1. DR RAVARI 2014 Impact of Birthing Practices on Newborn Baby Care and Breastfeeding دكتر محمود راوري متخصص کودکان عضوكميته كشوري شيرمادر دانشکده علوم پزشكي ساوه

2. DR RAVARI 2014 W OMEN NEVER FORGET THEIR BIRTH DAYS Giving birth is one of the most significant events in a woman’s life. Pregnancy, birth and breastfeeding are all part of the same continuum

3. DR RAVARI 2014 The medicalization of birth and postpartum processes has created additional barrier to successful breastfeeding Birth interventions that disrupt the natural interaction between the mother and the infant in the immediate postpartum period can impact long-term breastfeeding success.

4. DR RAVARI 2014 The first minutes after birth are a very vulnerable period for both mother and newborn. Babies born by cesarean may also suffer from the consequences of this type of birth process. A mother's breastfeeding experience can be: “Profoundly affected by what happens during the first hours after birth”

5. DR RAVARI 2014 Benefits of normal vaginal delivery For Babies BIRTH CANAL Lowered risk of respiratory problems As the babies pass through the vagina, pressure in the vaginal helps baby to expulse the amniotic fluid inside the lung. This can help babies to breathe better once they are outside the mothers' body.

6. DR RAVARI 2014 What physical effects may occur in babies more frequently with CESAREAN DELIVERY ? Respiratory distress syndrome (TTN.HMD) elective CS Pulmonary hypertension Not breastfeeding Neonatal mortality

7. DR RAVARI 2014 C ESAREAN SECTION Risk of maternal death is 3.6 times higher for cesarean than vaginal birth. Infants are 1.5 times more likely to die during elective first cesarean than vaginal birth.

8. DR RAVARI 2014 Benefits of normal vaginal delivery For Babies ☻BIRTH CANAL Babies will pick up a protective bacterial as they pass through the vagina. This bacterial can boost his or her immune system and make him or her less vulnerable to some infectious diseases and protection against childhood chronic disease

9. DR RAVARI 2014 VAGINAL DELIVERY, among other advantages, fosters the growth of trillions of good bacteria that reside peacefully in the human body, many of them in the intestine. The gut microbiota is essential to human health, playing central roles in host metabolism and immunity C-S ECTION M AY D ISRUPT 'G OOD ' B ACTERIA IN B ABIES

10. DR RAVARI 2014 F ACTORS INFLUENCING THE COMPOSITION OF THE INTESTINAL MICROBIOTA IN EARLY INFANCY The most important determination of gut microbiota composition in infants were The mode of delivery Type of infant feeding Gestational age Infant hospitalization and Antibiotic use by the infant

11. DR RAVARI 2014 C-S ECTION M AY D ISRUPT 'G OOD ' B ACTERIA IN B ABIES Mothers who have C-sections also tend to start breast-feeding later and require antibiotics, affect the baby's microbiome, and lower circulating levels of Th1 chemokines in infants compared with vaginal delivery C-sections interfere with the newborn's exposure to bacteria in the vaginal tract, bacteria that essentially trains the immune system to react appropriately to future events,

12. DR RAVARI 2014 C ESAREAN DELIVERY VERSUS VAGINAL DELIVERY Play in the development of childhood chronic disease(Autoimmune) Allergic diseases (Asthma, food allergy, allergic rhinitis, Wheezing, Hay fever) and Cow's milk allergy/intolerance Type 1 diabetes Obesity Influences neonatal mucosal immunity Increases the risk digestive, respiratory and infectious disease Increases the risk in adults for allergic diseases(asthma) Influences the acquisition time of cariogenic Bactria in children.

13. DR RAVARI 2014 Benefits of normal vaginal delivery For Babies Endorphin levels are highest during vaginal deliveries in unmediated mothers. During labor, endorphin levels rise during each contraction, most noticeably in the second stage of labor. Endorphin levels are highest just after birth. It takes two weeks after birth for endorphin levels in the body to return to normal. Endorphin levels protect and serve babies during childbirth as well. Endorphins are elevated in newborns that experience distress during the birth process. Endorphins stimulate the production of prolactin, the relaxing “mothering” hormone that aids in breastfeeding and mama- baby bonding after birth Epidural Analgesia decrease maternal endorphin production and lower endorphin levels to the neonate during breast-feeding. Lower endorphin levels, in turn, may render the neonate less likely to suckle optimally Endorphins in Childbirth :Body’s Natural Painkillers

14. DR RAVARI 2014 These high levels of circulating catecholamines cause the olfactory bulbs in the infant’s nares to be extremely sensitive to the odor cues that guide the infant towards the mother’s nipple Benefits of normal vaginal delivery For Babies Human infants experience a catecholamine surge immediately post birth secondary to compression of the fetal head and intermittent hypoxia during contractions.

