Breastfeeding and You:A handbook for antenatal educatorsSecond editionHandbook coordinator and principal authorDr Jane Svensson1Breastfeeding and you: A handbook for antenatal educatorsOnline ISBN: 978-1-76007-082-3 Publications approval nuber: 10621!op"ri#$t Stateents:Paper-based publications% !oon&ealt$ o' (ustralia 201)*$is &or+ is cop"ri#$t, -ou a" repro.uce t$e &$ole or part o' t$is &or+ inunaltere.'or'or "our o&n personal useor/ i' "ou are part o' anor#anisation/ 'or internal use &it$in "our or#anisation/ but onl" i' "ou or"our or#anisation .o not use t$e repro.uction 'or an" coercial purposean. retain t$is cop"ri#$t notice an. all .isclaier notices as part o' t$atrepro.uction, (part 'ro ri#$ts to use as peritte. b" t$e Copyright Act1968 or allo&e. b" t$is cop"ri#$t notice, all ot$er ri#$ts are reserve. an."ou are not allo&e. to repro.uce t$e &$ole or an" part o' t$is &or+ in an"&a" 0electronic or ot$er&ise1 &it$out 2rst bein# #iven t$e speci2c &rittenperission'rot$e!oon&ealt$to.oso, 3e4uests an.in4uiriesconcernin# repro.uction an. ri#$ts are to be sent to t$e !ounicationBranc$/ 5epartent o' 6ealt$/ 7PO Bo8 9898/ !anberra (!* 2601/ or viae-ail to cop"ri#$t:$ealt$,#ov,au, nternet sites% !oon&ealt$ o' (ustralia 201)*$is &or+ iscop"ri#$t,-oua".o&nloa./.ispla"/print an.repro.ucet$e &$ole or part o' t$is &or+ in unaltere. 'or 'or "our o&n personal useor/ i' "ou are part o' an or#anisation/ 'or internal use &it$in "ouror#anisation/ but onl" i' "ou or "our or#anisation .o not use t$erepro.uction 'or an" coercial purpose an. retain t$is cop"ri#$t noticean. all .isclaier notices as part o' t$at repro.uction, (part 'ro ri#$ts touse as peritte. b" t$e Copyright Act 1968 or allo&e. b" t$is cop"ri#$tnotice, all ot$er ri#$ts are reserve. an. "ou are not allo&e. to repro.ucet$e &$ole or an" part o' t$is &or+ in an" &a"0electronic or ot$er&ise1&it$out 2rst bein# #iven t$e speci2c &ritten perission 'rot$e!oon&ealt$ to .o so, 3e4uests an. in4uiries concernin# repro.uctionan. ri#$ts are to be sent to t$e !ounication Branc$/ 5epartent o'6ealt$/ 7PO Bo8 9898/ !anberra (!* 2601/ or via e-ail tocop"ri#$t:$ealt$,#ov,au, *$is pro;ect &as 'un.e. b" t$e 5epartent o' 6ealt$/ !anberra,2TENTS!able of "ontents#!$%D&"!%# !% !H' HA#DB%%())))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))))*1, !ON* *6IS 6(N5BOO?,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 62, *6< (I@ O> *6< 6(N5BOO?,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 73, 6OA *O BS< *6IS 6(N5BOO?,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 7+%D&,' -: P$'PA$#. !% B$'AS!/''D)))))))))))))))))))))))))))))))))))))))))))))))))))))))))01, IN*3O5B!*ION,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 102, *6< 3 P3 (N*I5oreaseo'uset$e $an.boo+$asbeen.ivi.e. into t&o sections/&it$eac$ section .ivi.e. into o.ules, Section %ne provi.es a suar" o' current breast'ee.in# an. antenatale.ucation evi.ence an. best practice, *$e o.ules in t$is section are: @o.ule 1 Preparin# to breast'ee. @o.ule 2 *$e breast'ee.in# e8perience @o.ule 3>acilitatin# #roups @o.ule 9Plannin# pro#ras @o.ule )6IK an. e.ucator or 'acilitator instea. o' teac$er,,ist of abbreviations (ppen.i81provi.es alist o' t$eabbreviations use.t$rou#$out t$is$an.boo+,"onsultation*$e consultation 'or t$is e.ition o' t$e $an.boo+/ con.ucte.over 3ont$s in 2013/ involve.: 32 e8pectant parents/ bot$ &oen an. t$eir partnersK 96 ne& parents/ pre.oinantl" &oenK an. 26 pro'essionals 'ro a ran#e o' .isciplines 0see list in (ppen.i8 21, Quotations 'rot$oseconsulte.appear t$rou#$out t$e$an.boo+'orillustrative purposes, 9+odule -: Preparing to breastfeed"%#!'#!1, Intro.uction 102, *$e realisation o' Pre#nanc" 103,*$e .ecision to Breast'ee. 109,*$e Iportance o' (ntenatal urt$er in'oration on p$"sicalc$an#es to t$e breasts in pre#nanc" is provi.e. un.er@o.ule 1,), *$eBreast in Pre#nanc"1 Soe &oen/ even at t$is earl" sta#e o' pre#nanc"/ e8press t$eir.ecision an. t$eir abilit" to breast'ee. in ters o' Ibein# a #oo. ot$erJ,G11/12H*$e .esire to #ive t$eir in'ant t$e IbestJ $as been s$o&n to be t$esin#le/ ost inOuential otivator t$at &oen #ive 'or c$oosin# tobreast'ee.,G11/ 13/ 19H *$e" be#in to construct an ia#e o' t$e c$aracteristicsan.4ualitieso'aI#oo.ot$erJ/ an.seebreast'ee.in#asaparto'aaternali.entit"/ an.even asa oralobli#ation,*$e"reOect on t$eiro&n upbrin#in#/ observe t$eir 'ailies an. 'rien.s an. be#in to 'orulatei.eas o' &$at t$e" &ill an. &onJt .o as parents,*$is broa. e8ploration is.escribe.ase8ainin#I#lobal parentin#J concepts/ an.contrasts&it$e8ainin# Ispeci2c parentin#J tas+s or s+ills &$ic$ t"picall" occurs later int$e pre#nanc"/ &$en bot$ &oen an. t$eir partners see+ in-.ept$in'oration about breast'ee.in# an. &ant to learn t$e necessar" s+ills,G1)HBreast'ee.in# 'or t$ese &oen is not onl" $ealt$ier 'or t$eir in'ant/ buta" also be iportant to t$eir i.entit" as a ot$er,G16H4) !he decision to Breastfeed11>orcenturies/ in'ant 'ee.in#$asbeeninOuence.b"prevailin#culturalattitu.es an. t$e availabilit" o' viable alternatives,G17H 0See (ppen.i8 3 'oran $istorical perspective on t$e .ecision to breast'ee.,1 urt$erintot$epre#nanc"/o'tenint$esecon. triester/&oen an. t$eir partners be#in to activel" see+breast'ee.in# in'oration,G8/1)H*$e callouts $ere capture t$e &or.s use.b" &oen in t$eir secon. triester &$o &ere intervie&e. 'or t$is$an.boo+,Pre#nant&oena"t$ere'oresee+breast'ee.in#in'orationpriorto'oral antenatal e.ucation sessions/ 'or e8aple at antenatalII *$e essa#eIbreast is bestJiplie. t$at t$ere is anot$er option t$at isper$aps alost as #oo./ lea.in# breast'ee.in# a.vocates to propose t$at breast'ee.in# s$oul. sipl" be presente. as t$e p$"siolo#ical nor,12appointents,A$et$er "ou are an e.ucator or a i.&i'e/ breast'ee.in#concerns an. 4uestions 'ro &oen in t$e earl" sta#es o' pre#nanc" areiportant Iteac$able oentsJ, *$e I-our 3ole as an or e8aple/ in one stu."/ &oen in(ustralia 'ro In.ia/ Eietna/ t$e P$ilippines/ rural !$ina an. ?orea reportt$atint$eircountrieso'ori#in&oeno'tenbreast'ee.'oronetot&o"ears/ "et $ere in (ustralia t$e" a" breast'ee. 'or a s$orter tie, *$ese&oen state t$at breast'ee.in#is ore.iScult in (ustralia 'or severalreasons/ suc$ as: t$eir transition 'ro an e8ten.e. to a nuclear 'ail" &$ere t$e" nolon#er $ave t$e support t$e" re4uire to care 'or t$eir in'ant an. an"ot$er c$il.renK t$eir nee. to return to &or+ an.Por stu." soon a'ter t$e birt$ o' t$eirin'antK an. $ealt$ services an. breast'ee.in# support are not al&a"s accessibleor culturall" appropriate to t$e nee.s o' i#rant an. re'u#ee&oen,G98/ 99H In a..ition/ an" believe. t$at (ustralian &oen .o not breast'ee./ ast$e" are rarel" seen breast'ee.in# in public an. as in'ant 'orula is sorea.il" available, G99H(cculturation $as been s$o&n to $ave an ipact on breast'ee.in#practice/ &it$ breast'ee.in# initiation bein# $i#$est aon# &oen 'rosoe counities &$o are least acculturate./ an. lo&est aon# &oenost acculturate.,G)0/)1H>or e8aple/ as @a$ara; $i#$li#$ts 'ro a stu."con.ucte. in @elbourne/ I'or et$nic In.ian ii#rant &oen16breast'ee.in# practice is closel" lin+e. to acculturation an. i.entit"construction/ bot$ personal an. counal, *$e lac+ o' social an. culturalnet&or+s 'or recent ii#rants prevents t$e involveent in t$e culturals"stest$at tra.itionall"support breast'ee.in#, Ait$ana&arenesso't$is/ $ealt$care pro'essionals s$oul. .eliver services in a culturall"appropriate an. sensitive anner &$ere &oen 'eel supporte. as &ell asepo&ere.J,G)0H!hei:ageof thebreast ;ithinsociety:(not$er inOuenceona&oanJs .ecisiontobreast'ee.appears tobet$e&a"in&$ic$t$e'eale breast is vie&e. in $er societ", Soe coentators believe t$att$e preoccupation in &estern societies &it$ breasts as ob;ects o' se8ual.esirean.#rati2cation/ visibl"use.inar+etin#/ canbeparticularl"inOuential ina&oanJs.ecisionon$o&to'ee.$erin'ant,G)2/)3HSoe&oenappeartobeconcerne.t$att$eirbreasts&ill loset$eirse8ualattractivenessi' t$e"breast'ee.G23H/ or t$at t$eir partner a"becoe;ealous o' t$e in'ant suc+lin# at t$eir breast,G)9HAoen livin# inconteporar" &estern societies pa" .etaile. attention to t$e appearanceo' t$eir bo."/ itscontrol an.'unction, *$ep$"siolo#ical c$an#est$atoccur in relation to pre#nanc" an. lactation a" .istress soe &oen/.eterrin# t$e 'ro consi.erin# breast'ee.in#, >or soe &oen t$ere isalso a #eneral 'eelin# o' unease or even repulsion at t$e t$ou#$t o' breastil+ lea+in# 'rot$eir breasts/ an. bot$ breast'ee.in# an. 'orula'ee.in# &oen can be abivalent about breast'ee.in# in 'ront o'ot$ersG)2/))H/ &it$'eelin#so' ebarrassent an..is#ust e8presse.b"&oen o' varie. socio-econoic bac+#roun.s, *$is 'urt$er $i#$li#$ts t$etensionbet&eent$ebreastJs'unctionasas"bol o' se8ualit"&it$in&estern societ" an. its 'unction as an or#anic source o' nutrition 'or t$ein'ant,G)6H!he :edia and breastfeeding: @e.ia ia#es o' t$e 'eale breast areiportant in s$apin# our i.eas about t$e breast an. t$ere'ore &oenJsco'ort &it$ breast'ee.in#, *$e e.ia also activel" s$apes ourun.erstan.in# about breast'ee.in#, (n e8aination o' t$ree lea.in#17(ustralian&oenJsa#aLinessu##este.t$at&$ilet$ereare're4uentre'erences to celebrities c$oosin# to breast'ee./ t$e 'ocus o' t$eessa#es is 're4uentl" $o& breast'ee.in# can optiise aternal &ei#$tloss,G)7H A$ile t$e i.ea o' breast'ee.in# as a &ei#$t loss strate#" is/ at 2rst#lance/ pro-breast'ee.in#/ it also rein'orces a ne#ative post-partu bo."ia#e, *$e eroticiso' t$e breast an. t$e i.olisation o' slian.iature bo.ies are at o..s &it$t$e realit"o' ot$er$oo., Ia#es o'scantil" cla. &oen/ o'ten portra"e. in provocative poses/ .o not treat&oen as &$ole persons &it$ uni4ue t$ou#$ts an. 