Session 5BIRTH PRACTICES & BREASTFEEDING- STEP 4BIRTH PRACTICES & BREASTFEEDING- STEP 4

Objectives

1. Describe how the actions during labour and birth can support early breastfeeding.2. Explain the importance of early contact for mother and baby. 3. Explain ways to help initiate early breastfeeding. 4. List ways to support breastfeeding after a

caesarean section. 5. Discuss how BFHI practices apply to women who are not breastfeeding

Effect of Labor and Delivery Practices on Breastfeeding

Effect of Labor and Delivery Practices on Breastfeeding

Sensitive, responsive care of mother during labor and delivery is associated with better breastfeeding outcomes.

Pain medications have potential cumulative negative effects on infant suckling and milk supply.

Effective breastfeeding may be delayed when analgesia/anesthesia is administered well before delivery.

Concerns about Labor & Delivery Medications Concerns about Labor & Delivery Medications

Epidural pain meds are associated with: depression of infant’s motor abilities interference with infant’s ability to

control and modulate state changesdevelopment of maternal feversLower Apgar scoresIncreased risk of seizure in neonatal

period

Non-Medication Methods for Pain Relief Labour support Walking and moving around Massage Warm water Verbal and physical reassurances Quiet environment with no bright lights and as few people as possible Labouring and giving birth positioning a

position of the mother’s choice.

More Concerns about Labor & Delivery Medications

Research is needed to identify most beneficial medication protocols.

Women should be informed of possible negative impact of analgesia/anesthesia on early infant behavior and breastfeeding initiation.

Other Labor Events Which Can Impact BreastfeedingOther Labor Events Which Can Impact Breastfeeding

Gastric suctioning has been associated with delayed suckling and rooting movements.

When necessary, gentle bulb suctioning of mouth and nares is recommended.

Eye drops may impair infant’s ability to seek the breast and self-attach. Delay routine eye drops and procedures

until first feeding has occurred.

Operative Vaginal Deliveries

Use of forceps and/or vacuum extraction increased odds ratios for feeding difficulties

Practices to Promote Baby and Mother Contact

Emotional support during labour.Attention to the effects of pain medication

on the baby.Offering light foods and fluids during early

labour.Freedom of movement during labour.Avoidance of unnecessary caesarean

sections.Early mother-baby contact.Facilitating the first feed.

The First Hour After BirthThe First Hour After Birth

Initiation of breastfeeding in the first hour postpartum is positively associated with:continuation of breastfeeding post-dischargecontinuation of breastfeeding at 2-3 months

Mothers should be offered the opportunity to breastfeed their newborns as soon as possible after delivery

The First Hour of LifeThe First Hour of Life

Separation during the first hour interrupts the infant’s predictable behavior patterns and delays the beginning of effective suckling.

“Avoid procedures that may interfere with breastfeeding or that may traumatize the infant including unnecessary, excessive, and overly vigorous suctioning of the oral cavity, esophagus and airways…” (p.498, AAP 2005)

“Delay weighing, measuring, bathing, needle-sticks and eye prophylaxis until after the first feeding is complete.” (p. 500, AAP 2005)

Importance of Skin-to-Skin ContactImportance of Skin-to-Skin Contact

Uninterrupted skin-to-skin contact is recommended in the first hour postpartum or until first breastfeeding occurs.

When analgesia has been administered, longer periods of skin-to-skin contact may be required to trigger self-attachment and suckling.

Infant Self-AttachmentInfant Self-Attachment

When infants are placed on mother’s abdomen or chest immediately postpartum and left undisturbed for at least one hour, they have been observed to propel themselves to the breast (using stepping-crawling reflex), to attach to the breast, and to suckle effectively.

AAP (2005) recommends that the newborn should remain skin-to-skin “throughout the recovery period.”

For mothers who do not intend to breastfeed

Skin to Skin immediately after birth should be routine practice regardless of feeding choice or plan.

Skin-to-Skin Contact is associated with:Skin-to-Skin Contact is associated with:

enhanced maternal-infant bondinghigher infant weight gainbetter regulation of respiratory and

arousal mechanismsmore organized feedingsdecreased infant crying

Complicated BirthsComplicated BirthsUninterrupted skin-to-skin contact should

begin as soon as mother and infant can comfortably respond, e.g. Cesarean sections.

After medicated labors, infants may require more time for skin-to-skin contact.

If infant is unable to feed at the breast, manual expression or pumping should begin as soon as possible for a minimum of 120 minutes/day.

Infants Who Do Not Self-Attach at First ContactInfants Who Do Not Self-Attach at First Contact

If self-attachment, feeding cues and/or breastfeeding are not observed within the first hour or two, staff should begin observing the infant at routine intervals for feeding cues.

A comprehensive pediatric evaluation should be considered.

Impact of BFHI on Breastfeeding Success

Improving hospital practices through BFHI improved breastfeeding rates and child health outcomes

PROBIT trial a cluster-randomization of hospitals to initiate the BFHI or not

17046 mother infant pairsInfants from the intervention sites were

significantly more likely than control infants to be breastfed at 3, 6, and 12 months.

BFHI improves breastfeeding rates and child health outcomes II

Babies at intervention sites had a significant reduction in the risk of 1 or more gastrointestinal tract infections and of atopic eczema but no significant reduction in respiratory tract infection.

“a solid scientific underpinning for future interventions to promote breastfeeding.”

HOSPITAL AND BIRTH CENTER STAFF AND ADMINISTRATORS CAN SUPPORT OPTIMAL BREASTFEEDING BY BUILDING POLICIES AND PROTOCOLS THAT REFLECT THE IMPORTANCE OF THE FIRST HOURS AFTER BIRTH.

HOSPITAL AND BIRTH CENTER STAFF AND ADMINISTRATORS CAN SUPPORT OPTIMAL BREASTFEEDING BY BUILDING POLICIES AND PROTOCOLS THAT REFLECT THE IMPORTANCE OF THE FIRST HOURS AFTER BIRTH.