Breastfeeding SCORPIO

The Importance of Breastfeeding

WHO and UNICEF now recommend that

every infant should be exclusively breastfed
for the first six months of life, with continued
breastfeeding for up to two years or longer

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Newborn benefits
• “Breastmilk provides all of the nutrients, vitamins
and minerals an infant needs for growth for the first
six months, and no other liquids or food are
needed.
• Breastmilk carries antibodies from the mother that
help combat disease, which breastmilk substitutes
cannot contain.”*

*UNICEF 2012
Lancet 2008 4
What is so special about breastmilk?
• Vitamins & Minerals
– If a mother is adequately nourished during her
pregnancy, exclusive breastfeeding for 6 months
will provide adequate:
– Iron
– Calcium
– Essential vitamins
• Supplementation of iron and vitamins should be
considered on the basis of individual maternal
nutritional status*

*ESPGHAN 2009 5
*UNICEF 2012
Lancet 2008 7
“Colostrum ...is very important for
the infant”
• Rich in antibodies and white cells to protect against
infection; [also lactoferrin and lyzozyme]
• Helps prevent jaundice,
• Has growth factors which help the intestine to mature
and is rich in Vitamin A.
• A study in India showed that neonatal and
postneonatal deaths were around 5-6 times lower in
infants fed colostrum than among those not fed
colostrum.

*UNICEF 2012
Lancet 2008 8
Newborn benefits
• “Optimal breastfeeding practices in the first two
years of life, especially exclusive breastfeeding for
the first six months of life, have the ...the potential
to prevent:
• 12-13% of all under-5 deaths in the developing
world, or
• 1.4 million lives”*

*UNICEF 2012
Lancet 2008 1
0
Newborn benefits
Breastfeeding reduces respiratory
morbidity

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50
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63

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77

40
26

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Evidence-based Practice Centers of the Agency for Healthcare Research and

Quality (AHRQ). Breastfeeding and
Breastfeeding reduces gastrointestinal and
allergic morbidity

77

27

42

64
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Evidence-based Practice Centers of the Agency for Healthcare Research and

Quality (AHRQ). Breastfeeding and Maternal and Infant Health Outcomes in
Developed Countries 20074
Breast feeding has substantial potential
long term advantages

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30
40
20
15
36

Evidence-based Practice Centers of the Agency for Healthcare Research and

Quality (AHRQ). Breastfeeding and Maternal and Infant Health Outcomes in
Developed Countries 20074
Breastfeeding increases intelligence
Benefits for mother – short term6
• Reduced post-partum blood loss

• More rapid involution of uterus

• Delayed return of menses

• Expedited return to pre-pregnancy weight

Benefits for mother – long term4
• Reduced breast cancer
up to 28% reduction in risk for each year of
breastfeeding
• Reduced ovarian cancer
up to 21% reduction in risk compared to never
breastfeeding
• Reduced postpartum depression
early cessation or not breastfeeding associated with
increased risk of postpartum depression
Breastfeeding in SEA-URCHIN Countries
(2000-2007):
    Exclusive Breastfeeding Rate
  Year <4 months <6 months  
Indonesia1 2007 41% 32%
Malaysia1 1996 29% 29%
2003 /
Myanmar1 2006 15% 24%
Philippines1 2003 42% 34%
Thailand1 2005 8% 5%
Australia2 2004 46% 14%
1 WHO/UNICEF Breast feeding statistics

2 AIFS 2008, Growing Up In Australia: The Longitudinal Study of Australian Children, Annual Report 2006-07
What needs to change?
 Unang Yakap 4&5
ESSENTIAL INTRAPARTUM AND NEWBORN CARE

Safer, evidence-based,
better quality care
for mothers & newborns
in all health facilities
Milk chain
Antenatal education
SUCCESS OF BREAST FEEDING

• 90% Psychological
• 10% Physical – Correct Position ,
attachment
• Before giving birth – Women are
psychologically and emotionally ready ,
received adequate information about
breastfeeding
Relactation. A review of experience and recommendation for practice. WHO Geneva 1998
Relactation. A review of experience and recommendation for practice. WHO Geneva 1998
Relactation. A review of experience and recommendation for practice. WHO Geneva 1998
Skin to skin at birth
Uninterrupted skin to skin contact

Phil. ENCC 37
Breastfeeding within first hour once with feeding
reflexes

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Mother and baby together
Show how to breast feed
When to feed the baby?
Mid Feeding Cues
Late Feeding Cues
 I am full ,
please don’t
wake me up

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• With permission from Atty Jenny and Stanley Ong (LATCH)
 Correct Position

Baby’s body needs to be

⦿In line with ear, shoulder and hip
in a straight line,
⦿Close to mother’s body
⦿Supported at the head, shoulders
and if newborn, the whole body
⦿Facing the breast
Side – lying Position
 How to support
the breast

demo
Signs of good Signs of poor
attachment attachment
Chin touching breast Chin away from breast
Mouth wide open Mouth not wide open
Lower lip turned Lower lip pointing
outwards forward, or turned in
Areola: more visible Areola: more visible
above than below the below than above, or
mouth
equal amounts
 Signs that a baby is suckling
effectively

