ten steps to breast feeding and fetal circulation
TRANSCRIPT
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
1/42
Ten Steps to
SuccessfulBreastfeeding
Prepared by:IBALI, JarliequeenA.
BSN3G Group29
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
2/42
STEP 1: Breastfeeding policy
Have a written breastfeeding policy that is routinely
communicated to all health care staff.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
3/42
The health-care facility should
Have a breastfeeding policy that covers all Ten Steps to Successful Breastfeeding and
prohibits the display or distribution of materials that promote breast milk substitutes,
feeding bottles, teats and dummies.
Ensure that the policy is communicated to pregnant women and parents; they should be
able to access a copy of the full policy if they wish to do so.
Audit compliance with the policy at least every year.
Assessment
A breastfeeding policy that covers all the Baby Friendly best practice standards.
A written description of the mechanism for ensuring that the policy is communicated to
pregnant women and parents in an appropriate and effective manner.
The mechanism for auditing the breastfeeding policy.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
4/42
STEP 2: Staff Training
Train all health-care staff in the skillsnecessary to implement the breastfeeding policy
Standards
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
5/42
The health-care facility should
All new staff should be orientated to the breastfeeding policy within their first week of employment and
then fully trained to implement the breastfeeding policy according to their role within six months.
Written curricula that cover the Baby Friendly best practice standards should be available for all staff
training.
Breastfeeding training should be mandatory for all staff, and accurate records of attendance should be kept.
Staff should be able to answer questions on basic breastfeeding management correctly.
Assessment
A written description of the mechanism for orientating new staff to the breastfeeding policy.
The written curricula for all staff training.
A written description of the mechanism for allocating staff to attend training and for recording attendance at
training.
Records to confirm that all new staff has been orientated to the policy and that all staff has received
training.
Staff to answer correctly a range of questions on basic breastfeeding management.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
6/42
STEP 3: Antenatal information
Inform all pregnant women about the benefits and management of
breastfeeding Standards
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
7/42
The health-care facility should
Before 34 weeks of pregnancy all pregnant women should receive full and clear information about the health
benefits of breastfeeding and the importance of:
- keeping their baby close
- avoiding supplements and teats
- feeding when their baby shows signs of wanting to feed
- effective positioning and attachment
- skin contact after delivery.
All written materials intended for pregnant women should be accurate and effective, and free from the promotionof breast milk substitutes, bottles, teats and dummies.
Antenatal parent education classes (where these are provided) should provide good quality and effective
information to supplement that provided during one to one discussion. Routine antenatal group education should
not include instruction in how to prepare a bottle of infant formula.
Assessment
The written minimum standard of information provided to all pregnant women.
A description of how, where and when all pregnant women are to be informed of the benefits and management ofbreastfeeding.
An outline of antenatal parent education (where this exists)
Written information intended for pregnant women must be accurate and effective, and free from the advertising
of breast milk substitutes, bottles, teats and dummies.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
8/42
STEP 4: Initiating breastfeeding
Help mothers initiate breastfeeding soon after birth
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
9/42
Standards
All mothers should be given their baby to hold with skin-to-skin contact in an
unhurried environment for at least one hour or until after the first breastfeed.
All mothers should be offered help to initiate a first breastfeed when their baby
shows signs of readiness to feed.Assessment
New mothers to confirm that they were given the opportunity to hold their baby in
skin-to-skin contact as soon as possible after birth.
New mothers to confirm that they were able to hold their baby in skin contact for at
least one hour or until after the first breastfeed.
New mothers to confirm that they were offered help with a first breastfeed.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
10/42
STEP 5: Teaching breastfeeding
Show mothers how to breastfeed and how to maintain lactation, even if
they should be separated from their infants
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
11/42
Standards
All breastfeeding mothers should be offered help with a further breastfeed within six hours of
delivery. (NB: the baby does not have to breastfeed again within six hours, but an offer of help
should be made.)
