UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 BABY-FRIENDLY HOSPITAL INITIATIVE Revised, Updated and.
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BABY-FRIENDLY HOSPITAL INITIATIVERevised, Updated and Expanded for Integrated Care
“Ma
tern
ity”,
19
63,
© 2
003
Est
ate
of
Pa
blo
Pic
asso
/Art
ists
Rig
hts
So
cie
ty (
AR
S),
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w
Yor
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Global Strategy for Infant and Young Child Feeding The aim of the Global Strategy is to improve
– through optimal feeding – the nutritional status, growth and development, health, and
thus the survival of infants and young children.
It supports exclusive breastfeeding for 6 months, with timely, adequate, safe and appropriate complementary feeding, while continuing breastfeeding for two years and beyond.
It also supports maternal nutrition, and social and community support.
1/1
The aim of the Baby Friendly Hospital Initiative
To implement the Ten Steps to Successful Breastfeeding
and to end the distribution of free and low-cost
supplies of breastmilk substitutes to health facilities.
1/2
Course Aims
The aim of this course is that every staff member will confidently
support mothers with early and exclusive breastfeeding,
and that this facility moves towards achieving Baby-friendly designation.
1/3
3/1
Orig
inal
illu
stra
tion
by J
enny
Cor
kery
Infant Feeding Recommendation for HIV-positive Women
When replacement feeding is acceptable, feasible, affordable, sustainable and safe,
avoidance of all breastfeeding by HIV-infected mothers is recommended.
Otherwise, exclusive breastfeeding is recommended during the first months of life and then should be discontinued
as soon as it is feasible.
3/2
4/1
Orig
inal
illu
stra
tion
by J
enny
Cor
kery
The overall aim of the International Code of Marketing
of Breastmilk Substitutes is the safe and adequate nutrition
of all infants.
4/2
Skin to Skin Contact and Early Breastfeeding
5/1
©U
NIC
EF
C10
7-2
Skin to Skin Contact and Early Breastfeeding
5/2
UN
ICE
F/H
Q92
-036
9/ R
oger
Lem
oyne
, Tha
iland
First Skin to Skin Contact 5/3
Dr
Nils
Ber
gman
, Cap
e
Tow
n, S
outh
Afr
ica
Parts of the Breast6/1
Ada
pted
from
Bre
astfe
edin
g C
ouns
ellin
g: a
trai
ning
cou
rse,
W
HO
/CH
D/9
3.4,
UN
ICE
F/N
UT
/93.
2
Helping the Oxytocin Reflex 6/2
Bre
astfe
edin
g C
ouns
ellin
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trai
ning
cou
rse,
WH
O/C
HD
/93.
4, U
NIC
EF
/NU
T/9
3.2
What can you see?
Good attachment Poor attachment
6/3
Bre
astfe
edin
g C
ouns
ellin
g: a
trai
ning
cou
rse,
WH
O/C
HD
/93.
4, U
NIC
EF
/NU
T/9
3.2
What can you see?
Good attachment Poor attachment
6/4
Bre
astfe
edin
g C
ouns
ellin
g: a
trai
ning
cou
rse,
WH
O/C
HD
/93.
4, U
NIC
EF
/NU
T/9
3.2
Breastfeeding Positions7/1
In line
Close
Supported
Facing
Bre
astfe
edin
g C
ouns
ellin
g: a
trai
ning
cou
rse,
WH
O/C
HD
/93.
4, U
NIC
EF
/NU
T/9
3.2
BREASTFEED OBSERVATION AIDMother's name _______________________________ Date ___________________Baby's name _________________________________ Baby's age ______________Signs that breastfeeding is going well: Signs of possible difficulty:GENERALMother: Mother: Mother looks healthy Mother looks ill or depressed Mother relaxed and comfortable Mother looks tense and uncomfortable Signs of bonding between mother and baby No mother/baby eye contactBaby: Baby: Baby looks healthy Baby looks sleepy or ill Baby calm and relaxed Baby is restless or crying Baby reaches or roots for breast if hungry Baby does not reach or rootBREASTS Breasts look healthy Breasts look red, swollen, or sore No pain or discomfort Breast or nipple painfulBreast well supported with fingers away from nipple Breasts held with fingers on areola BABY’S POSITION Baby’s head and body in line Baby’s neck and head twisted to feed Baby held close to mother’s body Baby not held close Baby’s whole body supported Baby supported by head and neck only Baby approaches breast, nose to nipple Baby approaches breast, lower lip/chin to nippleBABY’S ATTACHMENT More areola seen above baby’s top lip More areola seen below bottom lip Baby’s mouth open wide Baby’s mouth not open wide Lower lip turned outwards Lips pointing forward or turned in Baby’s chin touches breast Baby’s chin not touching breastSUCKLING Slow, deep sucks with pauses Rapid shallow sucks Cheeks round when suckling Cheeks pulled in when suckling Baby releases breast when finished Mother takes baby off the breastMother notices signs of oxytocin reflex No signs of oxytocin reflex noticedNotes:
7/2
Assess a Breastfeed
7/3
©U
NIC
EF
C10
7-5
©U
NIC
EF
C10
7-7
Wide Open Mouth
7/4
Assess a Breastfeed
7/5
©U
NIC
EF
C10
7-9
Assess a Breastfeed
7/6
UN
ICE
F/H
Q91
-016
8/ B
etty
Pre
ss, K
enya
8/1 9/1
Orig
inal
illu
stra
tion
by J
enny
Cor
kery
Case study9/2
UN
ICE
F/H
Q91
-016
8/ B
etty
Pre
ss, K
enya
“Sleeping all the time”
“Refusing” the breast
3 stools in week
12% under birth weight
Bottle with honey and water twice yesterday
2 weeks old Healthy at birth Discharged Day 2
Case study
Bre
astfe
edin
g C
ouns
ellin
g: a
trai
ning
cou
rse,
WH
O/C
HD
/93.