'eelin#s,G)8H>urt$er/ soeia#esan.essa#essu##est breast'ee.in#is.iScult/re4uires patience/ practice/ tie an. is a battle or a proble to be solve.,*$is t"pe o' e.ia portra"al is ne#ative/ un.erestiates an.un.erep$asises &oenJs copetencean.a"un.erinea'ealerea.ersJ con2.ence in $er prospects o' success'ull" breast'ee.in#,Bn.erl"in# an" o' t$ese reports is t$e essa#e t$at &oen re4uire t$eassistance o' $ealt$ pro'essionals to succee. at breast'ee.in#,*$rou#$ a.vertisin#/ t$e e.ia not onl" alerts t$e public to ne&erc$an.ise/ but alsosu##ests topeople&$"t$e"nee.tobu"t$epro.uct,G)9H ( recent (ustralian stu." o' &oenJs un.erstan.in# o' 'ollo&-up to..ler il+ a.vertiseents in.icate. t$at alt$ou#$ t$e &oen clearl"un.erstoo. t$e a.vertiseents &ere not ;ust 'or a sin#le pro.uct/ but anaSliate. ran#e o' pro.ucts/ inclu.in# 'orula 'or in'ants un.er si8 ont$st$at coul. un.erine breast'ee.in#/ t$e &oen accepte. t$e a.vertisin#clais uncriticall",G60Hnternational :arketingofinfantfor:ulaandrelatedproducts:3esearc$ersan.coentators$avei.enti2e.t$att$ear+etin#an.suppl" o' 'ree an. lo&-cost in'ant 'orula an. relate. pro.uctscontribute. to t$e rapi. .ecline in breast'ee.in# t$is centur" an.proote. bottle 'ee.in# as t$e nor in &estern societies,G)9H *$e A6O an.BNI!G61H$el. a suit o' in'ant 'ee.in# e8perts in 1979 re#ar.in# t$ear+etin# an. use o' in'ant 'orula/ an. conclu.e. t$at an internationalco.e o' et$ics &as re4uire. to control t$e ar+etin# o' in'ant 'orula, (sa result/ t$e 39t$ Aorl. 6ealt$ (ssebl" a.opte. t$e International !o.e o'@ar+etin#o' Breast-il+Substitutesin19810t$eA6O!o.e1,G62H*$e!o.e ais to liit t$e prootion an. suppl" o' 'orulas to consuers inor.er to protect breast'ee.in#an.assist in increasin#initiation an..uration rates, In response to t$e !o.e/ (ustralia intro.uce. t$e-arketinginAustraliaofInfant.ormulas' -anufacturersandImporters18Agreement199)0@(I>(#reeent1&$ic$isavoluntar"sel'-re#ulator"co.eo' con.uct bet&eensoeanu'acturersan.iporterso' in'ant'orula, *$e @(I> (#reeent ais to protect an. proote breast'ee.in#b"ensurin#t$eproper useo' breast il+substitutes/ &$ent$e"arenecessar", Itrestrictst$ear+etin#o'in'ant'orulastot$epublicb"anu'acturers an. iporters &$o are si#natories to t$e (#reeent,III!he>:edicalisation? ofbreastfeedingandlossofbreastfeedingculture:In(ustraliaint$e1960s/ $ealt$pro'essionalsrecoen.e.t$at in'ants be 'e. on a ri#i. 'our-$ourl" sc$e.ule an. 'or liite. ties,Ae are no& a&are suc$ practices coproise t$e initiation an.aintenance o' breast'ee.in# b" $in.erin# breast il+ pro.uction, (s aconse4uence/ &oen cae to vie& breast'ee.in# as probleatic an. apractice t$at re4uire. continuous assistance an. support o' pro'essionals,G9/63H*$isun.erine.&oenJscon2.enceint$eirabilit"tobreast'ee.an. resulte. int$e loss o' a breast'ee.in# culture in t$e counit" an. a.isinte#ration o' tra.itional +no&le.#e about $o& breast'ee.in# ot$ersan. in'ants be$ave/ t$e +in. o' stren#t$s t$e" possess an. t$e t"pe o'support t$e" re4uire,G63H*$ere becae/ an. reains/ an increase.ep$asis on pro'essional +no&le.#e to 2ll t$e #ap, 3i#i. 'ee.in# practices $ave all but .isappeare. in (ustralia/ $o&ever/ as&it$ all o' t$e ot$er 'actors inOuencin# t$e in'ant 'ee.in# .ecision/ untilt$ere is a return to a stron# breast'ee.in# culture in our societ"/ &oena"lac+con2.ence/ an.4uali'"t$eir.ecisiontobreast'ee.&it$Ii'IcanJ, (s an antenatal e.ucator "ou can $elp couples to un.erstan. t$etrue &ort$ o' breast'ee.in#/ an. t$e totalit" o' its p$"siolo#ical processes/to $ope'ull" assist t$e to soli.i'" t$eir .ecision,*) !he :portance of Antenatal 'ducation?no&le.#e o' t$e contribution o' breast'ee.in# to li'e-lon# $ealt$ is notenou#$ to .evelop &oenJs con2.ence an. increase t$e rates o'breast'ee.in# initiation an. .uration,!opre$ensive .iscussion o'breast'ee.in# is t$ere'ore an iportant part o' antenatal care/ especiall"as t$e tra.itional learnin# o' breast'ee.in# s+ills 'ro ot$ers an. 'ail"ebers is no& less coon, (s t$e preparator" sta#e 'or breast'ee.in#/t$e #oal is to enable &oen to .evelop +no&le.#e/ stren#t$encoitent to breast'ee.in# an. establis$ or consoli.ate supportnet&or+s,G)H(planne.approac$evenint$eearl"&ee+so'pre#nanc"/an.continuit"o' carean.support .urin#pre#nanc"/ birt$an.earl"parent$oo. canensure t$at &oen receive opportunities 'or e.ucation/consistent a.vice/an. appropriate support to continue breast'ee.in#, (cobination o' antenatal an. postnatal interventions increases t$einitiation an. .uration o' breast'ee.in#,G69H III 5espite t$e intro.uction o' t$e !o.e/ t$e continue. a##ressive ar+etin# o' in'ant 'orula b" ultinational copanies continues in an"ot$er parts o' t$e &orl.,G62H

19!urrentl" recoen.e. are:1, antenatal e.ucational strate#ies/ t$at inclu.e: $ealt$pro'essionals Icapturin#J t$ean"teac$ableoents inpre#nanc"K an. sall #roup/ .iscursive antenatal breast'ee.in# e.ucation/ inclu.in#topics suc$ as $o& breast'ee.in# &or+s/ t$e ipact o' interventionin labour on initiation o' breast'ee.in#/ prevention o' coonprobles/ an. resources available to parentsK couple. &it$ 2, rea.il" available breast'ee.in# speci2c/ practical an. proble solvin#support 'ro a $ealt$ pro'essional in t$e earl" postnatal perio.,G6)-67H >at$ers bene2t &$en soe o' t$e sub;ect atter o' t$e e.ucationa..resses 'actors &$ic$ are .irectl" lin+e. to outcoes relatin# to 'at$erFc$il.an.'at$erFpartner relations$ips,G68HInvolvin#enin.iscussionsre#ar.in# t$e t"pe o' 'ee.in# t$eir in'ant &ill receive/ an. in'orin# t$eabout potential probles an. strate#ies to solve t$e $as been s$o&n toincreaset$elevel o'support&oenreceive.at6&ee+spostbirt$,G69H>urt$er/ peersupport at bot$t$epre- an.post-natal sta#esiprovesearl" breast'ee.in# outcoes G69/70HK "ou coul. t$ere'ore consi.er invitin#an (B( counsellor an.Por breast'ee.in# ot$er to "our antenatal class,*$ereisevi.encet$atcertain#roupsarelessli+el"tobreast'ee.t$anot$ersan.&oul.t$usbene2t 'roincrease.antenatal an.postnatalsupport,G3H*$eseinclu.e(bori#inal an.*orresStrait Islan.er &oen/"oun# &oen/ less e.ucate. &oen an.P or t$ose 'ro ot$er countries,In soe countries 'eale 'ail" el.ers an. t$e &i.er counit" supportan.prootebreast'ee.in#t$rou#$tra.itional aspects o' careint$epostpartu perio., Aoen &$o $ave recentl" arrive. in (ustralia 'rot$ese countries a" bene2t 'roet$nicall" speci2c peer support in$ospital an.Por in t$e counit"/ to assist &it$ breast'ee.in#,Ci+e&ise/peer an. el.er support 'or (bori#inal&oen an. t$ose 'ro t$e *orresStrait Islan.s can be bene2cial especiall" &$en t$e" are .istant 'ro t$eir'ail" an. counit", *$e inclusion o' partners/ ot$ers an. peers inbreast'ee.in# e.ucation an. support 'or "oun#er ot$ers $as also beeni.enti2e. as crucial,G71H7) !he Breasts in Pregnancy!he physical changes Breast c$an#es a" be t$e 2rst p$"sical c$an#es t$at &oen notice inpre#nanc" an. are ost apparent in t$e 2rst triester, *o support &oenan. ans&er t$eir 4uestions/ +no&le.#e o' t$e anato" an. 'unction o' t$ebreast is iportant, Ait$pre#nanc"t$ea.iposeor 'att"tissueo' t$ebreast/ &$ic$$aspriaril"beensupportin#t$ebreast sincepubert"/ .ecreases ast$e#lan.ular tissue an. t$e .uctal s"ste.evelops an. aturates inpreparation 'or t$e birt$, *&o sta#es o' breast #ro&t$ are un.erstoo. to20occur .urin#pre#nanc", 5urin#t$e2rst $al' t$ereis intenselobular-alveolar #ro&t$ 0ao#enesis1/ resultin# in bot$ an increase. nuberan. siLe o' alveoli an. e8tension an. branc$in# o' t$e .uctal s"ste,G72H*$is #ro&t$ o' t$e aar" #lan. is inOuence. b" a nuber o'$orones inclu.in# oestro#en/ pro#esterone/ prolactin/ #ro&t$ $orone/epi.eral#ro&t$ 'actor/2broblast#ro&t$ 'actor an.insulin-li+e #ro&t$'actorG73Han. parat$"roi. $orone-relate. protein,G79H6i#$ levels o'oestro#en an. pro#esterone in$ibit lactation prior to birt$, *$e nipples be#in to enlar#e an. becoe ore erect/ t$e areola .ar+ensan. a" enlar#e/ an. t$e @ont#oer" #lan.s/ &$ic$ are a cobination o'sebaceous #lan.s an. aar" il+ #lan.s/ becoe ore pronounce.an. noticeable, It is believe. t$e secretions 'ro t$ese #lan.s protect t$enipple 'robot$ ec$anical stress o' suc+in# later an. pat$o#enicinvasion,G79/ 7)H (s t$e breasts enlar#e/ t$e s+in becoes translucent an. ast$e bloo. suppl" to t$e breast increases t$e veins becoe oreproinent, *$esec$an#esall in.icatet$at t$ebreast isun.er#oin#arear+able aturation to .evelop t$e il+-a+in# cells an. .uctals"ste/ in rea.iness 'or t$e in'ant to be 'e. a'ter birt$,Proli'eration o' t$e #lan.ular tissue is believe. to occur b" an invasion o't$e a.ipose tissue in t$e breast, B" i.-pre#nanc" t$ere is soesecretor".evelopent &it$colostrupresent int$ealveoli an.il+.ucts increasin# t$rou#$out t$e secon. $al' o' pre#nanc" 0lacto#enesis I1,Branc$in# o' t$e .uctal s"ste continues but is less ar+e. t$an in t$e2rst $al' o' pre#nanc",G72H3asa" an. co-&or+ers $ave .eonstrate. usin# ultrasoun. t$at t$e il+.ucts in t$e lactatin# breast are sall/ super2cial an. easil" copresse.,G76HO' possibl" #reater si#ni2canceis t$eir .iscover" t$at t$e.uctals"ste .oes not .ispla" t$e t"pical sac-li+e appearance o' t$e Ilacti'eroussinusJ, Instea..ucts.rain#lan.ular tissuet$rou#$out t$ebreast an.er#eintoaincollectin#.uctsclosetot$enipple,G76H0See>i#ure2,1Bltrasoun. stu.ies $ave also .eonstrate. t$at t$e il+ .ucts increase in.iaeter at il+ e;ection/ conclu.in# t$at t$e ain 'unction o' t$e .ucts istransport o' il+ rat$er t$an stora#e, G77H21/igure 1 Anato:y of the lactating breast) @"opyright per:ission granted by P) Hart:ann)AHo; these changes are perceivedAoenJs responses to t$ese c$an#es are o'ten i8e. an. a" ran#e 'ro ;o" an. 'ascination to .istress an. .isa", -ou &ill 2n. t$at soe participants in antenatal e.ucation &ill re#ar. t$eir breasts an. breast'ee.in# as a sensitive issue an. "ou a" $ear a ran#e o' responses in .iscussion in "our sessions,*i#$tl" crosse. ars or $unc$e. s$oul.ers a" in.icate t$at a &oan is unco'ortable &it$ $er breasts an. t$e c$an#es, Soe &ill as+ .irect 4uestions suc$ as I@" breasts are $u#e no&- &$at &ill t$e" be li+e &$en I start breast'ee.in#DJ or I@" partner t$in+s t$e" are &on.er'ul F but $e .oesnJt $ave to carr" t$e aroun., Aill t$e" #et bi##erDJ Aoen &it$ saller breasts a" as+ about t$eir abilit" to pro.uce enou#$ breast il+, It can $elp &oen to un.erstan. t$at t$e a;or increase in breast siLe is usuall" coplete. b" 22 &ee+s o' pre#nanc" an. t$at t$ere is no correlation bet&een breast siLe an. abilit" to pro.uce breast il+, Int$esecon.triester an"&oenbecoeconcerne.about t$eirabilit"tobreast'ee./ ast$e"$ave$ear.t$at it isI$ar.J, Int$et$ir.triester partners see+ ans&ers to ore practical issues/ suc$ as IA$atcan I .o to $elp &it$ breast'ee.in#DJ A$enever "ou can/ captureopportunitiesan.a..ressissuesast$e"arise/ suc$as&$en"ouare22as+e. .irect 4uestions or &$en ne#ative coents are a.eK 'ears canbecoe si#ni2cant concerns i' t$e" are not .ealt &it$,Breast care during pregnancy One4uestiont$at&oeno'tenas+is&$att$e"s$oul..otopreparet$eir breasts'or breast'ee.in#, *$esipleans&er ist$at t$ereisnospeci2c carenecessar" .urin#t$e pre#nanc", No creas/ ointents/breast s$ellsor nipplepullers$aveproventoa+ean".iNerencetobreast'ee.in# outcoes, *$e best &a" to prepare 'or breast'ee.in# is tolearnoreabout it,*$ereisnoevi.encetosupport antenatal breaste8ainations as a eans o' prootin# breast'ee.in#,G7H 8) Bhy BreastfeedC*$ere is convincin# epi.eiolo#ical evi.ence o' t$e protective eNects o'breast'ee.in#'or ot$ersan.in'ants,[78,79]It isoneo' t$eost cost-eNectiveinvestents in c$il.survival an..evelopent an.li'e-lon#$ealt$, !he i:portance of breastfeeding for the health of the infant>or t$e .evelopin#in'ant/ breast'ee.in# con'ers iprove. visualacuit"/ps"c$ootor .evelopentG78Han. co#nitive .evelopent/G80Han. re.uce.ris+ o' alocclusion as a result o' better ;a& s$ape an. .evelopent,G81HBreast'ee.in# t$en re.uces t$e ris+ or severit" o' a nuber o' con.itionsin in'anc" an. later li'e/ inclu.in#: p$"siolo#ical reOu8G82H p"loric stenosisG83/ 89H #astrointestinal in'ectionsG79/ 8)/ 86H respirator" illnessG79H otitis e.iaG79/ 87/ 88H urinar" tract in'ectionsG89/ 90H bacteraeia-enin#itisG91H necrotiLin# enterocolitis in preter in'antsG79H soe c$il.$oo. cancersG79H t"pe 1G79H an. t"pe 2 .iabetesG78/ 79H car.iovascular .isease ris+ 'actors inclu.in# bloo. pressureG92/ 93H an.total an. lo&-.ensit" lipoprotein c$olesterolG78/ 79H obesit" in c$il.$oo. an. in later li'eG78/ 79/ 99/ 9)H

