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Newborn Care-Education to Mothers
Priya is a 20 year old mother who has delivered a healthy baby girl yesterday at your hospital. This is her first baby. She will be going home tomorrow and asks you about how to take care of the baby at home. What are the things you will advise her about? Let few students respond. Then tell them that, in this session you will learn about the health education messages regarding newborn care at home which need to be given to mothers, specifically on exclusive breast feeding, maintenance of warmth, physical care, and immunization.
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Review of Previous Session
Q1. What are the risk factors of early onset sepsis in new born? A1. Premature rupture of membranes, prolonged rupture of membranes >24 hours, maternal fever, Chorioamnionitis, frequent P/V examinations in labour Q2. Name some major congenital anomalies? A2. Imperforate anus, spina bifida, cleft palate, omphalocele/gastroschisis Tell the students that, before we begin today’s session, let us recall what we learned in the previous sessions. Ask Q 1 from the slide and wait for the students to respond. Acknowledge if the answer is correct and show the correct answer on the slide. Proceed with Q2 in the same way.
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Objectives At the end of the session, students will be able to educate mothers on: Exclusive breast feeding How to express breast milk How to keep baby warm How to meet hygienic needs of baby Importance of immunization When to come for follow-up visits Present the objectives of the session from the slide. Do not discuss any point at this time.
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Exclusive Breast Feeding
Explain to the mother what is exclusive breast feeding (EBF): Start breastfeeding within 1 hour of birth Give baby first breast milk (colostrum), it is nutritious and has antibodies Give only breast milk day and night on demand for first 6 months of life at least 6-8 times during the day and at least 1-2 times during the night Do not give any other food/drink before starting breastfeed (pre-lacteal feeds) Medicines if prescribed for baby can be given with EBF On first day full-term baby may sleep many hrs after feed Explain to the mother to initiate breast feeding early within one hour of birth. Explain the steps of EBF from the slide. Explain that colostrum is nutritious and has antibodies to help keep your baby healthy Giving pre-lacteal feeds may make the stomach of the baby full resulting in not taking the breast feed completely. This will make the baby weak and also prone to infections of the GI tract. However, if medicines are prescribed to the baby, they may be given with EBF.
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Benefits of Exclusive Breast Feeding
Provides all nutrients baby needs, is easily digested and efficiently used by baby’s body Breast milk protects baby against infection especially diarrhoeas and respiratory infections Helps baby’s development and mother-baby bonding Can help delay new pregnancy Helps mother return to pre-pregnancy state faster
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Messages for Breast Feeding
While breastfeeding, drink plenty of water Eat healthy foods easily available at home and rest when you can Baby’s suckling stimulates milk production, more the baby feeds, more milk will be produced At night, let your baby sleep with you to promote breastfeeding
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Messages for Breast Feeding…
Do not use artificial teats or pacifiers in between feeds, they may cause infection of GI tract If mother is taking cotrimoxazole, monitor baby for jaundice Fore milk has more water and satisfies the water requirement of baby. Hind milk is thicker and has more proteins and fat and satisfies the hunger of the baby It is important to empty breasts at each feed. Let baby feed and release the breast, help to burp and then offer second breast. At next feeding, alternate and begin with second breast
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Technique of Breast Feeding
Explain and teach the mother correct positioning and attachment of the baby for effective breast feeding Holding the baby Hold baby’s head and body straight so that baby faces mother’s breast, baby’s nose near her nipple and abdomen facing the abdomen of mother in skin-to-skin contact Support baby’s whole body, not just neck and shoulders Attachment Touch baby’s cheek or lips with nipple Wait until baby’s mouth opens wide Move baby quickly onto breast, so that baby’s lower lip is well below the nipple Review knowledge of students on correct positioning and attachment taught in the previous class Slides 8 and 9 may be moved fast if the students tell the correct positioning and attachment technique. If not, then present and explain the technique.