4, U
NIC
EF
/NU
T/9
3.2
Kangaroo Mother Care
10/1
Dr
Nils
Ber
gman
, C
ape
Tow
n,
Sou
th A
fric
a
Kangaroo Mother Care
Dr
Nils
Ber
gman
, Cap
e T
own,
Sou
th A
fric
a10/2
Positioning a preterminfant
10/3
UN
ICE
F/H
Q93
-028
7/ R
oger
Lem
oyne
, Chi
na
Twins Grow Well on
Breastmilk
UN
ICE
F/H
Q92
-026
0/ L
aure
n G
oods
mith
, Mau
ritan
ia
10/4
DANCER Hand Position
10/5
©U
NIC
EF
C10
7-21
Chin Support 10/6
Kay
Hoo
ver
and
Bar
bara
Wils
on-C
lay,
from
The
Bre
astfe
edin
g A
tlas
Hand Expression
11/1
©UNICEF 910164F
Cup Feeding 11/2
Pro
mot
ing
brea
stfe
edin
g in
hea
lth fa
cilit
ies:
A s
hort
cou
rse
for
adm
inis
trat
ors
and
polic
y m
aker
s W
HO
/NU
T/9
6.3,
Wel
lsta
rt In
tern
atio
nal
Supplementer
11/3
Dr
Rus
khan
a H
aide
r, D
haka
, Ban
glad
esh
Size and Shape
There are many different shapes and sizes of breast and nipple.
Babies can breastfeed from almost all of them.
12/1
Bre
astfe
edin
g C
ouns
ellin
g: a
trai
ning
cou
rse,
WH
O/C
HD
/93.
4, U
NIC
EF
/NU
T/9
3.2
Full Breast
UN
ICE
F C
-107
-19
12/2
Engorged Breast
© U
NIC
EF
C-1
0-25
12/3
Mastitis12/4
©U
NIC
EF
C10
7-39
Sore Nipple12/5
©U
NIC
EF
C10
7-31
Sore Nipple
12/6
©U
NIC
EF
C10
7-32
Syringe method for inverted nipples12/7
Bre
astfe
edin
g C
ouns
ellin
g: a
trai
ning
cou
rse,
WH
O/C
HD
/93.
4, U
NIC
EF
/NU
T/9
3.2
Candida on the nipple12/8
©U
NIC
EF
C10
7-34
Candida on the nipple12/9
©U
NIC
EF
C10
7- 3
3
Tongue-tie 12/10
©U
NIC
EF
C10
7-35
Lactational Amenorrhea Method (LAM)13/1
Institute for Reproductive Health, Georgetown, Washington, DC
1. Have your menses returned?
2. Are you giving supplements or are there long periods without breastfeeding either day or night?
3. Is your baby more than six months old?
Ask the mother or advise her to ask herself these three questions:
There is only a 1-2% chance of pregnancy at this time.
YES
NO
NO
NO
YES
YES
When the answer to ANY one of these questions
becomes YESThe mother’s chance of pregnancy is increased.
For continued protection, and to achieve child
spacing, a complementary family planning method
needs to be used, and breastfeeding continue.
UNICEF/WHO/UNAIDS 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.
13/2
14/1
Orig
inal
illu
stra
tion
by J
enny
Cor
kery
Course Aims
The aim of this course is that every staff member will confidently support
mothers to succeed with early and exclusive breastfeeding,
and that this facility moves towards achieving Baby-Friendly designation.
15/1
Where are we now?
Developing a Plan:
Step One
15/2
Where do we want to be?
15/3Developing a Plan:
Step Two
Developing a Plan:Step Three
15/4
How will
we get
there?
How will we know if we are there?
Developing a Plan:Step Four
15/5
How will we sustain it?
15/6Developing a Plan:Step Five
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