BASIC TRAINING FOR BARANGAY BASIC TRAINING FOR BARANGAY HEALTH WORKERS HEALTH WORKERS

Calasiao, PangasinanCalasiao, Pangasinan

BREASTFEEDINGBREASTFEEDING

All mothers can breastfeed regardless All mothers can breastfeed regardless

of the sizes of their breasts. Even of the sizes of their breasts. Even

mothers with flat or invented nipples mothers with flat or invented nipples

can breastfeed. Taking good care of can breastfeed. Taking good care of

the breasts is very important for the the breasts is very important for the

health of both mother and her baby.health of both mother and her baby.

Feeding the infant breastmilk exclusively for the Feeding the infant breastmilk exclusively for the first 6 months is the best nutrition a mother first 6 months is the best nutrition a mother can provide. This will also minimize the chance can provide. This will also minimize the chance of the baby getting infected with sickness.of the baby getting infected with sickness.

The BHW should help promote exclusive The BHW should help promote exclusive breastfeeding among mothers. breastfeeding among mothers.

A. The three E’s of BreastfeedingA. The three E’s of Breastfeeding1. Exclusive1. Exclusive2. Early start2. Early start3. Extended 3. Extended

B. Importance of BreastfeedingB. Importance of Breastfeeding

C. Composition of BreastmilkC. Composition of Breastmilk

D. Advantages of Exclusive BreastfeedingD. Advantages of Exclusive Breastfeeding

E. Proper Breastfeeding Procedures E. Proper Breastfeeding Procedures 1. Care of the Breast1. Care of the Breast2. Anatomy of the Breast2. Anatomy of the Breast3. Proper Positioning3. Proper Positioning4. Duration of Feeds4. Duration of Feeds

F. Help that mothers need to Breastfeed F. Help that mothers need to Breastfeed successfullysuccessfully1. Psychological preparation1. Psychological preparation2. Practical advice2. Practical advice

G. Problems and their solution during BreastfeedingG. Problems and their solution during Breastfeeding1. Early problems1. Early problems2. Later problems2. Later problems

A. The Three E’s of A. The Three E’s of BreastfeedingBreastfeeding

1. Exclusive breastfeeding1. Exclusive breastfeeding

Exclusive Breastfeeding means that Exclusive Breastfeeding means that the baby should receive only the baby should receive only breastmilk for the first 6 months of breastmilk for the first 6 months of life. life.

Breastmilk already contains almost Breastmilk already contains almost everything the baby needs.everything the baby needs.

2. Early Start 2. Early Start

Breastfeeding should be started Breastfeeding should be started immediately after delivery. This is a immediately after delivery. This is a good time for the baby to learn to good time for the baby to learn to suck. In most cases, the real milk of suck. In most cases, the real milk of the mother comes in on the second the mother comes in on the second or third day.or third day.

You must encourage the mother to let You must encourage the mother to let the baby suck even if the milk has the baby suck even if the milk has “not come out” yet.“not come out” yet.

As the baby sucksAs the baby sucks

• He gets the “colostrum”He gets the “colostrum”• The milk will be stimulated to The milk will be stimulated to

flow earlierflow earlier• The uterus will contract and The uterus will contract and

return to shapereturn to shape

3. Extended breastfeeding3. Extended breastfeeding

Breastfeeding can continue for as long Breastfeeding can continue for as long as the mother feels comfortable doing as the mother feels comfortable doing it. However, the baby will need other it. However, the baby will need other foods in addition to breastmilk upon foods in addition to breastmilk upon reaching the age of 6 months. reaching the age of 6 months.

Breastfeeding should continue for Breastfeeding should continue for another 12-18 months while the child another 12-18 months while the child gets more and more solid foods.gets more and more solid foods.