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Technique of Breast Feeding…
Signs of correct attachment Baby’s chin touches breast Baby’s mouth wide open Lower lip curled out More areola visible above than below mouth Baby suckles with slow, deep sucks and pauses sometimes If baby does not attach well, it will lead to sore nipples and pain to the mother during feeding, irritability to the baby as milk will not come freely
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Expressing Breast Milk
Teach mother when to express breast milk: If mother cannot be with baby, she can express breast milk and someone else can feed expressed breast milk by cup to baby Mother needs clean containers to collect and store milk in wide necked jug/jar/bowl/cup with lid Expressed milk is used to Feed breast milk to the baby when she is away Feed small baby too weak to suckle Relieve engorgement and help baby attach Drain breast in severe mastitis/abscess Teach mother how to express milk by herself
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Steps of Expressing Breast Milk
Wash both hands Sit or stand comfortably and hold a clean container underneath the breast Put her index finger and thumb on either side of areola, behind nipple Press slightly inwards towards breast between her finger & thumb Express one breast until milk flow slows then express other side Continue alternating sides for at least mins Soften engorged breast by hot compress before expressing milk If milk does not flow well: Apply warm compresses Have someone massage her back & neck before expressing Teach mother breast and nipple massage
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Feeding Expressed Breast Milk
Feed by cup immediately. If not, store expressed milk in cool, clean and safe place If necessary, repeat procedure to express breast milk at least 8 times in 24 hrs
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Signs of Adequate Breastfeeding
Baby is satisfied with feed Weight loss is <10% in first week of life Baby gains at least 160g in following weeks or minimum 300g in first month Baby passes urine every day almost after every feed Baby’s stool changes from dark to light brown or yellow by day 3
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Keeping the Baby Warm at Home
Keeping baby warm is important for baby to remain healthy Dress baby or wrap in soft dry clean cloth Cover head with cap for first few days, especially if baby is small Ensure baby is dressed/wrapped and covered with a blanket Keep baby with the mother (rooming-in) to promote warmth and breastfeeding Assess warmth every 4 hours by touching baby’s feet. If feet are cold use skin-to-skin contact, add extra blanket and reassess
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Keeping the Baby Warm at Home…
Explain mother that babies need one more layer of clothes than other children or adults Keep room or part of room warm, especially in cold climate During day, dress or wrap baby At night, let baby sleep with mother or within easy reach to facilitate breastfeeding Do not put baby on any cold/wet surface Do not bath baby at birth, wait at least 24 hours before bathing healthy baby and 7 days for low birth weight baby Do not swaddle (wrap too tightly) Do not leave baby in direct sun Swaddling makes them cold
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Hygienic Care of the Baby-Bath
Always wash hands before and after taking care of the baby. Do not share supplies with other babies Delay bath of baby for 24 hours, dry baby quickly soon after birth Only remove blood or meconium. Do not remove vernix Later and at home Wash face, neck, underarms daily Wash buttocks when soiled. Dry thoroughly Bathe when necessary with warm water ensuring warm room, no draught, Thoroughly dry baby, dress and cover after bath
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Hygienic Care of the Baby-Cord Care
Wash hands before and after cord care Put nothing on cord stump Fold nappy (diaper) below cord stump Avoid touching it unnecessarily Cover cord stump loosely with clean clothes Do not bandage stump/apply any medicine If stump is soiled, wash with clean water and soap, dry thoroughly with clean cloth Explain mother to seek care if umbilicus is red/draining pus/blood
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Hygienic Care of the Baby-Sleeping
Use bed net day and night for a sleeping baby Let baby sleep on her/his back or on the side Keep baby away from smoke or people smoking Keep baby, especially a small baby, away from sick children or adults
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Importance of Immunization
Explain to mother: Immunization is safe and effective in preventing common and life threatening diseases Vaccines are available at all public health centres free of cost Baby should receive BCG, OPV and Hep B vaccines at birth Baby must get injection Vitamin K within 24 hours of birth
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Importance of Immunization
The common vaccine preventable diseases are- Poliomyelitis Diphtheria Pertussis Tetanus Measles Hepatitis B Japanese Encephalitis
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Follow-up Visit Routine visits by ASHAs at home or to bring the baby to the facility Postnatal visit: Within first week, preferably within 2-3 days Immunization visit : At 6 weeks (If BCG, OPV-0 and HB-1 given in first week of life)
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When to return? Return or go to hospital immediately if baby has:
difficulty breathing convulsions fever or feels cold bleeding diarrhoea very small, just born not feeding at all
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Summary Encourage mother to initiate early exclusive breast feeding (EBF) within one hour of birth, feed colostrum Give baby only breast milk day and night on demand upto 6 months is EBF Breast feeding promotes breast feeding, warmth to the baby and mother-baby emotional bonding Delay first bath for 24 hrs for normal weight healthy babies and 7 days for small, LBW babies. Do not remove vernix Keeping the baby warm prevents hypothermia and problems related to it. Inform mother danger signs of baby for return to the health facility for care Primary immunization must be completed by 9 months. Ask the students about the main points covered in this session. Show them the key points on the slide to summarize the session.
