10 Steps to Successful Breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
Importance of breastfeeding to mother:
 -protects against breast cancer and hip fracture in later life
 -helps mother form close relationship with the baby
 -help prevent becoming pregnant soon after baby's birth (LAM / Lactation Amenorrhea Method:
exclusively breastfeeding for the first 6 months)
 -help prevent developing anemia and to retain fat deposited during pregnancy, which may result in
later obesity
Importance of breastfeeding to baby:
 -protects against many illnesses such as chest infections (pneumonia), diarrhea, ear infections
 -helps baby to grow and develop well
 -all the baby need for the first 6 months
 -underweight and not grow well (poor)
 -overweight and to have later heart problems (rich)
Benefits of breastfeeding to the family:
ECONOMICAL
 Readily available / no preparation
 Simple / no equipment needed
 Reduced absences of parents from work
 No lost of income
4. Help mothers initiate breastfeeding within a half-hour of birth.
#4 to focus on the importance of skin-to-skin contact and watching for the infant readiness, this step is
interpreted as:
- Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour
and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.
Importance of skin-to-skin contact immediately after birth (90 minutes):
 Calms the mother and baby
 Keeps baby warm
 Assist in metabolic adaptation and blood glucose stabilization in the baby
 Reduces baby crying and stress
 Enables colonization of baby’s gut with mother’s normal body bacteria
 Facilitates bonding
 Allows the baby to find the breast and self-attach
5. Show mothers how to breastfed, and how to maintain lactation even if they should've separated from
their infants.
Proper attachment
 the baby's mouth is wide open
 the lower lip is turned out
 the chin is touching the breast
 more areole is visible above the baby's mouth than below
Proper position
 in line with the ear, shoulder and hip in a straight line
 close to the mother's body
 supported at the head, shoulder and the whole body
 facing the breast with the baby's nose to the nipple

Manual expression
It may be useful to know how to hand express:
 For breast comfort, such as to relieve engorgement or a blocked duct or to rub a few drops of hind milk
on the nipple area to soothe if the nipple is tender.
 To encourage a baby to breastfeed. Express milk on to the nipple so that the baby can smell and taste
it directly into the baby’s mouth if the baby has a weak suck, or to soften the areola of a full breast so
that the baby can attach.
 To keep up the milk production when the baby is not suckling or to increase milk production. The more
milk you remove, the more milk is produced.
 To obtain milk if the baby is unable to breastfeed, or if the baby is small and tires quickly, when mother
and baby are separated.
 To pasteurize the milk for the baby, as an option if the mother is HIV-positive.
 The key steps in order to hand express are:
- Encourage the milk to flow.
- Find the milk ducts.
- Compress the breast over the ducts.
 - Repeat in all parts of the breast.

Cup feeding
- for babies who are able to swallow but cannot (yet) suckle well enough to feed themselves fully from the
breast.
 Difficulty attaching
 Attach and suckle for short time
 Tires easily
 30-32 weeks gestation
 DO NOT POUR the milk into the baby's mouth. Just hold the cup to the baby’s lips and let him or her take it
himself or herself.

Breastmilk Storagre:
Fresh milk = 25 – 37˚C 4 hours
= 15-25˚C 8 hours
= Below 15˚C 24 hours
Refrigerated = 2-4˚C 8 days
Freezer = 1 door ref 2 weeks
= 2 door ref 3 months
(separate)
= Deep freezer 6 months

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

7. Practice rooming-in, allow mothers and infants to stay together 24 hours a day.
Benefits of rooming-in:
 Babies sleep better, cry less
 Continuation of sleep/awake rhythm developed before birth,
 BF is well established, continues longer, baby gains weight quickly,
 Feeding on cues is easier, develops good milk supply,
 Mother becomes confident in caring,
 Baby exposed to fewer infection,
 Promotes bonding

8. Encourage breastfeeding per demand.

Pre-feeding behaviors or cues:
 Taking a short rest in an alert state
 Increases eye movements or opens eyes, arches his or her back.
 Bringing hands to his mouth and making sucking motions, sounds, and touching the nipple with the
hand
 Focusing on areola
 Moving towards breast and rooting
 Finding the nipple and attaching with a wide open mouth
 Sore nipples are the result of poor attachment, not the result of feeding too often.

