Breast Feeding

Outline:
1. 2. 3. 4. 5. !. $. %. &. Introduction. Nutritional requirements during infancy. Types of feeding. Anatomy of the breast. hysiology of lactation. Ad"antages of breast#feeding. sychological impact of breast#feeding. Technique of breast#feeding. 'riteria for successful breast#feeding.

1(. 'riteria for adequate breast#feeding. 11. )ifficulties encountered in breast feeding* )ifficulties on part of ne+born* rematurity. 'left lip and cleft plate. 'ongenital malformation. ,aundice. Nipple trauma. In"erted nipple. .reast engorgement. 'andidias thrush. /bstructed lactiferous duct. -astitis. .reast abscess.

-aternal breast feeding problems*

12. 'ommunity resources. 13. 'ommunity support for continued breast#feeding. 14. The role of breast#feeding support groups. 15. Ten steps to successful breast#feeding. 1!. 0eferences.

Breast Feeding
Introduction:
There is a direct ratio bet+een the rate of gro+th and the nutritional requirements of infants and children. /ptimal nutrition during first year of life is "ery important for three reasons* 1ro+th is proceeding "ery rapidly2 requiring adequate amounts and proper ratio of the "arious nutrition. 'ellular gro+th of essential organs is completed during this period. 3eeding pro"ide time for meeting the emotional needs of infants.

Nutritional Requirements during Infancy:

1. 'alories* 1(( 4 2( calories 5g6day2 one calorie is supplied by 1.5 cc.of mil5 78uman#co+9s:. In the second year the needs are $( calories65g6day. 2. 3luid* 15( ml65g6day. 3. 3ood stuffs* rotein* 2gm65g6day. ;it. A* 4(((I<6day. ;it. '* 4( mg6day. ;it. )* 4((#%(( I<6day. Niacin* 4mg6day. Iron* 1( mg6day. ;it. .1* (.4 mg. 'alcium* (.5gm6day. ;it. =.* 4 I<6day.

Types of Feeding of an Infant:

.reast#feeding. Artificial feeding 7bottle#feeding:.

Anatomy of Breast:
The female breast2 also 5no+n as the mammary glands2 are accessory organs of reproduction.

Situation:
/ne breast is situated on each side of the sternum and e>tends bet+een the second and si>th rib.

Shape:
=ach breast is hemispherical s+elling in shape and has a tail e>tending to+ards the a>illa.

Structure:
The a>illary tail is the breast tissue e>tending to+ards the a>illa. The areola is the area of pigmented s5in about 2.5 cm in diameter at the center of each breast. It contains -ontogomery9s glands2 +hich produce sebum. The nipple lies in the center of the areola at the le"el of the fourth rib. It is composed of pigmented erectile tissue and plain muscle fibers2 +hich ha"e a sphincter li5e action in controlling the flo+ of mil5. The surface of the nipple is perforated by the openings of the lactiferous ducts. The breast is composed of glandular tissue. ?ome fatty tissue and co"ered by s5in. The glandular tissue is di"ided into about 15#2( lobes2 +hich are separated by fibrous tissue. =ach lobe is composed of the follo+ing structures*

Al"eoli contain the mil5 secreting cells 7the acine:. Around each al"eolus lie myoepithelial cells. @hich contract and propel the mil5 into the lactiferous duct. Aactiferous tubules are small ducts2 +hich connect the al"eoli. Aactiferous duct is a central duct into +hich the lactiferous tubules run. Aactiferous sinus is the +idened out portion of the lactiferous duct2 +hich lies under the areola and +here mil5 is stored. 73ig 1:

(Fig. !

Types of Nipple:
Normal or protruded. 7a: .ifid or di"ided into t+o parts. 7b: 3lat at the le"el of the s5in. 7c: )epressed belo+ the le"el of the s5in. 7d:

3ig. 72:

Fig. " Types of Nipple.

