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Feeding the baby - Feeding the baby - BreastfeedingBreastfeeding

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Breastfeeding: A Public Health Breastfeeding: A Public Health PriorityPriority

Breastfeeding has major public health benefits in reducing the Breastfeeding has major public health benefits in reducing the incidence of certain conditions, reducing risks of infections incidence of certain conditions, reducing risks of infections and diseases in babies, children and women and also and diseases in babies, children and women and also promoting good health in babies through transfer of promoting good health in babies through transfer of antibodies from mother to baby. It also contributes to antibodies from mother to baby. It also contributes to reducing children’s risks of becoming obese in the future. It is reducing children’s risks of becoming obese in the future. It is particularly important to this service because obese women particularly important to this service because obese women are less likely to initiate and continue breastfeeding – and are less likely to initiate and continue breastfeeding – and their children are already at increased risks of obesity.their children are already at increased risks of obesity.

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Why Breastfeed?Why Breastfeed?

Breastfeeding has a number of benefits for the mother, Breastfeeding has a number of benefits for the mother, baby and the wider family. Given your current knowledge, baby and the wider family. Given your current knowledge, complete the ‘Benefits of Breastfeeding’ activity.complete the ‘Benefits of Breastfeeding’ activity.

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Why Breastfeed? - MumsWhy Breastfeed? - Mums• Protects against ovarian and breast cancer. Protection against Protects against ovarian and breast cancer. Protection against breast cancer is dose related – the longer the mother breast cancer is dose related – the longer the mother breastfeeds for, the better the protectionbreastfeeds for, the better the protection• Protects against weaker bones in later lifeProtects against weaker bones in later life• Protects against hip fracturesProtects against hip fractures•Reduced risk of Type 2 diabetesReduced risk of Type 2 diabetes• Can help promote weight loss – breastfeeding uses Can help promote weight loss – breastfeeding uses

around 500 calories a dayaround 500 calories a day• Can reduced stress/feelings of anxietyCan reduced stress/feelings of anxiety• Promotes bonding with babyPromotes bonding with baby

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Why Breastfeed? - BabiesWhy Breastfeed? - Babies• Protects against gastroenteritisProtects against gastroenteritis

• Protects against infections including: ear, urine and chest Protects against infections including: ear, urine and chest

infectionsinfections

• Reduces risks of allergies, eczema and asthmaReduces risks of allergies, eczema and asthma

• Reduces risk of diabetesReduces risk of diabetes

• Reduces risk of sudden infant death syndromeReduces risk of sudden infant death syndrome

• Reduces risk of obesityReduces risk of obesity

• Gives the baby the exact nutrients they need – no Gives the baby the exact nutrients they need – no

additives, preservatives or manufactured ingredients.additives, preservatives or manufactured ingredients.

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Why Breastfeed? - BabiesWhy Breastfeed? - Babies• Better jaw formation so lower risk of crowded teeth andBetter jaw formation so lower risk of crowded teeth and better speech development– because of the action of the better speech development– because of the action of the jaw when feeding (a narrower jaw action is used to suck jaw when feeding (a narrower jaw action is used to suck from a bottle)from a bottle)• Antibodies – babies are protected against any germs thatAntibodies – babies are protected against any germs that the mother comes into contact with – once the germs arethe mother comes into contact with – once the germs are breathed in, the mother begins to produce antibodies tobreathed in, the mother begins to produce antibodies to fight the infection. These are sent to the breasts to befight the infection. These are sent to the breasts to be included in breast milk and offer the baby immediateincluded in breast milk and offer the baby immediate protection from anything the mother faces.protection from anything the mother faces.

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Why Breastfeed? - BabiesWhy Breastfeed? - Babies

Benefits that are particular to Benefits that are particular to pre-term babies pre-term babies are that are that breastfeeding has been linked to better cognitive (brain) breastfeeding has been linked to better cognitive (brain) development and visual acuity as well as reducing th development and visual acuity as well as reducing th incidence of necrotising enterocolitis (a serious stomach incidence of necrotising enterocolitis (a serious stomach condition in premature babies)condition in premature babies)

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Why Breastfeed? Benefits for familiesWhy Breastfeed? Benefits for families

Cost and ConvenienceCost and Convenience• Breast milk costs very little – there is no special Breast milk costs very little – there is no special equipment required (although some mums will buy equipment required (although some mums will buy maternity/feeding bras, breastpads, feeding cushions etc)maternity/feeding bras, breastpads, feeding cushions etc)•Formula milk costs approximately £35 per month. This Formula milk costs approximately £35 per month. This doesn’t include the cost of equipment such as bottles, doesn’t include the cost of equipment such as bottles, teats, cleaning and sterilising.teats, cleaning and sterilising.• Convenience – breastmilk is at the right temperature, is Convenience – breastmilk is at the right temperature, is made on demand and available at a moment’s notice, it made on demand and available at a moment’s notice, it contains exactly right nutrients for the babycontains exactly right nutrients for the baby

