nutrition for health and development, world health organization baby friendly hospital initiative...

Nutrition for Health and Development, World Health Organization

Baby Friendly Hospital Initiativeand

Rules of Obstetricians & Midwives

omar


GOALS (Aims) OF BFHI

Transform hospitals and maternity wards to a place where breastfeeding carried out:

a. Exclusively

b. Successfully

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BFHI Rules of Obstetricians and Midwives

1. Course for Hospital Decision-makers

2. “20 hour” Course for Maternity Staff (health care staff)

3. Ten steps to successful breastfeeding

4. Hospital Self-appraisal & Monitoring

5. External Assessment & Reassessment

Materials for Initiation of BFHI

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Materials for Initiation of BFHI

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Health care staff ?

1.Obstetricians2.Midwifes3.Nurses in Antenatal ward.4.Maternity staff in Polyclinics.5.Pediatricians.6.Nurses in Neonatal and Pediatric departments.


I- During Pregnancy

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1. ↑ in size of breast2. ↑ weight of breast3. Hyper pigmentation4. ↑ size & mobility of nipple and areola5. Estrogen: Deposition of the fat : Lactiferous duct proliferation6. Progesterone: growth of lobules : Development of alveoli and it's

secretary cells.7. Colostrums from 16 weeks gestation.

Physiological changes of breast during pregnancy


I- During Pregnancy

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A. Antenatal Breast Care

1. At booking visit . History . Examination: size, abnormality,….2. With any complain3. History about breast each visit


I- During Pregnancy

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B. Antenatal Education

GroupsSingle


I- During Pregnancy

• Advantages and benefits of breastfeeding• Risks of artificial feeding• Mechanisms of lactation and suckling, Colostrum and milk• How to help mothers initiate and sustain breastfeeding

• How to assess a breastfeed• How to resolve breastfeeding difficulties• Hospital breastfeeding policies and practices• Focus on changing negative attitudes which set up barriers


I- During Pregnancy

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• Basic facts on HIV• Prevention of mother-to-child transmission of HIV

(PMTCT)• Voluntary testing and counselling (VCT) for HIV

and infant feeding counselling for HIV+ women• Antenatal education should not include group

education on formula preparation. • How to maintain privacy and confidentiality


II- Postnatal & After Delivery

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. Set with your patients

. Take history : Did she start breast feeding : Did she do as antenataly advised : Any problem with lactation : Any complain : Any thing she want to ask about. Exam both Breasts : Nipple and areola : signs of infection : signs of engorgement. Explain to her mechanism of lactation and suckling. Advices your patient



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• Early initiation• Show mothers how to breastfeed and how to maintain

lactation, (even if they should be separated from their infants).• Importance of rooming-in (if new concept)• Importance of feeding on demand• Importance of exclusive breastfeeding• How to assure enough breast milk• Risks of artificial feeding and use of bottles and pacifiers

(soothers, teats, nipples, etc.)



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1. Early initiation : Help mothers initiate breastfeeding within a half

hour of birth: . Vaginal delivery : Babies breastfed immediately after

birth . Caesarean Section: a. General anaesthesia: Babies breastfed within an hour

of mother able to respond. b. Regional anaesthesia


• : How e arly initiation?• . Keep mother and baby together• . Place baby on mother’s chest• . Let baby start suckling when ready• . Do not hurry or interrupt the process• . Delay non-urgent medical routines for

at least one hour.



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: Why early initiation?

. Increases duration of breastfeeding . Allows skin-to-skin contact for warmth and colonization of baby with maternal organisms (Normal flora) . Provides colostrum as the baby’s first immunization . Takes advantage of the first hour of alertness . Babies learn to suckle more effectively . Improved developmental outcomes



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Contrary to popular belief, attaching the baby on the breast is not an ability with which a

mother is [born…]; rather it is a learned skill which she must acquire by observation and

experience.

From: Woolridge M. The “anatomy” of infant sucking. Midwifery, 1986, 2:164-171.

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



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. One of the causes let mothers stop lactation is failure to know correct position for breastfeeding.. That is why, Teaching of mothers about right positions is one of the 10 steps for successful breastfeeding. (as advised by WHO). This is the Duty of the Obstetrician and midwife.