15. DR RAVARI 2014 Benefits of normal vaginal delivery For Babies Newborns from VAGINAL DELIVERY, with high levels of catecholamines from the maternal circulation, are better equipped to adapt to extra uterine life than those delivered by cesarean section.

16. DR RAVARI 2014 NINE INSTINCTIVE STAGES Skin-to-Skin contact with their mothers immediately following birth and Early Breastfeeding STEP 4 BFHI

17. DR RAVARI 2014 Benefits of normal vaginal delivery For Babies Babies born by normal delivery demonstrate more interest in pre- breastfeeding behaviors such as sucking mother's breasts. Babies born by normal delivery are also reported to nurse for longer periods within the first 90 minutes after birth, which has many benefits for both the mother and the baby Higher breastfeeding success rate.

18. DR RAVARI 2014 I NITIATION OF B REASTFEEDING Self-attachment refers to the phenomenon that full term undrugged infants, left on their mother's chest undisturbed, will breastfeed spontaneously within one hour, without any assistance. However, skin-to-skin contact is required in order for this behaviour to succeed. Mothers and babies should not be separated at birth. The newborn actually stimulates hormonal responses ( oxytocin ) in the mother, which trigger caregiving and protective behaviours from the mother. By kicking on the mother’s abdomen the baby helps the mother’s uterus to contract strongly, preventing post-partum bleeding. Babies that are placed on their mother's bare chest are more likely to latch on to their mother's breast and are likely to latch on well, compared to babies that are not immediately placed on their mothers.

19. DR RAVARI 2014 S KIN - TO - SKIN CONTACT Research has shown that early skin-to-skin contact between a mother and baby at birth reduces crying, decreased stress metabolic adaptation improves mother-baby interaction keeps the baby warmer facilitate the early initiation of exclusive breastfeeding helps women breastfeed successfully (effective suckling) and for longer

20. DR RAVARI 2014 S KIN -T O -S KIN C ONTACT The first hour or so after birth are crucial for mother and baby in terms of their wellbeing, the opportunity to bond with each other and, the first breastfeed. SKIN-TO-SKIN CONTACT promotes all three of these things.

21. DR RAVARI 2014 DYAD DYAD MOTHER AND INFANT PAIR A baby knows instinctively that she is dependent on her mother to survive, and so if they are separated, the baby experiences distress and the mother does not experience the release of hormones that triggers her strong, protective 'mothering' instincts.

22. DR RAVARI 2014 M ATERNAL INFANT SEPARATION Separation “distress cry” when separated. Levels of stress hormones rise and temperature, blood sugar, breathing, and heart rate become unstable when separated Separation my lead to complications such as: hypothermia and hypoglycemia, increased the likelihood of supplementation.

23. DR RAVARI 2014 B REASTFEEDING A FTER A C ESAREAN Babies born via c-section may be somewhat drowsy and lethargic, especially if the mother was exposed to analgesia and anesthetics for a prolonged period of time during labor. analgesia and anesthetics Initiation of breastfeeding is often delayed Urgent cesarean births have been associated with delayed milk production, possibly related to the stress involved(Risk factor in delayed Lactogenesis II)

24. DR RAVARI 2014 Analgesia and Anesthesia for the Breastfeeding Mother N ARCOTIC OR A GENERAL ANAESTHETIC, AS THE BABY MAY NOT INITIALLY BE RESPONSIVE TO FEEDING

25. DR RAVARI 2014 Narcotic analgesics as pethidine is central nervous system depression, in both the mother and the infant. Depressed or delayed suckling, which can be caused by medications given to mothers, can lead to delayed or suppressed lactogenesis and risk of excess infant weight loss. Intravenous opiates for labor may block the newborn’s normal reflexes to seek the breast, root, and suckle within the first hour after birth. Meperidine/pethidine generally should not be used except in small doses less than 1 hour before anticipated delivery because of greater incidence and duration of neonatal depression, cyanosis, and bradycardia.

26. DR RAVARI 2014 C AESAREAN BIRTH Reduce initiation of breastfeeding, Increase the length of time before the first breastfeed, Reduce the incidence of exclusive breastfeeding, Significantly delay the onset of lactation Increase the likelihood of supplementation.

27. DR RAVARI 2014 I NDUCTION ( OXYTOCIN ) Pitocin, when used to induce or stimulate labor, has an antidiuretic effect. Edema may result from pitocin use, particulary in extremities such as the breast and nipple tissue ( meaty and flat) that make it difficult for infant to latch. it can take as long as 2 weeks for the edema is relieved. Inducing laber > strong,close contarction > pressure on the baby head > more painful for the mother > more drugs > iv hydration > more need forceps or vacuum or surgery(episiotomy or CS) > duration epidural anesthesia> maternal fever > infant fever > more separation > sepsis workups.

28. DR RAVARI 2014 R E - EVALUATING C ESAREAN B IRTH Cesareans with regional anesthesia is an option And mothers are able to breastfeed sooner

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