B. Importance of B. Importance of BreastfeedingBreastfeeding

Advantages of Advantages of BREASTFEEDINGBREASTFEEDINGBreastmilk Breastfeeding

Perfect nutrients Helps bonding and development

Easily digested Efficiently used

Helps delay a new pregnancy

Protects against infection

Protects mothers’ health

Costs less than artificial feeding

C. Composition of BreastmilkC. Composition of BreastmilkThe yellowish or clear in colour is called The yellowish or clear in colour is called

COLOSTRUM. It is the breastmilk that women COLOSTRUM. It is the breastmilk that women produce in the first few days after delivery. produce in the first few days after delivery.

Colostrum contains antibodies and more white Colostrum contains antibodies and more white blood cells than white milk. It protects the blood cells than white milk. It protects the body from infection.body from infection.

Colostrum is also rich in a substance which Colostrum is also rich in a substance which stimulates the development of the baby’s stimulates the development of the baby’s intestines. It actually prepares the baby to intestines. It actually prepares the baby to absorb and digest milk. Although colostrum absorb and digest milk. Although colostrum is secreted in small amounts, it is enough for is secreted in small amounts, it is enough for a normal baby. a normal baby.

Besides colostrum, milk also contains an Besides colostrum, milk also contains an element which helps make special bacteria element which helps make special bacteria grow in the baby’s intestines. These bacteria grow in the baby’s intestines. These bacteria prevent diarrhea.prevent diarrhea.

ColostrumColostrum

Property Importance

Antibody Rich Protects against infection and allergy

Many white cells Protect against infection

Purgative Clears meconiumHelps to prevent jaundice

Growth factors Help intestine to maturePrevents allergy, intolerance

Vitamin A Rich Reduces severity of infectionPrevents eye disease

Breastmilk is good for the baby because Breastmilk is good for the baby because in contains all the nutrients that a in contains all the nutrients that a baby needs for the first 6 months of baby needs for the first 6 months of life.life.• The right amount of protein, iron , The right amount of protein, iron ,

fat, lactose (milk sugar) and ironfat, lactose (milk sugar) and iron• Enough vitamins for the baby Enough vitamins for the baby

(vitamin supplement or fruit juice (vitamin supplement or fruit juice not an absolute necessity)not an absolute necessity)

• Enough water for a baby even in a Enough water for a baby even in a hot climate hot climate

• The correct amount of salt, calcium The correct amount of salt, calcium and phosphateand phosphate

D. Advantages of Exclusive D. Advantages of Exclusive BreastfeedingBreastfeeding

1.1. Breastmilk is easily digested.Breastmilk is easily digested.2.2. It is always ready for the baby and It is always ready for the baby and

needs no preparation.needs no preparation.3.3. It never grows sour nor spoiled.It never grows sour nor spoiled.4.4. It helps stop bleeding after delivery.It helps stop bleeding after delivery.5.5. Breastfeeding on demand helps Breastfeeding on demand helps

protects the mother against another protects the mother against another pregnancy.pregnancy.

6.6. Breastfeeding is good psychologically Breastfeeding is good psychologically for both mother and child. It helps for both mother and child. It helps them to bond together, become them to bond together, become attached to each other and love one attached to each other and love one another better.another better.

7.7. It is cheap and available anytime.It is cheap and available anytime.8.8. Breastmilk prevents illnesses. Breastmilk prevents illnesses.

Summary of differences Summary of differences between milksbetween milks

Human Milk Animal Milk Formula

Bacterial contaminants

none Likely Likely when mixed

Anti-infective factors

Present Not present Not present

Growth factors Present Not present Not present

Protein Correct amount easy to digest

Too much difficult to digest

Partly corrected

Fat Enough essential fatty acids

lipase to digest

lacks essential fatty acids

lipase to digest

lacks essential fatty acids No lipase

Iron Small amount well absorbed

Small amount not well

absorbed

Extra needed not well

absorbed

Vitamins Enough Not enough A and C

Vitamins added

Water enough Extra needed May need extra

E. Proper E. Proper BreastfeedingProcedures BreastfeedingProcedures

1. Care of the Breast1. Care of the BreastBefore breastfeeding the baby, the Before breastfeeding the baby, the

mother should clean her breast with a mother should clean her breast with a wet piece of cloth or cotton. She wet piece of cloth or cotton. She should not use soap or alcohol on her should not use soap or alcohol on her breast as this can cause irritation. breast as this can cause irritation.