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Demonstration Role play on educating mothers on EBF Objectives:
By the end of the role play, the students will be able to: State key points to be informed to the mother regarding EBF State key points of good interpersonal communication Role play scenario: Priya, a 20 year old mother delivered her first baby, a healthy baby girl yesterday at your hospital. She will be going home tomorrow and wants to know how to care the baby at home. As a nurse in the postnatal ward what will you advise her? Tell the students that now we will see a demonstration of how to counsel a woman regarding care of the baby at home, through a role play. Present the objectives of the demonstration. Tell the students to observe carefully how the provider is counseling the mother, what advice she is giving and how is she communicating with the mother. Tell the scenario to the students from the slide and with a co-trainer, demonstrate the counseling session with correct information on how to care for the baby and good interpersonal skills. After the role play, discuss the points of care suggested by the nurse and the key points of their interpersonal communication. Highlight, that the nurse or provider must be respectful and polite, use the language the woman can understand easily, keep messages correct, simple and short, check for the woman’s understanding by asking her to repeat the messages, encourage woman to ask questions and address her queries, doubts and concerns.
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Assignment The facility in-charge or the site facilitator will group the students into small groups for classroom supervised practice through simulated role play situation of counseling a postpartum mother to take care of her newborn at home using the checklist 31.1 and provide constructive feedback. During the clinical posting, the students will practice counseling postpartum women for care of their newborn at home using the checklist under supervision of the site facilitator or the postpartum ward staff nurse and receive constructive feedback until competent. Explain that the facility in-charge or the site facilitator will supervise a practice session on communicating with the mothers regarding how to care for the newborn baby at home through simulation with peers and case scenarios in the class room using checklist 31.1 and will give constructive feedback. The students will perform supervised practice on counseling postpartum mothers in the clinical setting regarding care of the baby at home, under supervision of the site facilitator and the ward staff nurse and get constructive feedback until competent.
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Evaluation Q1. What is exclusive breastfeeding? A1. EBF is giving baby only breast milk day and night on demand until 6 months of age. No water, pre-lacteal feeds or top feeds are to be given. Medicines can be given to baby as prescribed. Q2. How should expressed milk be given to the baby? A2. Expressed milk must be collected and stored in a hygienic condition in a container and fed to the baby away by a cup and spoon or paladai. Q3. What are the benefits of early breast feeding? A3. Breast feeding must be started as early as possible within 1 hr of birth. It allows feeding of colostrum, protects baby from infections and keeps the baby warm. Tell the students that, let us recall what we have learned during the session. Ask question 1 from the slide and request one of the students from one of the schools to respond. If they respond correct, acknowledge her/him and show the answer on the slide. Proceed the same way with questions 2-5.
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Evaluation Q4. When care must be taken while bathing the baby? A4. The room must be warm and drought free, the water must be warm, the vernix must not be removed deliberately. Q5. What should the woman be told regarding immunization of the baby? A5. The six vaccine preventable diseases are dangerous for the baby and may put the baby at risk of disease and dying. immunization is a life saving initiative of the government which protect the baby from these diseases.
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THANK YOU
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