su..en in'ant .eat$ s"n.roe 0SI5S1,G79/ 96HBreast'ee.in# is particularl" iportant &$ile an in'antJs iune s"ste isiature but continues to oNer si#ni2cant protection t$rou#$out23lactation, >actorspresent inbreast il+t$at provi.eactiveor passiveiunoprotection inclu.e iuno#lobulins (/ 7 an. @,G97HIn t$e #eneralpopulation an. 'ailies &it$ a $istor" o' aller#ic .isease/ e8clusivebreast'ee.in#'oraroun.6ont$sre.ucest$eris+o' aller#icr$initis/&$eeLin#/ ast$a an. atop" in c$il.ren,G98/99HPreature an. sic+ne&borns survive an. t$rive at a si#ni2cantl" $i#$er rate &$en t$e" arebreast'e. or receive .onor $uan il+, G100/ 101HBreast'ee.in# can be an iportant 'actor in bon.in# bet&een ot$er an.in'ant, *$e inter.epen.ence bet&een t$e breast'ee.in# ot$er an.in'ant/ re#ular close interaction an. s+in-to-s+in contact .urin#breast'ee.in# encoura#es utual responsiveness an. attac$ent,[102, 103]IV !he i:portance of breastfeeding for the :other?s health@ot$ers &$o start breast'ee.in# ie.iatel" a'ter t$e" $ave #iven birt$recover ore 4uic+l", Breast'ee.in# $astens uterine involution an.re.uces t$e ris+ o' $aeorr$a#e/ t$us re.ucin# aternal ortalit",Preservationo' aternal $aeoo#lobinstores/ t$rou#$re.uce.bloo.loss/ lea.s to iprove. iron status,G109H*$ose &$o continue to breast'ee.also lose &ei#$t #aine. .urin# pre#nanc" ore 4uic+l" an. $ave re.uce.ris+ o' breast an. ovarian cancers/ car.iovascular .isease an.osteoporosis later in li'e,G10)/106HAoen &it$ .iabetes s$oul. beencoura#e.tobreast'ee.becauseo' aternal an.c$il.$oo.bene2tsspeci2c to .iabetes t$at are above an. be"on. ot$er +no&n bene2ts o'breast'ee.in#,G107HAoen&$obreast'ee.$aveare.uce.ris+o' post-partu .epression an. re.uce. 'ertilit"/ $elpin# to space t$eirpre#nancies, *$eli+eli$oo.o' pre#nanc".urin#perio.s o' lactationalaenorr$oeais aslo&as 1,7Mint$e2rst 6ont$s i' a&oanisaenorr$oeic an. 'ull" or nearl" 'ull" breast'ee.in# .a" an. ni#$t,G108/ 109H 0) Your role as an 'ducator@an" &oen $ave alrea." .eci.e. $o& to'ee. b" t$e tiet$e" $avecontact &it$a$ealt$pro'essional/ &it$t$at .ecisiont$epro.uct o' aran#e o' 'actors, So &$at is "our role as an antenatal e.ucatorD IES+in-to-s+in contact contributes not onl" to success'ul breast'ee.in# butalso to a bab"Ts brain bein# set on t$e best .evelopental pat$, In ?an#aroo @ot$er !are 0?@!1 t$e in'ant is care. 'or s+in-to-s+in verticall" bet&een t$e ot$erTs breasts an. belo& $er clot$es/ 29 $P.a"/ &it$ 'at$erPsubstitute0s1 participatin# as ?@! provi.ers, Interittent ?@!/ 'or s$ort perio.s once or a 'e& ties per .a"/ 'or a variable nuber o' .a"s/ is increasin#l" eplo"e. in $i#$-tec$ neonatal intensive care units, ?@! en$ances bon.in# an. attac$entK re.uces aternal postpartu .epression s"ptosK en$ances in'ant p$"siolo#ic stabilit" an. re.uces painK increases parental sensitivit" to in'ant cuesK contributes to t$e establis$ent an. lon#er .uration o' breast'ee.in#K an. $as positive eNects on in'ant .evelopent an. in'antPparent interaction,G102H 29(lt$ou#$e8pectant parents a"a+ea.ecisiontobreast'ee.t$eirin'ant be'ore t$e" see a $ealt$ pro'essional/ t$e" a" or a" not $ave a#oo. un.erstan.in# o' t$e iportance o' breast'ee.in# 'or an" aspectso' t$e $ealt$ o' t$e ot$er an. in'ant, *$is +no&le.#e can stren#t$ent$eir coitent to breast'ee./ &$ic$ in turn can $elp t$e overcoean" .iSculties t$e" a" e8perience a'ter t$e birt$,Parents &$o $ave not.eci.e. tobreast'ee.a" be encoura#e. toconsi.er it inli#$t o't$is+no&le.#e,(s note. in @o.ule 1/ researc$ $as s$o&n t$at t$e e8tent to&$ic$aot$ercoitstobreast'ee.att$ispointcanipactont$e.uration o' breast'ee.in#,G10H(..itionall"/ .iscussin#breastc$an#esan.&$att$e"ean&ill assist&oen an. t$eir partners to becoe ore a&are o' t$e p$"sical capacit"an. potentialo' t$eir breasts, *$is soeties lea.s to4uestions aboutt$e nee. 'or a supportive bra an. t$e iportance o' correct s$ape an.siLeo'bra,@a+e "oursel' available'or &oento privatel" .iscuss an"concerns t$e" a" $ave re#ar.in# t$eir breasts an. t$eir abilit" tobreast'ee., I' t$e in'oration t$e" re4uire is too speci2c or "ou are unsureo' t$e ans&er/ su##est t$at t$e" .iscuss t$e atter &it$ t$eir i.&i'e/obstetrician/ #eneral practitioner or International Boar. !erti2e. Cactation!onsultant 0IB!C!1,2)Soe &oen in antenatal classes &illbe .aunte. b" t$e breast'ee.in#.iSculties t$e" a" 'ace/ &$ile ot$ers a" bene2t 'ro bein#'ore&arne.,(s an antenatal e.ucator "ou can bot$ rein'orce a &oanJs.ecision to breast'ee. an. $elp #ive $er bot$ realistic e8pectations as &ellas con2.ence in overcoin# an" probles &$ic$ a" arise,@an" e.ucators believe it is iportant 'or participants in antenatale.ucation sessions to .iscuss $o& t$e" inten. to 'ee. t$eir in'ant, *$iscan/ $o&ever/ create ri'ts &it$in a #roup an. can alienate t$ose &$o arenot inten.in#tobreast'ee., Aoena"sa"t$at t$e"are#oin#tobreast'ee.;ust sot$e".onot 'eel ostracise., (sa2rst step/ tr"an.assess a#roupJs attitu.es/ e8pectations an.in'orationnee.s/ &$ileta+in# care to use inclusive lan#ua#e about in'ant 'ee.in# an. create asense o' acceptance o' an. respect 'or eac$ &oanJsPcoupleJs in.ivi.ual.ecision, -D) "onclusion!on#ratulations/ "ou $ave no& coplete. @o.ule 1 F Preparin# to Breast'ee., In t$is o.ule &e $ave e8plore.: &$en an. $o& t$e .ecision to breast'ee. is coonl" a.eK 'actors t$at inOuence t$e .ecisionK breast c$an#es t$at &oen e8perience in pre#nanc"K t$eiportanceo' breast'ee.in#'or t$e$ealt$o' t$ein'ant an.ot$erK an. strate#iest$atanantenatal e.ucatorcanusetoprepare&oenan. t$eir partners 'or breast'ee.in# t$eir in'ant,Ae $ope t$is o.ule $as #iven "ou an un.erstan.in# o' $o&breast'ee.in# is perceive. b" &oen an. t$eir partners .urin# apre#nanc" an. t$at "ou &ill be able to provi.e t$e &it$ t$e in'orationan. support t$e" re4uire as t$e" be#in t$eir ;ourne", 26+odule 1: !he breastfeeding e9perience"%#!'#!S1, Intro.uction 292, *$e Breast'ee.in# relations$ip 293, 6o& Breast'ee.in# &or+s 269, >actors t$at inOuence Breast'ee.in# 32) !oon probles an. t$eir ana#eent 926, (..itional !onsi.erations 937, or e8aple/ coentssuc$ as IitJs a special +in. o' oent &$en "ou breast'ee./ &$en "ou loo+upan.t$enloo+.o&nan.$eJs .o&nt$ereloo+in#at "ouJ/ an.IIsuppose itJs a bit o' an e#o trip, I li+e 'eelin# t$atUIJ responsible 'or $iJan. II 'eel reall" nee.e.U crucialJ are coon,Inanarticle b"Sc$ie.an. Barcla" breast'ee.in# is .escribe. as an Iebo.ie.J e8perience/ t$epo&er o' &$ic$ aaLe. an" o' t$e &oen in t$eir stu.",G9 H ats are t$e ost variablecopoun. in $uan il+ an. provi.e up to )0M o' +ilo;oules, >at contento' ature il+ is in.epen.ent o' breast'ee.in# 're4uenc" an. is .irectl"relate. to t$e relative 'ullness or eptiness o' t$e breast, (s t$e breastepties .urin# an in.ivi.ual 'ee. an.Por over a .a"/ t$e proportion o' 'atincreases,G112H *$e 'at content 'urt$er increases as t$e in'ant #ro&s,Breastfeeding in the initial postnatal periodIn'ants are $ar.&ire. to see+ out t$eir ot$erJs breast/ an. i' le't to t$eiro&n .evices t$e" are able to attac$ t$eselves an. start to 'ee.K t$is is+no&n as Ibab"-le. attac$entJ, In 'act t$e 2rst $ours a'ter birt$ are a.evelopentall" .istinct tie 'or an in'ant an. t$ere are &ell.ocuente. s$ort an. lon# ter p$"sical an. ps"c$olo#ical a.vanta#es&$en an in'ant is s+in-to-s+in on t$e ot$er a'ter birt$,G113H (s Ai.stro etal, $ave .escribe./ an in'ant place. s+in-to-s+in ie.iatel" a'ter birt$/&ill e8$ibit instinctive be$aviours in nine se4uential sta#es/ t$e .urationo' eac$ sta#e var"in# &it$ eac$ in'ant: 32 Sta#e 1: *$e birt$ cr"Intense cr"in# ;ust a'ter birt$, Sta#e 2: 3ela8ation In'ant restin# P recoverin#, Sta#e 3: (&a+enin#In'ant be#ins to s$o& si#ns o' activit", Sta#e 9: (ctivit" In'ant oves libs an. $ea., @ore .eterine.in activit", Sta#e ): !ra&lin# Pus$in# &$ic$ results in s$i'tin# bo.", Sta#e 6: 3estin# In'ant rests/ &it$soeactivit"/ e,#, suc+son$an.s, Sta#e 7: >ailiarisation In'ant reac$es areola &it$ out$ positione.to lic+ nipple, Sta#e 8: Suc+lin# In'ant ta+es nipple in out$ an. be#inssuc+lin#, Sta#e 9: Sleep *$e in'ant closes its e"es,G113H i#ure 9, t$e in'antJs out$ is &i.e open an. t$e lips turne. out&ar.s, *$elo&er lip especiall" is seen to be curle. ri#$t bac+ an. t$e in'antJsc$in is touc$in# t$e ot$erJs breastK t$e nipple &ill be .eep in t$e in'antJs out$/ &it$ t$e tip touc$in#t$e in'antJs palateK t$ein'antsuc+lesb"a+in#t&osiultaneousoveentsFt$elo&er ;a& #oes up an. .o&n an. a uscular &ave #oes 'ro t$e tipto t$e bac+ o' t$e ton#ue, *$is action presses t$e il+ out o' t$e.ucts/ t$rou#$ t$e nipple into t$e bac+ o' t$e in'antJs out$K t$e in'ant suc+les &it$ s$ort 4uic+ oveents at 2rst/ t$en c$an#est$e r$"t$ to a ore continuous .eep suc+lin# as t$e il+ Oo&s,*$e in'ant pauses t$rou#$out &it$ t$e pauses #ettin# lon#er as t$e'ee. continuesK t$e in'antJs c$ee+s &ill be roun.e. an. not .ra&n in an. soetiest$e ears &ill ove as it suc+lesKG116Han. at t$e en. o' t$e 'ee. t$e ot$erJs nipple a" be len#t$ene. butnot pinc$e.or s4uas$e., *ellin#ot$erstoobservet$eirnipples$ape at t$e en. o' 'ee.s enables t$e to assess 0'eel1 t$e 'ee. to.etect an. prevent probles,39/igure 5 'Eective attach:ent internal vie; @per:ission to copy grantedby $) .loverAAit$ poor attac$ent t$e in'ant: suc+s or c$e&s on t$e nipple onl"/ &it$ lips/ #us or ton#ueK t$e out$ is not &i.e open an. lips suc+e. inK t$e lips an. #us press a#ainst t$e nipple instea. o' t$e areolarK t$e ton#ue a" be isplace./ bloc+in# t$e protrusion o' t$e nippleinto t$e in'antJs out$K an.Por t$e c$ee+s are pulle. in,G116HAoen an. t$eir partners &ant to +no& &$at to e8pect in t$e 2rst 'e&$oursan.