate nutrition

of all infants.

4/2


Skin to Skin Contact and Early Breastfeeding

5/1

©U

NIC

EF

C10

7-2


Skin to Skin Contact and Early Breastfeeding

5/2

UN

ICEF

/HQ

92-0

369/

Rog

er L

emoy

ne, T

haila

nd


First Skin to Skin Contact5/3

Dr N

ils B

ergm

an, C

ape

Tow

n, S

outh

Afri

ca


Parts of the Breast6/1

Adap

ted

from

Bre

astfe

edin

g C

ouns

ellin

g: a

trai

ning

cou

rse,

WH

O/C

HD

/93.

4, U

NIC

EF/

NU

T/93

.2


Helping the Oxytocin Reflex 6/2

Bre

astfe

edin

g C

ouns

ellin

g: a

trai

ning

cou

rse,

WH

O/C

HD

/93.

4, U

NIC

EF/

NU

T/93

.2


What can you see?

Good attachment Poor attachment

6/3

Bre

astfe

edin

g C

ouns

ellin

g: a

trai

ning

cou

rse,

WH

O/C

HD

/93.

4, U

NIC

EF/

NU

T/93

.2


What can you see?

Good attachment Poor attachment

6/4

Bre

astfe

edin

g C

ouns

ellin

g: a

trai

ning

cou

rse,

WH

O/C

HD

/93.

4, U

NIC

EF/

NU

T/93

.2


Breastfeeding Positions7/1

In lineCloseSupported Facing

Bre

astfe

edin

g C

ouns

ellin

g: a

trai

ning

cou

rse,

WH

O/C

HD

/93.

4, U

NIC

EF/

NU

T/93

.2


BREASTFEED OBSERVATION AIDMother's name _______________________________ Date ___________________Baby's name _________________________________ Baby's age ______________Signs that breastfeeding is going well: Signs of possible difficulty:GENERALMother: Mother:

Mother looks healthy Mother looks ill or depressedMother relaxed and comfortable Mother looks tense and uncomfortableSigns of bonding between mother and baby No mother/baby eye contact

Baby: Baby:Baby looks healthy Baby looks sleepy or illBaby calm and relaxed Baby is restless or cryingBaby reaches or roots for breast if hungry Baby does not reach or root

BREASTSBreasts look healthy Breasts look red, swollen, or soreNo pain or discomfort Breast or nipple painfulBreast well supported with fingers away from nipple Breasts held with fingers on areola Nipples protractile Nipples flat, not protractileBABY’S POSITIONBaby’s head and body in line Baby’s neck and head twisted to feedBaby held close to mother’s body Baby not held closeBaby’s whole body supported Baby supported by head and neck onlyBaby approaches breast, nose to nipple Baby approaches breast, lower lip/chin to nipple

BABY’S ATTACHMENTMore areola seen above baby’s top lip More areola seen below bottom lipBaby’s mouth open wide Baby’s mouth not open wideLower lip turned outwards Lips pointing forward or turned inBaby’s chin touches breast Baby’s chin not touching breast

SUCKLINGSlow, deep sucks with pauses Rapid shallow sucksCheeks round when suckling Cheeks pulled in when sucklingBaby releases breast when finished Mother takes baby off the breast

Mother notices signs of oxytocin reflex No signs of oxytocin reflex noticedNotes:

7/2


Assess a Breastfeed

7/3

©U

NIC

EF

C10

7-5

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2009 ©U

NIC

EF

C10

7-7

Wide Open Mouth

7/4


Assess a Breastfeed

7/5

©U

NIC

EF

C10

7-9


Assess a Breastfeed

7/6

UN

ICEF

/HQ

91-0

168/

Bet

ty P

ress

, Ken

ya


8/1 9/1

Orig

inal

illu

stra

tion

by J

enny

Cor

kery


Case study9/2

UN

ICEF

/HQ

91-0

168/

Bet

ty P

ress

, Ken

ya

“Sleeping all the time”

“Refusing” the breast

3 stools in week

12% under birth weight

Bottle with honey and water twice yesterday

2 weeks old Healthy at birth Discharged Day 2

Case study

Bre

astfe

edin

g C

ouns

ellin

g: a

trai

ning

cou

rse,

WH

O/C

HD

/93.