#hysiology of $actation:
)uring pregnancy estrogen and progesterone secreted by the placenta prepare the breast for lactation. The estrogen inhibits mil5 production until the end of pregnancy. In the 3rd trimester of pregnancy colosterm is present and remains for the first 3 days post partum. .y the 3rd stage of labour 7deli"ery of the placenta: the hormonal production is reduced and during the ne>t 4% hrs. the blood le"el of estrogen and progesterone fall and this stimulates the anterior pituitary gland to produce the lactogenic hormone 7prolactin hormone:. This acts on the acini cells in the breast and mil5 is formed. The mil5 is pushed along the lactiferous ducts and some is stored in the lactiferous sinuses 7mil5 reser"oir:2 +hich lie Bust under the areola. @hen the baby suc5s2 he ta5es the nipple and the areola into his mouth and partly by a "accum2 +hich is created mostly by a che+ing action of his Ba+s2 mil5 is pushed into his mouth and he s+allo+s. As the lactiferous sinuses 7mil5 reser"oir: and lo+er ducts are emptiedC mil5 is pushed from the al"eoli by contraction of the myoepithelial cells. ?o2 the act of suc5ing by the baby is the stimulus2 +hich 5eeps lactation going on by some neuro# hormonal refle> mechanism2 +hich acti"ates the anterior pituitary gland to produce lactotrophin and the posterior pituitary lobe to produce o>ytocin +hich reaches the breast through the blood stream leading to contraction of myeo#epithelial cells and e>pulsion of mil5 results. />ytocin also stimulates the uterine contractions as +ell as after pains and lochial discharge during breast#feeding. @ith the onset of mil5 the breast becomes larger firmer2 hea"ier and full of mil5 +hich can be e>pressed on pressure or may escape spontaneously. This procedure is associated +ith a considerable local throbbing pain e>tending to the e>alae. 7?ee 3ig. 3:

Fig (%! #hysiology of $actation

Ad&antage of Breast Feeding:

.reast#feeding is the most suitable for human infant. It contains all the elements for gro+th and de"elopment in easily digested forms. It contains all the necessary "itamins and of course no other food is as complete for the infant as breast mil5. It pro"ides psychological and emotional satisfaction for both mother and child.

Ad&antages to the mother:

1. The infant suc5ing at the breast promotes in"olution of the uterus after parturition. 2. -any mothers find great satisfaction in feeding the infant at the breast. 3. The fact that breast#feeding sa"es time and troubles appeals to some +omen. 4. .reast mil5 is less of a strain on the family budget than buying fresh or e"en e"aporated mil5. 5. It fulfills the feminine role and motherly attitudes. !. Ao+er incidence rate of cancer breast in +oman.

Ad&antages to the infant:

1. 8uman mil5 is +arm2 ready2 sterile and perfectly balanced in protein2 carbohydrate2 fat and "itamin and does not cost anything. 2. It is more easily digested than co+9s mil5. 3. .reast#fed infants ha"e greater immunity to certain childhood diseases 7it pro"ides immunologic factors to certain disease:. 4. .reast mil5 is a"ailable all times. 5. Infants are less li5ely to ha"e gastro#intestinal disorders2 anemia and "itamin deficiency. !. Infants are less li5ely to acquire infection in homes +here cleanliness is difficult to attain. $. Infant is secure through constant contact +ith his mother and this has an effect on the child9s psychology and de"elopment.

Ad&antage of Breast'feeding Fig. ((!

#sychological Impact of Breast Feeding:

.reast#feeding has psychological ad"antages to the mother and the baby. The physical contact bet+een mother and baby may be important but the psychological factor is more. .reast#feeding establishes a close bond bet+een mother and babyC they typically report a feeling of +armth and openness. .reast#feeding positi"ely influence the quality of mother#child interaction because it establishes a more direct intimate biological relationship. If a mother and child are allo+ed to be in close physical contact immediately after birth comple> interactions bet+een mother and infant help to loc5 them together. Ao"e and security are "ital needs of children. They require the continuous affection gi"en by parents. The mother is the first one +ho cares for the child through breast#feeding. If trust is to de"elop consistency must be established. A sense of trust is "ital to the de"elopment of a healthy personality. -any consider it to be the foundation of emotional gro+th. -others are taught to tal52 sing2 and touch their babies +hile pro"iding breast#feeding.

