Intrapartum Care (uterus is composed of smooth

muscles).
Terms related to pregnancy status:
Gravida – the number of pregnancies that o Progesterone deprivation theory
reached viability , regardless of whether the o as pregnancy nears term,
infants born alive or not. progesterone level drops, hence
uterine contraction occurs.
Primipara – the women who is pregnant for the
first time.
Nulligravida – a woman who hasn’t given birth
to a chil or a woman who has never been
pregnant.
LABOR AND DELIVERY
o A process whereby with time regular
uterine contractions bring about
progressive effacement and dilation of
the cervix, resulting in the delivery of
the fetus and expulsion of the placenta.
o Also known as parturition , child birth,
birthing. o Theory of aging placenta
o A parturient is a woman in labor. o Advance placental age decreases
o Meaning childbirth. Toco and took (Gr.) blood supply to the uterus. This
are combing forms. event triggers uterine contractions,
o Eutocia – normal labor thereby, starting the labor as the
o Dystocia – difficult labor placenta ages it becomes less
efficient.
THEORIES OF LABOR ONSET
FACTOR AFFECTING LABOR AND
o Uterine stretch theory DELIVERY PROCESS: P’s
o any hollow body organ will
o Passage
contract and empty its content when
o Passenger
stretched to its fullest capacity.
o Oxytocin theory o Powers
o Increased production of oxytocin by o Psyche/Person
the anterior pituitary increases as
pregnancy nears term while
production of oxytinase by the I.Passage
placenta decreases  size and type of pelvis, ability of the
pressure on the cervix stimulates the cervix to efface and dilate,distensibility
hypophysis to release oxytocin from of the vagina and introitus,
the maternal posterior pituitary measurement.
gland. As pregnancy advances, the
uterus becomes more sensitive to  CPD
oxytocin. Presence of this hormone
 Mom 1.) < 4’9” tall
causes the initiation of contraction
of the smooth muscles of the body 2.) < 18 years old
 3.) Underwent pelvic dislocation Bones – 6 bones:
Important measurements: S – sphenoid
1. Diagonal Conjugate – measure between O –occuputal – occiput,
sacral promontory and inferior margin of the
symphysis pubis. T – temporal

Measurement: 11.5 cm - 12.5 cm basis P – parietal 2 x

in getting true conjugate. (DC – 11.5
F – frontal – sinciput
cm=true conjugate)
E – ethmoid,
2. True conjugate/conjugate vera – measure
between the anterior surface of the sacral
promontory and superior margin of the
symphysis pubis.
Measurement: 1 1.0 cm
3. Obstetrical conjugate – smallest AP
diameter. Pelvis at 10 cm or more.
Tuberoischi Diameter – transverse
diameter of the pelvic outlet.
Ischial tuberosity – approximated with use of
fist – 8 cm & above.

PASSENGER (Fetal)
 The passage of the fetus through the
birth canal is influenced by:
- Size of the fetal head &
shoulder
- Dimensions of the pelvic
girdle
- Fetal presentation
- Fetal position
Size – primarily related to fetal skull.
CPD
 cephalopelvic disproportion the baby's
head or body is too large to fit through
the mother’s pelvis.

Fetal skull: is the largest presenting part and

least compressible fetal structure, making it an
important factor in relation to labor and birth.
 Fontanels:
1.) Anterior fontanel – bregma, diamond
shape, 3 x 4 cm, (> 5 cm –
hydrocephalus), closes 12 – 18 months
after birth.

2.) Posterior fontanel or lambda – triangular

Sutures – intermembranous spaces that allow
molding.
ANTEROPOSTERIOR DIAMETER
1.) Sagittal suture – connects 2 parietal
bones
2.) Coronal suture – connect parietal &
frontal bone
3.) Lambdoidal suture – connects
occipital & parietal bone
Moldings: the overlapping of the sutures
of the skull to permit passage
of the head to the pelvis
shape, 1 x 1 cm, closes – 2 to 3 months
after birth.
o suboccipitobregmatic 9.5 cm, complete
flexion, smallest AP
o occipitofrontal 12cm partial flexion
o occipitomental – 13.5 cm hyper
extension submentobragmatic-face
presentation.
 Lie – relationship of spine
of fetus to spine of
mother: longitudinalL(parallel),
transverse, oblique.