All breastfeeding mothers should be shown how to effectively position and attach their baby for
breastfeeding.
All breastfeeding mothers should be shown how to express their breast milk by hand.
All breastfeeding mothers should receive information, both verbally and in writing, prior to transferhome about how to recognize effective feeding. In addition, a breastfeeding assessment will be
carried out at around day 5.
All mothers with a baby on the neonatal unit should be offered help to initiate lactation as soon as
possible after delivery, taught how to express by hand and by pump, and advised to do this at least
8 times in 24 hours, including at night.
All written materials intended for new mothers should be accurate and effective, and free from the
promotion of breast milk substitutes, bottles, teats and dummies. All health-care staff with primary responsibility for supporting breastfeeding mothers should have
the necessary skills to teach mothers how to position and attach their baby for breastfeeding and
how to hand express breast milk.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
12/42
Assessment
The method used for recording whether breastfeeding mothers have been given all relevant support and information.
The mechanism for ensuring that all new breastfeeding mothers receive information, both verbally and in writing about
how to recognize effective feeding.
The mechanism for ensuring that a feeding assessment is carried out on or around day 5.
The training curriculum for staff with primary responsibility for supporting breastfeeding mothers. This should show how
these staff is educated to acquire the skills needed to teach mothers to position and attach their babies for breastfeeding
and to hand express breast milk.
Written information for new mothers must be accurate and effective, and free from advertising of breast milk substitutes,
bottles, teats and dummies.Staff with primary responsibility for supporting breastfeeding mothers to demonstrate correctly how they would teach a
mother to position and attach her baby for breastfeeding and to hand express breast milk.
Breastfeeding mothers to confirm that they have:
- been offered further help with breastfeeding within six hours of delivery
- been shown how to position and attach their baby effectively for breastfeeding
- been shown how to hand express breast milk
- been given information, both verbal and in writing about how to recognize effective feeding
- had a breastfeeding assessment with a midwife or other member of staff.
Mothers with a baby on the neonatal unit to confirm that they have been:
- offered help to initiate lactation as soon as possible after delivery
- shown how to express breast milk by hand and by pump
- advised to express at least 8 times in 24 hours including at night.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
13/42
STEP 6: Avoid supplementation
Give newborn infants no food or drink other than breast milk, unless
medically indicated Standards
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
14/42
Standard
No food or drink other than breast milk should be given to breastfed babies unless:
- there is an acceptable clinical reason, the baby is unable to breastfeed and there is no/insufficient breast
milk available
- the mother has made a fully informed choice to feed her baby other than from the breast.
No promotion for infant food or drink other than breast milk should be displayed or distributed to mothers
or staff in the facility.Assessment
The head of service to provide written confirmation that there is no promotion of infant food or drink other
than breast milk allowed in the health-care facility.
Hypoglycemia guidelines and reluctant feeder guidelines to be provided. These guidelines to be evidence
based, safe and protective of exclusive breastfeeding.
Breastfeeding mothers to confirm that their baby was given no food or drink other than breast milk unless
this was clinically indicated or the result of a fully informed maternal choice. All policies and guidelines underpin good practice.
No promotion of infant food or drink other than breast milk to be found anywhere in the un
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
15/42
STEP 7: Practice rooming-in
Practice rooming-in: allow mothers and infants to remain together 24
hours a day
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
16/42
Standard
All mothers should be enabled to stay with their baby 24 hours a day.
Separation should only occur for acceptable clinical reasons or as a
result of a fully informed choice by the mother.
Assessment
All mothers to confirm that they have been able to stay with their baby
24 hours a day and that separation has only occurred for acceptable
clinical reasons.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
17/42
STEP 8: Encourage breastfeeding on demand
Encourage breastfeeding on demand
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
18/42
Standards
There should be no restrictions on the frequency or length of
breastfeeds.
