Early Initiation of Breastfeeding Benefits

EARLY INITIATION
OF BREAST FEEDING

Abla Al Alfy
RCPCH Lead for Egypt
Secretary General -ELCA

ANTENATAL PERIOD AND
EBF

 When Breast Milk Production start
antenatal?
 Do we need any Nipple Massage?
 When should we start Breast Feeding?
 How we should Start Breast Feeding?
 When milk let down occur?
 What to do till mother get enough milk?



THE CARE A MOTHER‘
RECEIVES DURING LABOUR
AND BIRTH CAN AFFECT
BREASTFEEDING & HOW
SHE CAN CARE FOR HER
BABY’

UNICEF-BFHI- 20 HOUR TRAINING

NEW INTERPRETATION OF
STEP 4 IN THE REVISED
BFHI GLOBAL CRITERIA
(:(2006

Place babies in skin-to-skin contact with their“
mothers immediately following birth for at
least an hour and encourage mothers to
recognize when their babies are ready to
.”breastfeed, offering help if needed

Slide 4.4.2

WHAT ARE THE BENEFITS THIS
?MOTHER AND BABY CAN GAIN

PRACTICES THAT HELP
WOMEN FEEL CONTROL OF
THEIR LABOR
 Emotional support during labor
 Attention to the effect of pain medication
on baby
 Offering light foods & fluids to mother in
labor
 Freedom of movement
 Avoiding unnecessary C-section
 Early mother-baby contact
 Leaving baby skin-to-skin for at least an
hour or until first feed (facilitating first
feed)

SUPPORT AT BIRTH
A companion can give Its effect on the birth
:non medical support :outcome
 Emotional  More alert baby
 Massages her back  Less hypothermia
 Helps her to walk  Less hypoglycemia
 Positive words  More early frequent
 Offers foods feedings
 Reassures  Easier bonding
 Builds her confidence

PAIN RELIEF

 Non medication methods of pain relief include:
 Walking around at labor
 Massage
 Warm water
 Verbal and physical reassurance
 Quiet environment

EFFECTS OF PAIN MEDICATION

 They increase risk of:
 Longer labor with its known complications
 Operative intervention
 Delayed first contact
 Separation/sleepy baby
 Decreased suckling
 Increased milk intake
Extra time and assistance is needed if
medications are used

FEEDBACK INHIBITOR OF
( LACTATION (FIL
 To prevent the Feedback Inhibitor of
Lactation from collecting and reducing
milk production:
 -Make sure that the baby is well attached;
 -Encourage frequent breastfeeds;
 -Allow baby to feed for as long as she or he
wants at each breast;
 -Let the baby finish the first breast before
offering the second breast;
 -If baby does not suckle, express the milk
so that milk production continues.

Good
attachment
?WHAT CAN YOU SEE

Poor attachment
6/3

,Breastfeeding Counselling: a training course
WHO/CHD/93.4, UNICEF/NUT/93.2

HOW TO DECIDE IF A
BABY IS WELL OR
POORLY ATTACHED

Looking from outside

Good
attachment
?WHAT CAN YOU SEE

Poor attachment
6/4


7/4

WIDE OPEN
MOUTH

UNICEF C107-7©

‫كيف تحققينه‬
‫قربي الحلمة من أنف الطفل و اتركي رأسه يميل للخلف قليل ليفتح فمه لكبر‬
‫اتساع و يخرج لسانه فيصبح لسانه مع فكه السفلي كالمغرفة.‬

‫بسرعة خذي الطفل عليك و ضعي ثديك على فكه السفلي و لسانه.‬

‫عندما يستقر ثديك على لسانه وهو مضموم إليك سيطبق شفته العليا علي‬
‫الثدي و يبدأ المص. ستسمعين صوت البلع بعد قليل.‬

‫ضعي كفك مفتوحا مع الربع أصابع تحت الثدي و سيف اليد مسنود على‬
‫الضلوع ثم ضعي البهام فوق الثدي خلف الهالة السمراء.‬

‫يترك الطفل يمص حتى يكتفي و يترك الثدي بنفسه‬

‫إذا أحسست بألم يمكنك وضع إصبعك الصغير في زاوية فمه ليترك ثديك برفق‬
‫بين الثديين يمكنك تكريعه لينشط للرضاعة من الثدي الخر‬

THE ACTION OF
SUCKLING
• Rooting reflex When the breast touches the
baby’s lips (or the baby smells the milk ), he or
she puts their head back slightly, opens their
mouth wide, and puts their tongue down and
forward, to seek the breast..
 The sucking reflex • When the baby is close
enough to the breast, and takes a large enough
mouthful, the baby can bring the nipple back
until it touches the soft palate..
 • The muscles then move the tongue in a wave
from the front to the back of the mouth,
expressing the milk from the ducts beneath the
areola into the baby’s mouth.
 The oxytocin reflex makes the milk flow along
the ducts.
 The swallowing reflex,The baby swallows when
the back of the mouth fills with milk.

