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Breastfeeding Breastfeeding how to support success A practical guide for health workers by Tine Vinther and Elisabet Helsing, Ph.D. WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE COPENHAGEN 1997 EUR/ICP/LVNG 01 02 12 E57592 TARGET 7 HEALTH OF CHILDREN AND YOUNG PEOPLE By the year 2000, the health of all children and young people should be improved, giving them the opportunity to grow and develop to their full physical, mental and social potential. TARGET 16 HEALTHY LIVING By the year 2000, there should be continuous efforts in all Member States to actively promote and support healthy patterns of living through balanced nutrition, appropriate physical activity, healthy sexuality, good stress management and other aspects of positive health behaviour. ABSTRACT Mothers eager to breastfeed their infants are often reliant on health workers for advice regarding breastfeeding. The knowledge and attitude of health workers can influence the success or failure of breastfeeding. However, the formal education of health workers on how to help mothers to cope with the process of lactation is often inadequate. This document is designed to guide health workers in the process of supporting mothers to breastfeed successfully. Keywords BREAST FEEDING HEALTH PERSONNEL – education GUIDELINES EUROPE Prepared for the Programme for Nutrition Policy, Infant Feeding and Food Security Lifestyles and Health Unit World Health Organization Regional Office for Europe, Copenhagen All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated, but not for sale or for use in conjunction with commercial purposes. Any views expressed by named authors are solely the responsibility of those authors. The Regional Office would appreciate receiving three copies of any translation. Breastfeeding: how to support success iii Contents Foreword ..........................................................................................................v Preface............................................................................................................vii Why breastfeed? ...............................................................................................1 Preparing for breastfeeding...............................................................................3 Building confidence..........................................................................................4 Communication and counselling.......................................................................5 How breastfeeding works ..................................................................................7 Anatomy of the breast...............................................................................7 Milk production........................................................................................7 Milk ejection ............................................................................................8 Milk extraction.........................................................................................8 Attachment of the baby’s mouth ...............................................................8 How to achieve good attachment.....................................................................10 The first feed ..........................................................................................10 Positioning of the baby’s body.................................................................11 Feeding positions....................................................................................13 How to check the position...............................................................................14 How to meet the baby’s needs .........................................................................15 How often and for how long............................................................................17 Common challenges .......................................................................................20 Enough milk? .........................................................................................20 Difficulties with the oxytocin reflex ........................................................21 Not enough milk.....................................................................................23 Too much milk .......................................................................................25 Leaking ..................................................................................................25 Sore and damaged nipples ......................................................................25 Engorgement ..........................................................................................27 Blocked milk ducts and mastitis..............................................................28 Infection and abscess ..............................................................................30 Special situations............................................................................................31 Multiple births........................................................................................31 Caesarean section ...................................................................................32 Cleft lip or palate....................................................................................33 Down’s syndrome...................................................................................34 Pre-term and low birth-weight babies......................................................34 Jaundice .................................................................................................37 Diarrhoea ...............................................................................................38 Allergies.................................................................................................39 Colic.......................................................................................................39 Short, flat or inverted nipples..................................................................40 Breast surgery.........................................................................................41 Maternal medication...............................................................................42 HIV ........................................................................................................42 Hospitalization .......................................................................................43 Re-lactation and induced lactation ..........................................................44 Breastfeeding supplementer ....................................................................45 iv Breastfeeding: how to support success Expression of breast-milk................................................................................46 Hand-expression .....................................................................................46 Storage and re-heating of breast-milk......................................................47 Feeding by cup........................................................................................48 Other important matters..................................................................................49 A new life ...............................................................................................49 The father ...............................................................................................49 The grandmother ....................................................................................50 The public...............................................................................................51 Mother-to-mother support .......................................................................51 Food for the mother.................................................................................52 Environmental pollution .........................................................................53 Breast care ..............................................................................................54 Sexuality and sexual intercourse..............................................................55 Menstruation...........................................................................................56 Fertility and contraception ......................................................................56 A new pregnancy ....................................................................................56 Work outside the home ...........................................................................58 Final remarks..................................................................................................60 International Code of Marketing of Breastmilk Substitutes......................60 Ten steps to successful breastfeeding.......................................................61 The Baby-Friendly Hospital Initiative......................................................62 Relevant resources ..........................................................................................64 Literature................................................................................................64 Training courses .....................................................................................64 Videotapes ..............................................................................................65 Pamphlets for mothers ............................................................................65 Information about the Baby-Friendly
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