&ee+s&it$t$eir ne&bornin'ant, Speci2call"t$e"&ant to+no& I$o& 're4uentl" &ill our in'ant 'ee.J/ I$o& &ill &e +no& &$et$er ourin'ant is #ettin# enou#$ il+J an. I.o &e nee. to #ive an"t$in# elseDJ *$isin'oration is outline. belo& an. provi.e. as a >act S$eet in @o.ule 8, Postnatal Day --1:*$eot$eran.in'antare4uitesleep" an.t$e"nee. to rest an. recover 'ro t$e labour an. birt$, *$e tie ta+en b" t$e in'ant &$en it is breast'ee.in# &ill beinial/ ast$eproteinan.+ilo;oule-ric$colostru&ill eet itsnee.s, *$e aount o' colostru an in'ant receives at eac$ 'ee. isappro8iatel" W a teaspoon, *$ein'ant is&ell $".rate.'robein#int$eanioticOui.&it$continual 'ee.in# 'ro t$e placenta/ so it &ill not re4uire 're4uent'ee.s, >ee.s a" onl" be ever" 3-3W $ours, I' t$e in'ant .oes not&ant to 'ee. a'ter about ) $ours/ $e or s$e s$oul. be rouse. an.put to t$e breast, In t$e 2rst 2 .a"s/ urine pro.uce. b" t$e in'ant is concentrate. an.o'tencontainsc$eicalscalle.urates/ &$ic$canturnt$enapp"oran#e or pin+, *$e 2rst bo&elotion is astic+" #reenis$ blac+substance calle.econiu, 6I1 is: I7ive ne&bornin'ants no 'oo. or .rin+ ot$er t$an breast il+/ unless e.icall"in.icate.J, 0(ppen.i8 9 e8plains t$e B>6I1, I' an in'ant is unable to ta+eall 'ee.s .irectl"at t$ebreast/ e8presse.breast il+s$oul.bet$epre'erre. et$o. o' 'ee.in#, In cases &$ere suppleentar" 'ee.in# is necessar"/ t$e ot$er s$oul.a+e an in'ore. .ecision an. #ive perission be'ore t$is is un.erta+en,*$e ot$er s$oul. be encoura#e.to breast'ee./ i' possible/ be'oreoNerin# t$e suppleentar" 'ee.,G3H ( nuber o' il+ ban+s in (ustraliaprovi.e screene. an. pasteuriLe. .onor $uan il+ 'or preter in'antsor t$ose &it$ serious e.ical con.itions,EIt is iportant t$at ot$ers un.erstan. t$at: t$erearespeci2c easures tosupport breast'ee.in#i' .iScultiesarise, 05epen.in# on t$e natureo' t$eproble/ t$ese a" inclu.es+ille. assistance &it$ latc$in# on/ proper positionin#/ e8pression0pupin#1 o' il+/ a..itional 'ee.s/ use o' a 'ee.in# tube an.e.ication1K an. a.vice an. support are available in $ospital an. a'ter .isc$ar#e 'ro aran#eo' sources inclu.in#$oei.&i'er"services/ aternal an.c$il.$ealt$nurses/ t$e(B(an.lactationconsultants'or cople8breast'ee.in# issues,E In October 2019 t$e (ustralian !olle#e o' @i.&ives publis$e. a Position Stateent on t$e Bse o' 5onor 6uan @il+, 39*$e 'ollo&in# is an overvie& o' 'actors &$ic$ can ipact upon success'ulbreast'ee.in#K 'urt$er .etail can be 'oun. in resources suc$ as Bro.ribb2012,.estation:3esearc$ers $ave'oun.t$at a'ter a.;ustin#'or stan.ar.con'oun.in# 'actors/ preter in'ants are less li+el" to be breast'e. at si8ont$s copare. to t$ose born at ter, A$en e8plore. 'urt$er/ in'antsborn at 37-39 &ee+s/ &$o are consi.ere. 'ull ter/ $a. lo&erbreast'ee.in#rates t$ant$osebornat 90&ee+s #estation,G119HAi#$t.escribes $o& t$e near to ter in'ant a" present &it$ subtle iaturit"/poor abilit"toclear noral lun#Oui./ increase.inci.enceo' apnoea/increase. ris+ o' $"pot$eria/ neurolo#ical iaturit" an. iature oro-otor .evelopent all o' &$ic$ can $ave an ipact on suc+lin#,G120H +aternal =uids in labour: *$e use o' intravenous Oui.s prior to birt$ isstan.ar. practice &it$ epi.ural anaest$etic an. caesarean section/ an. atties &it$ 'etal .ecelerations an. aternal $ealt$ coplications suc$ as.iabetes, *$is e8tra aternal Oui. raises a 4uestion about $o& t$e unbornneonate is aNecte. an. &$et$er t$e ensuin# post-birt$ ne&born &ei#$tloss is relate. to a Oui. s$i't rat$er t$an 'ee.in# or pat$olo#", ( !ana.ianstu." con.ucte. 'ro 2008 to 2010 'oun. positive relations$ipsaon#t$e variables o' aternal IE Oui.s/ neonatal output/ an. ne&born &ei#$tloss/ alt$ou#$ t$e relations$ip bet&een aternal IE Oui.s &as not evi.entuntil 60$ourspostpartu, Aoen&ereas+e.i' t$e"notice.t$e.a"t$eirYil+ cae inZ/ &it$ a si#ni2cant positive correlation bet&een lateonset o' lacto#enesis II 0.a" 3 'or 91M o' t$e saple1/ an. percenta#e o'ne&born &ei#$t loss at 72 $ours, *$e reporte. late onset o' lacto#enesis II&as positivel" relate. to t$e total aounts o' aternal Oui.s 'roa.ission to birt$, Noel-Aeiss et al, t$en propose. t$at baseline &ei#$tbe ta+en at a point a'ter t$e .iuresis/ not at birt$/ to potentiall" re.ucet$epracticeo'suppleent'ee.in#provi.e.toanin'ant&$ose&ei#$tloss since birt$ &ei#$t is #reater t$an 10M,G121H (protocol 'or clinicians&as .evelope. to collect an. anal"se .ata 'ro t$eir o&n aternit" site,Baseline &ei#$t at point o' .iuresis $as t$e potential to re.uceunnecessar" suppleentation,G122H+ode of birth:*$ereisevi.encet$atacaesareansectionan.soe'ors o' labour anal#esia a" be ne#ativel" associate. &it$ t$e initiationo' breast'ee.in#, Stu.ies proposet$at t$is is relate.tot$et"peo'anal#esia or anest$etic use./ in particular t$e potential in'antI.ro&sinessJ 'roopioi.s/ a .ela" in s+in-to-s+in contact &it$ t$eipairent o' t$e in'antJs natural breast'ee.in# reOe8es/ culinatin# in a.e'erral o' t$e initiation o' breast'ee.in#,G123/ 129H ( stress'ul va#inal birt$ e8perience/ &it$ a lon# 2n.sta#e/ a" inter'ere&it$ t$e release o' o8"tocin/ t$e $orone responsible 'or il+ e;ection,G12)HProspectiveobservational stu.iesin.icatet$atbot$aternal an.'etalstress .urin# labour an. birt$/ inclu.in# in cesarean birt$/ are associate.&it$ t$e .ela"e. onset o' lactation,G12)H

O8"tocininte#rates t$e'unctiono'several bo."s"stes an.e8ertsan"eNectsinot$ersan.in'ants.urin#breast'ee.in#,In'antsalso90pro.uce o8"tocin, In in'ants born b" va#inal.eliver"/ o8"tocin levels inubilical arterial bloo.s$o&n to be $i#$er t$an in in'ants born b"caesareansection/ &it$t$eaterial o8"tocinlevelsalso$i#$er, Bot$ot$er an. in'ant becoe ore sociall" interactive an. s"nc$ronise t$eirinteractions/ t$e" becoe caler/ t$e in'ant cries less/ t$e pain t$res$ol.increases/ cortisol levels .ecrease an. s+in teperature o' t$e ot$erTsbreast an.o' t$ein'ant increases, *$eseeNectsareli+el"toinvolveo8"tocin release in t$e brain,G126H!linicians are a.vise. to 'ocus onprovi.in# a..itional support to breast'ee.in# ot$ers &$o e8perience acaesarean or a .iScult labor an. birt$ &it$ ultiple interventions,G129HSkin-to-skin contact at birth: Bntil recent c$an#es in practice/ .r"in#/&ei#$in#/ e"e care an. vitain ? in;ections &ere per'ore. in ore t$an90M o' ne&borns &it$in inutes o' birt$, Ae no& +no& t$at earl" s+in-to-s+in contact 0i.eall" be#innin# at birt$ an. involvin# t$e placin# o' t$ena+e. in'ant/ $ea. covere./ &it$ a &ar to&el across t$e bac+/ prone ont$eot$erTsbarec$est1evo+esneurobe$aviorsensurin#'ul2llento'basicbiolo#ical nee.s, *$istiea"represent aps"c$op$"siolo#icalTsensitiveperio.T 'orpro#rain#'uturep$"siolo#"an.be$aviour,G127H>or e8aple/ it $as been s$o&n t$at s+in-to-s+in 'or 2) to 120 inutesa'ter birt$/ earl"suc+lin#/ or bot$/ positivel"inOuence.ot$er-in'antinteraction one "ear later &$en copare. &it$routines &$ic$involve.separation o' ot$er an. in'ant,G128H In'ants &$o .o not $ave s+in-to-s+incontact at birt$ are at #reater ris+ o' not bein# breast'ee./ o' neonatal$"pot$eria an. $"po#l"caeia an. increase. episo.es o' cr"in#,G129H $etained placental tissue: 3etaine. placental pro.ucts/ &it$ or &it$outapostpartu$aeorr$a#e0PP61/ cancontinuetosi#nal pro#esteronerelease/ &$ic$in$ibitsprolactin'rotri##erin#t$ebreaststo'unction,(..itionall" t$e e8pecte. increase in il+ volue on .a"s 3-9 a" t$enbe aNecte. i' aternal-in'ant separation occurs as a result o' t$e PP6,+aternal diabetes: *"pe 1 .iabetic ot$ers an. t$eir in'ants/ an. soe&it$ insulin-.epen.ent #estational .iabetes/G130Ha" e8perience birt$coplications as &ell as a .ela" in lacto#enesis II relate. to a teporar"ibalance in t$e aount o' insulin re4uire. 'or #lucose $oeostasisG131H/alt$ou#$ t$ese are less li+el" &it$ &ell-controlle. .iabetes, 6o&ever/ it isiportant t$at &oen &it$ *"pe 1 or #estational .iabetes +no&ina.vance o' t$e birt$ t$at: t$e" can breast'ee. success'ull"K t$ere isnosi#ni2cant .iNerenceint$e copositiono't$ebreastil+ o' .iabetic ot$ersK bot$ s+in-to-s+in contact an. breast'ee.in# can en$ance t$e.iabetes-relate. $ealt$ o' bot$ ot$er an. in'antK G132H an. specialise. care an. a.vice can assist in overcoin# an"breast'ee.in# .iSculties,Soecentresencoura#e &oentoe8pressan.storecolostrube'oret$e birt$ so t$at it can be provi.e. to t$e in'ant i' nee.e. 0'or e8aple/ i't$eot$er$asinsulintreatent 'or.iabetes1,G7HA$ilet$ebene2tso'91earl" colostru are &ell.ocuente.G3H/t$e bene2ts o' antenatalbreaste8pressionare"et tobesubstantiate./G133Han.itssa'et"is"et tobe.eterine.,G139H ( lar#e 3!* 0t$e 5iabetes an. (ntenatal @il+ orost a.ultst$eeliination$al'-li'eo' caNeinevariesbet&een3an.7$ours/ butinane&born in'ant it is )0-100 $ours, B" 3-9 ont$s o' a#e in'ants $ave t$eabilit" to etabolise caNeine,*$e re.uce. eliination b" ne&borns coul.potentiall" lea. to caNeine accuulation &it$ a.verse eNects,G3H llicit drugs:Breast'ee.in# ot$ers s$oul. not so+e ari;uana or useot$er oo.