Technique of Breast'Feeding:
1. .reast should be cleansed e"ery day +hen the mother ta5es a sho+er2 other+ise breast is +ashed +ith plain +ater and dries thoroughly. 2. -other9s clothes should not be tight o"er the breast and clean. 3. The mother should +ash hand thoroughly before nursing her infant. 4. The infant should be hungry2 dry and +arm. 5. The mother should be in comfortable position either in sitting or lying position 7support feet in sitting position:. !. ositioning of infant* i.e.2 ho+ the infant9s body is put near the mother9s body* The infant must be held close to his mother9s body2 tummy against tummy and the infant facing the breast2 so that he doesn9t ha"e to turn the head to feed. The infant9s nose should be le"el +ith nipple and he +ill tilt his head bac5 a little. In some positions2 the infant9s bottom is supported +ith mother9s hand 7sitting2 "ertical and horiDontal position:. In other position2 she can support the head gently +ith her hand. The classical feeding positions as sho+n in figure E5F are* a. 'radle position. b. 'ross cradle position. c. 3oot#ball hold. d. 8oriDontal position. e. .ac5 +ards position. f. osition for t+o babies. $. The mother can gently support her breastC she can cup her breast +ith her hand from underneath using four fingers underneath and +ell behind the areola. 8er thumb should be resting on the top of her breast F'#holdF. %. 0ub the nipple or a finger gently against the infant9s chee5 or lips to stimulate Erooting refle>F. ?o the infant focuses on the breast.

Fig. ()! &. Touch the infant9s lip +ith the nipple to e"o5e oral searching refle> +here the infant opens his mouth +idely and thrusts the tongue for+ard and hold the nipple and apart of the areola 7depending on the siDe of the areola2 if it is small it +ill disappear2 if it is large2 a large part +ill be "isible:. This is +hat is called Elatch onF. 0emember that the infant +ho should come to the breast2 not the breast to the infant. 73ig. !:

*$atch on+ Fig. (,! @hen the infant feeds2 his chin should touch the mother9s breast2 the most important signal for the mother is that feeding doesn9t hurt2 as pain is usually a sign of poor attachment. )uring feeding2 no need to press the breast a+ay from the infant9s nostrils +ith finger. If the infant is +ell positioned and +ell attached2 he +ill be able to breathe through the sides of the nostrils. The common used EscissorF position 7;#hold: of the fingers may pull the breast out of his mouth. -other can cup her breast +ith her hand from underneath 7'#hold: 73ig. $:. No position can be labeled EidealF2 the important thing is that the mother is rela>ed and can hold her infant close to her breast comfortably for the time it ta5es.

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Fig. (-! 1(. 8o+ often and for ho+ long* Unrestricted breast#feeding2 i.e. self#demand method is the 5ey to establish mil5 supply and +ill pre"ent many difficulties. 1i"e breast +hene"er the infant sho+s the signs of hunger during the day and the night. It also means letting the infant finish a feed and come off the breast spontaneously. All ne+born infants need some night feeds2 the breast feeding hormones help mothers go bac5 to sleep quic5ly after a feed2 therefore2 rooming in is "ery important. Infants ha"e different feeding patterns +here* a. ?ome infants feed fast2 others slo+ly. ?ome infants feed in spurt +ith rests in bet+een2 others feed more steadily. b. ?ome may need to feed as many as 1(#15 times or as fe+ as !# % times +ithin 24 hours. c. ?ome infants feed on both breasts2 others on one breast only. Exclusive breast-feeding: It means that no food or drin5 other than breast#feeding is offered to breast# feeding baby upto ! months and he6she is fed on demand2 day and night2 +ith no restriction on the length or frequency of breast feeding. 11. =ructate the infant 1#2 times during and once at the end of the feed. osition of eructation as sho+n in figure 7%:. 0egurgitation of 5#15 cc of mil5 +hen eructated or after feeding is normal.

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Fig. (.! 12. @hen nursing is completed2 the infant should be placed in a crib on his right side or in prone position to facilitate emptying if the stomach.

