BABY-FRIENDLY HOSPITAL INITIATIVE Revised, Updated and Expanded for Integrated Care “Maternity”, 1963, © 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Global Strategy for Infant and Young Child Feeding 1/1    The aim of the Global Strategy is to improve – through optimal feeding – the nutritional status, growth and development, health, and thus the survival of infants and young children. It supports exclusive breastfeeding for 6 months, with timely, adequate, safe and appropriate complementary feeding, while continuing breastfeeding for two years and beyond. It also supports maternal nutrition, and social and community support. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

The aim of the Baby Friendly Hospital Initiative 1/2 To implement the Ten Steps to Successful Breastfeeding and to end the distribution of free and low-cost supplies of breastmilk substitutes to health facilities. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Course Aims 1/3 The aim of this course is that every staff member will confidently support mothers with early and exclusive breastfeeding, and that this facility moves towards achieving Baby-friendly designation. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

3/1 Original illustration by Jenny Corkery UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Infant Feeding Recommendation for HIV-positive Women 3/2 When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and then should be discontinued as soon as it is feasible. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

4/1 Original illustration by Jenny Corkery UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

4/2 The overall aim of the International Code of Marketing of Breastmilk Substitutes is the safe and adequate nutrition of all infants. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Skin to Skin Contact and Early Breastfeeding 5/1 ©UNICEF C107-2 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Skin to Skin Contact and Early Breastfeeding 5/2 Skin to Skin Contact and Early Breastfeeding UNICEF/HQ92-0369/ Roger Lemoyne, Thailand UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

First Skin to Skin Contact 5/3 Dr Nils Bergman, Cape Town, South Africa UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Parts of the Breast 6/1 Adapted from Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Helping the Oxytocin Reflex 6/2 Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

What can you see? Good attachment Poor attachment 6/3 Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 Good attachment Poor attachment UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

What can you see? Good attachment Poor attachment 6/4 Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 Good attachment Poor attachment UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Breastfeeding Positions 7/1 In line Close Supported Facing Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

BREASTFEED OBSERVATION AID 7/2 BREASTFEED OBSERVATION AID Mother's name _______________________________ Date ___________________ Baby's name _________________________________ Baby's age ______________ Signs that breastfeeding is going well: Signs of possible difficulty: GENERAL Mother: Mother:  Mother looks healthy  Mother looks ill or depressed  Mother relaxed and comfortable  Mother looks tense and uncomfortable  Signs of bonding between mother and baby  No mother/baby eye contact Baby: Baby:  Baby looks healthy  Baby looks sleepy or ill  Baby calm and relaxed  Baby is restless or crying  Baby reaches or roots for breast if hungry  Baby does not reach or root BREASTS  Breasts look healthy  Breasts look red, swollen, or sore  No pain or discomfort  Breast or nipple painful Breast well supported with fingers away from nipple  Breasts held with fingers on areola BABY’S POSITION  Baby’s head and body in line  Baby’s neck and head twisted to feed  Baby held close to mother’s body  Baby not held close  Baby’s whole body supported  Baby supported by head and neck only  Baby approaches breast, nose to nipple  Baby approaches breast, lower lip/chin to nipple BABY’S ATTACHMENT  More areola seen above baby’s top lip  More areola seen below bottom lip  Baby’s mouth open wide  Baby’s mouth not open wide  Lower lip turned outwards  Lips pointing forward or turned in  Baby’s chin touches breast  Baby’s chin not touching breast SUCKLING  Slow, deep sucks with pauses  Rapid shallow sucks  Cheeks round when suckling  Cheeks pulled in when suckling  Baby releases breast when finished  Mother takes baby off the breast Mother notices signs of oxytocin reflex  No signs of oxytocin reflex noticed Notes: UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Assess a Breastfeed 7/3 ©UNICEF C107-5 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Wide Open Mouth 7/4 ©UNICEF C107-7 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Assess a Breastfeed 7/5 ©UNICEF C107-9 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Assess a Breastfeed 7/6 UNICEF/HQ91-0168/ Betty Press, Kenya UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

8/1 9/1 Original illustration by Jenny Corkery 8/1 9/1 Original illustration by Jenny Corkery UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Case study Case study 2 weeks old Healthy at birth Discharged Day 2 9/2 Case study 2 weeks old Healthy at birth Discharged Day 2 “Sleeping all the time” “Refusing” the breast 3 stools in week 12% under birth weight Bottle with honey and water twice yesterday Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 UNICEF/HQ91-0168/ Betty Press, Kenya UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Kangaroo Mother Care 10/1 Dr Nils Bergman, Cape Town, South Africa UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Kangaroo Mother Care 10/2 Dr Nils Bergman, Cape Town, South Africa UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Positioning a preterm infant 10/3 UNICEF/HQ93-0287/ Roger Lemoyne, China UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Twins Grow Well on Breastmilk 10/4 UNICEF/HQ92-0260/ Lauren Goodsmith, Mauritania UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

DANCER Hand Position 10/5 ©UNICEF C107-21 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Chin Support 10/6 Kay Hoover and Barbara Wilson-Clay, from The Breastfeeding Atlas UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Hand Expression 11/1 ©UNICEF 910164F UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Cup Feeding 11/2 A short course for administrators and policy makers WHO/NUT/96.3, Wellstart International Promoting breastfeeding in health facilities: UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Supplementer 11/3 Dr Ruskhana Haider, Dhaka, Bangladesh UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Size and Shape 12/1 There are many different shapes and sizes of breast and nipple. Babies can breastfeed from almost all of them. Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Full Breast 12/2 UNICEF C-107-19 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Engorged Breast 12/3 © UNICEF C-10-25 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Mastitis 12/4 ©UNICEF C107-39 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Sore Nipple 12/5 ©UNICEF C107-31 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Sore Nipple 12/6 ©UNICEF C107-32 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Syringe method for inverted nipples 12/7 Breastfeeding Counselling: a training course, WHO/CHD/93.4, UNICEF/NUT/93.2 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Candida on the nipple 12/8 ©UNICEF C107-34 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Candida on the nipple 12/9 ©UNICEF C107- 33 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Tongue-tie 12/10 ©UNICEF C107-35 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Lactational Amenorrhea Method (LAM) 13/1 Ask the mother or advise her to ask herself these three questions: YES 1. Have your menses returned? When the answer to ANY one of these questions becomes YES The mother’s chance of pregnancy is increased. For continued protection, and to achieve child spacing, a complementary family planning method needs to be used, and breastfeeding continue. NO 2. Are you giving supplements or are there long periods without breastfeeding either day or night? YES NO 3. Is your baby more than six months old? YES NO There is only a 1-2% chance of pregnancy at this time. Institute for Reproductive Health, Georgetown, Washington, DC UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO/UNAIDS Infant Feeding Recommendation for HIV-positive Women 13/2 When replacement feeding is acceptable, feasible, affordable, sustainable and safe, (AFASS) avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and should be then discontinued as soon as it is feasible. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

14/1 Original illustration by Jenny Corkery UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Course Aims 15/1 The aim of this course is that every staff member will confidently support mothers to succeed with early and exclusive breastfeeding, and that this facility moves towards achieving Baby-Friendly designation. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Where are we now? Developing a Plan: Step One 15/2 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Where do we want to be? Developing a Plan: Step Two 15/3 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Developing a Plan: Step Three 15/4 Developing a Plan: Step Three How will we get there? UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

How will we know if we are there? 15/5 Developing a Plan: Step Four How will we know if we are there? UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

How will we sustain it? Developing a Plan: Step Five 15/6 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006