Maternal And Child Separation

Maternal and Infant Separation

Assess Motivation  Discuss

plans/reasons to continue

lactation  Assess

activities of daily living

 Individual

mother

plan workable for each

When mother-infant separation is necessary,

EARLY INTERVENTION IS IMPORTANT.

Delays in expression :  Lead to engorgement  Cause irreversible involution of the glandular tissue which can lead to a low supply  Is associated with higher bacterial counts in the milk

Most common problems encountered by mothers separated from their infants  Inhibited

milk ejection reflex  Low milk supply

Methods to enhance Milk Ejection Reflex  Warm

compresses  Gentle massage  Pumping in pleasant surroundings  Looking at picture of baby

Methods to enhance Milk Ejection Reflex  Relaxation  LaMaze

Techniques

breathing  Listening to music  Imagining the milk flowing  Reading  Talking with a friend

Milk Supply reducers  Skipped

pumping sessions  Poor emptying ( ineffective pump)  Fatigue  Tension, worsening of baby’s condition  Illness, return to work or increased commitments inside or outside the home, some medications and drugs  Quick weight loss in mom

Milk Supply Enhancers  Frequent

pumping sessions  Complete emptying at each session  Rest

and relaxation  Improvement in baby’s condition A

nutritious diet of about 500 calories per day above pre-pregnant requirements

SEPARATION OF MOTHER & INFANT I.

Reason for Separation •

Premature /sick hospitalized infant

•

Working mother /studying

•

Hospitalized mother

Maintaining Milk Supply

A. Ideally = mother and child should stay together

B. If Mother is Separated from Infant ► Encourage mother to visit /touch / care of infant. ► Teach method of milk expression. ► Emphasize hand washing and hygiene. ► Initiate expression before 12 hours postpartum.

If Mother is Separated from Infant

1. Frequent expression = > 8 times /day ≠ > 5 hours interval ► Give take home handouts for milk expression and storage. ► Provide clean containers.

C. If Mother is Working  

  

Plan ahead of time Individualize cases  Flexi hours  Employer’s support  Creches  Express milk during office hours Breastfeed just before leaving Breastfeed on returning home Breastfeed more often at night and exclusively on weekends

HUMAN MIILK BANKING

MINI MILK BANKING

pa ste uri zer

MILK STORAGE  Collection

Storage Distribution

of milk

 Support

Encouragement Promotion

of successful lactation

WHEN

As often as possible At work SOURCE OF BREASTMILK

Own mother Wet nurse Other mothers ≠ pasteurization

HOW manual Breastmilk expression

pump

WHERE Plastic container

HOW TO GIVE

Cup feeding Dropper feeding

MILK STORAGE • •

Container – heavy plastic…. Label as collected  

• •

Date / Time PT – FT Milk

Store in small amounts Warm milk –

Bowl of warm water (excessive heat = destroy enzymes and protein)  “Slow defrost” – is best  Consume thawed milk

STORING EXPRESSED BREASTMILK When refrigerator is available •

•

•

Place container of Expressed Breastmilk in the coldest part of the ref or freezer Chill the milk well before adding to previously ref or frozen milk. Label container - Bed # __________ Name ____________ - Date __________ Time ____________

Leave space in container of milk to be frozen. Emphasize – preterm or full term milk

• STORAGE GUIDELINES: Method of Storage

Term Infant

Preterm /Sick Infants

Room Temperature

8 hours

4 hours

Refrigerator

48 hours

24 hours

Freezer (2 door ref)

3 months

3 months

Deep Freezer (- 20°)

1 year

Put at the back of the fridge NOT IN THE DOOR

FEEDING OPTIONS  Cup / Syringe Readily available • Easy to use /clean • Safe if used properly • Avoids nipple preference • Less chances of contamination  Bottles • Risk of nipple confusion • Readily contaminated •

WHEN REFRIGERATOR IS NOT AVAILABLE In temperature climate Expressed Breastmilk is safe in a clean container at room temperature for 8 – 10 hours Use evaporative cooling container. Water soaked earthen jar, cover with cloth that reaches down the water. Place in coolest part of the house.

METHODS OF COLLECTION Manual expression 

Simple Method 





Position – thumb above areola, forefingers below Push . . . Press . . . . Release Push . . Press . . . Release Massage all around, avoiding sliding of the fingers

Manual Expression

Stimulating milk flow (let -down or oxytocin reflex)

     

Breast or back massage Nipple massage Warm bath / shower Photo of baby Baby’s clothing / smell music

How to rub

a mother’s back

Practice > Rolling of fingers on the breast > Breastmilk expression – on yourself

Milk Collection (colostrum)

THE WARM BOTTLE METHOD OF EXPRESSING MILK a. Putting hot water into a bottle.

b. Pouring the hot water out.

c. A mother putting the heated bottle over her nipple.

Kaneso n Pump

Ll oy d – B Pump

Elec tr ic Pump

QUALIFICATION OF Breastmilk DONOR

QUA LIF IC AT IO N OF Brea st mil k DONOR

 Had normal pregnancy and delivery.  Is serogically negative for syphilis and hepab surface antigen.  Has no infection acute or chronic.  Not taking medications, smoking or using excessive alcohol.  Is capable of carrying out sterile technique or neat personally.  If donating for other infant, own child is healthy without jaundice.

Saf e St ora ge

(Sandra Lang 2007)

The lower the temperature the longer the storage! 

3 days in a refrigerator running below 10°C.



4 and 8 days in a refrigerator running between 0 and 4°C.



If the temperature rises above 4°C during this time the milk should be used within 8 hours or thrown away

Safe Stor age



If a refrigerator running at 4°C is not available - a cool bag with frozen ice packs (changed every 24 hours) can be used. The milk should be protected from freezing



If milk is to be kept for longer than 8 days it should be frozen as soon after expression as possible

REMEMBER…

 The

more often a refrigerator door is opened the more likely the temperature is to rise.

 Check

the temperature with a ‘fridge thermometer’ of ANY refrigerator (or cool bag) where human milk is being stored.

Using Stored Frozen Breastmilk



Defrost frozen breastmilk in a refrigerator or if needed quickly defrost under cool and then warm running water - dry container thoroughly



DO NOT HEAT BREASTMILK IN A MICROWAVE



Use defrosted breastmilk immediately and throw away any unused milk

Using Stored Frozen Breastmilk



IF the milk smells SOUR - DO NOT USE



When stored the milk will separate, gently shake the milk to mix it.



Give expressed breastmilk by cup or spoon or breastfeeding supplementer not a bottle if the baby is less than 7 weeks old or if the bottle cannot be cleaned properly.

Safe Storage of Breastmilk in the Home Place

Maximum time

Fresh breastmilk kept at home Room:

6 hours

Fridge: 5 to 10°C

3 days

Fridge: 0 to 4°C

8 days

If temperature goes above 4°C after 3 days use within 6 hours or throw away Freezer: -18°C or lower

6 months

Previously frozen milk Defrosted in fridge

12 hours

Defrosted in fridge

Use immediately