/riteria for Successful Breast Feeding:

0ooming in is "ery important. )on9t use the pacifier as it may reduce the time the infant +ould normally spend at the breast and intern mil5 is not stimulated adequately. An infant9s cry for food is the last sign of hunger. The infant ma5es characteristics E mil5ing mo"ementF of the tongue first. 8e starts sali"ating and +ith increasing intensity2 his hands and fingers mo"e to+ards the mouth2 turns head from side to side ErootingF for the breast. The infant should be fed before he starts to cry2 as distressed infant is less easy to put to the breast. )on9t gi"e the infant any fluids before2 after or in bet+een breast feeds2 as the fluids +ill result in less mil5 being remo"ed from the breast and consequently less stimulation.

/riteria for Adequate Breast Feeding:

Infant is calm and satisfied after feeds. Infant sleeps +ell 3#4 hours after feeds. Normal motions 7bo+el mo"ements 4#%624 hours:. Normal amount of urine 7! or more 624 hours:. Normal +eight gain 715( G21( grams6 +ee5:. The normal gain 0eight or insufficient 1reast mil2 can 1e assessed 1y * 7i.e.2 the method of mil5 adequacy:* a. Weight charts: 73ollo+ up +eight on +eight chart:. b. Test weighing: The infant is +eighed at 4 days inter"al at a fi>ed time of the day and under the same circumstances 7i.e. same clothes and before feeding:. If +eight gain is 1(( grams or more the amount of breast mil5 is adequate. c. Test feeds (not practical): The infant is +eighted before and after feed +ithout changing clothes 7e"en +et diaper:2 the difference in +eight sho+s the amount of mil5 ta5en. This should be repeated 3#4 times6day for 2#3 days and the mean amount of mil5 feed is calculated.

3anagement of 4nderfeeding:
1i"e supplementary or complementary feeding.

5ifficulties 6ncountered in Breast Feeding:

A. 5ifficulties on part of the ne01orn:
. #rematurity:
.reast mil5 changes in its composition according to length of pregnancy. -il5 from a mother gi"ing birth prematurity is +ell suited to the need of the premature infants. It has more protein and a different pattern of immune bodies than mil5 of full term infants. @hether a premature infant can nurse at breast depends largely on their maturity and health2 +hich determine the "igorousness of their suc5ing. ?ome prematures +ill be strong enough after a brief period2 so mothers

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should be instructed and encouraged to breast fed their infants. ?o mothers must understand the physiology of the premature infant. -others must maintain their mil5 supply either manual or by pumping at least !#% times6day +ith one nightime session. 1i"e the e>pressed breast mil5 to infant by a dropper or ga"age 7by a nurse: or by cup 7from 3(#32 +ee5s of gestation: but still let him lic5s the breast to associate the smell and contact +ith the breast mil5 feeding. -others can increase the frequency of feeding up to e"ery 2 hours. They should +a5e the baby for feeding by unrapping to arouse and stimulate him for suc5ing. 3eeding the infant by using supplementer or by cup. ?ee fig 7&:

Fig. (7!

". /left $ip and /left #alate:

-ost babies +ith a cleft lip alone can usually learn to nurse. An infant +ith a cleft palate is usually unable to suc5le at the breast. These infants may be gi"en breast mil5 by tube or through a special long teat.

%. /ongenital 3alformation 8/ardiac 5iseases:

'ardiac disorders may +ea5en the infant so that nursing is too e>hausting.

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 -other may pump her breasts and maintain the sic5 infant on breast mil5 gi"en by a fine tube2 +hich passes from a container 7cup or bottle: to the baby9s mouth2 +hile the baby9s suc5ling. 73ig.&:.

