Breastfeeding - Just 10 Steps

8/8/2019 Breastfeeding - Just 10 Steps

1/88


2/88

THESE 10 SMALL STEPS CAN BE A

GREAT LEAP FOR MANKIND!!!


3/88

Facts on Breastfeeding

Breastfeeding is one of the most effective ways to ensure

child health and survival.

A lack of exclusive breastfeeding during the first six months

of life contributes to over a million avoidable child deaths

each year. Globally less than 40% of infants under six months of age

are exclusively breastfed.

Health benefits for infants

Benefits for mothers

Long-term benefits for children

Support for mothers is essential


4/88

The Ten Steps

The Ten Steps to Successful

Breastfeeding is a guideline meant to

facilitate implementation of the BFI in

hospitals

Every facility providing maternity

services and care for newborn infants

should:


5/88

Have a written

breastfeeding policy

that is routinely

communicated to allhealth care staff.

Step 1


6/88

Breastfeeding policy

Why have a policy? Requires a course of action and

provides guidance

Helps establish consistent care formothers and babies

Provides a standard that can be

evaluated


7/88


8/88


What should it cover?At a minimum, it should include:

y The 10 steps to successful breastfeeding

y An institutional ban on acceptance of free or low

cost supplies of breast-milk substitutes, bottles,and teats and its distribution to mothers

y A framework for assisting HIV positive mothersto make informed infant feeding decisions thatmeet their individual circumstances and then

support for this decision Other points can be added


9/88


How should it be presented?

It should be:

Written in the most common languages

understood by patients and staff

Available to all staff caring for mothers

and babies

Posted or displayed in areas where

mothers and babies are cared for


10/88


11/88


12/88


13/88


14/88


15/88

Step 1: Improved exclusive breast-milk feeds while in

the birth hospital after implementing

the Baby-friendly Hospital Initiative

5.50%

33.50%

0%

5%

10%

15%

20%

25%30%

35%

40%

1995 Hospital ith minimal

lactation support

1999 Hospital designated as

Baby friendly

Percentage

Exclusive Breastfeeding Infants

Adapted from: Philipp BL, Merewood A, Miller LW et al. Baby-friendly Hospital Initiative improves

breastfeeding initiation rates in a US hospital setting. Pediatrics, 2001, 108:677-681.


16/88

Train all health care

staffin skills necessary

to implement this policy.

Step 2


17/88


18/88

Areas of knowledge

Advantages of

breastfeeding

Risks of artificial

feeding Mechanisms of

lactation and

suckling

How to help mothersinitiate and sustain

breastfeeding

How to assess a

breastfeed

How to resolve

breastfeedingdifficulties

Hospital breastfeeding

policies and practices

Focus on changingnegative attitudes

which set up barriers


19/88

Additional topics for BFHI training in the

context of HIVTrain all staff in:

Basic facts on HIV and on Prevention of Mother-to-Child Transmission (PMTCT)

Voluntary testing and counselling (VCT) forHIV

Locally appropriate replacement feeding options How to counsel HIV + women on risks and benefits of

various feeding options and how to make informedchoices

How to teach mothers to prepare and give feeds How to maintain privacy and confidentiality


20/88


21/88


22/88

Step 2: Effect of breastfeeding training

for hospital staff on exclusive breastfeeding rates

at hospital discharge

41%

77%

0%10%

20%

30%

40%

50%

60%70%

80%

90%

Pre-training, 1996 Post-training, 1998

Percentage

Exclusive Breastfeeding Rates at Hospital Discharge

Adapted from: Cattaneo A, Buzzetti R. Effect on rates of breast feeding of training for the Baby

Friendly Hospital Initiative. BMJ, 2001, 323:1358-1362.

Slide 4.2.4


23/88

Inform all pregnant women

about the benefits and

management ofbreastfeeding.

Step

3


24/88

Antenatal education should include:

Benefits of breastfeeding

Early initiation

Importance of rooming-in

(if new concept)

Importance of feeding ondemand

Importance of exclusive

breastfeeding

How to assure enough

breastmilk Risks of artificial feeding

and use of bottles and

pacifiers (soothers, teats,

nipples, etc.)