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Why Breastfeed? - ObesityWhy Breastfeed? - ObesityRecent research into breastfeeding and obesity has Recent research into breastfeeding and obesity has suggested that:suggested that:•Breastfed babies were better at self-regulation of appetite Breastfed babies were better at self-regulation of appetite – they are in control of what they eat and in later life – they are in control of what they eat and in later life demonstrate thisdemonstrate this•Formula fed babies have faster growth patterns/weight Formula fed babies have faster growth patterns/weight gain in the early period which has been linked to childhood gain in the early period which has been linked to childhood obesityobesity•Growth in last trimester and first month are key growth Growth in last trimester and first month are key growth periods for impact on future obesityperiods for impact on future obesity

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Healthy Weight, Healthy Lives. A cross Healthy Weight, Healthy Lives. A cross government strategy for Englandgovernment strategy for England

““Identify at risk families as early as possible and Identify at risk families as early as possible and plans to promote breastfeeding as the norm for plans to promote breastfeeding as the norm for mothers.”mothers.”

““Whether a child is breastfed or not, and at what Whether a child is breastfed or not, and at what stage weaning begins have also shown to affect stage weaning begins have also shown to affect risk of excess weight later in life.”risk of excess weight later in life.”

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Why Breastfeed? Why Breastfeed?

When talking about benefits, it is important to recognise When talking about benefits, it is important to recognise that many of the benefits are about reducing risks. This that many of the benefits are about reducing risks. This doesn’t meant to say they will never get infections or other doesn’t meant to say they will never get infections or other conditions, but they are less likely to if the mother conditions, but they are less likely to if the mother breastfeeds/baby is breastfed. For gastroenteritis, breastfeeds/baby is breastfed. For gastroenteritis, diarrhea, formula feeding gives an diarrhea, formula feeding gives an increasedincreased risk because risk because the bacteria are in the formula milk power.the bacteria are in the formula milk power.

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Why promote breastfeeding? Why promote breastfeeding? Considering the wealth of benefits, it may seem surprising Considering the wealth of benefits, it may seem surprising to learn that despite those benefits, many women choose to learn that despite those benefits, many women choose not to breastfeed. The average initiation rate for the West not to breastfeed. The average initiation rate for the West Midlands (percentage of babies having breastfed at within Midlands (percentage of babies having breastfed at within the first 48 hours) is 73% - but in many areas, the rates are the first 48 hours) is 73% - but in many areas, the rates are much lower than that.much lower than that.

By 6 weeks, this number has dropped to less than 50%. By 6 weeks, this number has dropped to less than 50%.

UK rates of breastfeeding also compare miserably with UK rates of breastfeeding also compare miserably with those of our European counterparts for whom rates are those of our European counterparts for whom rates are nearer 100% at birth. nearer 100% at birth.

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The decline in breastfeedingThe decline in breastfeeding

Mexico 1960-100% 6 month old babies were Mexico 1960-100% 6 month old babies were breastfed by 1966 only 40%breastfed by 1966 only 40%

Chile 1960- 90% of 13 month babies breastfed by Chile 1960- 90% of 13 month babies breastfed by 1968 only 5%1968 only 5%

Singapore 1951 80% 3 month babies breastfed by Singapore 1951 80% 3 month babies breastfed by 1971 only 5%1971 only 5%

UK steady decline from the 1950’s until late 1980’sUK steady decline from the 1950’s until late 1980’s

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Why promote breastfeeding? Why promote breastfeeding?

Consider the activity “Breastfeeding – why not?”Consider the activity “Breastfeeding – why not?”

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Barriers Barriers There are a number of reasons that women may give as to There are a number of reasons that women may give as to why they are concerned about breastfeeding.why they are concerned about breastfeeding.

Bottle feeding is more ‘normal’Bottle feeding is more ‘normal’ Breasts being for pleasureBreasts being for pleasure

Perception that bottles are more convenientPerception that bottles are more convenient Influence of family/friendsInfluence of family/friends

Negative prior experiencesNegative prior experiences Worry about feeding in publicWorry about feeding in public

Embarrassment about feeding in publicEmbarrassment about feeding in public Lacking in confidence to feedLacking in confidence to feed

Wanting baby to sleep through the nightWanting baby to sleep through the night Wanting others to be involvedWanting others to be involved

Lack of knowledge/understanding – how it worksLack of knowledge/understanding – how it works

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NHS RecommendationsNHS RecommendationsIn 2002 the Department of Health adopted the World In 2002 the Department of Health adopted the World Health Assembly’s resolution on infant and child nutrition Health Assembly’s resolution on infant and child nutrition to:to:

““Protect, promote and support exclusive Protect, promote and support exclusive breastfeeding for six months as a global health breastfeeding for six months as a global health recommendation…. And to provide safe and recommendation…. And to provide safe and appropriate complementary foods, with appropriate complementary foods, with breastfeeding for up to 2 years and beyond.”breastfeeding for up to 2 years and beyond.”

Your role is to explain the benefits and offer the client information Your role is to explain the benefits and offer the client information and support to enable them to make an informed choice.and support to enable them to make an informed choice.