(. 9aundice: */alled Breast'3il2 9aundice+

Although breast#feeding is sometimes associated +ith Baundice for the infant it is not contraindication to breast#feeding. It occurs after 1 st +ee5 of deli"ery. It is characteriDed by drop in the le"el of unconBugated .ilirubin in blood in response to +ithholding breast#feeding for one day. ?ome mothers e>crete a substance in their mil5 that interferes +ith .ilirubin metabolism resulting in Baundice. If .ilirubin le"el reach 15#1! mg61(( ml the physician may suggest interruption of nursing for 1#2 days as a diagnostic test. .reast#feeding then is resumed +ithout problems. It usually subside after a +ee5 or t+o +ithout any treatment. )on9t gi"e +ater2 de>trose fluids or other supplements as they may ma5e the infant9s demand of breast#feeding is less frequent and +orse the Baundice. =ncourage and help the mother 5eep her mil5 supply by frequent e>pression2 if breast#feeding is temporaily interrupted. The supplement should be gi"en by cup rather than bottle.

B. 3aternal Breast Feeding #ro1lems:

Types:
1. 2. 3. 4. 5. !. $. Nipple trauma. In"erted nipples. =ngorgement. 'andidasis 6 Thrush. /bstructed Aactiferous )uct. -astitis. .reast Abscess.

Factors that may $ead to Breast Feeding #ro1lems:

1. 2. 3. 4. 5. Aac5 of mother9s 5no+ledge. Improper attachment of baby to breast. ?eparation of mother and baby. /"erburdened by +or5. sychological factors* a. An>iety. b. 'oncern about nipple shape and siDe. c. -isbelie"es about colostrums and her o+n mil5* Not enough. )eficient. )iluted mil5.

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Nipple Trauma
5efinition:
Tenderness and soreness of the nipple are usually the result of trauma and irritation.

/auses:
Incorrect positioning and technique. =ngorgement. Irritants such as soaps or lotions. 'andidiasis. 'ontact dermatitis. Apply moist heat and massage before feedings 73#5minutes:. .egin each feeding on the least in"ol"ed side. 3requent2 short feedings 72#2.5 hours:. roper positioning2 attachment2 and remo"al technique. Air6sun e>posure. A"oid engorgement2 nurse more frequent2 not less. -ild analgesic. A"oid irritating substances. Treatment for candidacies. )ermatitis treatment. ?upporti"e bra.

3anagement:

Inverted Nipples
5efinition:
In"erted nipples are rear and some postnatal measures may be helpful in order to facilitate breast#feeding.

/auses:
ersistence of original in"agination of managing dimples.

3anagement:
.reast shells. .reast pump. re#nursing nipple stimulation. ?ide#sitting position. A"oid bottle2 nipples and pacifiers.

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Breast Engorgement
It is an accumulation of increased amount of blood and other body fluids as +ell as mil5 in the breasts.

/auses:
Inadequate and 6or infrequent mil5 remo"al. Inhibited mil5 eBection refle>.

3anagement:
Apply moist +arm pac5s to the in"ol"ed breast 2#3 minutes before each feeding. -assage and hand e>press or pump to relie"e areolar engorgement before feeding to facilitate attachment. 'old pac5s after feeding. ?tress reduction2 rela>ation techniques. Nec5 and bac5 massage. -ild analgesic.

Candidiasis /Thrush
ersistent sore nipple may be caused by candida albicans2 also called monilia or thrush.

/auses:
Thrush or candidal diaper rash in the infant. 0ecurrent candidal "aginitis in the mother. For mother: Apply medication to nipple after e"ery feeding for 14 days. Heep area dry* e>pose nipples to air or sun and use a fresh bra liner e"ery feeding. @ash clothes and other articles that come into contact +ith breasts in "ery hot +ater. @ash hands +ell2 especially after changing infant9s diaper. For infants: Apply oral medication directly to affected areas for 14 days. .oil articles that come in contact +ith infant9s mouth for 2( minutes daily. Treat diaper rash until healing is complete.

3anagement:

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Obstructed Lactiferous Duct

5efinition:
It results in a tender area or painful lump in the breast.

/auses:
il! stasis secondar" to: Infrequent nursing. Incomplete emptying. Aocal pressure.

3anagement:
-oist +arm pac5s to area before nursing. -assage prior to and during nursing. roper positioning2 attachment2 and remo"al techniques. -ore frequent nursing. 'hec5 fit of clothing.

astitis
5efinition:
It is an infection of breast tissue surrounding the mil5 ducts.

