maternal and child separation

8/14/2019 Maternal and Child Separation

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Maternal and Infant

Separation


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Assess Motivation

Discuss plans/reasons to continueDiscuss plans/reasons to continue

lactationlactation

Assess activities of daily livingAssess activities of daily living

Individual plan workable for eachIndividual plan workable for each

mothermother


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When mother-infant separation isWhen mother-infant separation is

necessary,necessary,

EARLY INTERVENTION IS IMPORTANT.EARLY INTERVENTION IS IMPORTANT.

Delays in expression :Delays in expression :

Lead to engorgementLead to engorgement

Cause irreversible involution ofCause irreversible involution of

the glandular tissue which canthe glandular tissue which canlead to a low supplylead to a low supply

Is associated with higher bacterialIs associated with higher bacterial

counts in the milkcounts in the milk


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Most common problems encounteredMost common problems encountered

by mothers separated from theirby mothers separated from their

infantsinfants

Inhibited milk ejection reflexInhibited milk ejection reflexLow milk supplyLow milk supply


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Methods to enhance Milk EjectionMethods to enhance Milk Ejection

ReflexReflex

Warm compressesWarm compresses

Gentle massageGentle massagePumping in pleasantPumping in pleasant

surroundingssurroundings

Looking at picture of babyLooking at picture of baby


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Methods to enhance MilkMethods to enhance Milk

Ejection ReflexEjection Reflex

Relaxation TechniquesRelaxation Techniques

LaMaze breathingLaMaze breathing Listening to musicListening to music

Imagining the milk flowingImagining the milk flowing

ReadingReading Talking with a friendTalking with a friend


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Milk Supply reducersMilk Supply reducers

Skipped pumping sessionsSkipped pumping sessions

Poor emptying ( ineffective pump)Poor emptying ( ineffective pump)

FatigueFatigue

Tension, worsening of babysTension, worsening of babys

conditioncondition

Illness, return to work or increasedIllness, return to work or increased

commitments inside or outside thecommitments inside or outside the

home, some medications and drugshome, some medications and drugs

Quick weight loss in momQuick weight loss in mom


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Milk SupplyMilk Supply EnhancersEnhancers

Frequent pumping sessionsFrequent pumping sessions

Complete emptying at each sessionComplete emptying at each session Rest and relaxationRest and relaxation

Improvement in babys conditionImprovement in babys condition

A nutritious diet of about 500 caloriesA nutritious diet of about 500 caloriesper day above pre-pregnantper day above pre-pregnant

requirementsrequirements


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SEPARATION OF MOTHER &SEPARATION OF MOTHER &

INFANTINFANT

I. Reason for Separation

Premature /sick hospitalizedinfant

Working mother /studying

Hospitalized mother


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Maintaining Milk SupplyMaintaining Milk Supply

A. Ideally =A. Ideally =

mother andmother and

child shouldchild should

stay togetherstay together


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B. If Mother is Separated fromB. If Mother is Separated from

InfantInfant

Encourage mother to visit /touch /care of infant.

Teach method of milk expression.

Emphasize hand washing and

hygiene.

Initiate expression before 12 hourspostpartum.


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If Mother is Separated from Infant

1.1. Frequent expression =Frequent expression =

> 8 times /day> 8 times /day

> 5 hours interval> 5 hours interval

Give take home handouts forGive take home handouts for

milk expression and storage.milk expression and storage.

Provide clean containers.Provide clean containers.


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C. If Mother is WorkingC. If Mother is Working

Plan ahead of timePlan ahead of time Individualize casesIndividualize cases

Flexi hoursFlexi hours

Employers supportEmployers support CrechesCreches

Express milk during office hoursExpress milk during office hours

Breastfeed just before leavingBreastfeed just before leaving Breastfeed on returning homeBreastfeed on returning home

Breastfeed more often at night andBreastfeed more often at night and

exclusively on weekendsexclusively on weekends


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MINI MILK BANKING

pasteurizerasteurizer

HUMAN

MIILK BANKING


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MILK STORAGEMILK STORAGE

Collection

Storage of milk

Distribution

SupportSupportEncouragement of successfulEncouragement of successful

PromotionPromotion lactationlactation


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WHENWHEN

As often as possibleAs often as possible

At workAt work

SOURCE OFSOURCE OF

BREASTMILKBREASTMILK

Own motherOwn motherWet nurseWet nurse

Other mothers pasteurizationOther mothers pasteurization


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HOWHOW

manualmanual

BreastmilkBreastmilk

expression pumpexpression pump

WHEREWHERE

Plastic containerPlastic container


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HOW TO

GIVE

Cup feeding

Dropper feeding


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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


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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 orfrozen milk.