Basic facts on HIV

Antenatal education

should not include group

education on formula

preparation


25/88

Slide 4e


26/88

Slide 4f


27/88


28/88

Step 3: The influence of antenatal care

on infant feeding behaviour

43

18

58

27

0

10

20

30

40

50

60

70

Colostrum BF < 2 h

Percentag

e

No prenatal BF information

Prenatal BF information

Adapted from: Nielsen B, Hedegaard M, Thilsted S, Joseph A, Liljestrand J. Does antenatal care

influence postpartum health behaviour? Evidence from a community based cross-sectional study in

rural Tamil Nadu, South India. British JournalofObstetrics and Gynaecology, 1998, 105:697-703.

Slide 4.3.3


29/88


30/88

Help mothers initiate

breastfeeding within a

half-hourof birth.

Step 4


31/88

New interpretation of Step 4 in the revised

BFHI Global Criteria (2006):

Place babies in skin-to-skin contact with their

mothers immediatelyfollowingbirth for at

least an hour and encourage mothers torecognize when their babies are ready to

breastfeed, offeringhelp ifneeded.


32/88

Early initiation of breastfeeding

for the normal newborn

Why?

Increases duration of breastfeeding

Allows skin-to-skin contact for warmth and

colonization of baby with maternal organisms

Provides colostrum as the babys first

immunization

Takes advantage of the first hour of alertness Babies learn to suckle more effectively

Improved developmental outcomes


33/88

Early initiation of breastfeeding

for the normal newborn

How? [Breast crawl]

Keep mother and baby together

Place baby on mothers chest Let baby start suckling when ready

Do not hurry or interrupt the process

Delay non-urgent medical routines for atleast one hour


34/88

Slide 4g


35/88

Slide 4h


36/88


37/88

Slide 4j


38/88


39/88

Impact on breastfeeding duration

of early infant-mother contact

Adapted from: DeChateau P, Wiberg B. Long term effect on mother-infant behavior of extra

contact during the first hour postpartum. Acta Peadiatr, 1977, 66:145-151.

58%

26%

0%

10%

20%

30%

40%

50%

60%

70%

Ear tact ( =21) Control (n=19)

P

ercent

st

llbreastfeedin

gat

3mont

sEarly contact: 15-20 min suckling and

skin-to-skin contact within

first hour after delivery

Control: No contact within first

hour

Slide 4.4.5


40/88

Effect of delivery room practices

on early breastfeeding

Adapted from: Righard L, Alade O. Effect of delivery room routines on success of first

breastfeed .Lancet, 1990, 336:1105-1107.

0

10

20

3040

50

60

70

Continuous contactn=38

Separation forproceduresn=34

ercentage

Successful sucking pattern

63%

P


41/88


42/88

Show mothers how to

breastfeedand how to

maintain lactation, even if

they should be separatedfrom their infants.

Step

5


43/88


44/88


45/88


46/88

Supply and demand

Milk removal stimulates milk production.

The amount of breast milk removed at each

feed determines the rate of milk productionin the next few hours.

Milk removal must be continued duringseparation to maintain supply.


47/88


48/88


49/88

Step 5: Effect of health provider encouragement of

breastfeeding in the hospital

on breastfeeding initiation rates

74.6%

43.2%

0%

10%

20%

30%

40%

50%60%

70%

80%

Encouraged to breastfeed Not encouraged to

breastfeed

Percentage

Breastfeeding initiation rates p


50/88


51/88

6.GIVE NEWBORNINFANTS NO FOOD OR

DRINK OTHER THANBREAST MILK UNLESS

MEDICALLY INDICATED


52/88

Slide 4n


53/88

Slide 4o


54/88

Decreased frequency or effectiveness of suckling

Decreased amount of milk removed from breasts

Delayed milk production or reduced milk supply

Some infants have difficulty attaching to breast if

formula given by bottle

Impact of routine formula supplementation

Slide 4.6.4


55/88

Acceptable medical reasons for supplementation or

replacement

Infant conditions: Infants who are very weak, have sucking difficulties or

oral abnormalities or are separated from their mothers.

Infants very low birth weight or preterm infants, infants

at risk of hypoglycaemia, or those who are dehydratedor malnourished.

Infants with galactosemia should not receive BM or the

usual BMS. They will need a galactose free formula.

Infants with phenylketonuria may be BF and receive

some phenylalanine free formula.


56/88


57/88

Maternal conditions (continued):

If a mother is weak, she may be assisted to positionher baby so she can BF.

