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Sesi 5 Birth practices
1. SESSION 5
BIRTH PRACTICES AND
BREASTFEEDING - STEP 4
1
Breastfeeding Promotion and Support
A Training Course for Health Professionals
Adapted from Maryland Department of Health and Mental Hygiene
2. 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 .
22
4. • Step 4 of the 10 Steps to
Successful Breastfeeding :
“Help mothers to initiate
breastfeeding within half hour
of birth.”
4
5. Current implementation in Malaysia :
Place babies in skin to skin contact
with mothers immediately following birth
for at least 10 minutes, however longer
period up to one hour is recommended
and encourage mothers to recognise
when their babies are ready to
breastfeed, offering help if needed.
5
6. What practices may help a woman
to initiate breastfeeding soon after
birth?
6
8. Birth Practices That Support
Breastfeeding
Support person or doula during labor
Encourage comfortable birthing
positions and ambulation
Food or drink during EARLY labor
Encourage non-medicated births
Keep mother and baby together
8
9. Positions for resting during labour
9
Session 5 : Birth Practices and Breastfeeding
Ministry of Health Malaysia
10. Birth Practices That Hinder Breastfeeding
Pitocin use
Lower Apgar scores
Increased anxiety and pain
Inhibits oxytocin release
Fluid retention
Overhydration with IV fluids
Breast edema
Difficulty latching
Increased newborn weight loss
10
11. Labour Pain Management
All pain relief medications cross the
placenta
Timing of analgesia is important
Non-medicated pain relief
11
12. Other Procedures That Can Interfere With BF
Forceps and vacuum extraction
Episiotomy
Gastric and vigorous suctioning
Eye prophylaxis before the first hour
Separating mother and baby
Bathing newborn at delivery
Swaddling and wrapping newborn
Taking newborn to nursery for assessments/ procedures
12
14. Skin-to-skin
Place babies skin-to-skin
Immediately following birth
Uninterrupted for first hour
No clothing between mother and baby
Dry infant while on mother’s chest
Until first breastfeeding completed
All infants, regardless of feeding plan
14
15. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006
First Skin to Skin Contact
5/3
DrNilsBergman,Cape
Town,SouthAfrica
15First Skin to Skin Contact
16. Skin-to-skin contact: WHEN?
• Vaginal delivery
– Put the baby on mother’s abdomen while
delivering placenta and stitching epi
• LSCS
– If under epidural/spinal, skin-to skin and
breastfeeding initiated immediately after baby out
– If under GA – once mother able to
respond/recovery room
16
17. Skin-to-skin contact
All babies should be dried off as they are placed on
mother’s skin.
Baby does not need to be bathed immediately after birth.
Holding baby is not implicated in HIV transmission.
For mother with HIV
Babies, who are not stable immediately after
birth can receive skin-to-skin contact later
when they are stable.
17
18. Benefits of Skin To Skin Contact
Increases duration of breastfeeding
Warms and colonizes baby
More quickly stabilizes vital signs
Provides antibody protection through
colostrum
Babies learn to suckle more effectively
Facilitate bonding
Improves developmental outcomes
18
19. What are barriers to early skin-to-skin
contact?
How could these barriers be overcome?
19
21. Overcoming barriers
• Concern that baby will be cold
– Dry baby
– Place naked on mother’s chest
– Put dry cloth over both baby and
mother
– If room is cold, cover baby’s head
to reduce heat loss
– Skin to skin contact with mother
provides better heat regulation than heater
21
22. Overcoming barriers
• Baby needs to be examined
–Most examinations can be done with baby
on mother’s chest
• Baby likely to be lying quietly
–Weighing can be done later
22
23. Overcoming barriers
• Mother needs to be stitched
– baby can remain on mother’s chest for stitching of
epi/ LSCS
23
24. Overcoming barriers
• Baby needs to be bathed
–Delaying first bath allow vernix to soak into
baby’s skin
• Lubricating n Protecting
–Delaying first bath prevents temp loss
–Baby can be wiped dry after birth
24
25. Overcoming barriers
• Labour room is busy
– Transfer mother and baby to the ward in skin-to-
skin contact
– Continue contact in ward
• No staff available to stay with mother and
baby
– Family member/companion can stay
25
26. Overcoming barriers
• Baby is not alert
– More important to have contact
– Sleepy baby due to pain
medication needs extra support
to bond and feed
• Mother is tired
– Mother rarely so tired, does not want to hold baby
– Contact with baby helps mother relax
– Review practices of withholding food/fluids
26
27. Overcoming barriers
• Mother does not want to hold baby
– If mother unwilling to hold baby
• Indication mother is depressed
• Greater risk of abandonment/neglect/abuse
–Encouraging contact increases bonding
potential
• Reduce risk of harm to baby
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28. Overcoming barriers
• Twins
– interval between births varies.