Label container

- Bed # __________ Name ____________

- Date __________ Time ____________

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


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STORAGE GUIDELINES:

4 hours

24 hours

3 months

8 hours

48 hours

3 months

1 year

Room Temperature

Refrigerator

Freezer (2 door ref)

Deep Freezer (- 20)

Preterm /Sick

Infants

Term InfantMethod of Storage

Put at the back of the fridge NOT IN THE DOORPut at the back of the fridge NOT IN THE DOOR


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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


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WHEN REFRIGERATOR IS NOTWHEN REFRIGERATOR IS NOT

AVAILABLEAVAILABLE

In temperature climate ExpressedIn temperature climate Expressed

Breastmilk is safe in a clean containerBreastmilk is safe in a clean container

at room temperature for 8 10 hoursat room temperature for 8 10 hours

Use evaporative cooling container.Use evaporative cooling container.

Water soaked earthen jar, cover withWater soaked earthen jar, cover withcloth that reaches down the water.cloth that reaches down the water.

Place in coolest part of the house.Place in coolest part of the house.


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METHODS OF COLLECTIONMETHODS OF COLLECTION

Manual expressionManual expression

Simple MethodSimple Method

Position thumb above areola,Position thumb above areola,forefingers belowforefingers below

Push . . . Press . . . . Release -Push . . . Press . . . . Release -

Push . . Press . . . ReleasePush . . Press . . . Release Massage all around, avoidingMassage all around, avoiding

sliding of the fingerssliding of the fingers


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Manual Expression


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Stimulating milk flow

(let -down or oxytocin reflex)

Breast or back massage

Nipple massage

Warm bath / shower Photo of baby

Babys clothing / smell

music

How to rub a mothers back


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Practice

>Rolling of fingers on the breast

> Breastmilk expression on yourself


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Milk Collection (colostrum)Milk Collection (colostrum)


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THE WARM BOTTLE METHOD OFTHE WARM BOTTLE METHOD OF

EXPRESSING MILKEXPRESSING MILK

a. Putting hot water into a bottle.

b. Pouring the hot water out.

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


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Kaneson Pumpaneson Pump Lloyd B Pumployd B Pump

Elec tr ic Pumplec tr ic Pump


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QUALIFICATION OF Breastmilk DONOR


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Had normal pregnancy and delivery.Had normal pregnancy and delivery.

Is serogically negative for syphilis and hepa-Is serogically negative for syphilis and hepa-b surface antigen.b surface antigen.

Has no infection acute or chronic.Has no infection acute or chronic.

Not taking medications, smoking or usingNot taking medications, smoking or usingexcessive alcohol.excessive alcohol.

Is capable of carrying out sterile technique orIs capable of carrying out sterile technique orneat personally.neat personally.

If donating for other infant, own child isIf donating for other infant, own child ishealthy without jaundice.healthy without jaundice.

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


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The lower the temperature the longer theThe lower the temperature the longer thestorage!storage!

3 days in a refrigerator running below3 days in a refrigerator running below

10C.10C.

4 and 8 days in a refrigerator running4 and 8 days in a refrigerator running

between 0 and 4C.between 0 and 4C. If the temperature rises above 4C duringIf the temperature rises above 4C during

this time the milk should be usedthis time the milk should be used

within 8 hours or thrown awaywithin 8 hours or thrown away

Saf e St ora geaf e St ora ge (Sandra Lang 2007)


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If a refrigerator running at 4C is notIf a refrigerator running at 4C is notavailable - a cool bag with frozen iceavailable - a cool bag with frozen ice

packs (changed every 24 hours) can bepacks (changed every 24 hours) can be

used. The milk should beused. The milk should be protectedprotectedfrom freezingfrom freezing

If milk is to be kept for longerIf milk is to be kept for longerthan 8than 8

days it should be frozendays it should be frozen as soon afteras soon after

expression as possibleexpression as possible

Safe Stor ageafe Stor age


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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 beingstored.


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Using Stored Frozen Breastmilk

Defrost frozen breastmilk in a refrigeratoror 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


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IF the milk smells SOUR - DO NOTIF the milk smells SOUR - DO NOT

USEUSE

When stored the milk will separate,When stored the milk will separate,

gently shake the milk to mix it.gently shake the milk to mix it.

Give expressed breastmilk byGive expressed breastmilk by cup orcup or

spoon or breastfeedingspoon or breastfeeding supplementersupplementernot a bottle if the baby is less than 7not a bottle if the baby is less than 7

weeks old or if the bottle cannot beweeks old or if the bottle cannot be

cleaned properly.cleaned properly.

Using Stored Frozen BreastmilkUsing Stored Frozen Breastmilk


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Safe Storage of Breastmilk in the HomeSafe Storage of Breastmilk in the Home

Use immediatelyUse immediatelyDefrosted in fridgeDefrosted in fridge

12 hours12 hoursDefrosted in fridgeDefrosted in fridge

Previously frozen milkPreviously frozen milk6 months6 monthsFreezer: -18C or lowerFreezer: -18C or lower

If temperature goes above 4C after 3 days use within 6If temperature goes above 4C after 3 days use within 6hours or throw awayhours or throw away

8 days8 daysFridge: 0 to 4CFridge: 0 to 4C

3 days3 daysFridge: 5 to 10CFridge: 5 to 10C

6 hours6 hoursRoom:Room:

Fresh breastmilk kept at homeFresh breastmilk kept at home

Maximum timeMaximum timePlacePlace


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maternal and child separation

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