In case the mother takes a bath daily, In case the mother takes a bath daily, there is no need to clean her breast there is no need to clean her breast before every breasfeeding.before every breasfeeding.

2. Anatomy of the Breast2. Anatomy of the Breast

The breast is made up of some milk-The breast is made up of some milk-producing glands and some other producing glands and some other tissues and fat. This milk goes through tissues and fat. This milk goes through tubes or ducts toward the nipple.tubes or ducts toward the nipple.

Before the ducts reach the nipple they Before the ducts reach the nipple they become wider and form lactiferous become wider and form lactiferous sinuses. Milk collects in them. About sinuses. Milk collects in them. About 10 fine ducts lead from the sinuses to 10 fine ducts lead from the sinuses to the nipple.the nipple.

The nipple is very sensitive. Around the The nipple is very sensitive. Around the nipple is a circle of dark skin called nipple is a circle of dark skin called areola. On the areola are very small areola. On the areola are very small swellings. These are glands that swellings. These are glands that produce oils. This oil helps keep the produce oils. This oil helps keep the nipple skin soft and in good condition.nipple skin soft and in good condition.

When a baby takes the nipple into his/her When a baby takes the nipple into his/her mouth, he/she must also take in much of mouth, he/she must also take in much of the areola. The mother should position the areola. The mother should position the baby so that he/she can take in as the baby so that he/she can take in as much milk as possible.much milk as possible.

The baby’s sucking stimulates the mother’s The baby’s sucking stimulates the mother’s breast to produce milk. The more the breast to produce milk. The more the baby sucks, the more milk is produced.baby sucks, the more milk is produced.

3. Proper positioning3. Proper positioning

Let the mother sit or lie Let the mother sit or lie somewhere comfortable so that somewhere comfortable so that she is relaxed. A low seat is she is relaxed. A low seat is usually best.usually best.

Show her how to hold the baby in Show her how to hold the baby in her arms. The baby faces the her arms. The baby faces the breast while the baby’s stomach breast while the baby’s stomach is against the mother’s stomach.is against the mother’s stomach.

Let the back of the baby’s Let the back of the baby’s shoulders rest on the mother’s shoulders rest on the mother’s arm. The baby’s head should be arm. The baby’s head should be free to bend back a little.free to bend back a little.

The correct steps to follow in The correct steps to follow in positioning the baby for breastfeeding.positioning the baby for breastfeeding.

She should touch the baby’s She should touch the baby’s cheek or the side of the baby’s cheek or the side of the baby’s mouth. This will stimulate the mouth. This will stimulate the rooting reflex.rooting reflex.

She should wait until the baby’s She should wait until the baby’s mouth is open and ready to start mouth is open and ready to start sucking.sucking.

The mother should hold and offer The mother should hold and offer the whole breast. She should not the whole breast. She should not pinch the nipple or areola.pinch the nipple or areola.

She should aim the baby’s lower She should aim the baby’s lower lip towards the base of the lip towards the base of the areola.areola.

Four key points in Four key points in breasfeedingbreasfeeding The baby is:The baby is:

– With his head and body straight;With his head and body straight;– With his face facing the breast; and With his face facing the breast; and

his nose opposite her nipple;his nose opposite her nipple;– With his body close to her body;With his body close to her body;– Supporting his bottom (if newborn);Supporting his bottom (if newborn);

How to support her How to support her breast:breast: With her fingers against her chest With her fingers against her chest

wall below her breast;wall below her breast; With her four finger supporting the With her four finger supporting the

breast;breast; With her thumb above;With her thumb above;

Her fingers should not be too near Her fingers should not be too near the nipple.the nipple.