Mothers should be encouraged to breastfeed on demand unless regular
feeds are required for acceptable clinical reasons.
Assessment
Breastfeeding mothers to confirm that no unnecessary restrictions
have been placed on the frequency or lengths of breastfeeds and those
they have been advised to observe for feeding cues.
Breastfeeding mothers to confirm that they have been encouraged tofeed on demand.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
19/42
STEP 9: No artificial teats or dummies
No artificial teats or dummies
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
20/42
Standard
No teats or dummies to be given to breastfeeding infants during the
establishment of breastfeeding.
It remains a strong recommendation that dummies and teats are used
with caution in the neonatal unit setting particularly when the baby islearning to breastfeed. This standard will not, however, be assessed
formally as part of the Baby Friendly assessment process.
Assessment
Breastfeeding mothers to confirm that their baby has not been given a
teat or dummy except in cases where the mother has made a fullyinformed choice.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
21/42
STEP 10: Support groups
Identify sources of national and local support for breastfeeding andensure that mothers know how to access these prior to discharge from
hospital
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
22/42
Standard
All breastfeeding mothers to be informed of both professional and
voluntary support available to them in the community, including contact
details of community midwives, voluntary counselors and any
breastfeeding support groups.Assessment
The written information given to mothers about the breastfeeding support
available after discharge from hospital.
Breastfeeding mothers to confirm that they have been informed of how to
contact both professional and voluntary help with breastfeeding afterdischarge from hospital.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
23/42
Placenta
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
24/42
Placenta
The wordplacenta comes from the Latin forcake.
The placenta is an organ that connects the developing fetus to theuterine wall to allow nutrient uptake, waste elimination, and gas exchange
via the mother's blood supply. The placenta develops from the same sperm
and egg cells that form the fetus, and functions as a fetomaternal organ with
two components, the fetal part (Chorion frondosum), and the maternal part
(Decidua basalis).
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
25/42
StructureIn humans, the placenta averages 22 cm (9 inch) in
length and 22.5 cm (0.81 inch) in thickness (greatest
thickness at the center and become thinner peripherally). It
typically weighs approximately 500 grams (1 lb). It has a
dark reddish-blue or maroon color. It connects to the fetus byan umbilical cord of approximately 5560 cm (2224 inch) in
length that contains two arteries and one vein. The umbilical
cord inserts into the chorionic plate (has an eccentric
attachment). Vessels branch out over the surface of the
placenta and further divide to form a network covered by a
thin layer of cells. This results in the formation of villous tree
structures. On the maternal side, these villous tree structuresare grouped into lobules called cotyledons. In humans the
placenta usually has a disc shape, but size varies vastly
between different mammalian species.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
26/42
DevelopmentalThe placenta begins to develop upon implantation
of the blastocyst into the maternal endometrium. The
outer layer of the blastocyst becomes the
trophoblast which forms the outer layer of the placenta.
This outer layer is divided into two further layers: the
underlying cytotrophoblast layer and the overlying
syncytiotrophoblast layer. The syncytiotrophoblast is a
multinucleate continuous cell layer which covers the
surface of the placenta. It forms as a result of
differentiation and fusion of the underlying
cytotrophoblast cells, a process which continues
throughout placental development. The
syncytiotrophoblast (otherwise known as syncytium),
thereby contributes to the barrier function of the placenta.
The placenta grows throughout pregnancy.Development of the maternal blood supply to the placenta
is suggested to be complete by the end of the first
trimester of pregnancy (approximately 1213 weeks
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
27/42
Function1.Nutrition and immunity
The perfusion of the intervillous spaces of the placenta with maternal blood allows the transfer of nutrients and
oxygen from the mother to the fetus and the transfer of waste products and carbon dioxide back from the fetus to the mother.
Nutrient transfer to the fetus is both actively and passively mediated by proteins called nutrient transporters that are expressed
within
2. Endocrine function
In humans, aside from serving as the conduit for oxygen and nutrients for fetus, placenta secretes hormone that is
importantduring pregnancy.