Longitudinal Lie
o fetal spine is parallel to maternal spine
 o fetuses line vertically

o can be both cephalic or breach

o most common, about 99%

Presentation – part of fetus that presents to

maternal pelvic inlet: Cephalic, vertex,
transverse, breech

CEPHALIC FETAL PRESENATION

Transverse Lie
o fetal spine is 90° to maternal spine
o fetuses line horizontally
A. Vertex
parietal bones of the presenting part of the
fetus
considered optimal for fetal descent
longitudinal lie with complete flexion
attitude

Oblique Lie
o fetal spine is 45° to maternal spine
o midway between longitudinal and
transverse
o rare and considered abnormal
B. Brow & Sinciput o longitudinal lie with partial extension
attitude
o Brow or forehead is the presenting
part of the fetus o severe edema and facial distortion
occur from pressure of uterine
o longitudinal lie with moderate
contractions
flexion attitude
o vaginal delivery is usually
impossible

C. Face
o face is the presenting part of the
fetus
o longitudinal lie with partial extension
attitude
o severe edema and facial distortion
occur from pressure of uterine
contractions
BREECH FETAL PRESENTATION

A. Complete
o buttocks and feet are the presenting
part of the fetus
D. Mentum
o longitudinal lie with complete
o chin is the presenting part of the flexion attitude
fetus
o legs are crossed
 o least difficult breech position

B.Frank
o buttocks are the presenting part of
the fetus
o longitudinal lie with moderate
flexion attitude
o both legs are drawn up

C. Incomplete & Footling

o One or both of the knees and legs
are the presenting part of the fetus
o longitudinal lie

o legs are extended with little or no hip

flexion
o most difficult breech position
o cord prolapsed is common
OTHER FETAL PRESENTATION
A. Shoulder
o Shoulder, iliac crest, hand or elbow
is the presenting part
o Transverse lie

o Ranges from complete flexion to

complete extension
o In mulitparous it can be caused due
to relaxation of the abdominal walls
o Other causes: pelvic contraction,
placenta previa

COMPLETE FLEXION
o most common
o "the fetal position"; vertex
presentation; chin touches the chest.

B. Compound
o Extremity presents with another
major presenting part (usually head)
o They present simultaneously

MODERATE FLEXION
o Second most common;
o "military position";
o sinciput presentation;
o chin does not touch the chest

 Attitude – relationship of fetal parts to OCCIPITOFRONTAL DIAMETER

each other. Usually flexion of head &
extremities on chest & abdomen.
PARTIAL EXTENSION
o uncommon;
o brow presentation; LEFT OCCIPUT ANTERIOR (LOA)
o can make birth difficult

COMPLETE EXTENSION
o relatively rare; RIGHT OCCIPUT ANTERIOR (ROA)
o face presentation;
o the occiput touches the fetuses upper
back

 Position – relationship the landmark on the

presenting fetal part to the front, sides, and
back of the pelvis
o First Letter – which way the presenting
part is facing
o Second Letter – the presenting part of LEFT OCCIPUT TRANSVERSE (LOT)
the fetus
o Third Letter – which way the presenting
part is lying in relation to maternal
pelvis
 LEFT OCCIPUT POSTERIOR (LOP)

RIGHT OCCIPUT TRANSVERSE

(ROT)

RIGHT OCCIPUT POSTERIOR (ROP)

FETAL POSITION

OCCIPUT POSTERIOR (OP)

OCCIPUT ANTERIOR (OA)

o Station – refers to the level of the

presenting part in relation to
the maternal ischial spines.
o Engagement has occurred when the
presenting part is at station zero.

o The placenta may impede labor
when implantation took place in the
lower uterine segment. The placenta
may cover part or all of the internal
cervical os.
o This is known as placenta previa
Signs of placental separation
1.Fundus rises – becomes firm &
globular “ Calkins sign”
2.Lengthening of the cord
3.Sudden gush of blood
Hurrying of placental delivery will
lead to inversion of uterus.
POWER Is the force acting to expel the
fetus and placenta (myometrium) – powers
of labor.
PRIMARY
o Is the uterine contractions
o Involuntary uterine contractions
o Three phases:
– Increment (cresendo)– steep
crescent slope from
beginning of a contraction
until its peak
– Acme/peak – strongest
intensity
– Decrement (decresendo)–
diminishing intensity
Characteristics : wave like
Timing :
Duration – beginning of contractions to end
of same contraction
Interval – end of 1 contraction to beginning
of next contraction
Frequency – beginning of 1 contraction to
beginning of next contraction
Intensity - strength of contraction