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How breastfeeding worksHow breastfeeding worksIn order to provide information and support to clients, In order to provide information and support to clients, the information in this section gives the principles of the information in this section gives the principles of how breastfeeding works, ‘busts’ common myths and how breastfeeding works, ‘busts’ common myths and gives you the information you need to reassure and gives you the information you need to reassure and convince your clients that breastfeeding is working convince your clients that breastfeeding is working well – and to identify what to do if it is not.well – and to identify what to do if it is not.

You may need to review some of the information more You may need to review some of the information more than once and have a look at other appropriate sources than once and have a look at other appropriate sources of information such as of information such as www.breastfeeding.nhs.uk . .

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Anatomy of the BreastAnatomy of the BreastA basic knowledge of anatomy is all A basic knowledge of anatomy is all that you need in order to understand that you need in order to understand

the principles of breastfeedingthe principles of breastfeeding..The diagram to the left outlines the The diagram to the left outlines the key elements. key elements. Milk is made to order in the alveolus Milk is made to order in the alveolus by acini cells, then drawn down the by acini cells, then drawn down the ducts towards the areola and nipple ducts towards the areola and nipple when the baby sucks. There is not a when the baby sucks. There is not a huge reservoir that fills with milk and huge reservoir that fills with milk and then is emptied – alveolus are then is emptied – alveolus are constantly making milk to the constantly making milk to the demands of messages sent through demands of messages sent through the nipple by baby sucking.the nipple by baby sucking.

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Roles of HormonesRoles of HormonesThere are two hormones – Prolactin and Oxytocin – that There are two hormones – Prolactin and Oxytocin – that have key roles in breastfeeding. When the baby is near, have key roles in breastfeeding. When the baby is near, oxytocin is produced Oxytocin is also produced as a result oxytocin is produced Oxytocin is also produced as a result of the baby sucking at the breast. Prolactin is only of the baby sucking at the breast. Prolactin is only produced as a result of the baby sucking at the breast.produced as a result of the baby sucking at the breast.

•Prolactin is responsible for milk production. Prolactin is responsible for milk production.

•Oxytocin is responsible for the delivery of milkOxytocin is responsible for the delivery of milk

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Prolactin and milk productionProlactin and milk production

When the baby suckles at the breast as message is sent to When the baby suckles at the breast as message is sent to the brain – this makes the pituitary gland produce prolactin.the brain – this makes the pituitary gland produce prolactin.The prolactin travels via the bloodstream to the breasts and The prolactin travels via the bloodstream to the breasts and the milk producing cells in the breasts (acini) begin to the milk producing cells in the breasts (acini) begin to produce milk.produce milk.The time taken for the message to travel is imperceptible The time taken for the message to travel is imperceptible as, the milk will be made and released almost as soon as as, the milk will be made and released almost as soon as the baby begins to suck at the breast.the baby begins to suck at the breast.Within the acini cells, there are ‘prolactin receptors’. Within the acini cells, there are ‘prolactin receptors’. Recent research has suggested that these receptors need Recent research has suggested that these receptors need to be ‘primed’ in the early days.to be ‘primed’ in the early days.

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Prolactin ReceptorsProlactin ReceptorsThe acini cells have receptors in them and it is believed that in The acini cells have receptors in them and it is believed that in the first few weeks, frequent feeding enables the receptors to be the first few weeks, frequent feeding enables the receptors to be ‘switched on’ by the prolactin response. ‘switched on’ by the prolactin response. Compare it to a 3 bedroom house. It has light fittings in all Compare it to a 3 bedroom house. It has light fittings in all bedrooms – but unless there is a bulb in each fitting, you can only bedrooms – but unless there is a bulb in each fitting, you can only switch on the lights in the rooms with a bulb. Or you would need switch on the lights in the rooms with a bulb. Or you would need to move the bulb around. This would limit the light you could to move the bulb around. This would limit the light you could have in your house.have in your house.It is believed that early, frequent feeding enables all the receptors It is believed that early, frequent feeding enables all the receptors to be ‘switched on’ so that in the future, the mother will be able to to be ‘switched on’ so that in the future, the mother will be able to make as much milk as her growing baby needs. The ability to make as much milk as her growing baby needs. The ability to switch on new receptors is thought to finish at around 2 weeks switch on new receptors is thought to finish at around 2 weeks after birth – so early feeding is very important for future feeding.after birth – so early feeding is very important for future feeding.