3. Human Chorionic Gonadotropin (hCG)
The first placental hormone produced is hCG, which can be found in maternal blood and urine as early as the first
missed menstrual period (shortly after implantation has occurred) through about the 100th day of pregnancy. This is the
hormone analyzed by pregnancy test; a false-negative result from a pregnancy test may be obtained before or after this
period. Women's blood serum will be completely negative for hCG by one to two weeks after birth. hCG testing is proof that
all placental tissue is delivered. hCG is only present during pregnancy because it is secreted by the placenta, which of course
is present only during pregnancy. hCG also ensures that the corpus luteum continue to secrete progesterone and estrogen.
Progesterone is very important during pregnancy because when its secretion decreases, endometrial lining will slough off and
pregnancywill be lost. hCG suppresses the maternal immunologic responseso that placenta is not rejected.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
28/42
Function4. Human Placental Lactogen (hPL[Human Chorionic Somatomammotropin])
This hormone is lactogenic and growth-promoting properties. It promotes mammary gland growth in preparation for
lactation in the mother. It also regulates maternal glucose, protein, fat levels so that this is always available to the fetus.
5. Estrogen
It is referred to as the "hormone of woman" because it influences the female appearance. It contributes to thewoman's mammary gland development in preparation for lactation and stimulates uterine growth to accommodate growing
fetus.
6. Progesterone
This is referred to as the "hormone of mothers" because it is necessary to maintain endometrial lining of the uterus
during pregnancy. This hormone prevents preterm labor by reducing myometrial contraction. This hormone is high during
pregnancy.
7. Other functions
The placenta also provides a reservoir of blood for the fetus, delivering blood to it in case of hypotension and vice
versa, comparable to a capacitor.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
29/42
PlacentalAbnormalities
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
30/42
1. Placenta PreviaPlacenta previa is defined as implantation of the placenta in the lower uterine
segment in advance of the fetal presenting part. The placenta either totally or
partially lies within the lower uterine segment. Placenta previa complicates
approximately 0.3%-0.5% of pregnancies or about 4.8 per 1,000 deliveries. The riskof recurrent placenta previa is as high as 4% to 8%. The risk of placenta previa
increases with the number of prior cesarean sections, rising to 10% with four or
more. Although some distinctions in outcome may be made among the different
degrees of true placenta previa, all are potentially associated with life-threatening
hemorrhage during labor. The degree of placenta previa cannot alone predict the
clinical course accurately, nor can it serve as the sole guide for managementdecisions. Thus, the importance of such classifications has diminished.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
31/42
Traditionally, placenta previa has been categorized into 4 types (1):
1. Complete placenta previa: where the placenta completely covers the internal os;
2. Partial placenta previa: where the placenta partially covers the internal os.
Thus, this scenario occurs only when the internal os is dilated to some degree;
3. Marginal placenta previa: where placenta just reaches the internal os, but does not cover it;4. Low-lying placenta: where placenta extends into the lower
uterine segment but does not reach the internal os.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
32/42
2. Abruptio Placentae
The term abruptio placentae denote separation of a normally implanted placenta prior to the birth of the fetus. Thediagnosis is most commonly made in third trimester, but the term may be used after the 20th week of pregnancy when the
clinical and pathologic criteria are met. This is uniquely dangerous condition to both the mother and the fetus because of its
pathologic sequelae. Placental separation is a serious complication of pregnancy. The reported incidence varies from 0.49%
to 1.29% with a mean incidence of 0.83% or one per 120 deliveries.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
33/42
3. Vasa PreviaVasa previa refers to fetal vessels running through the membranes
over the cervix and under the fetal presenting part, unprotected by placenta
or umbilical cord. The condition usually results either from a velamentous
insertion of the cord into the membranes rather than the placenta or from
vessels running between lobes of a placenta with one or more accessory lobe.