Other Position while Other Position while breastfeedingbreastfeeding

Other Position while Other Position while breastfeedingbreastfeeding

WHICH OF THIS TWO PICTURE WHICH OF THIS TWO PICTURE HAS A GOOD ATTACHMENTHAS A GOOD ATTACHMENT

RightRight LeftLeft

Show how to support her breastShow how to support her breast((demonstrate )demonstrate )

If she has small and high breast If she has small and high breast – no need to support– no need to support

C- position of the handC- position of the hand Not hold her breast too near to Not hold her breast too near to

the nipplethe nipple Scissors’ hold – block milk flowScissors’ hold – block milk flow

C- position of the handC- position of the hand

Scissors’ hold – block milk Scissors’ hold – block milk flowflow

AttachmentAttachment

For teaching purposes only and not for publication.

For teaching purposes only and not for publication.

Signs of good Signs of good attachmentattachment Mouth wide openMouth wide open More areola in the upper lipMore areola in the upper lip Lower lip is turned outwardLower lip is turned outward Chin touches the breastChin touches the breast

©U

NIC

EF

C1

07

-7

Wide Wide Open Open MouthMouth

7/4

Signs of good Signs of good attachmentattachment Mouth wide openMouth wide open More areola in the upper lipMore areola in the upper lip Lower lip is turned outwardLower lip is turned outward Chin touches the breastChin touches the breast

©U

NIC

EF

C1

07

-7

Wide Wide Open Open MouthMouth

7/4

Signs of good Signs of good attachmentattachment Mouth wide openMouth wide open More areola in the upper lipMore areola in the upper lip Lower lip is turned outwardLower lip is turned outward Chin touches the breastChin touches the breast

©U

NIC

EF

C1

07

-7

Wide Wide Open Open MouthMouth

7/4

Signs of good Signs of good attachmentattachment Mouth wide openMouth wide open More areola in the upper lipMore areola in the upper lip Lower lip is turned outwardLower lip is turned outward Chin touches the breastChin touches the breast

©U

NIC

EF

C1

07

-7

Wide Wide Open Open MouthMouth

7/4

Signs of good Signs of good attachmentattachment

Mouth wide openMouth wide open More areola in the More areola in the

upper lipupper lip Lower lip is turned Lower lip is turned

outwardoutward Chin touches the breastChin touches the breast

WHICH OF THIS TWO PICTURE WHICH OF THIS TWO PICTURE HAS A GOOD ATTACHMENTHAS A GOOD ATTACHMENT

RightRight oror LeftLeft

These are the signs that the baby is These are the signs that the baby is in good position for breastfeeding.in good position for breastfeeding.

1.1. The baby’s whole body is close to the mother; The baby’s whole body is close to the mother; the baby is facing the mother; and the stomach the baby is facing the mother; and the stomach of the baby is touching the mother’s stomach.of the baby is touching the mother’s stomach.

2.2. The baby mouth and chin are close to the breast.The baby mouth and chin are close to the breast.

3.3. The baby’s mouth is wide open.The baby’s mouth is wide open.

4.4. More part of the areola is seen above the baby’s More part of the areola is seen above the baby’s upper lip and less of it can be seen below his/her upper lip and less of it can be seen below his/her lower lip.lower lip.

5.5. The baby takes slow deed sucks.The baby takes slow deed sucks.

6.6. The baby is relaxed and happy.The baby is relaxed and happy.

7.7. The mother does not feel pain on her nipple.The mother does not feel pain on her nipple.

These are signs that the baby is in These are signs that the baby is in bad position while sucking:bad position while sucking:

1.1. The baby’s stomach is not touching the The baby’s stomach is not touching the mother’s stomach.mother’s stomach.

2.2. The baby’s mouth and chin are separated The baby’s mouth and chin are separated from the breast.from the breast.

3.3. There is too much areola seen below the There is too much areola seen below the lower lip of the baby.lower lip of the baby.