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The prolactin receptor theory

acini (milk-secreting) cell

Expulsion of placenta opens receptor sites

Unprimed receptor sites shut down, reducing potential for milk production

Surges of prolactin prime the receptor sites

prolactin receptor site

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Prolactin and milk productionProlactin and milk production• Prolactin is at its highest at nightProlactin is at its highest at night• Helps mum to go back to sleep after feeding (bottle Helps mum to go back to sleep after feeding (bottle

feeding mothers don’t have that advantage)feeding mothers don’t have that advantage)• Suppresses ovulationSuppresses ovulation• Levels peak after the feed – getting the cells ready for Levels peak after the feed – getting the cells ready for

the next feedthe next feed• Needs to be stimulated early and frequently to be Needs to be stimulated early and frequently to be

effective long termeffective long term• Switches on the ability for all cells to make milkSwitches on the ability for all cells to make milk

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Oxytocin and milk deliveryOxytocin and milk deliveryWhen the baby suckles at the breast a message is sent to When the baby suckles at the breast a message is sent to the brain – this makes the pituitary gland produce oxytocin. the brain – this makes the pituitary gland produce oxytocin. It can also be triggered by sight, sound and smell of the It can also be triggered by sight, sound and smell of the baby.baby.The oxytocin travels via the bloodstream to the breasts and The oxytocin travels via the bloodstream to the breasts and the muscular cells contract to squeeze the milk out towards the muscular cells contract to squeeze the milk out towards the nipple.the nipple.The oxytocin reflex is also referred to as the ‘let down’ The oxytocin reflex is also referred to as the ‘let down’ reflex.reflex.

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Oxytocin and milk deliveryOxytocin and milk delivery Levels are highest when baby is close to motherLevels are highest when baby is close to mother Stimulated by positive emotions Stimulated by positive emotions May be inhibited by stressMay be inhibited by stress Induces feelings of well being Induces feelings of well being After first few days is a conditioned responseAfter first few days is a conditioned response Works before or during a feed to make the milk Works before or during a feed to make the milk

flowflow

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Who or what is FIL?Who or what is FIL?

Breastfeeding works on a supply and demand basis. Breastfeeding works on a supply and demand basis.

The baby suckles and sends messages that milk is needed. The baby suckles and sends messages that milk is needed. The hormones respond and supply and release the milk The hormones respond and supply and release the milk required. The baby stops sucking and the milk stops being required. The baby stops sucking and the milk stops being produced/ejected.produced/ejected.

There is also another factor in play – FIL.There is also another factor in play – FIL.

FIL is also known as Feedback Inhibitor of Lactation.FIL is also known as Feedback Inhibitor of Lactation.

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Feedback inhibitor of lactation [FIL]Feedback inhibitor of lactation [FIL]FIL is a protein that is found in the breastmilk. Whilst milk is FIL is a protein that is found in the breastmilk. Whilst milk is being removed and the nipple stimulated it is inert – ie is isn’t being removed and the nipple stimulated it is inert – ie is isn’t doing anything. When the nipple stops being stimulated, or milk doing anything. When the nipple stops being stimulated, or milk stops being removed, FIL begins to act within the breast to stop stops being removed, FIL begins to act within the breast to stop the acini cells making milk.the acini cells making milk.Whilst the levels of FIL in the breast are high, this will stop the Whilst the levels of FIL in the breast are high, this will stop the breast producing milk – milk that isn’t needed. When the baby breast producing milk – milk that isn’t needed. When the baby suckles again and milk begins to be removed, FIL stops working suckles again and milk begins to be removed, FIL stops working to allow milk to be produced. This ensures that the breasts don’t to allow milk to be produced. This ensures that the breasts don’t over produce milk that isn’t needed and responds to the needs of over produce milk that isn’t needed and responds to the needs of the baby. This is a reason frequent feeding is encouraged.the baby. This is a reason frequent feeding is encouraged.

FIL needs to be removed to ensure continued milk production.FIL needs to be removed to ensure continued milk production.

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Early DaysEarly DaysThe first milk produced by the mum will be colostrum – this is The first milk produced by the mum will be colostrum – this is a highly concentrated type of milk that contains a huge does a highly concentrated type of milk that contains a huge does of antibodies and enough nutrients to sustain the bay until of antibodies and enough nutrients to sustain the bay until the breasts begin to produce milk at day 3-5. It also contains the breasts begin to produce milk at day 3-5. It also contains a laxative that helps the baby get rid of the dark, sticky first a laxative that helps the baby get rid of the dark, sticky first poo. Colostrum is only made in very small quantities, so it is poo. Colostrum is only made in very small quantities, so it is common for the baby to feed frequently in the first few days – common for the baby to feed frequently in the first few days – and for the mum to think that they haven’t got enough milk. and for the mum to think that they haven’t got enough milk. On the 3On the 3rdrd or 4 or 4thth day, her breasts will begin to produce larger day, her breasts will begin to produce larger quantities of milk and will become quite full until the breasts quantities of milk and will become quite full until the breasts adapt to how much milk the baby needs/wants. adapt to how much milk the baby needs/wants.

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Feeding PatternsFeeding PatternsIn the early days it is quite common for babies to feed In the early days it is quite common for babies to feed frequently – every hour or couple of hours – as they are frequently – every hour or couple of hours – as they are developing their skills, switching on the receptors and developing their skills, switching on the receptors and developing patterns of feeding. They also use feeding a developing patterns of feeding. They also use feeding a comfort and to be close to their mother. Consider the last comfort and to be close to their mother. Consider the last 24 hours and how frequently you ate or drank something – 24 hours and how frequently you ate or drank something – some days you would have a set pattern, other days you some days you would have a set pattern, other days you may not. Babies are not so different – they enjoy comfort may not. Babies are not so different – they enjoy comfort eating, sometimes they are thirsty – others they are feeding eating, sometimes they are thirsty – others they are feeding to satisfy hunger. to satisfy hunger.

