BABY-FRIENDLY HOSPITAL INITIATIVE...FSlow, deep sucks with pauses FRapid shallow sucks FCheeks round when suckling FCheeks pulled in when suckling FBaby releases breast when finished

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2009

BABY-FRIENDLY HOSPITAL INITIATIVERevised, Updated and Expanded for Integrated Care

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Global Strategy for Infant and Young Child Feeding

The aim of the Global Strategy is to improve – through optimal feeding – the nutritional

status, growth and development, health, and thus the survival of infants and young children.

It supports exclusive breastfeeding for 6 months, with timely, adequate, safe and appropriate complementary feeding, while continuing breastfeeding for two years and beyond.

It also supports maternal nutrition, and social and community support.

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The aim of the Baby Friendly Hospital Initiative

To implement the Ten Steps to Successful Breastfeeding

and to end the distribution of free and low-cost

supplies of breastmilk substitutes to health facilities.

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Course Aims

The aim of this course is that every staff member will confidently

support mothers with early and exclusive breastfeeding,

and that this facility moves towards achieving Baby-friendly designation.

1/3


3/1

Orig

inal

illu

stra

tion

by J

enny

Cor

kery


Infant Feeding Recommendation for HIV-positive Women

Exclusive breastfeeding is recommended for HIV-infected mothers for the first six months of life

unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for

them and their infants before that time.

When replacement feeding is acceptable, feasible, affordable, sustainable and safe avoidance of all

breastfeeding by HIV-infected mothers is recommended.

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4/1

Orig

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by J

enny

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kery


The overall aim of the International Code of Marketing

of Breast-milk Substitutes is the safe and adequate nutrition

of all infants.

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Skin to Skin Contact and Early Breastfeeding

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Skin to Skin Contact and Early Breastfeeding

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First Skin to Skin Contact5/3

Dr N

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Parts of the Breast6/1

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Helping the Oxytocin Reflex 6/2

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What can you see?

Good attachment Poor attachment

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What can you see?

Good attachment Poor attachment

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Breastfeeding Positions7/1

In lineCloseSupported Facing

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BREASTFEED OBSERVATION AIDMother's name _______________________________ Date ___________________Baby's name _________________________________ Baby's age ______________Signs that breastfeeding is going well: Signs of possible difficulty:GENERALMother: Mother:

Mother looks healthy Mother looks ill or depressedMother relaxed and comfortable Mother looks tense and uncomfortableSigns of bonding between mother and baby No mother/baby eye contact

Baby: Baby:Baby looks healthy Baby looks sleepy or illBaby calm and relaxed Baby is restless or cryingBaby reaches or roots for breast if hungry Baby does not reach or root

BREASTSBreasts look healthy Breasts look red, swollen, or soreNo pain or discomfort Breast or nipple painfulBreast well supported with fingers away from nipple Breasts held with fingers on areola Nipples protractile Nipples flat, not protractileBABY’S POSITIONBaby’s head and body in line Baby’s neck and head twisted to feedBaby held close to mother’s body Baby not held closeBaby’s whole body supported Baby supported by head and neck onlyBaby approaches breast, nose to nipple Baby approaches breast, lower lip/chin to nipple

BABY’S ATTACHMENTMore areola seen above baby’s top lip More areola seen below bottom lipBaby’s mouth open wide Baby’s mouth not open wideLower lip turned outwards Lips pointing forward or turned inBaby’s chin touches breast Baby’s chin not touching breast

SUCKLINGSlow, deep sucks with pauses Rapid shallow sucksCheeks round when suckling Cheeks pulled in when sucklingBaby releases breast when finished Mother takes baby off the breast

Mother notices signs of oxytocin reflex No signs of oxytocin reflex noticedNotes:

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Assess a Breastfeed

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UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2009 ©U

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Wide Open Mouth

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Assess a Breastfeed

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Assess a Breastfeed

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8/1 9/1

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Case study9/2

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“Sleeping all the time”

“Refusing” the breast

3 stools in week

12% under birth weight

Bottle with honey and water twice yesterday

2 weeks old Healthy at birth Discharged Day 2

Case study

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Kangaroo Mother Care

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Kangaroo Mother Care

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Positioning a preterminfant

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Twins Grow Well on

Breastmilk

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DANCER Hand Position

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Chin Support 10/6

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Hand Expression

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©UNICEF 910164F


Cup Feeding 11/2

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Supplementer

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Dr R

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Dha

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Size and Shape

There are many different shapes and sizes of breast and nipple.

Babies can breastfeed from almost all of them.

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Full Breast

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Engorged Breast

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Mastitis12/4

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Sore Nipple12/5

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Sore Nipple

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Syringe method for inverted nipples12/7

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Candida on the nipple12/8

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Candida on the nipple12/9

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Tongue-tie 12/10

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Lactational Amenorrhea Method (LAM)13/1

Institute for Reproductive Health, Georgetown, Washington, DC

1. Have your menses returned?

2. Are you giving supplements or are there long periods without breastfeeding either day or night?

3. Is your baby more than six months old?

Ask the mother or advise her to ask herself these three questions:

There is only a 1-2% chance of pregnancy at this time.

YES

NO

NO

NO

YES

YES

When the answer to ANY one of these questions

becomes YESThe mother’s chance of pregnancy is increased.

For continued protection, and to achieve child

spacing, a complementary family planning method

needs to be used, and breastfeeding continue.


UNICEF/WHO/UNAIDS Infant Feeding Recommendation for

HIV-positive Women

Exclusive breastfeeding is recommended for HIV-infected mothers for the first six months of life

unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for

them and their infants before that time.

When replacement feeding is acceptable, feasible, affordable, sustainable and safe avoidance of all

breastfeeding by HIV-infected mothers is recommended.

13/2


14/1

Orig

inal

illu

stra

tion

by J

enny

Cor

kery


Course Aims

The aim of this course is that every staff member will confidently support

mothers to succeed with early and exclusive breastfeeding,and that this facility moves towards achieving Baby-Friendly designation.

15/1


Where are we now?

Developing a Plan:

Step One

15/2


Where do we want to be?

15/3Developing a Plan:

Step Two


Developing a Plan:Step Three

15/4

How will we get there?


How will we know if we are there?

Developing a Plan:Step Four

15/5


How will we sustain it?

15/6Developing a Plan:Step Five

Documents

BABY-FRIENDLY HOSPITAL INITIATIVE...FSlow, deep sucks with pauses FRapid shallow sucks FCheeks round when suckling FCheeks pulled in when suckling FBaby releases breast when finished