-alterin# substances/ as t$ese substances a" be e8crete. int$e breast il+, In a..ition to t$e eNects o' suc$ .ru#s on t$e in'ant/ aot$er&$ois not'ull" alertcan bea $aLar. to $ersel' an.t$e in'ant&$ile breast'ee.in# or preparin# in'ant 'orula, Specialise. ana#eento' breast'ee.in# is nee.e. &$ere a ot$er is usin# a..ictive .ru#s,G3HHepatitis B:!urrent (ustralian recoen.ations are t$at all in'ants bevaccinate.a#ainst$epatitisB&it$in29$ourso' birt$, In6epatitisB-positive ot$ers breast'ee.in# a" be#in once t$e in'ant $as beeniunise., ive >oo. 7roups/ .rin+ plent" o' &ater an. ta+ea .ail" oral io.ine suppleent o' 1)0c#, 0>or 'urt$er in'oration see t$eN6@3! In'ant >ee.in# 7ui.elines 2012 an. t$e N6@3! (ustralian 5ietar"7ui.elines 20131, @aternal .iet .urin# pre#nanc" an. breast'ee.in#0inclu.in#consuptiono' nuts1/ .oesnot appear toaNect t$eris+o'ast$a/ ecLea or ot$er aller#" s"ptos in in'ants,Iron.e2cienc"is coonin(ustraliaan.ironsuppleents a"benee.e., @ot$ers &$o are on restrictive .iets 0'or e8aple soe ve#an.iets1areatris+o'.e2ciencieso'nutrientsinclu.in#vitainB12/ iron/Linc an. calciuan. a" nee. re'erral to a .ietitian, Eitain 5suppleentation o' 10c#P.a" is recoen.e. 'or breast'e.in'ants o'.ar+-s+inne. an. veile. &oen,SDS< bed-sharingandco-sleeping:SI5S\?i.s/ as&ell asot$eror#anisations/ recoen. t$at to iniiLe t$e ris+ o' SI5S/ in'ants s$oul.sleep in a cot in t$eir parentPs roo 'or t$e 2rst 6-12 ont$s, 6o&everbe.-s$arin# an. co-sleepin# are coon an. $ave been s$o&n to $avepotential bene2ts suc$ as ore an. lon#er breast'ee.in# episo.es/ oreaternal touc$in# an. loo+in#/ 'aster an. ore 're4uent aternalresponses/ an.oresleep'or t$eot$er,G72HSoeparents a+eaconscious.ecisiontobe.-s$areorco-sleep/ ot$ers.osoina.vertentl"an.Por interittentl", (ntenatal e.ucation s$oul. oNer up-to-.atein'oration on sa'e sleepin# practices so t$at parents &$o c$oose to co-sleep &it$ t$eir in'ant can .o so 'ull" in'ore. about t$e potential ris+san. bene2ts 'or t$eir particular circustances, ( sa'e sleepin#environent inclu.es placin# t$e in'ant in t$e supine position 'ro birt$Kusin# a 2r/ Oat sur'ace an. avoi.in# &aterbe.s/ couc$es/ so'as/ pillo&san. loose be..in#K usin# a t$in blan+et to cover t$e in'ant/ ensurin# t$att$e $ea. &ill not be covere. 0s&a..lin# a co-sleepin# in'ant cancontribute to over-$eatin# an. also restricts in'antJs abilit" to ove1K an.avoi.in# t$e use o' 4uilts/ co'orters/ pillo&s an. stuNe. anials in t$ein'antJssleepenvironent, (nin'ants$oul.neverbele'taloneonana.ult be.an.t$eres$oul.benospaces bet&eent$eattress an.$ea.boar./ &allsan.ot$ersur'aces,G163H(lsoiportantinre.ucin#t$e)9ris+ o' SI5S is +eepin# in'ants so+e 'ree be'ore birt$ an. a'ter&ar.s, It isnot sa'e 'or a parent to co-sleep &it$ t$eir in'ant i' an" parent is a so+eror i' t$e ot$er so+e. .urin# pre#nanc", (s note. in @o.ule 1/ researc$su##ests t$at breast'ee.in#is protective a#ainst SI5S,G79/96H(use'ulresource 'or ore .etaile. in'oration is t$e (B( position stateent onSa'e Sleepin#, Adolescent :others:(.olescentot$ers can 'ace uni4ue c$allen#es/suc$ as poor nutrition an. 'or soe/ ina.e4uate antenatal care/resentent to&ar. t$e in'ant an. parentin# because t$e" inter'ere &it$t$eir social li'e/ unresolve. issues about t$eir se8ualit" an. t$e nee. toreturn to sc$ool &it$in as little as a 'e& &ee+s a'ter birt$, (n a.olescentot$er nee.s a trustin# relations$ip &it$ $er ot$er/ #ran.ot$er/partner/ a i.&i'e or even a peer counsellor, Specialise. antenatale.ucation&$eret$e"learn'ro/ an.#ainuc$nee.e.support'ropeers an. t$e e.ucatorPs $as been s$o&n to increase .esire to breast'ee.an.subse4uent initiationan..urationo' breast'ee.in#, >ollo&in#t$ebirt$$ospital staNcanencoura#ea.olescent ot$erstoroo-in&it$t$eirin'ant/ inviteinteractionbet&eenot$eran.in'antan.treatt$eot$er in an a.ult &a"/ #ivin# options an. inclu.in# $er an. close 'ail"in .ecision a+in#,G163H -*) '9pressing and storing Breast :ilk(lost all breast'ee.in# ot$ers in (ustralia &ill e8press breast il+ atsoe point be'ore t$eirin'ant is 6ont$s ol.,@ot$ers a"c$oose ornee.to.ot$is'oraran#eo' reasonsinclu.in#toincreaset$eiril+suppl"/ tostiulatelacto#enesisII &$eninitiationo' breast'ee.in#is.ela"e. .ue separation o' in'ant an. ot$er/ to prevent or relieve breasten#or#eent/ to$aveil+availablei' s$eleaves$er in'ant &it$$erpartner or anot$er care#iver or to suppl" il+ i' $er in'ant is sic+/ preteror$ospitalise., >or&$ic$everreason/ reoval o'breastil+eit$erb"$an. or ec$anical breast pup is a learne. tec$ni4ue,In certain circustances $an. e8pression is pre'erre./ inclu.in#: to so'ten t$e areola to a+e it easier 'or t$e in'ant to attac$K to elicit t$e il+ e;ection reOe8 prior to breast'ee.in# or pupin#K to increase il+ trans'er especiall" &it$ a sleep" or preter in'antto +eep t$e suc+lin#K i' nipplesarepain'ul or acerate.an.t$euseo' apup&ille8acerbate t$e tissue .aa#eK &$ere un'avorable sanitation con.itions preclu.e t$e eNectivecleanin# o' pup partsK an. &$en breast pups are unaNor.able,G169H *$e N6@3! recoen.s t$at ever" &oan s$oul. be s$o&n $o& to $an.e8press/ re#ar.less o' &$et$er s$e c$ooses ot$er et$o.s to use in t$e))lon#er ter, >or soeit is .iScult but an"&oen2n.t$at $an.e8pressin# becoes easier &it$ practice,G3H @ec$anical .evices 'or e8pressin# can be easier an. less tirin# t$an $an.e8pressin#/ can be 'aster/ can collect ore il+/ can be ore co'ortableespeciall" &it$ a severel" en#or#e. breast/ an. soe &oen &$o $avee8perience. se8ual abuse a" better tolerate ec$anical pupin# over$an. e8pression,G169H 6an. pups are portable an. relativel" ine8pensive/&it$an"t"pesavailable, oo.Stan.ar.s!o.e'or in'ant 'orulaisavailable, Interc$an#in# bet&een 'orulas &it$ t$e sae #eneric #roup ispossible/ but 're4uent c$an#es create con'usion an. increase t$e ris+ o'inaccurate preparation, *ap &ater is pre'erre. 'or preparin# in'ant'orulaK it s$oul. be boile. an. t$en coole. prior to bein# use., Bottle.&ater can be use. i' unopene. but it is not necessar", I.eall" onl" onebottle o' 'orula s$oul. be prepare. at a tie, I' it nee.s to be prepare.in a.vance t$en it ust be re'ri#erate. an. use. &it$in 29 $ours,(lternativel"/ prepare. sterilise. bottles o' boile. &ater can bere'ri#erate. an. use. as re4uire./ 2rst &arin# t$e bottle b" stan.in# itin a container o' &ar &ater an. t$en a..in# t$e 'orula, *$e 4uantit" o''orula po&er re4uire. per bottle o' &ater varies so parents ust be tol.o't$eiportanceo'correctl"preparin#in'ant'orula/ inclu.in#usin#t$ecorrectscoopan.notun.er2llin#orover2llin#t$escoop, 6ealt$pro'essionals $ave a responsibilit" to ensure t$at parents 'ro culturall"an. lin#uisticall" .iverse bac+#roun.s/ or in.ee. an" parent/ can rea. an.un.erstan.t$einstructions, (use'ul resourceist$e3aisin#!$il.renNet&or+ in'ant 'orula preparation in pictures, >orula 'ee.in# can be a calin# tie 'or bot$ parent an. in'ant/ &it$$ol.in#/ cu..lin# an. tal+in# to t$e in'ant &$ile 'ee.in# an. respon.in# tot$e in'antJs cues, Parents s$oul. be in'ore.: t$atbottle'ee.in#accor.in#tonee.isbest, *$ein'orationon'orula pac+a#es recoen.in# certain aounts 'or various a#esis a #ui.e onl" an. .oes not necessaril" suit ever" in'antK to use co&Js il+-base. in'ant 'orulas until 12 ont$s o' a#eK t$atspecial 'orulasa"beuse.un.ere.ical supervision'orin'ants &$o cannot ta+e co&Js il+-base. 'orulasK to c$ec+ t$e teperature o' t$e 'orula be'ore 'ee.in# b" s$a+in# alittle il+ on to t$e &rist, It s$oul. 'eel &ar/ not $otK)8 t$at t$e" ust not leave t$e in'ant to 'ee. on its o&nK t$at an in'ant s$oul. not be put to sleep &$ilst .rin+in# a bottleK t$at a cup can be intro.uce. at aroun. 6 ont$s o' a#eK an. t$at it is sa'er to prepare bottles o' in'ant 'orula at t$e .estination&$entravellin#/ because$ar'ul bacteriat$rivein&ar/ oistcon.itions,G3H

Ait$ sterilisation o' e4uipent an. bottles/ boilin# is t$e pre'erre. et$o.as it provi.es consistent an. reliable results i' un.erta+en correctl",Parents s$oul.: &as$ bottles/ teats an. caps in $ot soap" &ater &it$ a bottle brus$prior to sterilisationK place utensils/ inclu.in# bottles/ teats an. caps in a lar#e saucepanon t$e bac+ burner o' t$e stoveK cover utensils &it$&ater/ a+in#suret$at all air bubbles arereove. 'ro t$e bottlesK brin#&ater tot$eboil an.boil 'or )inutest$enturnoNt$eeleentK allo& t$e e4uipent to cool in t$e saucepan/ an. reove it &$en$an. $otK storee4uipent t$at isnot bein#use.strai#$t a&a"inacleancontainer in t$e re'ri#eratorK an. boil all e4uipent &it$in 29 $ours o' use, Ot$er et$o.s o' sterilisation are usin# c$eicals/ stea sterilisers an.icro&ave ste sterilisers,G3H -8) Your role as an educator*$e in'ant 'ee.in# e8perience is a len#t$" one/ be#innin# be'ore birt$ an.inOuence. b" a "ria. o' interactin# p$"siolo#ical/ personal/ cultural an.ot$er 'actors,*$e antenatal e.ucatorJs &in.o& is sall but iportant 'or)9#ivin# copre$ensive an. evi.ence-base. in'oration to e8pectantparents, Parents coonl" see+ breast'ee.in# in'oration in antenatal sessions,(s ane.ucator "ounee.tobeprepare.'or aran#eo' nee.s an.4uestions/ suc$ as: I6o& &ill I +no& i' t$e bab" is #ettin# enou#$DJ I6o& 're4uentl" &ill I $ave to 'ee. " bab"DJ I6o& &ill I +no& &$en t$in#s are #oin# &ron#DJ I(ll " 'rien.s $ave $a. probles, A$at can I .o to prevent t$eD*$rou#$ t$is o.ule "ou $ave learne. about t$e realit" o' t$ebreast'ee.in# e8perience an. $o& breast'ee.in# &or+s, acilitatin# a #roup is a s+ill t$at .evelops over tie, Soe o' t$eaterial a"alsobeo' use'or one-to-oneteac$in#sessionsan.'orIteac$ableJ oents, ,earning outco:esBpon copletion o' t$is o.ule "ou s$oul. be able to: i.enti'" t$e c$aracteristics o' antenatal #roup participantsK .escribe 'actors t$at can aNect t$e 'unctionin# o' #roupsK an. i.enti'" areas 'or "our o&n pro'essional .evelopent as an e.ucator,1) Antenatal group participants(s anantenatal e.ucator "ou&ill priaril"&or+&it$otivate.an.ent$usiastic a.ults/ ost o' &$o alrea." $ave a &ealt$ o' +no&le.#e/ sot$eapproac$re4uire.is4uite.iNerent'rot$at&$ic$"oua"$avee8perience. at sc$ool/ colle#eor universit", -ou a" li+e to ta+ea 'e&oents to t$in+ about in.ivi.uals an. #roups "ou $ave en#a#e. &it$ asa.ult eit$er as a teac$er or stu.ent, 7enerall"/ &$at are t$ec$aracteristics o' a.ult learnersD A$at are t$e c$aracteristics o'e8pectant &oen an. t$eir partnersP'ailies as learnersD (.ults $ave +no&le.#e/ e8perience an. values an. attitu.es t$at t$e" li+eto $ave respecte., *o suarise/ antenatal #roup participants: have speciFc learning needs) -ou a" t$in+ "ou +no& &$" t$e"are atten.in# "our pro#ra or session/ but it is &ort$&$ile c$ec+in#t$e speci2c nee.s o' t$e #roup, *$e" a" be .iNerent 'ro t$oset$at "ou e8pecte., 05oin# t$is at t$e outset o' a session can also bea use'ul icebrea+er F see t$e ItipJ bo8 on pa#e )6,1 bringkno;ledgeande9periencetoanylearningsituation,(#en.asettin#an.4uestionin#aretec$ni4ues "oucanuseto69#au#e t$e e8istin# +no&le.