Symptoms:
A tender reddened area of the 1reast accompanied 1y: 3e"er. 'hills. 8eadache. 1eneraliDed achiness.

/auses:
<sually proceeded by nipple trauma. <ntreated obstructed lactiferous duct or engorgement. 'ontributing factors. ?tress. 3atigue. )on9t discontinue nursing. Nurse more frequently 72#2.5 hours:. /ffer baby in"ol"ed breast first. roper positioning2 attachment2 and remo"al technique. -oist +arm pac5s 73#5 minutes:. .ed rest for 24 hours. -ild analgesic. Antibiotic. )rin5 fluid to satisfy thirst 7fe"er:.

3anagement:

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Breast !bscess
)elayed or inadequate treatment of mastitis leads to breast abscess.

/auses:
Improperly treated mastitis.

3anagement:
Antibiotics. Incision and drainage. @arm pac5s. .reast#feed from affected side if the incision is a+ay from the areola or mother need to hands e>press her mil5 until healing is complete. 0est.

/ommunity Resources: 0hich Support the 3other and /hild for Breast Feeding ;uidance:
="ery facility pro"iding maternity ser"ices and care of ne+born infants should adopt the Eten stepsF to successful breast# feeding. Ale>andria <ni"ersity 'hildren 8ospital2 -inistry of 8ealth2 'hildren 8ospital and -'8 centers pro"ide friendly relationship +ith the mothers +ho are breast# feeding. 1i"e training and health teaching about the technique of breast#feeding2 benefits2 ho+ to manage the breast problems if occurs. reparation for pregnant +oman for lactation by gi"ing indi"idual teaching or counseling and mothers classes about breast feeding and common breast problems and its management.

/ommunity Support for /ontinued Breast Feeding:

Aactation mothers should recei"e support to continue e>clusi"ely breast#feeding up to ! months. 1. Aegislation to protect e>clusi"e breast feeding are included in the national policy2 such as the present maternity lea"e for +or5ing mothers for 3 months paid lea"e in the go"ernment sectors. 2. .reast#feeding support groups should include local influential +omen such as traditional birth attendants 7TA.?:2 rural +oman leaders2 teachers2 and mothers in la+2 e>perienced mothers2 social +or5er and non#go"ernment organiDations 7N1/?: and religious leaders. 3. -other +ho need special attention include* +or5ing mothers2 mothers ha"ing first breast feeding e>perience2 young mothers li"ing alone. Also mothers +ith medical2 social or psychological problems.

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The Role of Breast Feeding Support ;roup is to:

=mphasiDe to mothers the benefits of breast#feeding. articularly2 the economic "alue and effect on brain de"elopment. Teach mothers the correct technique for successful breast#feeding. Aisten to mothers and gi"e sympathy and support to help them and their babies to adapt to ne+ situations. 1i"e ad"ice on ho+ to ensure continuity by proper diet2 e>ercise2 rest2 fluid inta5e2 breast care2 clothing and bathing. =mphasiDing the role of the father in sharing the rearing responsibility and pro"iding support for the mother. =mphasiDing gender issues +ith respect to equality of care2 rearing and education. 0aising a+areness of the importance of child spacing for maternal and child health2 as +ell as community +ell fare. Arrange for close contact of mothers +ith their premature babies through2 encouraging them to handle2 care and touch their babies. Teach mothers ho+ to e>press their mil5 +ith utmost hygiene for their pre#term baby. -others should +ash hands and breast. The container should be +ashed and rinsed +ith boiling +ater. 'on"ince mothers that e"en if the e>pressed amount is small2 it is nutritionally adequate for her baby9s needs for gro+th. <se no bottles2 teats or pacifiers as this can cause babies to de"elop nipple confusion. /nce the baby is capable of nutriti"e suc5ling the mother should be guided on positioning of baby using the illustrated positions to support the Ba+. lace the baby clinging +ith s5in to s5in on the mother using 75angaroo method: for lo+ birth +eight. 0epeated periodical stimulation is required during feeding. ?uper"ise the feed to gi"e the mother confidence2 teach mothers to be patient and e>pect a preterm baby to ta5e a longer time to feed. This fact should be emphasiDed to mothers to help them2 accept the longer feeding time. rolactin stimulates the initiation and maintenance of breast#feeding. 'orrect mothers9 misconception that they ha"e insufficient mil5 to feed their babies for the 1st fe+ days during +hich colostrums is a"ailable.

