1. 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.

2. 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.

3. 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.

4. 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.

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Importance of Immunization
The common vaccine preventable diseases are-
Poliomyelitis
Diphtheria
Pertussis
Tetanus
Measles
Hepatitis B
Japanese Encephalitis

21. 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)

22. 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

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. THANK YOU