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Feeding PatternsFeeding PatternsDuring a feed, the make up of the milk changes to meet the During a feed, the make up of the milk changes to meet the needs of the baby. The milk at the start of the feed is in needs of the baby. The milk at the start of the feed is in larger quantities of lower fat, thirst quenching milk. Later in larger quantities of lower fat, thirst quenching milk. Later in the feed, this becomes more fatty, hunger satisfying milk. the feed, this becomes more fatty, hunger satisfying milk. Consequently, babies suck more quickly at the beginning of Consequently, babies suck more quickly at the beginning of a feed and then settle into a slower sucking pattern, often a feed and then settle into a slower sucking pattern, often resting and then sucking again. At the end of the feed, they resting and then sucking again. At the end of the feed, they must work even harder to get the small quantities of high must work even harder to get the small quantities of high fat milk. See the graph on the next page for a visual image fat milk. See the graph on the next page for a visual image of fat during a feed.of fat during a feed.

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Feeding PatternsFeeding Patterns

Volume of milk

TIME

Low-fat milk Fat globules

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Feeding CuesFeeding CuesThere are a number of ways a new baby communicates that it There are a number of ways a new baby communicates that it wants to feed – often we perceive that crying is the way for it to wants to feed – often we perceive that crying is the way for it to tell us. Crying is the way a baby communicates for a number of tell us. Crying is the way a baby communicates for a number of reasons – unhappy, confused, tired, wet, dirty, etc.reasons – unhappy, confused, tired, wet, dirty, etc.By recognising early feeding cues, mums can actually stop a baby By recognising early feeding cues, mums can actually stop a baby from reaching the point that they are so hungry that they cry. from reaching the point that they are so hungry that they cry. •Moving their eyesMoving their eyes•Wriggling or wavingWriggling or waving•Rooting for the breastRooting for the breast•Sucking their fists, blankets etcSucking their fists, blankets etc•Making murmuring noisesMaking murmuring noises

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How breastfeeding works activityHow breastfeeding works activity

Thinking about the principles of milk Thinking about the principles of milk production you’ve just learned, complete the production you’ve just learned, complete the Etivity – How breastfeeding works.Etivity – How breastfeeding works.

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Helping Breastfeeding to workHelping Breastfeeding to workFollowing the activity, you will have come up with some things that Following the activity, you will have come up with some things that could interfere could interfere with breastfeeding – particularly in the early days. with breastfeeding – particularly in the early days. •Supplementary feeds – reduce stimulation of the breast, interfere Supplementary feeds – reduce stimulation of the breast, interfere with supply of milk – breasts think milk is not needed, interferes with supply of milk – breasts think milk is not needed, interferes with positive health outcomes from breastfeeding, undermines with positive health outcomes from breastfeeding, undermines mother’s confidencemother’s confidence•Use of a dummy – pacifies baby when it may want to feed so Use of a dummy – pacifies baby when it may want to feed so interferes with supply/demand, can cause confusion for baby as interferes with supply/demand, can cause confusion for baby as the sucking action is different to sucking at the breast, delays the sucking action is different to sucking at the breast, delays feeding cues so baby may get to crying pointfeeding cues so baby may get to crying point•Using teats/bottles – can cause baby to be confused as with Using teats/bottles – can cause baby to be confused as with dummies, reduces milk transferdummies, reduces milk transfer

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Helping Breastfeeding to workHelping Breastfeeding to workTo To support breastfeedingsupport breastfeeding, the following are useful points, , the following are useful points, particularly in the early days. particularly in the early days. •Unrestricted feeding – letting baby decide how much/little they Unrestricted feeding – letting baby decide how much/little they want to take, allows baby to get at the higher fat milk, less colic, want to take, allows baby to get at the higher fat milk, less colic, ‘satisfied’ baby, baby regulates milk supply‘satisfied’ baby, baby regulates milk supply•Feeding on demand/frequent feeding – help practice skills, Feeding on demand/frequent feeding – help practice skills, switches on receptors, stops FIL being produced, prevents switches on receptors, stops FIL being produced, prevents breasts becoming engorged (too full with milk)breasts becoming engorged (too full with milk)•Keeping baby close – stimulates oxytocin, allows response to Keeping baby close – stimulates oxytocin, allows response to early feeding cuesearly feeding cues•Teaching hand expression is an important skill to support Teaching hand expression is an important skill to support breastfeeding – this will be covered laterbreastfeeding – this will be covered later

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Breastfeeding SkillsBreastfeeding Skills

Complete the activity “Breastfeeding observation”.Complete the activity “Breastfeeding observation”.

You may find it useful to contact your local breastfeeding You may find it useful to contact your local breastfeeding coordinator (Hospital or Community Trust) or a Children’s coordinator (Hospital or Community Trust) or a Children’s Centre locally if they run Breastfeeding Support Groups to Centre locally if they run Breastfeeding Support Groups to help you to organise your breastfeeding observation.help you to organise your breastfeeding observation.