9. Give no artificial tears or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from
the hospital or clinic.
What practices may help a woman to initiate breastfeeding soon after birth?
 emotional support during labor
 attention to the effects of pain medication on the baby
 offering light foods and fluids during early labor
 freedom of movement during labor
 avoidance of unnecessary CS
 early mother-baby contact (skin-to-skin contact)
 facilitating the first feed

What practices may hinder early mother and baby contact?

 requiring the mother to lie in bed during labor and birth
 lack of support
 withholding foods and fluids during early labor
 pain medications that sedate mother or baby, episiotomy, IV lines, continues electronic fetal monitoring and
other IV used as routine without medical reasons
 wrapping the baby tightly afterbirth
 separating the mother and baby after birth

Role of the health worker during initiation of breastfeeding:

 provide time and a calm atmosphere
 help the mother to find a comfortable position
 point out positive behaviors of the baby such as alertness and rooting
 build the mother's confidence
 avoid rushing the baby to the breast or pushing the breast into the baby's mouth

Hospital practices that can help breastfeeding to go well

 have a companion with you during labor, can help to be more comfortable and in control
 avoid labor and birth interventions, such as sedating pain relief or CS unless medically indicated
 skin-to-skin contact immediately after birth (90 minutes)
 rooming-in or bedding-in so that baby is easy to fed
 learn feeding signs so that feeding is baby-led rather than to a schedule
 frequent feeding helps develop a good milk supply
 breastfeeding exclusively with no supplements, bottles or artificial teats

What are the practices that can help breastfeeding go well?

 TEACHING how to position and attach the baby correctly.
 GIVING support when needed.

UNICEF/WHO Infant Feeding Recommendation for HIV-positive Women

- When replacement feeding is acceptable, feasible, affordable, sustainable, and safe (AFASS) avoidance of all
breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during
the first months of life and should be then discontinued as soon as it is feasible.
- however, it’s still the mothers informed choice if she wants to breastfed her baby after proper counseling about the
pros and cons of breastfeeding.
- Each woman who is HIV-positive needs a one-to-one discussion with a trained person to help her to decide the best
way to feed her child in her individual situation and referred to ITRMC for further management.
NOT routinely done in the DR: (X)
 IV insertion
 Catheterization
 Episiotomy
 Fundal push

E.O.51 : PHILIPPINE CODE OF MARKETING OF BREAST-MILK SUBSTITUTES

- The overall aim is the safe and adequate nutrition of all infants by:
 Protecting, promoting and supporting breastfeeding.
 Ensuring that breast-milk substitutes are used properly when they are necessary.
 Providing adequate information about infant feeding.
 Prohibiting the advertisement or any other form of promotion of breast-milk substitutes such as free samples
and supplies.

Breast engorgement:
Causes:
- Delayed initiation
- Poor attachment
 - Infrequent feeding
Management:
- Check attachment
- Express between feeds
- Encourage frequent feeds
- Apply warm compress just before feeds
- Massage
- Help mother to be comfortable
- Cold compress may lessen pain between feeds

Sore nipple:
Causes:
- Poor attachment
- Secondary to engorgement
- Candida that can be passed from the baby’s mouth to the nipples
- The infant’s tongue-tie (short frenulum)
Management:
- Reassurance
- Improve attachment & positioning
- Treat source of irritation: Candida / Short Frenulum
- Comfort measure

Dangers from the use of the Breast-milk substitutes:

Formula maybe contaminated thru manufacturing
Formula may contain unsafe ingredient or lack of vital ingredient
Contaminated water for washing or mixing
Errors in mixing (diluted or concentrated)
Formula maybe given to settle a crying baby which can lead to overweight