1. Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Maternal and Newborn Health Training Package Session 8: Breastfeeding

2. Breastfeeding Recommendations  Early initiation of breastfeeding – all infants should be put to the breast within an hour of birth  Exclusive breastfeeding for the first six months – giving no other food or drink – not even water – except breast milk  From six months, babies should be given complementary foods in addition to breast milk.

3. Post Adaptation  Share data on the rate of early initiation of breastfeeding within the country  Share data on the rate of exclusive breastfeeding within the country

4. The Benefits of Breastfeeding for Newborn Health  If every baby was exclusively breastfed from birth, about 1.5 million lives would be saved each year. – Colostrum: strengthen the baby’s immune system; “first vaccination” – Breast milk: perfect food, provides all nutrients and liquid for first six months of life – Breastfeeding: reduces deaths from pneumonia and diarrhea; early childhood development

5. The Benefits of Breastfeeding for the Mother’s Health  Helps expel placenta and prevent postpartum hemorrhage  Prevents painful breast engorgement; helps uterus return to normal size; reduces anemia  Reduces workload and family expenses, including costs for health care of baby  LAM (lactational amenorrhea method) for family planning  Reduces certain disease risks

6. Risks of Artificial Feeding  Non-breastfed infant is 14 times more likely to die than an exclusively breastfed baby in the first six months of life – Formula provides no antibodies – Babies struggle to digest formula – More frequent diarrhea, subject to frequent respiratory infections, more likely to get malnourished  Other negative outcomes

7. Risks of Mixed Feeding  In the first six months: higher risk of death, ill more often and more seriously, especially with diarrhea, more likely to get malnourished  Causes the supply of breast milk to decrease  Increases the risk of mother to child transmission of HIV  LAM is not effective

8. Breast is Best  International Code of Marketing of Breast-milk Substitutes in 1981  84 countries have enacted legislation implementing all or many of the provisions of the code (no action in the U.S.)  The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991: 10 specific steps to support successful breastfeeding.

9. Successful Breastfeeding Virtually every mother can breastfeed if given appropriate advice, encouragement, and support, as well as practical assistance to resolve any problems.

10. The First Feed  Skin-to-skin contact; not separating baby until after first breastfeed  Help the mother get into a comfortable position: on her back, side-lying, or sitting up  Position the baby  Help baby attach and suck  Poor position, poor attachment, and poor suckling can reduce milk flow, hurt the nipple, and cause breast engorgement

11. Continuing to Breastfeed  Feed on demand; 8-12 times in 24 hours or once every 2-3 hours  Empty the first breast at each feed, before offering the second  Use different, comfortable positions to hold the baby; no matter the hold, baby faces the breast and body in a straight line

12. Care for the Mother and Breastfeeding Problems  Care: Extra liquids, extra food, naps/sleep during day; support by family members  Problems: – Breast engorgement – Sore or cracked nipples – Plugged ducts/mastitis – Perception that “baby isn’t getting enough”

13. Breastfeeding Options for HIV-positive Mothers  Assess and determine best option through counseling  Most low-income countries: national policy for HIV-exposed infants is exclusive breastfeeding along with ARVs; if no ARVs, still should exclusively breastfeed  Middle/high income countries: If acceptable, affordable, feasible, sustainable, and safe, infant formula alone can be given to the child for first six months (with no breast milk or other foods)  No mixed feeding: increases risk of HIV transmission + more illness, malnutrition

14. When to Cup Feed a Baby  In some cases, a mother will need to express milk and cup feed a baby. – Mothers work or they must be separated – Low birth weight babies – Babies with mouth problems (cleft palate) – Babies whose mothers are ill  Cup feeding is better than bottle feeding.

15. Protect, Support, and Promote Breastfeeding  Breastfeeding protection involves the protection of existing good breastfeeding practices  Breastfeeding support refers to the skills, knowledge, and support systems around optimal breastfeeding  Breastfeeding promotion involves motivation to breastfeed where disinclined or have not done so previously; reverse declines in breastfeeding