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Breastfeeding SkillsBreastfeeding SkillsFrom your breastfeeding observation you will have been able to From your breastfeeding observation you will have been able to identify some of the key points in how the mother was positioned identify some of the key points in how the mother was positioned and how the baby was attached during the feed. This section and how the baby was attached during the feed. This section will cover these points in more detail and should be used will cover these points in more detail and should be used alongside the video in the resources panel.alongside the video in the resources panel.

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Breastfeeding SkillsBreastfeeding SkillsPosition of the Mother and BabyPosition of the Mother and Baby•Mother and baby must both be comfortableMother and baby must both be comfortable•The mum can sit, stand or lie down – but the position she The mum can sit, stand or lie down – but the position she chooses should be a position she can maintain for 30 mins-60 chooses should be a position she can maintain for 30 mins-60 mins comfortably. At the beginning many mums choose to sit in mins comfortably. At the beginning many mums choose to sit in a chair or lie on a bed.a chair or lie on a bed.•The baby should be held close to the mother with their bodies The baby should be held close to the mother with their bodies touching.touching.•The baby’s body should be in a straight line from the top of the The baby’s body should be in a straight line from the top of the baby’s head down to their toes.baby’s head down to their toes.•They should be held behind their neck – their head should be They should be held behind their neck – their head should be free to extendfree to extend•The baby should be held with its nose level with the nippleThe baby should be held with its nose level with the nipple

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Breastfeeding SkillsBreastfeeding SkillsPositions Positions

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Breastfeeding SkillsBreastfeeding SkillsAttachment of the babyAttachment of the babyIn order to effectively remove milk from the breast, the baby’s In order to effectively remove milk from the breast, the baby’s mouth needs to be attached effectively.mouth needs to be attached effectively.•Baby feeds from the Baby feeds from the breast breast not just the nipple so it important not just the nipple so it important that they get a big mouthful of breast tissuethat they get a big mouthful of breast tissue•Mouth will be wide openMouth will be wide open•Chin should be tucked into the breastChin should be tucked into the breast•The nose should be free from the breastThe nose should be free from the breast•Baby’s cheeks should be full and round, not sucked inBaby’s cheeks should be full and round, not sucked in•They use their jaw action to milk the breastThey use their jaw action to milk the breast•More areola should be visible above the mouth than belowMore areola should be visible above the mouth than below•Feeding should not be painful Feeding should not be painful

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Breastfeeding SkillsBreastfeeding SkillsAttachment of the babyAttachment of the baby•The baby should release the breast themselves.The baby should release the breast themselves.•When they do, the nipple should not be misshapen, squashed When they do, the nipple should not be misshapen, squashed or soreor sore•If the baby is attached effectively, the nipple is drawn to the If the baby is attached effectively, the nipple is drawn to the back of the mouth, beyond the hard roof of the mouth.back of the mouth, beyond the hard roof of the mouth.•Whilst the baby is feeding, a jaw will move and mum may see Whilst the baby is feeding, a jaw will move and mum may see baby’s ears moving up and downbaby’s ears moving up and down•Nipple shape or size shouldn’t make a difference – but those Nipple shape or size shouldn’t make a difference – but those with larger nipples shouldn’t expect all of the areola to be in the with larger nipples shouldn’t expect all of the areola to be in the baby’s mouth!baby’s mouth!

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Breastfeeding Skills Step-by StepBreastfeeding Skills Step-by Step

1 2

3 4

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Position and AttachmentPosition and AttachmentWatch the video on position and attachment Watch the video on position and attachment to consolidate your learning in this section. to consolidate your learning in this section. If you have the opportunity, practice talking If you have the opportunity, practice talking through the steps of effective position and through the steps of effective position and attachment with a colleague.attachment with a colleague.

The information in this section should give you a The information in this section should give you a basic understanding of good position and basic understanding of good position and

attachment. attachment. If a mother is having difficulties with breastfeeding, If a mother is having difficulties with breastfeeding,

refer them to their midwife/health visitor, refer them to their midwife/health visitor, breastfeeding supporter or the national breastfeeding supporter or the national

breastfeeding helpline for support.breastfeeding helpline for support.

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Skin to SkinSkin to SkinSkin to skin contact is an important part of the baby’s Skin to skin contact is an important part of the baby’s first breastfeed – allowing mothers and babies to get first breastfeed – allowing mothers and babies to get to know each other and giving easy access to the to know each other and giving easy access to the breast for the baby. It is offered in most maternity breast for the baby. It is offered in most maternity units and the baby is given to the mother naked to units and the baby is given to the mother naked to be held against the mother’s naked chest.be held against the mother’s naked chest.After birth, it helps the baby regulate its breathing After birth, it helps the baby regulate its breathing and temperature, promotes the release of oxytocin in and temperature, promotes the release of oxytocin in the mother and for some babies helps them to attach the mother and for some babies helps them to attach themselves to the breast. It can also be used later themselves to the breast. It can also be used later on to help sooth fractious babies, relax mum and on to help sooth fractious babies, relax mum and encourage milk production.encourage milk production.