– the first infant can have skin to skin contact until
mother starts to labour for second birth.
– First twin can be held in skin to skin contact by a
family member for warmth and contact while
second twin is born.
– Then the two infants are held by mother in skin to
skin contact and assisted to breastfeed when
ready.
28
31. Initiating Breast Feeding
Assist the first feeding
Pre-feeding behaviors
Short rest periods
Recognises feeding cues
Hands to mouth
Licking
Sucking motions
Touching nipple
Moving towards breast
Finding nipple
31
32. Helping to Initiate breastfeeding
• Help mother to recognise pre-feeding
behaviours or cues.
– When mother and baby are kept quietly in skin-to-
skin contact, baby typically works through a series
of pre-feeding behaviours.
– may be a few minutes or an hour
or more.
32
33. 33
Session 5 : Birth Practices and Breastfeeding
Ministry of Health Malaysia
34. Further advantage
Skin to skin and eye contact :
•optimise oxytocin release
•Coordinate suckling, swallowing and breathing
34
35. Helping to initiate breastfeeding
• There should be no pressure on mother
or baby
– how soon first feed takes place,
– how long first feed lasts, how well
– Consider as an introduction to breast rather
than a feed.
35
36. Role of health care worker
• Provide time and a calm atmosphere
• Help mother to find comfortable
position
• Build mother’s confidence
• Avoid rushing baby to breast or
pushing breast into baby’s mouth.
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38. Caesarean Section
Maternal disappointment in birthing process
Unexpected or unplanned
Separation from newborn
Impact on breastfeeding
Delay in Lactogenesis II
Newborn lethargic
Suctioning of infant
Delay in early contact
Separation
38
39. Supporting BF after Caesarean Section
Assist mother with skin-to-skin as soon
after delivery as possible
Assist mother to find comfortable
positions
Laid-back (biological nurturing)
Side lying
Clutch/football
39
41. Supporting BF after Caesarean Section
• Presence of supportive health worker
Help initiate /Encourage skin to skin asap
Spinal/epidural - immediate
GA- contact in recovery room if mother
responsive
Skin to skin by father /family member while
waiting for mother to return from OT
Prem/unstable baby – contact when stable
41
42. Infants Who Do Not Self Attach
Observe infants closely for feeding cues
Assessment of infant by physician
Limit visitors
42
43. BFHI practices and women who are not
breastfeeding
All mothers should be encouraged to let baby
suckle at breast unless:
– there is a known medical reason for not
breastfeeding, (e.g HIV-positive woman )
– If a mother has a strong personal desire
not to breastfeed
43
44. Summary
Baby-friendly practices support women whether
or not they are breastfeeding
Support during labor
Skin-to-skin
Limiting invasive interventions & pain relief
Offering light food and fluids
Respect a mother wishes
Replacement feedings, if applicable
44
SUMMARY SESSION 5
BIRTH PRACTICES AND BREASTFEEDING - STEP 4
45. Session 5 Knowledge Check
1. Name three possible barriers to early skin-to-
skin contact and how each might be
overcome
2. List four labour or birth practices that can
help mother and baby get a good start with
breastfeeding.
3. List three ways to assist a mother following a
caesarean section with breastfeeding.
45
47. Birth Practices That Support
Breastfeeding
Support person or doula during labor
Encourage comfortable birthing
positions and ambulation
Food or drink during EARLY labor
Encourage non-medicated births
Keep mother and baby together
47
48. Supporting BF after Caesarean Section
Presence of supportive health worker
Assist mother with skin-to-skin as soon
after delivery as possible
Assist mother to find comfortable
positions
Laid-back (biological nurturing)
Side lying
Clutch/football
48