SIGNS THAT A BABY IS
SUCKLING EFFECTIVELY

-The baby takes slow, deep sucks,
sometimes pausing for a short time,
-You can see or hear the baby swallowing.
-The baby’s cheeks are full and not drawn
inward during a feed.
-The baby finishes the feed and releases the
breast by himself or herself and looks
contented.

SIGNS THAT A BABY IS NOT
SUCKLING EFFECTIVELY
 -makes only rapid sucks;
 -makes smacking or clicking sounds;
 -has cheeks drawn in;
 -fusses or appears unsettled at the breast, and
comes on and off the breast;
 -feeds very frequently - more often than every
hour or so EVERY day;
 -feeds for a very long time - for more than an
hour at EVERY feed, unless low birth weight;
 -is not contented at the end of a feed,
 Cluster feeding – when baby feeds very
frequently for a few hours and then sleeps for a
few hours, is
 norm

TEACH MOTHERS HOW THEY
CAN KEEP MILK PRODUCTION
PLENTIFUL
 -Help the baby to breastfed soon after birth,
 -Make sure the baby is well attached at the
breast and do not give any artificial dummies or
teats that would confuse his or her suckling and
reduce stimulation of
the breast.
 -Breastfeed exclusively,
 -Feed the baby as frequently as he or she wants,
usually every 1-3 hours, for aslong as he or she
wants at a feed.
 -Feed the baby at night, when prolactin release
in response to suckling is high.

TEACH MOTHERS HOW TO
. CARE FOR THEIR BREASTS
 -Clean the breasts with water only. Soaps,
lotions, oils, and Vaseline all interfere
with the natural lubrication of the skin.
 -Washing the breasts once a day as part of
general body hygiene is sufficient.
 It is not necessary to wash the breasts
directly before feeds. This removes
protective oils and alters the scent that
the baby can identify as his or her
mother's breasts.
 - Brassieres are not necessary, but can be
used if desired. Choose a brassiere that
fits well and is not too tight

SECOND DAY OF LIFE
 Baby is not feeding well
 Proper positioning and attachment
 Frequency of Nursing
 Mothers Diet
 Sleep
 Avoid engorgement
 Pain and cracking

MANAGEMENT OF
RELUCTANCE TO FEED
 • Remove or treat the cause if possible:
 -Help the mother to position and attach the baby well,
 -Help the mother to express some milk before feeding if the
milk is coming too
 fast or if the breast is too engorged.
 -Treat a sore mouth or thrush if you are able or refer the baby
for medical help.
 -Provide pain relief if the baby is in pain,
 -Help the mother to hold the baby without causing pain, if the
baby is bruised,
 -Avoid using artificial teats or pacifiers. If needed, give feeds
by cup.
 -Stop using anything that is causing an unpleasant taste or
smell to the breast.

• 

MANAGEMENT OF
RELUCTANCE TO FEED
 Encourage skin-to-skin contact between mother
and baby in a calm environment
 when the baby is not hungry. This helps both the
mother and baby to see the breast as a pleasant
place to be. Then the baby can explore the breast
and attach when he or she is ready. This may be
an hour or more and may not happen on the first
occasion there is skin-to-skin contact.
 • Do not try to force the baby to the breast when
the baby is crying. He or she needs to associate
the breast with comfort. It may be necessary to
express the milk and feed it by cup until the baby
learns to breastfeed happil

PREVENTION OF
RELUCTANCE TO FEED

 -Early and frequent skin-to-skin contact
that helps the baby to learn that the
breast is a safe place from the first few
hours;
 -Helping the mother to learn the skill of
positioning and attachment in a calm
unhurried environment,
 -Being patient while the baby learns to
breastfeed,
 -Caring for the baby in a gentle confident
manner.

 Contrary to popular belief,
attaching the baby on the breast
is not an ability with which a
mother is [born…]; rather it is a
learned skill which she must
acquire by observation and
experience.
.From: Woolridge M. The “anatomy” of infant sucking. Midwifery, 1986, 2:164-171

Slide 4.5.2

POSITIONS

Supporte
Close
In line

Facing
d
BREASTFEEDING
7/1


‫في كل دقيقة احتاج لك ضميني اليك ولحتحرميني لبنك –ارضعيني متي اردت‬
‫حتي اكتفي )8(‬

MOTHER’S POSITIONS
 There are many positions that a mother
may use – for example, sitting on the floor
or the ground, or sitting on a chair, lying
down, standing up, or walking.
 If the mother is sitting or lying down, she
should be:
 -Comfortable with back supported
 -Feet supported if sitting so that the legs
are not hanging loose or uncomfortable,
 -Breast supported, if needed.

BABY’S POSITION

 The baby also can be in different positions, such as along
the mother’s arm, under the mother’s arm, or along her
side.
Four key points are used to help the baby be comfortable.
The baby’s body needs to be:
 -in line with ear, shoulder and hip in a straight line, so
that the neck is neither twisted nor bent forward or far
back;
 -close to the mother’s body so the baby is brought to the
breast rather than the breast taken to the baby;
 -supported at the head, shoulders and if newborn, the
whole body supported; and
 -facing the breast with the baby’s nose to the nipple as she
or he comes to the breast.