It is a condition which, if undiagnosed is associated with a perinatalmortality of approximately 60%. The condition is important because, when
the membranes rupture, spontaneously or artificially, the fetal vessels
running through the membranes have a high risk of concomitant rupture,
frequently resulting in fetal exsanguination and death. The incidence of vasa
previa is approximately 1 in 2,500 deliveries. Risk factors for the condition
include a second-trimester low-lying placenta (even if the "low lying"
placenta or placenta previa resolves in the third-trimester), pregnancies in
which the placenta has accessory lobes, multiple pregnancies, andpregnancies resulting from in vitro fertilization.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
34/42
FetalCirculation
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
35/42
Special Structures in Fetal
Circulation
PlacentaWhere gas exchange takes place during fetal life
Ductus VenosusCarry oxygenated blood from umbilical
vein to inferior vena cava, bypassing fetal liver
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
36/42
Umbilical ArteriesCarry unoxygenatedblood from the fetus to
placenta
Umbilical VeinBrings oxygenated blood coming from the placenta
to the fetus
Ductus ArteriosusCarry oxygenated blood from pulmonary
artery to aorta, bypassing fetal lungs.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
37/42
Foramen OvaleConnects the left and right atrium.
It pushes blood from the right atrium to the left
atrium so that blood can be supplied to brain,
heart and kidney
Heart
Is to pump blood through blood vesselsto the body's cells
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
38/42
How does the fetal circulatory system work?
During pregnancy, the fetal circulatory system works differently than after birth:
The fetus is connected by the umbilical cord to the placenta, the organ that
develops and implants in the mother's uterus during pregnancy.
Through the blood vessels in the umbilical cord, the fetus receives all the
necessary nutrition, oxygen, and life support from the mother through the
placenta.
Waste products and carbon dioxide from the fetus are sent back through the
umbilical cord and placenta to the mother's circulation to be eliminated.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
39/42
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
40/42
Inside the fetal heart:
Blood enters the right atrium, the chamber on the upper right side of the heart. Most
of the blood flows to the left side through a special fetal opening between the left
and right atria, called the foramen ovale.
Blood then passes into the left ventricle (lower chamber of the heart) and then to the
aorta, (the large artery coming from the heart).\From the aorta, blood is sent to the
heart muscle itself in addition to the brain and arms. After circulating there, the
blood returns to the right atrium of the heart through the superior vena cava.
About one-third of the blood entering the right atrium does not flow through theforamen ovale, but, instead, stays in the right side of the heart. This blood enters the
right ventricle from the right atrium, then exits the right ventricle to end up in,
eventually flowing into the pulmonary artery. From there, some of the blood will
travel to the lungs. The majority of the blood in the pulmonary artery, however,
enters the descending aorta through a special artery called the patent ductus
arteriosus (PDA). It then travels through smaller vessels to reach back into the
placenta.
Because the placenta does the work of exchanging oxygen (O2) and carbon dioxide
(CO2) through the mother's circulation, the fetal lungs are not used for breathing.Instead of blood flowing to the lungs to pick up oxygen and then flowing to the rest
of the body, the fetal circulation shunts (bypasses) most of the blood away from the
lungs. In the fetus, blood is shunted from the pulmonary artery to the aorta through
the patent ductus arteriosus.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
41/42
Blood circulation after birth:
With the first breaths of air the baby takes at birth,
the fetal circulation changes. A larger amount of
blood is sent to the lungs to pick up oxygen.
Because the patent ductus arteriosus (the normalconnection between the aorta and the pulmonary
artery) is no longer needed, it begins to narrow and
close off.
The circulation in the lungs increases and more
blood flows into the left atrium of the heart. This
increased pressure causes the foramen ovale to
close and blood circulates normally.
-
8/6/2019 Ten Steps to Breast Feeding and Fetal Circulation
42/42
The End