breastfeeding tips for moms and health workers

7/30/2019 Breastfeeding Tips For Moms and Health Workers

1/34

BREASTFEEDING

Best Food For the NewbornJosephine T.R. Holgado,M.D.,D.P.P.S.

October 31, 2012Calamba Medical Center


2/34

INTRODUCTION

W.H.O. strongly recommends

exclusive breastfeeding

for the first six months of life.


3/34

INTRODUCTION

Ten Steps To Successful Breastfeeding*

Every facility providing maternity services and care for newborn infants should:1. Have a written breastfeeding policy that is routinely communicated to all health care staff.2. Train all health care staff in skills necessary to implement this policy.3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within a half-hour of birth.5. Show mothers how to breastfeed, and how to maintain lactation even if they are separatedfrom their infants.6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.7. Practise rooming-in - allow mothers and infants to remain together - 24 hours a day.8. Encourage breastfeeding on demand.9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them ondischarge from the hospital or clinic.

* A summary of the main recommendations of the Joint WHO/UNICEF Statement (1989) called"Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services"


4/34

INTRODUCTION

Summary of the International Code of Marketing of Breastmilk Substitutes*The Code includes these 10 important provisions:

1. No advertising of all breastmilk substitutes** to the public.2. No free samples to mothers.3. No promotion of products in health care facilities, including no free or low-cost formula.4. No company representatives to contact mothers.5. No gifts or personal samples to health workers. Health workers should never pass products

on to mothers.6. No words or pictures idealizing artificial feeding, including pictures of infants, on the labels.7. Information to health workers must be scientific and factual.8. All information on artificial infant feeding must explain the benefits and superiority ofbreastfeeding, and the costs and hazards associated with artificial feeding.9. Unsuitable products, such as sweetened condensed milk should not be promotedfor babies.10. Manufacturers and distributors should comply with the Code's provisions even if countrieshave not acted to implement the Code.

* The International Code of Marketing of Breastmilk Substitutes was adopted by the WorldHealth Assembly in 1981 as a tool to protect breastfeeding.** Breastmilk Substitutes include: infant formula, follow-up formula, feeding bottles, teats, babyfood and beverages etc.


5/34

INTRODUCTION

Republic Act No. 7600

AN ACT PROVIDING INCENTIVES TO

ALL GOVERNMENT AND PRIVATEHEALTH INSTITUTIONS WITHROOMING-IN AND BREAST-FEEDING

PRACTICES AND FOR OTHERPURPOSES.


6/34

OBJECTIVES

General Objective

To acquire a general knowledge on theimportance and practice of breastfeeding


7/34

OBJECTIVES

Specific Objectives1. To determine the benefits of breastfeeding2. To find out the different positions to breastfeed3. To know the steps on correct latching4. To enumerate the absolute and temporary

contraindications to breastfeeding5. To know how to express and store breastmilk

6. To differentiate full breasts from engorgedbreasts7. To find out the management of sore nipples

and mastitis


8/34

BENEFITS OF BREASTFEEDING

Health benefits for infants

1. gives infants all the nutrients they need forhealthy development.

2. safe and contains antibodies that help protectinfants from common childhood illnesses - suchas diarrhoea and pneumonia, the two primarycauses of child mortality worldwide.

3. readily available and affordable, which helps toensure that infants get adequate sustenance


9/34

BENEFITS OF BREASTFEEDING

Health benefits for mothers

1. associated with a natural (though not fail-safe)method of birth control (98% of protection in the

first 6 months after birth) if done exclusively2. reduces risks of breast and ovarian cancer later

in life,

3. helps women return to their pre-pregnancyweight faster,

4. lowers rates of obesity.


10/34

POSITIONS

1. Cross-cradle Hold

2. Cradle Hold

3. Football Hold4. Side-lying Hold

5. Football Hold for twins


11/34

Good and poor attachment


12/34

Key points to good attachment

The mouth is widely open

The lower lip is turned outwards

The chin is touching the breast

More areola is visible above the babys mouththan below it

The tongue is forward in the mouth, and maybeseen over the bottom gum


13/34

CORRECT LATCHING/SUCKLING

VIDEOS

GOOD ATTACHMENT

POSITIONING


14/34

CONTRAINDICATIONS

ABSOLUTE

Mental Disorder

Mental Retardation

Seizure Disorder

Cardiac Disease

Advanced Nephritis

Open Tuberculosis

Thyrotoxicosis


15/34

CONTRAINDICATIONS

TEMPORARY

intake of drugs like anticoagulants,antibiotics,

toxic substances like mercury andbenzene

mechanical problems like retracted andoversized nipples.