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األم وال:-أ وضع : إلنجاح - ضروريا أمرا والمريح الصحيح األم وضع يعتبر

الطبيعية :الرضاعةإلى - ظهرك تسندي أن بحيث مريح بوضع اجلسي

وسادة أو كرسي أو الحائطومرتاحة - مسترخية تكوني ان للطفل ثانيا :-. يجب بالنسبة :

من ذراعيك بين حضنك في طفلك ضعيبحيث الرأس مؤخرة وليس الكتف مؤخرةالطفل رقبة جعل مع كله جسمه تسندي

الخلف إلى قليال منحنية أو .مستقيمةالثدي مواجهة في كله الطفل جسم اجعليتالمس بحيث فقط رأسه وليس األم وجسم

األم بطن الطفل .بطن

Nutrition for Health and Development, World Health Organization 16

طفلك يفتح وعندما طفلك فم تلمس ثديك حلمة اجعليوهالتها الحلمة ضعي لسانه. فمه وفوق فمه في

مع جدا متسع والفم الثدي يالمس الطفل ذقن اجعلياألكبر الجزء ليكون للخارج منحية السفلى الشفة جعل

الطفل فم فوق الثدي هالة .من

والفعال ثالثا :- السليم للمص بالنسبة :وعميق بطيء الطفل مص يكون أن يجب

تسمعيها أن ال المص عملية تري أن ويجب .فقط



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Good attachmentللثدي صحيح إمساك

Poor attachment

للثدي صحيح غير إمساك



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أو بنفسه الحلمة يخرج طفلك اتركي الرضعة، نهاية فيفم في الصغير إصبعك بإدخال الحلمة إخراج حاولي

.الطفل

علي فراشه في وضعيه طفلك جشئي الرضاعة إكماله بعدللنوم ظهره أو األيمن .جنبه

على مستلقية وأنت طفلك ترضعي أن يمكنك رغبت إذاالليل أثناء خاصة .جانبك

ابدي ولكن بالتبادل الثديين من طفلك ارضعي مرة كل فيالسابقة الرضعة به بدأت الذي غير .بالثدي



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3. Importance of Rooming-in (if new concept)

. A hospital arrangement where a mother/baby pair stay in the same

room 24 h, allowing unlimited contact between mother and infant.

. Rooming-in Why?

a. Reduces costsb. Requires minimal equipmentc. Relieve nursing staffd. Reduces infectione. Helps establish and maintain breastfeeding



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4. How to assure enough breast milk:

Milk removal stimulates milk production.

The amount of breast milk removed at each feed determines the rate

of milk production in the next few hours.

Milk removal must be continued during separation to maintain supply.



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5. Importance of exclusive breastfeeding

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



Acceptable medical reasons for supplementation or replacement feeding

. Severe illness: if breastfeeding difficult to achieve

. Drugs: anti-metabolites, radioactive iodine, and some anti-thyroid drugs.. Social circumstances: as hard drug use (to be decided on a case-by- case basis), absence of mother.. HIV positive mother (should be counselled about decision). Infectious conditions: as herpes simplex lesions on the breast

A. Maternal conditions



Acceptable medical reasons for supplementation or replacement feeding

. Very low birth weight (<1500g) or born before 32 wks gestations age – enteral feed should be withheld first 24 hours. Inborn errors of metabolism such as galactosemia, PKU, and maple syrup urine disease. Sick infants in intensive care. Severe dehydration and malnutrition

B. Infant conditions


6. Importance of feeding on demand

. Mothers taught to recognize cues of babies hungry?. Mothers encouraged to feed as often and as long as babies want?. Breastfeeding mothers advised for waking babies that sleep too long or if their breasts overfull.

Bbreastfeeding whenever the baby or mother wants, with no restrictions on the length or frequency of feeds.


6. Importance of feeding on demand

. On demand, unrestricted breastfeeding Why?

. Earlier passage of meconium

. Lower maximal weight loss

. Breast-milk flow established sooner

. Larger volume of milk intake on day 3 (↓ Risk of Engorgement). Less incidence of jaundice


7. Risks of artificial feeding and use of bottles and pacifiers (soothers, teats, nipples, etc.)

. Decreased frequency or effectiveness of suckling

. Decreased amount of milk removed from breasts

. Delayed milk production or reduced milk supply (↓ Prolactin). Some infants have difficulty attaching to breast if formula given by bottle


7. Risks of artificial feeding and use of bottles and pacifiers (soothers, teats, nipples, etc.)

Only then if indicated

milk expression . Cup . Spoon . Syringe

Retracted nipple, Fissure, Painful Suckling


7. Hygiene:

. Clean breast before and after each breastfeeding

. Clean hands before and after each breastfeeding

. No bath, only shower

8. Family planning: lactation can be effective if Breast feeding is . Exclusive . Short interval . Before sleep


BFHIRules of Obstetricians and Midwives


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9. When to come back?

. Usually we advice patient to come back for follow up and reevaluation in 4 to 6 weeks.

. Whenever she or her baby have problem a. Engorgement b. Painful suckling c. Changes in breast

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