6mphasi<e the Follo0ing Facts:

'olostrums is the perfect food as it meets the ne+born9s nutritional need +ith more protein2 "itamins and minerals than the mature mil5 +hich comes later. If any +ater or artificial feeds are gi"en2 the effect of the colostrums is diluted.

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 A baby9s 5idney9s can9t handle more fluids and are under stress by additional +ater and6or solute load. The la>ati"e effect of colostrums helps to ameliorate physiological Baundice. A baby +ill normally loose up to 1(I of its birth +eight due to e>tra +ater in its body but rapidly regain it +ith frequent breast#feeding on colostrums. Aess eagerness to suc5le and drain the ducts efficiently predisposes to breast engorgement. reterm .reast -il5 is for reterm .abies* reterm mil5 contains essential components to help the brain to complete its de"elopment and is a highly immunoligical differentiated fluid. Action: 1i"e preterms breast mil5 by cup2 spoon2 dropper2 supplementer2 +hile encouraging the babies to practice at the breast.

The Ten Steps to Successful Breast'Feeding:

1. 8a"e a +ritten breast#feeding policy that is routinely communicated to the health care staff. 2. Train all health care staff necessary to implement this policy. 3. Inform all pregnant +omen about the benefits and management of breast# feeding. 4. 8elp mothers initiate breast#feeding +ithin half#hour of birth. 5. ?ho+ mothers ho+ to breast#feed2 and ho+ to maintain lactation e"en if they should be separated from their baby. !. 1i"e ne+born babies no food or mil5 other than beast mil5 unless medically indicated. $. ractice rooming in allo+s mothers and babies to remain together 24 hours a day. %. =ncourage breast#feeding on demand. &. 1i"e no artificial teats or pacifiers to breast#feeding babies. 1(. 3oster the establishment of breast#feeding support groups and refer mothers to them on discharge from the hospital or clinic.

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"eferences:
1. .oba5 -I2 ,eusen )-. -aternity and 1ynecologic 'are. Aondon* -osby Jear .oo5#Inc.2 1&&32 !2%#!3$. 2. 'lement ')#1ray9s Anatomy of the 8uman .ody. hiladelphia2 1&%5. 3. 1rosse -;2 8ill =. The reterm .aby. Ne+ Jor5* 'hurchill Ai"ingstone2 2&$52 1((#1(5. 4. 8arfouche ,H. .reast 3eeding atterns. @8/6=-0/ technical ublication2 1ene"a2 1&%22 &3#114. 5. Issacs ,. Te>tboo5 of .reast )iseases. Aondon* -osby#Jear .oo52 1&&5.2 1(3# 1(5. 12$#12%. !. Aang ?. E.reast 3eeding ?pecial 'are .abiesF the National Nurses Association. .ailliere Tindall. Aondon2 1&&$. $. Aa+rence2 0uth A.2 .reast 3eeding* A 1uide for the -edical rofession2 4 th ed. ?t. Aouis. -osby2 1&&4. %. -arlo+ )02 Te>tboo5 of ediatric Nursing. !th ed. hiladelphia2 @. ?aunders 'o.2 1&%%.p 2%2. &. Ne"ille -'. The hysiological .asis of -ild ?ecretion# art1. lenum ress2 Ne+ Jor52 1&&(. 1(. Thompson =). Introduction to -aternity and ediatric Nursing. hiladelphia* @.. ?aunders 'o. 1&&5.23$#242. 11. ;inther T2 8elsing =. .reast 3eeding* ho+ to ?upport ?uccess2 A ractical 1uide for health @or5er. @8/. 1&&$. 12. @8/ -anual about .reast 3eeding 1&&4. 13. @ong )A.2 @haley and @ong Nursing 'are of Infants and 'hildren.5 th ed. ?t. Aouis* -osby co.2 1&&52 4$!2 523.

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