BF is not recommended when a mother has a breastabscess, but BM should be expressed and BFresumed once the breast is drained and antibiotics

have commenced. BF can continue on the unaffectedbreast.

Mothers with herpes lesions on their breasts shouldrefrain from BF until active lesions have been resolved.

BF is not encouraged for mothers with Human T-cellleukaemia virus, if safe and feasible options areavailable.

BF can be continued when mothers have hepatitis B,TB and mastitis, with appropriate treatmentsundertaken.

Slide 4.6.10


58/88


59/88

Long-term effects of a change

in maternity ward feeding routines

Adapted from: Nylander G et al. Unsupplemented breastfeeding in the maternity ward: positive

long-term effects. Acta Obstet GynecolScand, 1991, 70:208.

0%

20%

40%

60%

80%

100%

1.5 3 6 9

onth ft r rth

%

exclusive

lybreastfed

Intervention group = early,frequent, and unsupplementedbreastfeeding in maternity ward.

Control group = sucrose waterand formula supplements given.

P


60/88


61/88

Rooming-in

A hospital arrangement where amother/baby pair stay in the same room

day and night, allowing unlimited

contact between mother and infant


62/88


63/88


64/88

Rooming-in

Why? Reduces costs

Requires minimal equipment

Requires no additional personnel

Reduces infection

Helps establish and maintain

breastfeeding

Facilitates the bonding process


65/88


66/88

Morbidity of newborn babies at Sanglah Hospital

before and after rooming-in

Adapted from: Soetjiningsih, Suraatmaja S. The advantages of rooming-in. Pediatrica

Indonesia, 1986, 26:231.

Slide 4.7.4

2

4

6

8

1

12

e i i

edi

i e e l e i e i i i

e

ie

6 e e i i

6 e i i

=2 5

=17

=77

=11

=61

=17=25

=4


67/88


68/88


69/88

On demand, unrestricted breastfeeding

Why?

Earlier passage of meconium

Lower maximal weight loss Breast-milk flow established sooner

Larger volume of milk intake on day 3

Less incidence of jaundice


70/88


71/88


72/88

9


73/88

9.GIVE NOARTIFICIAL TEATSAND PACIFIER

Step 9


74/88


75/88

Alternatives to artificial teats

cup

spoon

dropper

Syringe


76/88


77/88

An international code to regulate the marketing of

breast-milk substitutes was adopted in 198

1. Itcalls for:

all formula labels and information to state the

benefits of breastfeeding and the health risksof substitutes;no promotion of breast-milk substitutes;no free samples of substitutes to be given to

pregnant women, mothers or their families; andno distribution of free or subsidizedsubstitutes to health workers or facilities.


78/88

P ti f i f t h b tf d t 6


79/88

Proportion of infants who were breastfed up to 6

months of age according to frequency of pacifier

use at 1 month

Non-users vs part-

time users:P


80/88

10


81/88

10.FOSTER THEESTABLISHMENT OFBREASTFEEDINGSUPPORT GROUPS ANDREFER MOTHERS TOTHEM ON DISCHARGEFROM HOSPITAL OR

CLINIC

Step 10


82/88

Support can include:

Early postnatal or

clinic checkup

Home visits

Telephone calls Community services

y Outpatient

breastfeeding clinics

y Peer counsellingprogrammes

Mother supportgroupsy Help set up new

groups

y Establish workingrelationships with thosealready in existence

Family supportsystem


83/88

Types of breastfeeding mothers support groups

Traditional

Modern, non-traditional

Self-initiated

Government planned through:

networks of national development groups, clubs, etc.

health services -- especially primary health care (PHC)

and trained traditional birth attendants (TBAs)

extended family

culturally defined doulas

village women

by mothers

by concerned health professionals


84/88

Slide 4x


85/88

Slide 4yPhoto: Joan Schubert


86/88

S 10 ff f


87/88

Step 10: Effect of trained peer counsellors on the

duration of exclusive breastfeeding

70%

6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Project Area Control

Percentage

Exclusively

breastfeeding 5month old infants

Adapted from: HaiderR, Kabir I, Huttly S, Ashworth A. Training peer counselors to promote and

support exclusive breastfeeding in Bangladesh. JHum Lact, 2002;18(1):7-12.

Slide 4.10.5


88/88

Documents

Breastfeeding - Just 10 Steps