Session 25 Health Care Practices

Important points:

Health care practices CAN have major effect on breastfeeding (BF) Poor practices interfere with BF & contribute to the spread of artificial feeding Good practices support BF

25/1

Health care practices After completing this session participants will be able to: list the Ten Steps to Successful Breastfeeding describe the health care practices summarized by ‘The Ten Steps to Successful Breastfeeding’ explain why the Baby-friendly Hospital Initiative (BFHI) is important in areas with a high HIV prevalence

Important points: 1989, WHO and UNICEF issued a Joint Statement called

Protecting, Promoting and Supporting Breastfeeding: The special role of Maternity Services. This describes how maternity facilities can support breastfeeding

Important points:

The “10 Steps to Successful Breastfeeding” is the summary of the main recommendation of the Joint Statement. They are the basis for the “Baby Friendly Hospital Initiative (BFHI)” launched in1991 by WHO and UNICEF

25/2

Step one Have a written breastfeeding policy that is routinely communicated to all health staff

Written policy which addresses the 10 steps Visibly posted in: maternity ward all infant care areas ( well baby / sick baby ) antenatal care services Language / dialect commonly used

Disseminated to all

Should PROHIBIT





promotion of BM substitutes / teats /pacifiers distribution of gift packs

Mechanism for evaluating effectiveness of the policy

2006

25/3

Step two Train all health care staff in skills necessary to implement this policy

2 - Train all health care staff in skills necessary to implement this policy

All staff ( involved with mother and baby ) received orientation on BF policy Trained on 20 hours w/ 3 hours clinical experience includes the 10 steps & EO 51 of non-clinical staff (given their roles) to support

Step 2 Train all health care staff in skills necessary to implement this policy.

New employees - orientation & training w/in 6 months Available copy of the curricula or course outline

25/4

Step three Inform all pregnant women about the benefits and management of breastfeeding

25/525/5

3 -Inform all pregnant women about the benefits and management of breastfeeding

Breastfeeding counseling to most pregnant women at antenatal service

Step 3 - Inform all pregnant women about the benefits and management of breastfeeding.

written antenatal education: importance of exclusive breastfeeding for 6 months benefits of breastfeeding basic breastfeeding management (attachment / positioning ) Discuss mother’s questions (Group / individual discussion)

25/6

Step four Help mothers initiate breastfeeding within the first hour of birth

25/7

Both naked – skin to skin Place baby between the breast At the level of the nipple Cover mother and baby with the same blanket

4 - Help mothers initiate breastfeeding within the first hour of birth

Let baby suckle when he shows that he is ready Normally alert & responsive in the first 1-2 hours after birth Try to delay non urgent medical routines for at least an hour

Step 4 - Help mothers initiate breastfeeding within an hour after birth.

Q – What medical routines occur in health facility which could interrupt early contact between mother and her baby ? If the 1st feed is delayed for longer than an hour,

BF is LESS likely to be successful.

What about for HIV positive mothers , can you do skin to skin contact at birth ? Encourage her to hold and cuddle and have physical contact with her baby Help her feel close and affectionate towards her baby

25/9

Step five Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants

25/10

25/12 After caesarian section –usually 4-6 hrs.

Teach breastmilk expression / collection To establish and maintain lactation

25/13

Step six Give newborn infants no food or drink other than breast milk, unless medically indicated

6- Give newborn infants no food or drink other than breast milk, unless medically indicated

25/14

Prelacteal feeds replaces colostrum and baby is more likely to : develop infections such as diarrhea, intolerance to the protein in the feed, makes baby breastfeed less because he is full

25/15

Stomach capacity of the newborn and a 1-year-old child Newborn stomach capacity

1-year old stomach capacity

10 X bigger

10 X bigger

Step 6 - Give newborn infants no food or drink other than breastmilk, unless medically indicated.

25/16

Step seven Practice rooming-in: allow mothers and infants to remain together 24 hours a day

7 -Practice rooming-in: allow mothers and infants to remain together 24 hours a day

Enables mothers to respond to the needs Helps bonding and breastfeding Baby cries less Mothers become confident about BF BF continues longer when she leaves facility Bedding - in

Step 7 -Practice rooming-in: allow mothers and infants to remain together 24 hours a day

Mothers who are HIV positive do not need to be separated from their babies General mother to child contact does not transmit HIV

Rooming in

25/17

25/18

Step eight Encourage breastfeeding on demand

Step 8 - Encourage breastfeeding on demand

25/19

Step 8 -encourage breastfeeding on demand

Q – what does BF on demand mean ? Breastfeeding whenever the baby or mother wants with no restrictions on the length and frequency of feeds

8 -encourage breastfeeding on demand

Q – What are the advantages of feeding on demand ? There is earlier passage of meconium Baby gains weight faster Milk “comes in” sooner, larger volume of milk on day 3 Fewer difficulties like engorgement Less incidence of jaundice

Even babies in the NICU could be fed on demand basis

25/20

Step nine Give no artificial teats or pacifiers* to breastfeeding infants * also called dummies and soothers

Step 9 -Give no artificial teats or pacifiers* to breastfeeding infants

May carry infection If hungry baby is given pacifier, he may not grow well

Cup feeding is recommended

25/22

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

10 -Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic 25/23

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

The KEY to best BF practices is continued day-to-day for the breastfeeding mother within her home and community Breastfeeding counselors (YOU) should visit the mothers after discharge from health facility and support them to continue breastfeeding

25/24

Effect of trained peer counsellors on the duration of exclusive breastfeeding 80%

70%

70%

Percentage

60% 50%

Exclusively breastfeeding 5 month old infants

40% 30% 20% 6%

10% 0% Project area

Control

Adapted from Haider R, Kabir I, Huttly S and Ashworth A. Training peer counselors to promote and support exclusive breastfeeding in Bangladesh. J Hum Lact, 2002;18(1):7-12.