4.4. The baby takes many quick and small sucks.The baby takes many quick and small sucks.

5.5. The baby fusses or refuses to suck because The baby fusses or refuses to suck because he/she does not get the milk.he/she does not get the milk.

6.6. The mother may feel pain on her nippleThe mother may feel pain on her nipple

Ways on how to hold a Ways on how to hold a colicky babycolicky baby

3. Duration of feeds3. Duration of feedsWhen breastfeeding, the most important When breastfeeding, the most important

point to remember is that both breast are point to remember is that both breast are offered at one feeding time and for as offered at one feeding time and for as long as the baby still wants to suck.long as the baby still wants to suck.

Let the baby finish the first breast, to make Let the baby finish the first breast, to make sure that he/she gets the hindmilk. Let sure that he/she gets the hindmilk. Let him/her take the second breast if he/she him/her take the second breast if he/she wants to, but do not force him/her.wants to, but do not force him/her.

If the baby falls asleep after sucking only If the baby falls asleep after sucking only from the left breast, the right breast from the left breast, the right breast should be offered next feeding time.should be offered next feeding time.

F. Help that mothers need to F. Help that mothers need to Breastfeed Successfully Breastfeed Successfully

1. Psychological preparation 1. Psychological preparation

Try to let the mothers feel that the best Try to let the mothers feel that the best choice is breastmilk. However, don’t choice is breastmilk. However, don’t blame her if she does something else.blame her if she does something else.

You must be kind, gentle and You must be kind, gentle and sympathetic. Give each woman a sympathetic. Give each woman a chance to ask questions. Show interest chance to ask questions. Show interest and sincerity in helping her. Encourage and sincerity in helping her. Encourage her to tell you about any doubts and her to tell you about any doubts and fears that she might have. fears that she might have.

2. Practical Advice 2. Practical Advice Advise Pregnant MothersAdvise Pregnant Mothers

a. Your milk is the best food for your a. Your milk is the best food for your baby. The quality of the milk will baby. The quality of the milk will always be good regardless of your always be good regardless of your diet.diet.

b. The size and shape of the breast do b. The size and shape of the breast do not matter. Small breast and large not matter. Small breast and large breast both produce perfect milk in breast both produce perfect milk in sufficient quantity.sufficient quantity.

c. Breastfeeding need not spoil your figure. It should help you to lose weight after the is born. If you wear a good bra or other support while you breastfeed, your breast will return to a good shape after you wean the baby.

d. Bottle feeding is dangerous because it d. Bottle feeding is dangerous because it causes much illness.causes much illness.

e. let the baby suck soon after delivery- it e. let the baby suck soon after delivery- it will help your milk to flow freely.will help your milk to flow freely.

f. make one or two of your dresses open at f. make one or two of your dresses open at the front so that your baby can breastfeed the front so that your baby can breastfeed easily.easily.

g. All mothers feel more emotional and g. All mothers feel more emotional and sensitive than usual for a few weeks after sensitive than usual for a few weeks after delivery.delivery.

E. Problems and Solution E. Problems and Solution During During Breastfeeding Breastfeeding

There are so many problems that a There are so many problems that a mother experiences when she mother experiences when she breastfeeds. It is important that we breastfeeds. It is important that we anticipate these problems so that we anticipate these problems so that we will be able to help them when they will be able to help them when they occur.occur.1. Early Problems1. Early Problems

A. The breast are too full and they A. The breast are too full and they hurt (engorged breasts) hurt (engorged breasts)

SOLUTIONSOLUTION: Get the milk from the breast. If : Get the milk from the breast. If possible, let the baby suck through his/her possible, let the baby suck through his/her mouth in a good position. If the baby cannot mouth in a good position. If the baby cannot suck well, the mother can express by hands, suck well, the mother can express by hands, try putting a warm compress on the breast, or try putting a warm compress on the breast, or simply take a warm bath or shower.simply take a warm bath or shower.