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Hand ExpressionHand ExpressionHand expression is taught to mothers in the Hand expression is taught to mothers in the early days to help them:early days to help them:•Relieve breasts that are full and uncomfortableRelieve breasts that are full and uncomfortable•Release milk to tempt a baby who is reluctant Release milk to tempt a baby who is reluctant to feedto feed•To encourage production of milkTo encourage production of milk•Obtain milk for a baby who cannot feed (in the Obtain milk for a baby who cannot feed (in the neonatal unit for example)neonatal unit for example)•A pump is not effective in the early days A pump is not effective in the early days because only small amounts are produced at because only small amounts are produced at firstfirst

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Myths – I haven’t got enough milkMyths – I haven’t got enough milk• Most women have the capacity to make enough milk for Most women have the capacity to make enough milk for

their baby – provided they feed frequently, get the their baby – provided they feed frequently, get the position and attachment right and feed on demand and position and attachment right and feed on demand and do not restrict feeds. This ensures the messages for do not restrict feeds. This ensures the messages for making milk get to breasts and the breasts continue to making milk get to breasts and the breasts continue to produce milk for the baby on demand. There are only a produce milk for the baby on demand. There are only a tiny number of women (less than 3% who, for medical tiny number of women (less than 3% who, for medical reasons, cannot)reasons, cannot)

• A baby’s tummy is very small – and babies only need A baby’s tummy is very small – and babies only need very small amounts at each feed. The reason they drink very small amounts at each feed. The reason they drink more formula is that the way we feed formula milk more formula is that the way we feed formula milk encourages them to stretch their stomachs - they must encourages them to stretch their stomachs - they must finish that last ounce, finish the bottle etc. finish that last ounce, finish the bottle etc.

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Myths – I haven’t got enough milkMyths – I haven’t got enough milk• Babies aren’t programmed to feed every 4 hours like we Babies aren’t programmed to feed every 4 hours like we

all believe they are – do we, as adults, only eat and drink all believe they are – do we, as adults, only eat and drink every 4 hours? Breastmilk is also very easy to digest, every 4 hours? Breastmilk is also very easy to digest, which means it is digested more quickly than formula so which means it is digested more quickly than formula so breastfed babies may feed more frequently than formula breastfed babies may feed more frequently than formula fed babies.fed babies.

• Babies, when they have developed their breastfeeding Babies, when they have developed their breastfeeding skills, become very adept at getting their milk quickly – skills, become very adept at getting their milk quickly – so a mother may not feel they are getting enough if they so a mother may not feel they are getting enough if they are not feeding for very long.are not feeding for very long.

• Provided the baby is getting wet and dirty nappies, is Provided the baby is getting wet and dirty nappies, is content after a feed, releases the breast themselves – content after a feed, releases the breast themselves – these are all good signs of feeding going wellthese are all good signs of feeding going well

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Myths – I haven’t got enough milkMyths – I haven’t got enough milkTummy SizeTummy Size

Compared to a Compared to a 30ml - 90ml (1-3oz formula feed)30ml - 90ml (1-3oz formula feed)

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Myths - SleepingMyths - Sleeping• Formula fed babies sleep better – some do, some don’t. Formula fed babies sleep better – some do, some don’t.

Babies have only small stomachs so it is really hard for them Babies have only small stomachs so it is really hard for them to sleep all night without a pit-stop – they do sleep through the to sleep all night without a pit-stop – they do sleep through the night eventually. Prolactin also helps breastfeeding mums night eventually. Prolactin also helps breastfeeding mums (and babies) go back to sleep.(and babies) go back to sleep.

• It’s ok to give a breastfed baby a ‘good-night’ bottle to get a It’s ok to give a breastfed baby a ‘good-night’ bottle to get a good night’s sleep – this is likely to interfere with the supply of good night’s sleep – this is likely to interfere with the supply of milk by the mother, and will not guarantee that the baby will milk by the mother, and will not guarantee that the baby will sleep. It also interferes with the health benefits of sleep. It also interferes with the health benefits of breastfeedingbreastfeeding

• Formula fed babies are more content and sleep after feeds – Formula fed babies are more content and sleep after feeds – formula takes more energy for babies to digest so they sleep formula takes more energy for babies to digest so they sleep whilst their bodies use energy to process that milk. Breast whilst their bodies use energy to process that milk. Breast milk is much easier for a baby to digestmilk is much easier for a baby to digest

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Myths - BreastsMyths - Breasts• Breastfeeding makes breasts saggy – it is the hormones and body Breastfeeding makes breasts saggy – it is the hormones and body

changes that take place in pregnancy that can make breasts saggy changes that take place in pregnancy that can make breasts saggy – not breastfeeding. So even without breastfeeding, the breasts – not breastfeeding. So even without breastfeeding, the breasts may change their shape/size or position!may change their shape/size or position!

• Size – breasts are too big/small – it is the cells inside the breast that Size – breasts are too big/small – it is the cells inside the breast that make the milk – and this doesn’t depend on how big the breasts make the milk – and this doesn’t depend on how big the breasts are. Women will make enough milk for their baby no matter what are. Women will make enough milk for their baby no matter what the size of their breasts – provided they switch the receptors on and the size of their breasts – provided they switch the receptors on and feed on demand. feed on demand.