1. Slow deep sucks sometimes with short

pause
2. May hear or see the baby swallowing
3. Baby’s cheeks are full during a feed
4. Baby finishes the feed and releases the
breast by himself
5. Looks contended, relaxed
What are the signs that a baby
has finished feeding?
Signs of Satiety :
• As they get full, their body relaxes.
• Let go of the breast.
• Take small gentle sucks until they are
asleep.
 Breastfeeding

“Demand feeding” - “baby-led feeding”

This means that the frequency and length

of feeding is determined by the baby’s
needs and signs.
How to HAND EXPRESS
•Handwashing
•Encourage the milk to
flow – massage the breast
• Find the milk ducts –
area of compression: edge
of areola or 1 thumb from
nipple
• Compress over the
ducts first posteriorly then
press, release, press,
release
Demo / practice
• Repeat in all parts of
©UNICEF 910164F the breast.
Hand expression of breast milk initially using
tuberculin syringe every 2-3 hours if baby will be
. 6 hours after birth
separated from mother within
Bicycle-horn pump

Not recommended -- because of the potential

for build-up inside the bulb
It is also traumatic and ineffective
Collection of breast milk
Storage of breast milk – coolest portion of freezer, ref ,
breast milk is separated from meat and fish
Storage of breast milk

❖Room air 4 hours

❖Refrigerator 1-5 days
❖Freezer (one door compartment ) 2 weeks
❖Freezer (two door compartment) 3 months
❖Deep freezer 6-12 months
❖Cooler with frozen gel packs – 24 hours
Thawing of breast milk
• Recommended -- Slow thaw the frozen
milk by transferring from the freezer to
the refrigerator a day before use -
• Quick thawing in a wide container of
tap water or warm water. Hot water will
destroy the immune cells
Is this the problem?
Risks of Milk formula – Mothers need to know
• More allergy and
Baby
milk intolerance
• Interferes with bonding
• Increased risk of
• More diarrhea and some chronic
respiratory infections diseases –
• Persistent diarrhea X hypertension, stroke ,
diabetes
• Malnutrition
Vitamin A deficiency • Overweight

• More likely to die • Lower scores on

Mothe intelligence tests
r
• Increased risk of anemia, • May become pregnant
ovarian and breast cancer sooner
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993
(WHO/CDR/93.6).
 Cup feeding
• Safe alternative to
bottle feeding
• Use of expressed
breastmilk
• Does not result in
“nipple confusion”
• Associated with better
breastfeeding success

• Ya-Yi Huang, et al Chang Gung Med J 2009;32:423-31

International Code of Marketing of Breast-
milk Substitutes
• No advertising to the public of any product
• No free samples to mothers
• No promotion of products in health care facilities
• No company sales representatives to advise
mothers
• No gifts or personal samples to health workers
• No words or pictures idealizing artificial feeding
International Code of Marketing of Breast-
milk Substitutes
• Information to health workers should be scientific
and factual
• Information to mothers should include the benefits
and superiority of breastfeeding
• Materials must include: the cost of products, social
implications, and possible risks to the baby
• Unsuitable products should not be promoted
• Manufacturers should comply with Code even if the
country has not implemented the Code
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Thank you – join the path to sustained exclusive breastfeeding
to save lives
Key References
1. Agostoni C, Braegger C, Decsi T, Kolacek S, Koletzko B, Michaelsen
KF, Mihatsch W, Moreno LA, Puntis J, Shamir R, Szajewska H, Turck
D, van Goudoever J. Breast-feeding: A commentary by the ESPGHAN
Committee on Nutrition. Journal of pediatric gastroenterology and
nutrition. 2009;49:112-25.
2. AAP: Breastfeeding and the use of human milk. Pediatrics.
2012;129:e827-41.
3. Horta BL, Bahl R, Martines JC, Victora CG. Evidence on the long-term
effects of breastfeeding: Systematic reviews and meta-anlayses:
World Health Organization 2007.
4. Ip S, Chung M, Raman G, et al; Tufts-New England Medical Center
Evidence-based Practice Center. Breastfeeding and maternal and
infant health outcomes in developed countries. Evid Rep Technol
Assess. 2007;153(153):1–186
Key References
5. World Health Organization. Guidelines on optimal feeding of low
birth-weight infants in low- and middle-income countries.
Geneva: World Health Organization2011.
6. World Health Organization. Evidence for the Ten Steps to
Successful Breastfeeding: World Health Organization 1998.
7. UNICEF Scientific Rationale: Benefits of Breastfeeding. 2012
8. WHO and UNICEF. Acceptable medical reasons for use of breast-
milk substitutes 2009.
Phil. ENCC
Maraming