B. Painful Swelling in the Breast (Mastitis)B. Painful Swelling in the Breast (Mastitis)

SOLUTIONSOLUTION : Let the baby continue to feed : Let the baby continue to feed frequently from the breast. If the baby cannot, frequently from the breast. If the baby cannot, then express the milk. Gently massage the then express the milk. Gently massage the lump towards the nipple.lump towards the nipple.

C. Sore nipples (due to bad C. Sore nipples (due to bad positioning when the baby is sucking)positioning when the baby is sucking)

SOLUTION: SOLUTION: Help the baby by positioning Help the baby by positioning him towards the breast in the correct him towards the breast in the correct way. Advise mothers not to wash their way. Advise mothers not to wash their nipples with soap every time they nipples with soap every time they feed. Instead, just wash them once a feed. Instead, just wash them once a day during regular bathing. She day during regular bathing. She should take the baby off the breast at should take the baby off the breast at the end of a feed by inserting her little the end of a feed by inserting her little finger between her breast and the finger between her breast and the baby’s mouth. This will make the baby baby’s mouth. This will make the baby release the breast.release the breast.

D. Cracked NipplesD. Cracked Nipples

SOLUTION: SOLUTION: Correct the feeding Correct the feeding position. Advise the mother to position. Advise the mother to wash the nipples without soap only wash the nipples without soap only once a day. Expose the nipples to once a day. Expose the nipples to air and sun as much as possible. air and sun as much as possible. Leave a drop of hindmilk on the Leave a drop of hindmilk on the nipple after feeding because it nipple after feeding because it helps the skin to heal.helps the skin to heal.

E. Nipples are too short (flat but E. Nipples are too short (flat but protract easily)protract easily)

SOLUTION: SOLUTION: During pregnancy, During pregnancy, exercise to improve nipples exercise to improve nipples protractibility. After delivery, let the protractibility. After delivery, let the baby suck strongly as soon as baby suck strongly as soon as he/she can and make sure that he/she can and make sure that he/she fixes onto the breast in a he/she fixes onto the breast in a good position.good position.

F. Nipples are too longF. Nipples are too long

SOLUTION: SOLUTION: Help the mother to put Help the mother to put the areola as well as the long nipple the areola as well as the long nipple into the baby’s mouth.into the baby’s mouth.

2. Later problems2. Later problems

A. Not enough milkA. Not enough milk

SOLUTION:SOLUTION: Conduct the weight Conduct the weight check by weighing the baby and check by weighing the baby and checking his weight gain on a checking his weight gain on a growth chart. A healthy baby growth chart. A healthy baby should gain between half and should gain between half and 1kg/month. If the baby is gaining 1kg/month. If the baby is gaining weight, then there is enough milk. weight, then there is enough milk. Reassure the mother.Reassure the mother.

B. Mother has to go back to workB. Mother has to go back to work

SOLUTION: SOLUTION: Continue to breastfeed at Continue to breastfeed at night, in the early morning and at any night, in the early morning and at any other time that you are at home. other time that you are at home. Express milk before you go to work Express milk before you go to work and leave it for the helper to give the and leave it for the helper to give the baby. Express your milk at work to baby. Express your milk at work to keep up your supply. If you decide to keep up your supply. If you decide to use a formula, do not use a bottle. use a formula, do not use a bottle. Instead, feed the baby using a cup or Instead, feed the baby using a cup or spoon. It is better to use than a bottle spoon. It is better to use than a bottle because it does not satisfy the baby’s because it does not satisfy the baby’s need to suck. This will make the baby need to suck. This will make the baby continue to breastfeed.continue to breastfeed.

THANK YOU!THANK YOU!