Step 4

Birth Practices and

Breastfeeding
UNICEF/WHO 20 hour Course 2006
 (new interpretation)

Place babies skin to skin contact with

their others mothers immediately
following birth for at least an hour and
encourage mothers to recognize
when their babies
are ready to feed,
offering help when
needed.
 Sige nanay,
kaunting ire pa..

The care that a mother experiences during labor

and birth can affect breastfeeding and how she
cares for her baby .
What practices HELP
a woman initiate
breastfeeding soon
after birth ?
 Emotional support during labor
Attention on the effects of pain
medications on the baby
Offering light foods and fluids during
labor
Freedom of movement during labor
Avoidance of unnecessary CS
Early mother-baby contact
Facilitate the first feed.
 Lying on bed during labor &
delivery
Lack of support
Withholding food and fluids
Pain medications / IV lines
Episiotomy
Wrapping baby
Separating the mother from the
baby
 Will it make a difference to a
pregnant woman if her sister
stays with her during labor and
birth ?

(Effect of Support during labor and birth to both mother and baby?)
 Reduce
perception
of pain
Increase
mothers Encourage
confidence mobility

Reduced
need for
Reduce stress
intervention

Speed labor &

delivery
 Increased alertness of baby
Reduced risk of hypothermia
and hypoglycemia
Early and frequent feeding
Easier bonding with the baby
 Encourage her to walk and move in
labor
Offer light nourishment and fluids
Built mothers confidence
Suggest ways to lessen pain and
anxiety
Holding hands, massaging her
Using positive words
 Labor support
Walking and moving around
Massage
Warm water
Verbal and physical assurance
Quiet environment with no bright
lights, few people around
Labor and giving birth positioning of
the mothers choice
It can increase the risk of :

1. Longer labor
2. Operative interventions
3. Delayed start to mother - baby
contact and breastfeeding
4. Separation of mother baby after
birth
Cont
5. Sleepy, hard to arouse baby
6. Diminished sucking reflex
7. Reduced milk intake
 Labor and birth is hard work.
Woman needs energy to do this
work.
Gets hungry after a normal delivery.
IV fluid only if there is a clear
medical indication
When giving birth, all woman need:
A skilled attendant present
Minimal use of invasive procedure
Universal precaution against
infection
Use of Interventions only when
medically indicated
 5/1

UNICEF C107-2
 ENSURE uninterrupted, unhurried
skin to skin contact
Start immediately, even before cord
clamping,
Arrange that this skin to skin contact
continue for at least one hour after
birth.
1. Calms the mother and baby
2. Keeps baby warm
3. Assist in metabolic adaptation and
blood glucose stabilization in the
baby
4. Reduces baby crying and stress
cont
5. Enables colonization
of babys gut with mothers
normal body bacteria
6. Facilitates bonding
7. Allows the baby to find the
breast and self attach
 Babies should be dried off as they are
placed on the mothers skin.

Babies who are not stable at birth can

receive STS contact later when they are
stable.
Skin to Skin Contact and Early Breastfeeding

UNICEF/HQ92-0369/ Roger Lemoyne, Thailand

Dr Nils Bergman, Cape Town, South Africa
What could be BARRIERS
to ensuring early skin to
skin (STS) contact ?

?
1. Concern that baby will get cold
2. Baby needs to be examined
3. Baby needs to be bathed
4. Baby is not alert ,sedated

1/3
5. Mother needs to be stitched
6. Mother is tired
7. Mother does not want to hold
baby

2/3
8. Delivery room is busy
9. No staff available to stay
with mother and baby

3/3
 Twin births interval of
delivery usually varies

On mothers labor / delivery

chart, record the time STS
started and finished
1. Help recognize pre-feeding
behaviors or cues :
Taking a short rest in an alert state
Bringing hands to his mouth
Focusing on areola
Moving towards breast
Finding the nipple
cont
2. There should be no pressure on the
mother and baby regarding

how soon the first feed takes place

how long a first feed would last
how well attached the baby is or
how much colostrum the baby
takes
 Provide time and calm environment
Help mother find a comfortable position
Point out positive behaviors of the baby
such as alertness and rooting
Build the mothers confidence
Avoid rushing the baby to the breast or
pushing the breast into the babys
mouth
 Stressed
Have IV drip/ urinary catheter
Confined to bed
Restricted fluid and food intake
Have received anesthetics
Altered levels of hormones of lactation
Higher risk of infection, bleeding
Separated from baby
Feel a sense of failure
 Is a high risk of not breastfeeding
May have more breathing problems
May need suction of mucus
Maybe sedated
Is less likely to have early contact
Is more likely to receive
supplements
Is more likely to have nursery care
 Presence of a supportive health
worker / doula
Encourage mother to have STS
contact as soon as possible
Assist initiated breastfeeding
Help find comfortable position
STS skin to skin
Step 4 help mothers initiate BF
within half-hour of birth.
New interpretation:
Place babies skin to skin contact with
their mothers immediately after birth
for at least an hour and encourage
mothers to recognize whether their
babies are ready to breastfeed,
offering help when needed.
 SUMMARY

Good Competent woman

supportive In control
practices Supported
Ready to interact with baby

Early STS contact

Alert baby
Search breast
Breastfeeding initiated
 Health
facility

Family Community