#e o' t$e #roup, 3espect t$eir +no&le.#ean. &$en it is appropriate use t$eir coents as a sprin#boar. 'or'urt$er #roup .iscussion, On occasion "ou a" 'eel t$e" +no& oret$an "ou .o/ but t$eir +no&le.#e a" &ell be 'ra#ente. orincoplete, are sti:ulated by variety)(.ults $ear &$at t$e" &ant to $ear/see &$at t$e" &ant to see/ an.pa" attention to &$atever isrelevant/ interestin#or stiulatin#, Provi.in#aran#eo' relevantlearnin# strate#ies &it$in a session sustains interest, >or e8aple/ aone-$our session coul. be#in &it$ a )-inute icebrea+er/ 'ollo&e.b"a1)-inuteini lectureor.eonstration/ a10-inutesall#roup activit"/ a20-inute lar#e #roup 'ee.bac+ an. .iscussion/ an. conclu.in# &it$10-inutes suation an. 2nal 4uestions, 0In @o.ule 7 t$ere are aran#eo' activities"oua"&is$tousein"our sessions, Selectactivities care'ull"K 4ualit" is better t$an 4uantit",1 e9pect their dignitytoberespected)Nooneli+es to loo+stupi./ 'oolis$ or Ie8pose.J in 'ront o' ot$er people, *o prevent t$is'ro occurrin#/ tr" to create an atosp$ere t$at is in'oral/ rela8e.an. non-;u.#eental, >or e8aple/ &$en t$e #roup is usin# .olls topractise positionin# an. attac$ent/ rat$er t$an sin#lin# outparticipants &$o are incorrect/ "ou can a+e su##estions on $o& its$oul. be .one to t$e #roup as a &$ole, value their independence) A$en a.ults are treate. as i' t$e" are.epen.ent bein#s/ t$eir pri.e 'eels attac+e. an. t$eir sel'-respect isun.erine., (.ults .o not appreciate people tal+in# .o&n to t$eor treatin# t$e as c$il.ren, or e8aple/ ostantenatal e.ucation pro#ras are tie-liite. an. close. in or.er 'or t$eparticipants to $ave a c$ance to 'or a support net&or+ 'or t$eselves&$ilst t$e" are #ainin# t$e +no&le.#e an. s+ills t$e" re4uire, *$e potential o' t$e #roup priaril" .epen.s upon t$e s+ill o' t$e'acilitator, 7roup 'acilitation is t$e art o' #ui.in# a #roup to&ar.s its #oal,-ou &ill ac4uire t$e art over tie/ &it$ practice/ care'ul plannin# o' "oursessions an. reOection on "our per'orance an. t$at o' t$e #roup,Aatc$in# an e8perience. 'acilitator lea. a #roup can be ver" $elp'ul/ ascan an un.erstan.in# o' t$e 'actors t$at aNect #roup 'unctionin#, 5) /actors that in=uence group functioningStyle of leadershipOne o' "our ain roles as a #roup 'acilitator is to $elp t$e #roup .evelop/as 'ar as possible/ into &$at is .escribe. as a I#oal-.irecte./ utual-ai.s"steJ/ &$ic$ enables open counication an. encoura#es t$e'orationo' net&or+s an.'rien.s$ips, Onestu." o' eNectivelea.ertec$ni4ues 'oun. t$at it &as not ;ust t$e et$o.s use. b" lea.ers t$at&ere iportant/ but t$e 4ualities an. attributes o' t$e lea.ers t$eselves,G166Hee.in# &$en in'ant s$o&s si#ns o' &antin# to 'ee. F &$at toe8pect interso' ne&born'ee.in#'re4uenc"/ reco#nisin#'ee.in# cues,o ?eepin#t$ein'ant closeF t$eiportanceo' +eepin#t$ein'ant close to enablet$e ot$erto reco#nise 'ee.in# cuesan. #ain con2.ence in carin# 'or $er in'ant an. to $elp t$ein'ant learn to reco#nise $isP$er ot$er, Practical s+ills an. issueso *$e iportance o' eNective attac$ent an. $o& it I'eelsJ 'ort$e &oano 6o&anin'ant 'ee.sat t$ebreast an.instinctivene&bornreOe8eso 6o& to reco#nise eNective il+ trans'er o Positions t$at a ot$er a" li+e to use an. $o& attac$entcan be aintaine.o *$e iportance o' $ealt$" eatin# an. suppleentation &$enbreast'ee.in#, *$e realit" o' breast'ee.in# 'or parentso A$" 29-$our rooin#-in is iportant an. aternal-in'antinstinctive be$aviouro *$e partnerJs role in t$e breast'ee.in# e8perience/ ale-in'ant attac$ent an. potential relations$ip c$an#eso Breast'ee.in# be$aviour in t$e earl" postnatal &ee+s/ 'ee.in#cues an. sleep c"cleso Probles t$at can occur/ $o& to ana#e t$ese an. &$en tosee+ $elp76o *$eot$erJspreviouse8perienceo' breast'ee.in#an.an"concerns relate. to t$eseo *$e ran#e o' counit" support resources available toparentso or siplicit"/ t$e session plan e8aples at t$e en. o' t$is o.ulelist nubere. activities .escribe. in @o.ule 7K ti:e allo;ed'or eac$ strate#" F t$is is an appro8iation, A$enplannin# sessions &e recoen. "ou &rite a list o' topics t$at arever" iportant an. anot$er o' t$ose t$at can be covere. onl" i' tieallo&s, 5eci.e$o&"ou&ill presenteac$topican.t$enallocateenou#$tie'or eac$tobecovere.eNectivel", (s t$esessionun'ol.s .onotbesurprise. i'"ourtiin# is unrealistic/as activelearnin# strate#ies stiulate interest/ interaction an. participation/all o' &$ic$ re4uire tie, I' t$is $appens re'er to "our Tust inclu.eTlist an. be#in to prioritise t$e ites "ou &is$ to inclu.eK an. resources t$at are re4uire.,( session plan s$oul. i.eall" inclu.e all t$e in'oration nee.e. to'acilitatet$esession/ &$et$er b""ouor acollea#uein"our absence,A$ile a session plan s$oul. be copre$ensive/ as note. above "ou &illnee.tobeOe8iblein"our.eliver"/ toaccoo.atet$einterestsan.prior +no&le.#e o' "our #roup as &ell as issues/ 4uestions an.opportunities t$at arise .urin# t$e session,11) ,earning strategiesO' e4ual iportance to t$e content o' sessions is t$e et$o. o''acilitation an. t$e resources use., *$e &a"s "ou ipart in'oration to a#rouparecoonl"calle.learnin#strate#iesan.canbe.ivi.e.intot&oain#roups/ teac$er-centre.orlearner-centre., 5irectinstruction/lectures an. .e.uctive teac$in# are teac$er-centre. strate#ies &$ere t$eteac$er controls &$at an. $o& t$e stu.ents learn, 5iscover" learnin# an.in.uctivelearnin#arelearner-centre.an.placea#reaterep$asisont$e learnerTs role in t$e learnin# process,Ait$ learner-centre. strate#iest$e e.ucator sets t$e learnin# a#en.a or learnin# outcoes/ but .oes not$ave .irect control over &$at an. $o& t$e participants learn,79A$en consi.erin# t$e strate#ies to use in "our sessions/ "ou nee. to $avea clear i.ea o' &$at "ou &ant t$e participants to be able to .o as a resulto' atten.in# t$e session, >or e8aple/ i' "ou &ant e8pectant parents toe8plore t$eir 'eelin#s an. concerns about breast'ee.in#/ "ou coul. involvet$e in eit$er a sall or lar#e #roup .iscussion so t$e" can s$are t$eir'eelin#s/ t$eir concerns an. #ain support 'ro eac$ ot$er, Peer support/ asstate. in @o.ule 1/ can en#en.er a sense o' personal epo&erent an.it #ives cre.ibilit" an. value to in.ivi.ualsJ i.eas,Cearnin# strate#ies are not Iri#$tJ or I&ron#J/ but soe are ore eNectivet$an ot$ers in particular situations, Ae recoen. "ou use a variet" o'strate#iesan..eci.e&$eneac$oneisli+el"tobeoreeNectiveineetin# t$e nee.s o' t$e #roup an. t$e learnin# outcoes o' t$e session,(ran#eo' strate#iesisalsoiportant toaccoo.atet$e.iNerentlearnin# st"les o' t$e participants, >or e8aple/ a ini lecture 'ollo&e. b"a #roup .iscussion &it$ 'ee.bac+ an. t$en a practical coponent on t$esaetopic&oul.servet$enee.so' visual/ au.itor"an.+inaest$eticlearners, or a #roup o' 20 people place 9-) s$eets o'butc$erJs paper aroun. t$e roo &it$ t$ic+ ar+er pens, (cross t$e top o'eac$ s$eet o' paper &rite an open-en.e. stateent 'or t$e participants tocoplete/ 'or e8aple (ctivit" 3,6can be presente. usin# #raSti s$eets83rat$er t$an sall #roup .iscussion, inall"/ increasin#useo' social e.ia/ on-line'orus/ c$atroosan.blo#s 'or accessin#peer support eans t$at antenatal breast'ee.in#e.ucators nee. to e.ucate an. .irect participants about t$e ost reliablesources o' breast'ee.in# in'oration,+odels and 6isual Aids@o.els an. visual ai.s/ suc$ as/igure 5/ can en$ance a presentation/t$e"support t$ose&$oarepre.oinantl"visual learnersan.canbeuse. to counicate in'oration an. tri##er #roup .iscussion,*$rou#$out t$is$an.boo+&e$ave#ivene8apleso' $o&an.&$enspeci2c visual ai.s can be use., Parent 'ee.bac+ su##ests t$at use o' aarblean.#ol' ball to.eonstratet$esiLeo' anin'antJsstoac$isparticularl" $elp'ul, *$e use o' .olls in sessions 'or t$e learnin# o'attac$ent an. positionin# are also appreciate./ as is observin# a ot$erbreast'ee.in#, D6Ds and +edia "lips5E5s an.e.iaclips cancounicatein'oration/ rein'orceissuesalrea." .iscusse. an. stiulate t$ou#$ts an. .iscussion &it$in a #roup,@ost 5E5s can be use. at an" sta#e in a session/ but soe a" coe&it$ speci2c instructions,5E5s can be use. in t$eir entiret" or in.ivi.ualscenes or se#ents s$o&n 'or "our particular purpose, Prior to usin# an" 5E5/ becoe 'ailiar &it$ its content an. t$in+ o' $o&a#roup&oul.respon.toit, -ous$oul..eci.e&$eninasessionorpro#ra it coul. be s$o&n an. &$et$er it &ill be s$o&n 'ro be#innin# to89en./ or in se#ents as .escribe. above, !$ec+ t$e 5E5 pla"er an. trac+t$e 5E5 prior to t$e session/ #ive an overvie& o' its contents be'ore it isvie&e. an. allo& tie 'or sall or lar#e #roup .iscussions an. coentsat t$e en., Presentin# t$e #roup &it$ tri##er 4uestions/ suc$ as t$e +e"essa#es provi.e. in t$e 5E5/ can encoura#e an active #roup .iscussionon t$e conclusion o' t$is learnin# strate#", *$ere are no& a lar#e nuber o' breast'ee.in# 5E5s 'ro a .iverse ran#eo' countries available/ as are vi.eo-clips on -ou*ube, *a+e care &it$ "ourselectionasan"coe&it$cop"ri#$tinstructionsan.a"also$avebeen sponsore. or 'un.e. b" a copan" t$at pro.uces in'ant 'orula, -ou&ill 2n. a list o' su##este. 5E5s in @o.ule 6, $eference +aterialocus #roupst"picall" last 'or 60-90 inutes an. t$e" are a ver" eNective &a" to learn'ro a #roup o' participants o' t$eir e8periences aroun. t$e topics bein#evaluate., >or e8aple/ "ou a" &ant to +no& t$e eNectiveness o' t$eantenatal breast'ee.in#e.ucationat"our$ospital inpreparin#&oenan. t$eir partners 'or t$eir in'ant 'ee.in# e8perienceK t$is &as onestrate#" use. to collect .ata 'or t$is $an.boo+, Questions suc$ as t$esecoul. be use.: Overall $o& &oul. "ou .escribe "our 'ee.in# e8perience/ eit$er breast or 'orula/ in t$e 2rst &ee+ o' "our in'antJs li'eD o A$at $elpe. "ouD o A$at $in.ere. itD o 5i. "ou .o an" preparation 0classes P rea.in# P tal+ 'ail" etc,1 an. i' so &$at .i. "ou .oD A$at $elpe. an. &$at $in.ere. t$isD 96o Is t$ere an"t$in# else &e 0$ealt$ pro'essionals1 coul. $ave .one .urin# "our pre#nanc" &$ic$ a" $ave a.e t$ose earl" .a"s easierD >ocus #roups arenot necessaril" inten.e.to beIrepresentativeJ butrat$er are .esi#ne. as a eans o' e8plorin# speci2c topics an.e8periences,G172H ,etters and telephone calls*$esestrate#ies provi.e use'ul 'ee.bac+ an. eac$ one s$oul. be.ocuente.P+ept, Once a#ain/ c$ec+ i' "ou nee. to subit to an or e8aple/ it coul. be cobine. &it$ a sel'-assessent 4uestionnaire or a 'ee.bac+ session &it$ a collea#ue, *$ree steps are necessar" 'or eNective sel'-evaluation, *$ese steps are: Step 1: !urrent be$aviour ust be scrutinise., *$e 'acilitator ustbea&are o'&$att$e"are .oin# verball" an.non-verball"int$esession, Step 2: Stren#t$s nee. to be ac+no&le.