ASSESS A 7/3

BREASTFE
ED

UNICEF C107-5©

ASSESS A
BREASTFEE 7/5

D

UNICEF C107-9©

ED
BREASTFE
7/6

UNICEF/HQ91-0168/ Betty Press, Kenya

9/1
8/1

Original illustration by Jenny Corkery

‫أمي الحبيبة –أرضعيني لبنك‬

‫لاريد ماء ولأي شي‬ ‫‪‬‬
‫آخر يحرمني لبنك.‬
‫ماذلت صغيرا وجسدي‬
‫لم يكتمل بعد (6(‬

‫لاريد لهايات وليبيبرونات . طعمها مختلف عن لبنك وكلها امراض. لحتتسببي في‬
‫ضرري ياحبيبتي لولكتكذبي علي من يومي اللول. أنا اريد لبنك لو كل دة يبيلخبطني‬
‫وانا لسه صغير ومحتاج اركز لواحتعلم الرضاعة علي ثدييك فقط )9(‬

MY MILK IS NOT ENOUGH

My Milk is Too Much

‫التناسب المثالي لكمية اللبن مع حجم معدة الرضيع‬

‫معدة رضيع عمره سنة‬

‫معدة رضيع عمره يوم أو 2‬

‫02‬ ‫002 مل‬
‫مل‬
‫ملعقة شاي‬
‫ملعقة شاي‬

‫الممارسات المثالية لنجاح الرضاعة الطبيعية‬

‫علمات الرغبة في الرضاعة‬

‫يحرك الرضيع رأسه من جانب إلى آخر.‬ ‫•‬
‫يفتح فمه.‬ ‫•‬
‫يخرج لسانه.‬ ‫•‬
‫يضع أصايبعه و كفه في فمه.‬ ‫•‬
‫يقوم يببعض الصوات الهادئة أو المص.‬ ‫•‬
‫يحرك شفتيه و كأنه يرضع.‬ ‫•‬
‫يحك أنفه في صدر الم أثناء حملها له.‬ ‫•‬
‫إذا لمس أي شئ خده يلتفت لنفس الحتجاه.‬ ‫•‬

OXYTOCIN

.Oxytocin reflex, or milk ejection reflex, or letdown •
Oxytocin causes the muscle cells around the alveoli to
. contract and makes milk flow down the ducts
.This is essential to enable the baby to get the milk
It may happen several times during a feed. The reflex may
. feel different or be less noticeable as time goes by
Soon after a baby is born, the mother may experience •
: certain signs of the oxytocin reflex. These include
,painful uterine contractions, sometimes with a rush of blood -
, a sudden thirst-
milk spraying from her breast, or leaking from the breast -
, which is not being suckled
. feeling a squeezing sensation in her breast-

When the milk ejects, the rhythm of the baby's suckling •
changes from rapid to slow deep, sucks (about one per
. second) and swallows
Seeing, hearing, touching and thinking lovingly about •
.the baby, helps the oxytocin reflex

:The mother can assist the oxytocin to work by
Feeling pleased about her baby and confident that her -
, milk is best
. Relaxing and getting comfortable for feeds-
Expressing a little milk and gently stimulating the -
. nipple
Keeping her baby near so she can see, smell, touch and -
. respond to her baby
If necessary, asking someone to massage her upper-
. back, especially along the sides of the backbone

HELPING THE OXYTOCIN REFLEX
6/2


CASE
Case study
9/2

2 weeks old
STUDY Healthy at birth
Discharged Day 2

“Sleeping all the time”
“Refusing” the breast
Breastfeeding Counselling: a training course,
WHO/CHD/93.4, UNICEF/NUT/93.2 3 stools in week

UNICEF/HQ91-0168/ Betty Press, Kenya
12% under birth weight
Bottle with honey and
water twice yesterday

Dr Nils Bergman, Cape Town, South Africa
O
CARE
MOTHER
10/2

TRIPLET-I HAVE
TWINS
I am pregnant

I AM SICK –
HAVE COLD- HAVE
DIARRHEA

On Drugs

MY BABY IS VOMITING

My Baby Have frequent
watery stool

My Baby is constipated

SUCCESSFUL
BREASTFEEDING

Step 10. Foster the establishment
of breastfeeding support
groups and refer mothers
to them on discharge from
the hospital or clinic.

A JOINT WHO/UNICEF STATEMENT (1989)

HOW TO IMPLEMENT STEP 10
 It is the responsibility of the BFHI maternity hospital
to be linked to a support group or health unit that can
provide adequate skilled support to breastfeeding
mothers.
 These health facilities or support groups should be
‘Baby Friendly’ i.e. comply to the Ten Steps and the
International Code for prohibiting marketing inside
health facilities or permitting free supplies..

 The key to best breastfeeding
practices is continued day-to-day
support for the breastfeeding
mother within her home and
community.

From: Saadeh RJ, editor. Breast-feeding: the Technical Basis and Recommendations for
Action. Geneva, World Health Organization, pp.:62-74, 1993.

Slide 4.10.2

Early Initiation of Breastfeeding Benefits

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