• Breasts are for my partner – breastfeeding is what breasts were Breasts are for my partner – breastfeeding is what breasts were designed for – and their partner can still enjoy them as well. There designed for – and their partner can still enjoy them as well. There are lots of sexy celebrities breastfeeding – Salma Hayek, Christina are lots of sexy celebrities breastfeeding – Salma Hayek, Christina Aguilera, Halle Berry, Eva Herzigova). Breastfeeding won’t last Aguilera, Halle Berry, Eva Herzigova). Breastfeeding won’t last forever either. forever either.

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MythbustingMythbusting

Complete the activity Breastfeeding Myths and Complete the activity Breastfeeding Myths and post onto the forum your thoughts.post onto the forum your thoughts.

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Initiatives Supporting and Promoting Initiatives Supporting and Promoting BreastfeedingBreastfeeding

There are two key international initiatives There are two key international initiatives designed to support breastfeeding – designed to support breastfeeding – The WHO Code (World Heath Organisation)The WHO Code (World Heath Organisation)UNICEF UK Baby Friendly Best Practice UNICEF UK Baby Friendly Best Practice StandardsStandardsThese were introduced to reduce the impact of These were introduced to reduce the impact of marketing of formula milk companies and marketing of formula milk companies and practices in hospitals on the number of women practices in hospitals on the number of women choosing choosing nonot to breastfeed.t to breastfeed.

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The WHO CodeThe WHO CodeAdopted in 1981. 118 member states voted for 1 against. It is a voluntary code Adopted in 1981. 118 member states voted for 1 against. It is a voluntary code and each member state should adopt the code in their own lawand each member state should adopt the code in their own law

1.1.No advertising of breastmilk substitutes.No advertising of breastmilk substitutes.2.2.No free or subsidised samples or suppliesNo free or subsidised samples or supplies3.3.No promotion of products through health care facilities.No promotion of products through health care facilities.4.4.No contact between company marketing personnel and mothersNo contact between company marketing personnel and mothers5.5.No gifts or personal samples to health workers.No gifts or personal samples to health workers.6.6.No words or pictures idealising artificial feeding, including pictures of infants, No words or pictures idealising artificial feeding, including pictures of infants, on the labels of products.on the labels of products.7. 7. Information to health workers should be scientific and factual only.Information to health workers should be scientific and factual only.8.8.All information on artificial feeding, including the labels, should explain the All information on artificial feeding, including the labels, should explain the benefits of breastfeeding and the costs and hazards of artificial feeding.benefits of breastfeeding and the costs and hazards of artificial feeding.9. 9. Unsuitable products should not be promoted for babies.Unsuitable products should not be promoted for babies.

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The WHO CodeThe WHO CodeThe UK has not yet adapted in full the WHO Code. UK law still allows:

•advertising of infant formula within the health-care system

•advertising of follow-on milks

•does not restrict marketing of weaning foods and drinks intended for babies under 6 months

•does not restrict marketing of bottles, teats and dummies

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UNICEF UK Baby Friendly UNICEF UK Baby Friendly Best Practice StandardsBest Practice Standards

The Baby Friendly Initiative is a global programme of The Baby Friendly Initiative is a global programme of UNICEF and the World Health Organization which works UNICEF and the World Health Organization which works with the health services to improve practice so that parents with the health services to improve practice so that parents are enabled and supported to make informed choices about are enabled and supported to make informed choices about how they feed and care for their babies. It has established how they feed and care for their babies. It has established key standards of practice for Hospitals (The Ten Steps) and key standards of practice for Hospitals (The Ten Steps) and Community Trusts (The Seven Points) to develop staff Community Trusts (The Seven Points) to develop staff skills, information given and services provided to pregnant skills, information given and services provided to pregnant and breastfeeding women and their families.and breastfeeding women and their families.

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UNICEF UK Baby Friendly InitiativeUNICEF UK Baby Friendly InitiativeThe Ten StepsThe Ten Steps 1. Policy – have a policy promoting support to breastfeeding 2. Staff training – train all staff in skills to support breastfeeding 3. Information for pregnant women – on breastfeeding skills and where to seek support 4. Initiation of breastfeeding – promote initiation of breastfeeding after birth via skin to skin contact and uninterrupted first feeds 5. Teaching skills – to mothers 6. Avoiding supplements – encouraging hand expression 7. Rooming-in – ensuring babies are kept with their mothers 8. Baby-led feeding – uninterrupted feeds, baby leads the way 9. Avoiding teats and dummies10. Support groups

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UNICEF UK Baby Friendly InitiativeUNICEF UK Baby Friendly InitiativeThe Seven PointsThe Seven Points1.Policy2.Staff training3.Information for pregnant women4.Supporting breastfeeding5.Appropriate introduction of other foods and drinks6.Welcoming atmosphere – provide a welcoming atmosphere in buildings 7.Ongoing support