#e., IneNective be$avioursnee. to be i.enti2e. an. strate#ies 'or iproveent .eterine., Step 3: Ne& i.eas are inte#rate. into current practice an. t$e c"clerecoences,Sel'-evaluationisacontinuous/ on-#oin#processnotasin#le/ one-tieevent, 4) "onclusion!on#ratulations/"ou $ave no& coplete. @o.ule ) F 1ytocin.actor' 5appingthe2ormoneofCalm, /o8e and 2ealing, 2010, Aal+er/ @,Breastfeeding -anagement for the Clinician, 3r.e.ition,2013&seful D6Ds (!* 6ealt$ Breast'ee.in# 5E5 'or -oun# Parents Best Be#innin#s, >ro Bup to Breast'ee.in# Ber#an/ N, :row your Bay%s Brain! !o8/ S, Breastfeeding' -om and I can do that! !o8/ S, -other and Bay2 5E5 set: o -other and Bay3!the "rst week!o -other and Bay 3!ay can reastfeed easily when wellpositioned, 7lover/ 3, .ollow me -um! 6ast&ell/ *, Being a ?ad! Institute o' Ps"c$iatr"/ :etting to Anow &ou! Inc$/ S, an. Aoolri.#e/ @, /earning to Breastfeed your Bay! 5he -id (orth Coast Aoriginal Breastfeeding ?B? Sillie/ !, Bab" Ce. Breast'ee.in#U *$e @ot$er-Bab" 5ance, Queenslan. 6ealt$, Baies Anow, &seful Journals Breastfeeding =e8iew, (B( national ;ournal Interaction! !$il.birt$ (n. Parentin# ort$is reason it is use'ul 'or &oen an. t$eir partners to e8plore t$eir 'ail"I'ee.in#J tree, Ai: of the Activity*o #ive participants an un.erstan.in# o' $o& t$e in'ant 'ee.in#e8periences o' 'ail" ebers can inOuence t$eir belie's an. t$eire8perience, +aterials $eHuired Paper an. pen 'or eac$ participant!i:e Allocation5ra&in# t$e tree X ) inutesSall #roup .iscussion X 10 inutes+ethodail"/ 'rien.s/ on-lineD !lose t$e .iscussions &it$ a spo+esperson 'ro eac$ #roup presentin# t$eans&ers tot$elar#e #roup, >ollo&t$epresentations &it$ a #eneral.iscussion aboutt$estories&oenan.t$eir partners a"$earaboutbreast'ee.in# an. a.vice t$e" a" be #iven, ollo&t$epresentations&it$a#eneral.iscussion about t$e e.ia an. $o& it can sensationalise in'ant 'ee.in#,act S$eetin@o.ule 8: .escribet$esi8.e2ne.be$avioural stateso' anin'antan.$o&parents can tell t$e .iNerence bet&een eac$ stateK e8plain t$e .iNerent sleep states an. t$e .iNerence bet&een in'antan. a.ult sleep c"cles/ an. $o&to tell &$ic$ t$eir in'ant is inK outlineanavera#esleeppatterno' ane&bornbut reassuret$atever"in'ant is.iNerent an.t$at t$epattern&ill c$an#east$e&ee+s an. ont$s pro#ress,*$is .iscussion coul. be e8ten.e. &it$ t$e s$o&in# o' an In'ant!ounication 5E5 o' &$ic$ t$ere are several available F re'er to @o.ule6Predicted %utco:eollo&eac$presentation&it$a.iscussionabout t$e +e" issues in t$e scenario, Ae $ave provi.e. t$e +e" issues t$atnee. to be a..resse. on a 'act s$eet 'or "our re'erence, ollo&t$epresentations&it$a#eneral.iscussion about t$e c$an#es an. nee.s o' t$e parents an. t$e in'ant int$eearl"postnatal &ee+s,in. a Private Cactation !onsultant>in. a Private Cactation !onsultant >ail" \ !ounit" Services >ail" \ !ounit" Services Parent CineParent Cine 3aisin# !$il.ren Net&or+ 3aisin# !$il.ren Net&or+S".ne" !$il.renJs 6ospital >act S$eets S".ne" !$il.renTs 6ospital >act S$eets*$e !$il.renJs 6ospital Aestea. >act S$eets*$e !$il.renTs 6ospital Aestea. >act S$eetsIunise (ustralia Pro#raIunise (ustralia Pro#raSi.s an. ?i.sSi.s an. ?i.s!$il. (cci.ent Prevention >oun.ationo' (ustralia!$il. (cci.ent Prevention >oun.ation o' (ustraliaBe"on. Blue: *$e National 5epression InitiativeBe"on. Blue: *$e National 5epression InitiativeBab"-le. Aeanin# Bab"-le. Aeanin#(ustralian @ultiple Birt$ (ssociation (ustralian @ultiple Birt$ (ssociation*$e 3o"al AoenJs 6ospital/ Eictoria *$e 3o"al AoenTs 6ospital/ Eictoria&seful books (ustralian Breast'ee.in# (ssociation, Breast'ee.in# Unaturall", 2011, (ustralian Breast'ee.in# (ssociation Boo+s, !$ilton/ 6, Bab" on Boar., 3r. e.ition, 1)7 !o8/ S, Bab" @a#ic: Plannin# 'or a Ci'etie o' Cove, 2009, !o8/ S, Breast'ee.in# I !an .o *$at, 2002, !o8/ S, Breast'ee.in# &it$ !on2.ence, 2006 7et$in/ (, an. @ac7re#or/ B, 6elpin# "our Bab" to Sleep, 2n. e.ition, 2011, 3aple"/ 7, @ur+ett/ *, Bab"-le. Aeanin#: 6elpin# "our bab" to love#oo. 'oo./ 2008,0>ro: Breast'ee.in# an. -ou: ( $an.boo+ 'or antenatal e.ucators/ !oon&ealt$ o' (ustralia/ 201)1!he Frst ;eek Breastfeeding a #e;bornPostnatal Day --1:*$eot$eran.in'antare4uitesleep" an.t$e"nee. to rest an. recover 'ro t$e labour an. birt$, *$e tie ta+en b" t$e in'ant &$en it is breast'ee.in# &ill beinial/ ast$eproteinan.+ilo;oule-ric$colostru&ill eet itsnee.s, *$e aount o' colostru an in'ant receives at eac$ 'ee. isappro8iatel" W a teaspoon, *$ein'ant is&ell $".rate.'robein#int$eanioticOui.&it$continual 'ee.in# 'ro t$e placenta/ so it a" not re4uire 're4uent'ee.s,>ee.sa"onl"benee.e.ever"3-3W$ours,I' t$e in'ant.oesnot &antto'ee.a'terabout )$ours/ $eors$es$oul.berouse. an. put to t$e breast, In t$e 2rst 2 .a"s/ urine pro.uce. b" t$e in'ant is concentrate. an.'re4uentl" contains c$eicals calle.urates/ &$ic$canturnt$enapp" oran#e or pin+, *$e 2rst bo&elotion is astic+" #reenis$ blac+ substance calle.econiu, or t$e ot$er/ t$e si#ns o' a 'unctionin# il+-e;ection reOe8 are: t$eir in'ant s&allo&in# an. establis$in# a suc+-s&allo& r$"eK tin#lin# or pric+lin# pins an. nee.les &$ic$ a" ta+e several &ee+sto .evelopK a su..en 'eelin# o' 'ullnessK an increase in s+in teperatureK a 'eelin# o' &ellbein# or rela8ationK 'or soe ot$ers pain or nauseaK .rippin#/ lea+in# or spurtin# 'ro t$e unsuc+e. breast 'or soe ot$ers an intense t$irst uterine contractions accopanie. b" a #us$ o' loc$ia in t$e ie.iate postpartu perio.,0>ro: Breast'ee.in# an. -ou: ( $an.boo+ 'or antenatal e.ucators/ !oon&ealt$ o' (ustralia/ 201)1160nfant Behaviour(n in'ant state is in.icate. b" a #roup o' be$aviours t$at occur to#et$er/inclu.in# .e#ree an. nature o' bo." oveent/ e"e oveent/breat$in# an. responsiveness, Bn.erstan.in# an in'antJs states an. $o&an. &$" t$e" ove t$rou#$ t$ese states can $elp parents, *$ere are si8.e2ne.in'ant be$avioural statesasliste.belo&, A$ileever"in'ant is.iNerent t$e 'ollo&in# #eneral #ui.e a" be use'ul &$ile "ou are #ettin#to +no& "our in'ant,"rying !r"in# in'ants $ave ;er+" oveents/ 'acial colour c$an#es/ uscletension an. rapi. breat$in# Ne&borns .o not s$e. tears, *ear .ucts bloc+e. until bet&een 2 an.9 ont$s o' a#e !r"in#in'ant a"beunresponsivetocare#iverJs eNort tocal.o&n initiall", Active alert *$ese in'ants $ave o.erate to 're4uent bo." an. 'acialoveents/ irre#ular breat$in# an. open e"es, Soeties 'uss" an. sensitive to stiuli in t$e environent *$e alert state is coon be'ore 'ee.in#, Kuiet alert In'antsint$issta#e$avelittlebo."oveents/ t$eir e"esareopen/ an. stea."/ re#ular breat$in# *$e" are $i#$l" responsive an. t$is is t$e best state 'or interactionan. pla" @aintenance o' t$is state can be tirin# 'or an in'ant, Dro;sy infant Eariable bo." oveent/ irre#ular breat$in#/ #laLe. e"es an..ela"e. reaction tie @a" close an. open e"es Ciite. interest in interaction, Active sleep 3api. e"e oveent/ bo." an. 'acial t&itc$es/ an. irre#ular breat$in#In'ants .rea .urin# active sleep an. &$ilst .reain# can be easil"&a+ene., Kuiet sleep Eer" little bo." or 'acial oveent e8cept 'or occasional bursts o'suc+in# @a"startle&it$oveent or lou.noises but t"picall".onota&a+e, 161In'ants #ain increasin# abilit" to re#ulate t$eir be$avioral states over t$e2rst 'e& ont$s o' li'e, (.apte. 'ro: 6eini#/ @,V, et al, (ormal Infant Beha8iour, !ite. in @annel/3,/ @artens/ P, an. Aal+er/ @, 0ro: Breast'ee.in# an. -ou: ( $an.boo+ 'or antenatal e.ucators/ !oon&ealt$ o' (ustralia/ 201)1nfant Sleep "ycles!;o pri:ary states: (ctive sleep Quiet sleep(ctive sleep 5reain# occurs in active sleep/ resultin# in rapi. e"e oveents beneat$ e"eli.s/ bo." an. 'acial t&itc$es/ an. irre#ular breat$in#, Bloo. Oo& to brain increase. an. neural cells stiulate./ contributin# to brain #ro&t$ an. .evelopent, In'ant easil" a&a+ene.,Quiet sleep Cittle bo." or 'acial oveent ot$er t$an s$ort bursts o' suc+in# an. startle responses Breat$in# is re#ular an. $ar. to rouse, Sleep .eepl" an. resist environental stiuli, *$is is restorative sleep, nfant sleep patterns Sleep c"cles .iNer 'ro a.ults, (.ult sleep c"cles are 90 inutes &$ereas in'ant sleep c"cles are 60 inutes lon#, Ne&borns 'all asleep into active sleep/ an. a'ter 20-30 inutes c"cle to 4uiet sleep, (.ults 'all into 4uiet sleep 2rst, Ne&borns sleep on avera#e 16-17 $ours per 29 $our perio., Sleep patterns c$an#e as #et ol.er, Bet&een 12 an. 16 &ee+s/ in'ants be#in sleep in 4uiet sleep as a.ults .o,(.apte. 'ro: 6eini#/ @,V, et al, (ormal Infant Beha8iour, !ite. in @annel/3,/ @artens/ P, an. Aal+er/ @, 0ro: Breast'ee.in# an. -ou: ( $an.boo+ 'or antenatal e.ucators/ !oon&ealt$ o' (ustralia/ 201)1162+odule 0: Appendices"%#!'#!S(ppen.i8 1(bbreviations Bse. in t$is 6an.boo+16)(ppen.i8 2 !onsultation166(ppen.i8 3 *$e in'ant 'ee.in# .ecision F an $istorical perspective167(ppen.i8 9*$e Bab" >rien.l" 6ealt$ Initiative an. t$e *en Steps to Success'ul Breast'ee.in#170(ppen.i8 )*$e International Bab" >oo. (ction Net&or+ 0I>B(N1 Stateent179(ppen.i8 6 Sta#es o' 7roup 5evelopent17)(ppen.i8 7@ana#in# Proble Be$aviours178(ppen.i8 8 (ssessin# Nee. an. Pro#ra Plannin# >act S$eet189(ppen.i8 9 7ainin# an. @aintainin# t$e (ttention o' Participants188163Appendi9 -: Abbreviations &sed in this Handbook(B((ustralian Breast'ee.in# (ssociation B>6I Bab" >rien.l" 6ealt$ Initiative !(Pail" 6ealt$ Nurses: Nora !rott"/ ail" 6ealt$ Nurses (ssociation !$il.birt$ (n. oun.lin# 6ospitala" be o' ore Bse to t$e Aorl./ t$an per$aps at 2rst ia#inJ.b" t$e Prootors o' itK it &ill be a @eans not onl" o' preventin#t$e @ur.er o' an"/ but o' savin# ore/ b" intro.ucin# a orereasonable an. ore natural @et$o. o' Nursin#, In " Opinion/t$is Business $as been too lon# 'atall" le't to t$e @ana#eent o'Aoen/ &$o cannot be suppose. to $ave proper ?no&le.#e to2t t$e 'or suc$ a *as+/ not&it$stan.in# t$e" loo+ upon to bet$eir o&n ProvinceJ,G17)H*$e 2rst ar+ete. co&Js il+-base. 