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WHO/UNICEF Innocenti Declaration titled “ The Protection, Promotion and Support of breastfeeding – which year ?

WHO/UNICEF recommends exclusive breastfeeding for ?

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Human breast milk refers to the milk produced by a mother to feed her baby. It provides the primary source of nutrition for newborns before they are able to eat and digest other foods.

provides ideal nutrition for infants and contributes to provides ideal nutrition for infants and contributes to their healthy growth and developmenttheir healthy growth and development

Reduces incidence and severity of infectious diseases Reduces incidence and severity of infectious diseases thereby lowering infant morbidity and mortalitythereby lowering infant morbidity and mortality

Contributes to women’s health by reducing the risk Contributes to women’s health by reducing the risk of breast & ovarian ca by increasing the space of breast & ovarian ca by increasing the space between pregnanciesbetween pregnancies

Provides social and economic benefits to the family Provides social and economic benefits to the family and nationand nation

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Mother’s milk provides optimal nutrition & emotional nurturing Mother’s milk provides optimal nutrition & emotional nurturing for the growth of infantsfor the growth of infants

Provides positive economic advantages to baby, mother, Provides positive economic advantages to baby, mother, family and the communityfamily and the community

Healthy mothers & babies mean substantial saving in health Healthy mothers & babies mean substantial saving in health care costscare costs

Why Breastfeed ?

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Most complete form of Most complete form of nutritionnutrition

Protective against infection & Protective against infection & chronic diseasechronic disease

Enhanced immune systemEnhanced immune system Less obesity in childhood and Less obesity in childhood and

adulthoodadulthood

Benefits of Breastfeeding

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ConvenientConvenient Lose weight fasterLose weight faster Reduced the risk of:Reduced the risk of:

Ovarian CAOvarian CA

Breast CABreast CA

OsteoporosisOsteoporosis Safest in disaster setting & Safest in disaster setting &

povertypoverty

Benefits of breastfeeding

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Mother-infant separation Mother-infant separation after birthafter birth

Suggesting mom to get Suggesting mom to get some sleepsome sleep

Interruption/lack of privacyInterruption/lack of privacy Incorrect informationIncorrect information Lack of supportLack of support

Practices Which Discourage Breastfeeding

Unnecessary formula Unnecessary formula supplementationsupplementation

Pacifiers/bottlesPacifiers/bottles Strict timing of feedingStrict timing of feeding No role model or No role model or

promotion effortspromotion efforts

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Formula is SAME as mother’s milk Need a “perfect diet”- balanced diet to breastfeed Won’t make enough milk Can’t nurse when mother or baby are sick or on

meds

MYTHS

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Care providers play a crucial role in breastfeeding in the early postpartum period. Who are the care providers in the early postpartum period ?

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Promotion of breastfeeding depends on changing attitude Promotion of breastfeeding depends on changing attitude of staffof staff

Need to create a realistic expectations about breastfeedingNeed to create a realistic expectations about breastfeeding Information about breastfeeding needs to be available Information about breastfeeding needs to be available

throughout pregnancythroughout pregnancy Appropriate resources must be available to mothersAppropriate resources must be available to mothers

The Need for Education

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Review current hospital policyReview current hospital policy

Does it include national goals?Does it include national goals?

Does it meet JCIA & other hospital Does it meet JCIA & other hospital standards?standards?

Is there a training componentIs there a training component

What can Hospitals do ?

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Step 1

Have a written breastfeeding policy that is routinely communicated to all health care staff.

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Why have a Policy ?

• Requires a course of action, provides guidance• Helps establish consistent care for couples• Provides a standard that can be evaluated

What should the Policy Cover ?• Ten steps to Successful Breastfeeding

• An institutional ban on free supplies of breast-milk substitutes• No promotion of products in health care facility• No company reps to advise mothers• No gifts of personal samples to health care workers

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Use plain language to address each stepUse plain language to address each step Make it available to all staff caring for Make it available to all staff caring for

mothers & babiesmothers & babies Post it in areas where mothers & babies are Post it in areas where mothers & babies are

cared forcared for

How to Present the Policy

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Step 2

Train all health care staff in skills necessary to implement this policy.

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• Advantages of breastfeeding• Mechanism of lactation and sucking• Helping mothers initiate and sustain breastfeeding• How to assess a breastfeeding session• How to resolve breastfeeding difficulties• Importance of feeding on cue• Proper positioning and attachment• Risks of artificial feeding and using pacifiers• Hospital breastfeeding policies and practices

Training should include:

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Step 3

Inform all pregnant women about the benefits and management of breastfeeding.

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Prenatal education should include:

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• The benefits of breastfeeding• The benefits of early initiation• The importance of rooming in/ learning baby’s cues• The importance of feeding on cue• How to assure enough milk• Proper positioning and attachment• The importance of exclusive breastfeeding• The risk of using bottles and pacifiers• Within the cultural context of the patient

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WHO/UNICEF recommendation encourages that the baby should be put on the breast within ?

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Step 4

Help mothers initiate breastfeeding within half hour after birth.

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Get started right after delivery !

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• Baby is most alert in the first 1-2 hours• Baby will be alert and ready to feed by 20-30

minutes How to initiate in 30 minutes:

Keep mother and baby together Let the baby start nursing when ready do not hurry or interrupt the process

• Mom has a burst of energy• Helps the placenta release

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Why initiate soon ?

Provides emotional attachment and hormonal stimulation for milk production

Provides colostrum Takes advantages of the

first hour of alertness

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Step 5

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

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Step 6

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

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Step 7

Practice rooming-in; allow mothers and infants to remain together – 24 hours a day.

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Rooming-in

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• Has positive effect on duration of breastfeeding• Provides unlimited contact between mother and child• Enhances mother and infant bonding• Babies sleep more quietly than those who are separated

Benefits of rooming-in• Cost effective• Requires no additional personnel• Reduces infection• Helps establish and maintain breastfeeding• Facilitates the bonding process which can positively

effect BF duration

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How often should the baby be breast fed ?

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Step 8

Encourage breastfeeding on demand.

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Breastfeeding on cue results in:

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• Promotes bonding• Earlier passage of meconium• Decreased weight loss• Breast milk flow is established sooner• Less incidence of jaundice

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Step 9

Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

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Step 10

Foster the establishment of support groups and refer mothers to them on discharge from the hospital or clinic.

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Reference: Unicef/WHO 1989; Ten Steps to Breastfeeding Jan

Riordan/Baumbech 4th edition; ILCA BFHI sec. 3 Breastfeeding promotion & support in a baby

friendly hospital Yamauchi Y. Yamanouchi (1990) the relationship between

rooming-in/not rooming-in and breastfeeding variables. Acta Paed Scand 79;1017-1022

Rush J et al. (1989) Care of new mother and baby in ;Chalmers I et al. (eds) Effective care in pregnancy and childbirth oxford: 1333-1346

Handout #11 Some breastfeeding Myths – Jack Newman

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