4, U

NIC

EF/

NU

T/93

.2


Kangaroo Mother Care

10/1

Dr N

ils B

ergm

an,

Cap

e To

wn,

So

uth

Afric

a


Kangaroo Mother Care

Dr N

ils B

ergm

an, C

ape

Tow

n, S

outh

Afri

ca

10/2


Positioning a preterminfant

10/3

UN

ICEF

/HQ

93-0

287/

Rog

er L

emoy

ne, C

hina


Twins Grow Well on

Breastmilk

UN

ICEF

/HQ

92-0

260/

Lau

ren

Goo

dsm

ith, M

aurit

ania

10/4


DANCER Hand Position

10/5

©U

NIC

EF

C10

7-21


Chin Support 10/6

Kay

Hoo

ver a

nd B

arba

ra W

ilson

-Cla

y, fr

om T

he B

reas

tfeed

ing

Atla

s


Hand Expression

11/1

©UNICEF 910164F


Cup Feeding 11/2

Pro

mot

ing

brea

stfe

edin

g in

hea

lth fa

cilit

ies:

A

sho

rt co

urse

for a

dmin

istra

tors

and

pol

icy

mak

ers

WH

O/N

UT/

96.3

, Wel

lsta

rtIn

tern

atio

nal


Supplementer

11/3

Dr R

uskh

ana

Hai

der,

Dha

ka, B

angl

ades

h


Size and Shape

There are many different shapes and sizes of breast and nipple.

Babies can breastfeed from almost all of them.

12/1

Bre

astfe

edin

g C

ouns

ellin

g: a

trai

ning

cou

rse,

WH

O/C

HD

/93.

4, U

NIC

EF/

NU

T/93

.2


Full Breast

UN

ICE

F C

-107

-19

12/2


Engorged Breast

©U

NIC

EF

C-1

0-25

12/3


Mastitis12/4

©U

NIC

EF

C10

7-39


Sore Nipple12/5

©U

NIC

EF

C10

7-31


Sore Nipple

12/6

©U

NIC

EF

C10

7-32


Syringe method for inverted nipples12/7

Bre

astfe

edin

g C

ouns

ellin

g: a

trai

ning

cou

rse,

WH

O/C

HD

/93.

4, U

NIC

EF/

NU

T/93

.2


Candida on the nipple12/8

©U

NIC

EF

C10

7-34


Candida on the nipple12/9

©U

NIC

EF

C10

7-33


Tongue-tie 12/10

©U

NIC

EF

C10

7-35


Lactational Amenorrhea Method (LAM)13/1

Institute for Reproductive Health, Georgetown, Washington, DC

1. Have your menses returned?

2. Are you giving supplements or are there long periods without breastfeeding either day or night?

3. Is your baby more than six months old?

Ask the mother or advise her to ask herself these three questions:

There is only a 1-2% chance of pregnancy at this time.

YES

NO

NO

NO

YES

YES

When the answer to ANY one of these questions

becomes YESThe mother’s chance of pregnancy is increased.

For continued protection, and to achieve child

spacing, a complementary family planning method

needs to be used, and breastfeeding continue.


UNICEF/WHO/UNAIDS Infant Feeding Recommendation for

HIV-positive Women

Exclusive breastfeeding is recommended for HIV-infected mothers for the first six months of life

unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for

them and their infants before that time.

When replacement feeding is acceptable, feasible, affordable, sustainable and safe avoidance of all

breastfeeding by HIV-infected mothers is recommended.

13/2


14/1

Orig

inal

illu

stra

tion

by J

enny

Cor

kery


Course Aims

The aim of this course is that every staff member will confidently support

mothers to succeed with early and exclusive breastfeeding,and that this facility moves towards achieving Baby-Friendly designation.

15/1


Where are we now?

Developing a Plan:

Step One

15/2


Where do we want to be?

15/3Developing a Plan:

Step Two


Developing a Plan:Step Three

15/4

How will we get there?


How will we know if we are there?

Developing a Plan:Step Four

15/5


How will we sustain it?

15/6Developing a Plan:Step Five

Documents

BFHI Slides