'orula &as patente. in 1867 b" t$e7eranc$eistEonCeibi#,G176H*$ecoercial successo't$is'orulaspa&ne.a$osto' ot$er$uanil+substitutes, Int$eearl"1900saS&iss erc$ant/ 6enri Nestl`/ ar+ete. a Iscienti2call" prepare.Jsubstitute b" cobinin# su#ar an. &$eat Oour coo+e. in alt &it$ co&Jsil+, Nestl` a.vertise. $is pro.uct as Iscienti2call" correct so as to leavenot$in#tobe.esire.J an.$e.irecte.$isar+etin#atot$ersas$einsiste. Iot$ers &ill .o " publicit" 'or eJ,G177H166(t$rivin#.air"in.ustr"in(ustralia/ Ne&Realan./ rien.l"J, Caunc$e. b" A6Oan. BNI! in 1991/ 'ollo&in# t$e Innocenti 5eclaration o' 1990/ t$eB>6I $asbrou#$tpro'oun.c$an#estoaternit"practices,Sinceitslaunc$ B>6I $as #ro&n/ &it$ ore t$an 1)2 countries aroun. t$e &orl.ipleentin#t$einitiative, *$einitiative$as $a.easurablean.proven ipact in soe countries/ in particular increasin# t$e li+eli$oo.o' in'ants bein# e8clusivel" breast'e. on .isc$ar#e 'ro $ospital an. int$e earl" postnatal &ee+s,G186/ 187H *$e *en Steps: 6I on breast'ee.in#initiationan..uration$as"iel.e.i8e.results/ su##estin#t$atoreresearc$isnee.e., Sc$ie.et alG188Hint$eir&or+&arnt$at t$eItop.o&nJ/ per'orance.rivenannerin&$ic$B>6I isipleente.a"result in ri#i. practices t$at are unli+el" to eet t$e nee.s o' &oen an.t$eir'ailies, It appeare.t$att$ere&asa#enuinecoitent 'roi.&ives to $elp &oen un.erstan. an. #ain +no&le.#e aboutbreast'ee.in#/ $o&ever/ t$e prescriptiveapproac$ o' in'oration.elivere. in an oversipli2e. an. stan.ar.ise. &a" &as not 'avoure. b"t$e &oen,G188H!onversel"/ Bro.ribb et al state. t$at B>6I accre.itationcan pla" an iportant role as a 4ualit"-iproveent strate#"/ especiall"in areas &$ere breast'ee.in# initiation rates are lo&,G189H!opliance &it$B>6I practices aon# B>6I-accre.ite. 'acilities is not al&a"s optial/ an.t$usnee.stobeonitore./ as#reatercopliancea"$aveanevenlar#er ipact on breast'ee.in# rates an. potentiall" re.uce socio-econoic .isparities in breast 'ee.in#,G190H172Appendi9 4: !he nternational Baby /ood Action #et;ork @/BA#A State:ent*$e +e" points 'ro t$e I>B(N Stateent are: B(N Stateent Ibreast il+ is soeties cite. as asource o' .io8ins an. ot$er c$eical resi.ues, *$is is because breast il+$asa$i#$proportiono' 'atan.because'atsolublecontainantsarerelativel" easil" easure. in it, It is not because breast il+ is an" orecontainate. t$an ot$er parts o' t$e bo." or because resi.ues in breastil+ cause ore $ar t$an t$ose in ot$er parts o' t$e bo.", In 'act/ ostresearc$ers a#ree t$at e8posure to c$eical resi.ues via t$e placenta isuc$ ore .an#erous 'or t$e $ealt$ o' t$e ne&born t$an e8posure viabreast il+, >or e8aple/ a$i#$level o' containationb"pestici.es/P!Bs or .io8ins .urin# pre#nanc" can lea. to t$e ipairent o' 'oetal an.c$il. #ro&t$ an. inter'ere &it$ t$e correct .evelopent o' an" tissuesan. or#ans/ ainl" o' t$e ps"c$o-neuroen.ocrine an. iune s"stes,6o&ever/ breast'ee.in#$as beens$o&ntoiti#ateor iniiset$eeNects o' soe o' t$e .aa#e cause. b" e8posure to t$ese substances.urin# 'oetal li'e, >orula 'ee.in# $as no protective or iti#atin# eNect,Breast'ee.in#/ eveninacontainate.environentan.a'tera.;ustin#'or var"in# levels o' e8posure to c$eicals .urin# pre#nanc"/ $as suc$ apositive ipact on nutrition/ $ealt$ an. .evelopent o' c$il.ren t$at ost$ealt$ aut$orities recoen. t$at it s$oul. be protecte./ proote. an.supporte.,JG191H173Appendi9 *: Stages of .roup Develop:entorin# Storin# Norin# Per'orin# (.;ournin#Cet us consi.er eac$ o' t$ese sta#es, /or:ingInt$issta#eo' #roup.evelopent/ acollectiono' in.ivi.uals coesto#et$erusuall"&it$acoon#oal orinterest, Eer"o'tent$ereisacautious perio. &$en in.ivi.uals e8plore $o& t$e #roup &ill 'unction an.$o& eac$ o' t$e &ill 2t into t$e situation, (n8iet" levels can be $i#$ an.eac$ eber o' t$e #roup is silentl" 4uestionin# t$eir .ecision to becoeinvolve., *$e e.ucator nee.s to realise t$at t$is an8iet" .oes notnecessaril" reOect on $isP$er lea.ers$ip, Strategies for an educator ONer re'res$ents/ suc$ as tea/ coNee an. biscuits to ebers ast$e" arrive, eels sel'/ values/ attitu.es an. belie's are un.er t$reat 6as atten.e. un.er pressure 'ro spouse Aants attention Aants status$trategies' *r" to relieve tension, *reat as a #enuine an. real eNort to e8plore bot$ si.es o' an issue, Open t$e .iscussion to t$e #roup 'or coents, Quote ot$er sources o' in'oration t$at i#$t be cre.ible to t$e participant,(.apte. 'ro: , \ @c!leer/ !, Basic !ounit" ore8aple/ i' "ou cover soet$in#out o' se4uence/ sipl" ove t$erelevant car.s an. a.;ust t$e or.er o' "our topics, &sing coloured cards.reen cards Q Practical sessions*$esecar.s are'or topics t$at &ill involvet$e#roupinaphysicalactivity/'or e8aple/ breast'ee.in#positionsan.in'antattac$ent att$e breast an. in'ant assa#e, Practical sessions can even inclu.e a 4uic+brea+ to #et up an. stretc$, Plan to $ave t$e #roup .oin# soet$in# atleast once in eac$ session, I' t$e" sit 'or too lon# t$e" &ill loseconcentration,Blue cards Q Discussions(n"t$in# &$ic$ coul. be .escribe. as a .iscussion starter can beinclu.e., >ore8aple/ belie'sabout breast'ee.in#an.c$an#in#roles/an. #ains an. losses relate. to breast'ee.in#,Yello; cards Q S:all group activitiesInclu.e all topics t$at &ill be covere. b" #aesPsall #roup activities on t$ese car.s, >or e8aple/ t$e "t$s an. $al'-trut$s about breast'ee.in#/ an. t$e use o' oran#es to .eonstrate in'ant suc+lin#,$ed cards Q nfor:ationI' "ou&ritet$esecar.slast"ou&ill probabl"2n.t$ataconsi.erableaount o' in'oration $as alrea." been covere. in .iscussions an. sall#roup activities, *$ese car.s are 'or topics t$at nee. to present as a inilecture, >or e8aple/ noral ne&born be$aviour an. t$e anato" o' t$ebreast, Points to re:e:ber (i to $ave a i8ture o' colours in eac$ session, (i 'or a lo#ical pro#ression o' topics, (llo&tie'or participants toun&in.at t$ebe#innin#o' eac$session, Inclu.eat least oneopportunit"'or participantstoovearoun..urin# eac$ session, 3e'res$entbrea+sare#oo.'orsocialisin#an.t$e"#ive"ouac$ance to tal+ to participants &$o a" nee. assistance or #ui.ance, (voi. en.in# a session on a YOatZ topic,18) (s t$e #roup pro#resses t$rou#$ its li'ec"cle .ecrease t$e aount o''oral input "ou provi.e, Be Oe8ible an. creative,#ote:*$e antenatal pro#raoutlines 0pa#es 79-7)1 an. all o' t$estrate#ies an.activities provi.e.int$is $an.boo+arebase.ont$eresults o': a copre$ensive nee.s assessent con.ucte. over 18 ont$s in1998P9 b" t$e aut$or as part o' $er .octoral stu.ies/ &$ic$ involve.over200e8pectantan.ne&parentsan.90$ealt$pro'essionals'ro an" .isciplinesK consultation 'or t$is $an.boo+K breast'ee.in#/ $ealt$ e.ucation an. a.ult learnin# literatureK .ocuentation/ boo+s/ 'act s$eets an. broc$ures an. 5E5scollecte. an. revie&e. 'rosources inclu.in# t$e (ustralian5epartent o' 6ealt$/ B>6I an. BNI!, 186Appendi9 0: .aining and +aintaining the Attention of Participants( pro.uctive #roup .iscussion or in'oration session re4uires t$eattention o' t$e participants, 7ainin# an. aintainin# attention cansoeties be a c$allen#e, Bhen starting a group< you can gain their attention by: a+in# e"e contact &it$ ever"one as t$e" settle into t$e #roupK #ivin#a si#nal t$at in.icatesitis tieto start, >ore8aple/"oucoul. s$ut t$e .oor an. t$en stan.Psit in an alert anner in 'ront o't$e #roupK a+in# an intro.uctor" coent/ suc$ as IAelcoe to t$eYBreast'ee.in# a S+ill to CearnZ &or+s$op,J -ou a" nee. to spea+lou.l" initiall"/ but .onJt continue in a lou. voice, People &ill a+et$e eNort to listenK an. creatin# interest in t$e #roup earl", Aa"s to stiulate an. e8cite curiosit" inclu.e: s$o&in# an ob;ect or picture/ &$ic$ a" see at 2rst to bear norelations$ip to t$e topic/ but can brin# 'ocus a#ain to t$e #roupK statin# t$e ain topics 'or t$e session an. $o& t$e #roup &ill tac+let$eK as+in# a +e" 4uestion,It can be r$etorical an. a" not nee. an ie.iate responseK an. presentin# a c$allen#in# stateent,%nce the attention of the group has been captured< you should beable to :aintain it by: bein# aniate., Bse "our e"es an. appropriate #estures to en$ance"our presentation, var"in# t$e volue an. spee. o' "our voice, Pauses an. silence canen$ance a presentation as t$e" allo&tie 'or reOection an.absorption o' in'oration, usin# visual ai.s,@a+e t$e session visuall" e8citin# an. varie. &it$a ran#e o' posters/ articles/ ob;ects/ &or+s$eets, var"in# t$e learnin# strate#ies, !onstantlistenin# can a+eparticipantsbore., !$an#et$e&a"t$e#roupisparticipatin#int$eir learnin# b" $avin# #roup .iscussions/ activities an..eonstrations,As the session progresses there :ay be occasions ;hen you losethe concentration of the group) f this happens you could: re'ocust$eattentionont$etopic, (n"o' t$esu##estionsaboves$oul. $elp/ an. as "ou #ain con2.ence "ou &ill .evelop attention-#ettin# tric+s t$at suit "our st"le o' presentationK187 ta+e a brea+, I' people be#in tal+in# aon# t$eselves .urin# ane8planation or .iscussion/ .onJt tal+ over t$e top o' t$e, -ou &ill2n. it e8$austin# an. t$e #roup &ill becoe restless an. .istracte.,I' "ou$avelost t$eir attentionan.'eel out o' control/$aveare'res$ent brea+ an. then start a'res$] 188$eferences1, !ourtena"/ B,/5he 0ower of >ne, 1989/ (ustralia: Aillia6eineann,2, Aorl. 6ealt$ Or#anisation, 61clusi8e reastfeeding statement, 2011Gcite. 2019 11 Vanuar"HK>ro:Aorl. 6ealt$ Or#anisation, un./Acceptale medical reasons for the use of reast+milk susstitutes! ,2009,62, (ustralian Breast'ee.in# (ssociation,5he 92> code, 2019K(vailable 'ro: $ttps:PP(ustralian Breast'ee.in# (ssociation, *$eA6O co.e 2019,63, Barcla"/C,/et al,/5he professionalising of reastfeeding+ whereare we a decade onF @i.&i'er"/ 2012, 28031: p, 281-290,69, !$un#/ @,/ et al,/Inter8entions in primary care to promotereastfeeding' an e8idence re8iew for the 4!$! 0re8enti8e $er8ices5ask .orce! (nnals o' Internal @e.icine/ 2008, 199081: p, )6)-)82,6), !rai#/ 6,V, an.ail"Practice/ 2007, 29011: p, 89-91,68, @a"/ !, an.3, >letc$er/0reparingfathers for thetransitiontoparenthood' =ecommendations for the content of antenataleducation! @i.&i'er"/ 2013, 290)1: p, 979-978,69, *o$otoa/ V,/ et al,/$upporting mothers to reastfeed' thede8elopment and process e8aluation of a father inclusi8e perinataleducation support programin 0erth, 9estern Australia!6ealt$Prootion International/ 2011, 26031: p, 3)1-61,70, .eOliveira/ @,I,!,/ C,(,B, !aac$o/ an.(,etalan. Neonatal 998->9)0,120, Ai#$t/ N,