16/34

Drugs of Abuse for Which Adverse Effects on theInfant During Breastfeeding Have Been Reported*

Drug Reported Effect or Reasons for Concern

Amphetamine Irritability, poor sleeping pattern

Cocaine Cocaine intoxication: irritability,vomiting, diarrhea, tremulousness, seizures

Heroin Tremors, restlessness, vomiting, poor feedingMarijuana Only 1 report in literature; no effect mentioned;

very long half-life for some componentsPhencyclidine Potent hallucinogen

* The Committee on Drugs strongly believes that nursing mothers should notingest drugs of abuse, because they are hazardous to thenursing infant and to the health of the mother. Drug is concentrated in human milk.

The Transfer of Drugs and Other Chemicals Into Human MilkAmerican Academy of Pediatrics Committee on Drugs

Pediatrics2001;108;776


17/34

Drugs for Which the Effect on Nursing Infants Is Unknownbut May Be of Concern*

Drug Reported or Possible Effect

AntidepressantsFluoxetine Colic, irritability, feeding and sleep

disorders, slow weight gain

AntipsychoticChlorpromazine Galactorrhea in mother; drowsiness and

lethargy in infant; decline in developmentalscores

Haloperidol Decline in developmental scores

The Transfer of Drugs and Other Chemicals Into Human Milk

AAP Committee on Drugs

Pediatrics2001;108;776


18/34

Drugs for Which the Effect on Nursing Infants Is Unknownbut May Be of Concern*

OTHERSDrug Reported or Possible EffectAmiodarone Possible hypothyroidismChloramphenicol Possible idiosyncratic bone marrow

suppressionClofazimine Potential for transfer of high percentage of

maternal dose; possible increase in skinpigmentation

Lamotrigine Potential therapeutic serum concentrationsin infant

Metoclopramide None described;dopaminergic blocking agent

Metronidazole In vitro mutagen; may discontinuebreastfeeding for 1224 h to allowexcretion of dose when single-dosetherapy given to mother

Tinidazole See metronidazole


19/34

Drugs That Have Been Associated With Significant Effectson Some Nursing Infants and Should Be Given to Nursing

Mothers With Caution*

Drug Reported EffectAcebutolol Hypotension; bradycardia; tachypnea5-Aminosalicylic acid Diarrhea (1 case)

Atenolol Cyanosis; bradycardiaBromocriptine Suppresses lactation; may be hazardous to the mother

Aspirin (salicylates) Metabolic acidosis (1 case)Clemastine Drowsiness, irritability, refusal to feed, high-pitched cry,

neck stiffness (1 case)Ergotamine Vomiting, diarrhea, convulsions (doses used in migrainemedications)

Lithium One-third to one-half therapeutic blood concentration ininfants

Phenindione Anticoagulant: increased prothrombin and partialthromboplastin time in 1 infant; not used in United States

Phenobarbital Sedation; infantile spasms after weaning from milkcontaining phenobarbital, methemoglobinemia (1 case)

Primidone Sedation, feeding problemsSulfasalazine(salicylazosulfapyridine) Bloody diarrhea (1 case)* Blood concentration in the infant may be of clinical importance.


20/34

Maternal Medication Usually Compatible WithBreastfeeding

Drug Reported Sign or Symptom in Infant or

Effect on Lactation

Alcohol (ethanol) With large amounts, drowsiness, diaphoresis, deep sleep,weakness, decrease in linear growth, abnormal weightgain; maternal ingestion of 1 g/kg daily decreases

milk ejection reflexCaffeine Irritability, poor sleeping pattern, excreted slowly; no

effect with moderate intake of caffeinated beverages(23 cups per day)

Carbimazole GoiterChloral hydrate SleepinessContraceptive pillwith estrogen/progesterone Rare breast enlargement; decrease in milk production

and protein content (not confirmed in several studies)Indomethacin Seizure (1 case)Iodides May affect thyroid activity; see iodineIodine GoiterIodine (povidone-iodine, eg, in a vaginal douche) Elevated iodine levels in breast milk, odor of

iodine on infants skinIsoniazid None; acetyl (hepatotoxic) metabolite secreted but no hepatotoxicity

reported in infants


21/34

Maternal Medication Usually Compatible WithBreastfeeding

Drug Reported Sign or Symptom in Infant or

Effect on LactationMorphine None; infant may have measurable blood concentration

Nalidixic acid Hemolysis in infant with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency

Nitrofurantoin Hemolysis in infant with G-6-PD deficiencyPhenytoin Methemoglobinemia (1 case)

Sulfapyridine Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, orpremature infant; appears in infants milk

Sulfisoxazole Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, orpremature infant; appears in infants milk

Tetracycline None; negligible absorption by infant

Tolbutamide Possible jaundice


22/34

Food and Environmental Agents:Effects on Breastfeeding

Agent Reported Sign or Symptom in Infant orEffect on Lactation

Aspartame Caution if mother or infant has phenylketonuriaBromide (photographic laboratory) Potential absorption and bromide transfer into milk;Chocolate (theobromine) Irritability or increased bowel activity if excess amounts

($16 oz/d) consumed by mother

Fava beans Hemolysis in patient with G-6-PD deficiency FluoridesHexachlorobenzene Skin rash, diarrhea, vomiting, dark urine, neurotoxicity,death

Hexachlorophene None; possible contamination of milk from nipple washingLead Possible neurotoxicityMercury, methylmercury May affect neurodevelopmentPolychlorinated biphenyls and

polybrominated biphenyls Lack of endurance, hypotonia, sullen, expressionlessfaciesSilicone Esophageal dysmotilityTetrachloroethylene cleaning fluid

(perchloroethylene) Obstructive jaundice, dark urineVegetarian diet Signs of B12 deficiency


23/34

EXPRESS BREASTMILK

VIDEO ON HAND EXPRESSION


24/34

BREASTMILK STORAGE

Breastmilk Hospital Use Home Use

Fresh, room temperature 4 hours 8 hoursFresh, refrigerated 72 hours 8 days

Thawed, after freezing 24 hours 24 hours

Frozen (-20 to 0 F) 12 months 12 monthsFrozen in home freezer

(5 - 15 F) 6 months 6 months

Frozen in small interior freezer 2 weeks 2 weeks

*Do not store milk in the door compartments of therefrigerator or freezer


25/34

CHARACTERISTICS OF FULL BREASTS

NORMAL

36/72 hours after birth.

Hot, heavy, may be hard

Milk flowing or dripping

Fever uncommon


26/34

CHARACTERISTICS OF ENGORGEDBREASTS

ABNORMAL can occur at any time duringbreastfeeding

Painful. edematous

Tight, especially nipple area

Shiny May look red

Milk NOT flowing

Fever may occur

Engorgement may causea decrease in milk supply

if it happens often


27/34

Management of Sore Nipples

Look for a cause:Check the babys position at the breast

Check the babys attachment at the breast.Examine the breasts engorgement, fissures, candida. Check the baby for candida.

Give appropriate treatment: Build the mothers confidence Improve the babys attachment and continue breastfeeding Reduce engorgement, feed frequently, express breast milk Treat candida.

Advise the mother to: Wash breasts only once a day, avoid using soap Avoid medicated lotions and ointments Gently smooth hindmilk into nipple and areola after a breastfeed.


28/34

MASTITIS

Manifestations:

fever with temp > 38 C or with flu-like symptoms

affects only one part of the breast

Well-defined, red, sore, and swollen area

Pathophysiology: a blocked duct so

milk does not flow from that part of the breast.

Complication: If no treatment is given and milk is

not removed by feeding or expressionthe mother may develop an abscess


29/34

Causes of Mastitis

Fissured nipples

Not feeding often enough

Tight clothesHolding the breast during a feed

Baby poorly attached and not removing

the milk properly from all parts (lobes) ofthe breast


30/34

Management of Mastitis

Breastfeed frequently at least every 3 hours.Using different feeding position may help clearthe blockage

If mother cannot breastfeed from affectedbreast, express milk every 3 hours untilimproved

If no change within 24 hours or if mother lives farfrom the health facility, she should beginantibiotics immediately


31/34

Management of Mastitis

Give Cloxacillin 500 mg q 6 hours for 10days.

If severe pain, give paracetamol.

Reassess in 2 days. If no improvement or

worse, refer to a hospital.

Do not give sugar water, formula or otherprelacteals


32/34

SUMMARY

It is BEST for babies up to 2 years and beyond.

B - Bonds the mother and the child;

E Economical in terms of time, money and

convenience,S Safe for it prevents diarrhea and otherdiseases, allergies and provides antibodies

against infection and necessary nutrients in theproper quality and quantity and

T Tried and Tested for years since it is alwaysat the right Temperature and with contraceptive

effect, especially with exclusive breastfeeding.


33/34


34/34

THANK YOU!

breastfeeding tips for moms and health workers

Documents