1. Session 5
BIRTH PRACTICES &
BREASTFEEDING- STEP 4

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

3. 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.

4. 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 changes
development of maternal fevers
Lower Apgar scores
Increased risk of seizure in neonatal period

5. 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.

6. 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.

7. Other 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.

8. Operative Vaginal Deliveries
Use of forceps and/or vacuum extraction
increased odds ratios for feeding difficulties

9. 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.

10. The First Hour After Birth
Initiation of breastfeeding in the first hour
postpartum is positively associated with:
continuation of breastfeeding post-discharge
continuation of breastfeeding at 2-3 months
Mothers should be offered the opportunity to
breastfeed their newborns as soon as possible after
delivery

11. The 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)

12. Importance 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.

13. Infant 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.”

14. For mothers who do not intend to
breastfeed
Skin to Skin immediately after birth should be
routine practice regardless of feeding choice or
plan.

15. Skin-to-Skin Contact
is associated with:
enhanced maternal-infant bonding
higher infant weight gain
better regulation of respiratory and arousal
mechanisms
more organized feedings
decreased infant crying

16. Complicated Births
Uninterrupted 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.

17. Infants 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.

18. 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 pairs
Infants from the intervention sites were
significantly more likely than control infants to be
breastfed at 3, 6, and 12 months.

19. 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.”

20. 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.