Session 5:

Step 4

Birth Practices and

Breastfeeding
UNICEF/WHO 20 hour Course 2006
 Step 4 -
Place babies skin to skin contact with
their others mothers immediately
following birth for at least an hour and
encourage mothers to recognize
when their babies
are ready to feed,
offering help when
needed.
 Sige nanay,
kaunting ire
pa..

The care that a mother experiences during

labor and birth can affect breastfeeding
and how she cares for her baby .
What practices HELP
a woman initiate
breastfeeding soon
after birth ?
 Practices that Helps
• Emotional support during labor
• Attention on the effects of pain
medications on the baby
• Offering light foods and fluids during
labor
• Freedom of movement during labor
• Avoidance of unnecessary CS
• Early mother-baby contact
• Facilitate the first feed.
 Practices that may HINDER

• Lying on bed during labor & delivery

• Lack of support
• Withholding food and fluids
• Pain medications / IV lines
• Episiotomy
• Wrapping baby
• Separating the mother from the baby
How might it make a difference
to Nanay if her sister stays with
her during labor and birth ?

(Effect of Support during labor and birth to both mother and baby?)
Effect of Support to Mother

Reduce
perception of
pain
Increase
mothers’ Encourage
confidence mobility

Reduced need
for intervention Reduce stress

Speed labor &

delivery
 Effect of Support to Baby :

• Increased alertness of baby

• Reduced risk of hypothermia and
hypoglycemia
• Early and frequent feeding
• Easier bonding with the baby
What support can the doula give ?

 Encourage her to walk and move in

labor
 Offer light nourishment and fluids
 Built mother’s confidence
 Suggest ways to lessen pain and
anxiety
 Holding hands, massaging her
 Using positive words
Non-medication methods of pain relief

 Labor support
 Walking and moving around
 Massage
 Warm water
 Verbal and physical assurance
 Quiet environment with no bright
lights, few people around
 Labor and giving birth positioning of
the mother’s choice
Effects of pain medications

It can increase the risk of :

1. Longer labor
2. Operative interventions
3. Delayed start to mother - baby
contact and breastfeeding
4. Separation of mother baby after
birth
Cont
 Effects of pain medications

5. Sleepy, hard to arouse baby

6. Diminished sucking reflex
7. Reduced milk intake
What effect might giving fluid or withholding
fluid have on a woman in labor ?

• Labor and birth is hard work. Woman

needs energy to do this work.
• Gets hungry after a normal delivery.
• IV fluid only if there is a clear medical
indication
 Birth Practices

When giving birth, all woman need:

• A skilled attendant present
• Minimal use of invasive procedure
• Universal precaution against infection
• Use of Interventions only when
medically indicated
 5/1

Skin to Skin Contact and

Early Breastfeeding

©UNICEF C107-2
Skin to skin contact

• ENSURE uninterrupted, unhurried skin

to skin contact
• Start immediately, even before cord
clamping,
• Arrange that this skin to skin contact
continue for at least one hour after birth.
Importance of skin to skin contact

1. Calms the mother and baby

2. Keeps baby warm
3. Assist in metabolic adaptation and
blood glucose stabilization in the baby
4. Reduces baby crying and stress

cont
Importance of skin to skin contact

• Enables colonization of baby’s

gut with mother’s normal body
bacteria
• Facilitates bonding
• Allows the baby to find the
breast and self attach
 • Babies should be dried off as they are placed
on the mother’s skin.

• Babies who are not stable at birth can receive

STS contact later when they are stable.

Skin to Skin Contact and Early Breastfeeding

UNICEF/HQ92-0369/ Roger Lemoyne, Thailand

Dr Nils Bergman, Cape Town, South Africa

What could be BARRIERS
to ensuring early skin to
skin (STS) contact ?

?
Barriers to Skin To Skin contact

1. Concern that baby will get

cold
2. Baby needs to be examined
3. Baby needs to be bathed
4. Baby is not alert ,sedated
1/3
 Barriers to Skin To Skin contact

5. Mother needs to be stitched

6. Mother is tired
7. Mother does not want to hold
baby

2/3
 Barriers to Skin To Skin contact

8. Delivery room is busy

9. No staff available to stay
with mother and baby

3/3
 Barriers to Skin To Skin contact

• Twin births – interval of delivery

usually varies

• On mother’s labor/delivery chart,

record the time STS started and
finished
How to assist the first time at the breast
(initiation)

1. Help recognize pre-feeding

behaviors or cues :

• Taking a short rest in an alert state

• Bringing hands to his mouth
• Focusing on areola
• Moving towards breast
• Finding the nipple
cont
 How to assist the first time at the breast (initiation)

2. There should be no pressure on the

mother and baby regarding

• how soon the first feed takes place,

• how long a first feed would last,
• how well attached the baby is or
• how much colostrum the baby takes
Role of the Health Worker during
initiation of breastfeeding

• Provide time and calm environment

• Help mother find a comfortable position
• Point out positive behaviors of the baby
such as alertness and rooting
• Build the mother’s confidence
• Avoid rushing the baby to the breast or
pushing the breast into the baby’s mouth
Possible effects of cesarean section
on the mother
• Stressed
• Have IV drip/ urinary catheter
• Confined to bed
• Restricted fluid and food intake
• Have received anesthetics
• Altered levels of hormones of lactation
• Higher risk of infection, bleeding
• Separated from baby
• Feel a sense of failure
 Possible Effect of cesarean section

• Is a high risk of not breastfeeding

• May have more breathing problems
• May need suction of mucus
• Maybe sedated
• Is less likely to have early contact
• Is more likely to receive supplements
• Is more likely to have nursery care
 How can we help initiate BF after
a cesarean section ?
• Presence of a supportive health
worker / doula
• Encourage mother to have STS
contact as soon as possible
• Assist initiated breastfeeding
• Help find comfortable position
STS – skin to skin
 Summary
Step 4 – help mothers initiate BF within
half-hour of birth.

New interpretation:
Place babies skin to skin contact with
their mothers immediately after birth for
at least an hour and encourage mothers
to recognize whether their babies are
ready to breastfeed, offering help when
needed.
 SUMMARY

Good Competent woman

supportive In control
practices Supported
Ready to interact with baby

Early STS contact

Alert baby
Search breast
Breastfeeding initiated
 Health
facility

Family Community