Promoting Effective Perinatal Care Essential Newborn Care and Breastfeeding Training modules WHO Regional Office for Europe 2002 EUR/02/5035043 30063 ORIGINAL: ENGLISH UNEDITED E79227 Keywords INFANT CARE INFANT, NEWBORN INFANT, NEWBORN, DISEASES – therapy BREAST FEEDING HEALTH PERSONNEL – education TEACHING MATERIALS EUROPE, EASTERN EUROPE COMMONWEALTH OF INDEPENDENT STATES © World Health Organization – 2003 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 into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. 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This document was text processed in Health Documentation Services WHO Regional Office for Europe, Copenhagen CONTENTS Page Preface............................................................................................................................................................i Introduction ...................................................................................................................................................1 Workshop Schedule.......................................................................................................................................4 Session 1: Understanding the determinants of perinatal and neonatal health ..............................................6 Perinatal, neonatal and infant mortality: current levels and time trends...................................................6 Causes of neonatal mortality and morbidity .............................................................................................7 Birth Asphyxia..........................................................................................................................................8 Low Birth Weight (LBW).........................................................................................................................8 Infections...................................................................................................................................................9 Congenital anomalies..............................................................................................................................10 Hypothermia ...........................................................................................................................................10 Other factors that influence the health of the newborn...........................................................................10 Reasons for not giving enough priority to newborn health care .............................................................11 Session 2: Strategies to reduce perinatal and neonatal mortality and morbidity and principles of essential newborn care.....................................................................................................12 Learning from experience .......................................................................................................................12 Strategies to improve perinatal and neonatal health ...............................................................................13 Principles and appropriate technologies for essential newborn care.......................................................13 Friendly environment for childbirth and promotion of maternal-infant bonding ...................................14 Initiation of spontaneous respiration.......................................................................................................15 Maintenance of body temperature...........................................................................................................16 Initiation and support of breastfeeding ...................................................................................................17 Prevention and management of infections ..............................................................................................18 Regionalization of neonatal care.............................................................................................................18 Session 3: Why promote breastfeeding? .....................................................................................................20 Advantages of breastfeeding and Disadvantages of artificial feeding ....................................................20 Breastfeeding and two million infant lives .............................................................................................20 Psychological benefits of breastfeeding..................................................................................................23 Benefits to society...................................................................................................................................24 The economics of breastfeeding .............................................................................................................25 Benefits to Ecology.................................................................................................................................25 Bottle-feeding: a waste of money, a waste of natural resources, a waste of time? .................................26 Benefits of breastfeeding to infant’s health ............................................................................................27 Protection against infection.....................................................................................................................27 Protection against infection.....................................................................................................................29 Protection against diarrhoea....................................................................................................................30 Protection against respiratory infection ..................................................................................................31 Colostrum, foremilk and hindmilk..........................................................................................................32 Protection from allergy ...........................................................................................................................34 Vitamins in different milks .....................................................................................................................37 Summary of differences between milks..................................................................................................38 Breastfeeding to delay a new pregnancy.................................................................................................39 Physiology of Lactational Infertility.......................................................................................................40 The Lactational Amenorrhoea Method (LAM).......................................................................................42 Session 4: Care of the healthy newborn ......................................................................................................45 Preparation for delivery in a maternity unit ............................................................................................45 Drying the infant.....................................................................................................................................45 Assessment of the infant .........................................................................................................................46 Give the baby to the mother....................................................................................................................46 Cleaning the airways...............................................................................................................................47 Cord care.................................................................................................................................................48 The First Feed .........................................................................................................................................49 Prophylactic procedures..........................................................................................................................50 Bathing the infant....................................................................................................................................51 Swaddling ...............................................................................................................................................51 Session 5: Breastfeeding Management in the Healthy Newborn ...............................................................53 How milk gets from breast to baby.........................................................................................................53 Anatomy of the breast.............................................................................................................................53 Prolactin ..................................................................................................................................................55