o Best time to get BP & FHT just after
a contraction or midway of
contractions
o Placental reserve – 60 sec for fetus
during contractions
o Duration of contractions shouldn’t
>60 sec Notify MD
o Mom has headache – check BP, if
same BP, let mom rest. If BP
increase , notify MD -preeclampsia
SECONDARY
o voluntary bearing-down efforts
o use of abdominal muscles to push
during the 2nd stage of labor.
o Pushing force adds to the primary
force after the cervix is fully dilated.)
PSYCHOSOCIAL INFLUENCES
o Women who are relaxed,
knowledgeable, and capable of
actively participating in the
control of the birth process
usually experience shorter, less
intense labors.
o Psychological state of the
woman – fear and anxiety may
lead to increased perception of
pain and impede progress of
labor; preparation and support for
childbirth may enhance coping
efforts
o Preparation for childbirth
education about the birthing
process and methods to decrease
discomfort and tension
o Relaxation of voluntary muscles
o Distraction, focal point, imagery
o Breathing techniques with each
contraction
a. Always begin and end with “cleansing”
or “relaxing” breath (inhale deeply through
nose and exhale passively through relaxed,
pursed lips)
b. Hyperventilation – may cause maternal
respiratory alkalosis and compromise fetal
oxygenation; characterized by light-
headedness, dizziness, tingling of fingers
and/or circum-oral numbness; managed by
having woman breathe into her cupped
hands or a paper bag
c. Support person/”coach” should be
involved in the formal preparation
POSITION (maternal)
 o Side-lying enhances blood flow to
the utero-feto-placental unit and
maternal kidneys
o Upright (standing, walking,
squatting) enlists gravity to aid in
fetal descent through the birth canal
o Frequent changes relieve fatigue and
improve circulation

SIGNS OF IMPENDING LABOR

SIGNS OF TRUE LABOR

o Increased energy level
o many women will focus this
energy in preparation by
cleaning, cooking, preparing the
nursery…it is usually occur 24-
48 hours before labor.
o GI upset
- women frequently experience
diarrhea, indigestion or
nausea & vomiting few days before
labor
• Bloody show
the mucus plug of the cervical canal
during pregnancy is expelled as a result of
cervical softening and Increased pressure of
the presenting part. The exposed cervical
capillaries release a small amount of blood
that mix with the mucus, resulting in bloody
show.
• Spontaneous rupture of membrane
one in four women experience
SROM before onset of labor. This reduces
the capacity of the uterus, thickens the
uterine wall, and increases uterine
irritability. Labor usually follows.
• Uterine Contractions
The surest sign that labor has begun
is productive uterine contractions. Because
contractions are involuntary and come
without warning.

At term, 90% will be in labor within 24 hr

after membrane rupture.
If labor does not begin in 24 hr, the case
must be considered complicated by STAGES OF LABOR
prolonged rupture of the membranes
because of the increased risk of ascending
infection.
Risk of cord prolapses is increased if
engagement of the presenting part not occur.

TRUE LABOR VS FALSE LABOR

A. FIRST STAGE (Stage of Dilation)

CERVICAL CHANGES
o Effacement – thinning and
shortening of the cervix during late
pregnancy and/or labor; measured in
percentages (100% is fully effaced).
o Dilation – opening and enlargement
of the cervical canal; measured in
centimeters 0-10 cm (10 cm is fully
dilated).
Mgt:
1. encourage ambulation
2. check V/S, FHR, contraction
3. clear fluids or ice chips
4. left-side lying position
5. breathing techniques: slow, deep
chest or
abdominal breathing
6. encourage voiding Q2H
Mgt:
1) check V/S, FHR, contractions
2) calm environment
 3) comfort measures
•back rub or effleurage
STAGES OF EXPULSION
•side lying position
Second stage (stage of expulsion)
4) breathing techniques:
 From complete dilation of cervix to
accelerated slow panting
delivery of the baby
5) IVF
AVE: 2 h for nulliparas
6) provide psychosocial support
20 min for multiparas
 Contractions are now severe, lasting
60-90sec at 1.5 to 3 min intervals
 Bearing down/pushing increases
intra-abdominal pressure from
voluntary contraction of maternal
abdominal muscles and pushes the
presenting part against the pelvic
floor, causing a stretching, burning
sensation and bulging of the
Hyperesthesia – increase sensitivity to
perineum;
touch, pain all over
 “crowning” occurs when the
Health Teaching :
presenting part appears at the vaginal
o Encourage sacral pressure on orifice, distending the vulva.
lower back to inhibit
transmission of pain
 keep informed of progress
 controlled chest breathing

Mgt:
1. check V/S, FHR, contractions
2. be alert for bladder distention
3. I.E.
4. avoid pushing
5. provide short, concise information
6. breathing technique: high – chest, pant-
blow
7. nausea & vomiting may occur
Timing of transfer to delivery room Purposes:
 Nulliparas – during second stage a. to avoid laceration of the perineum
when the presenting part begins to
b. to shorten the 2nd stage of labor
distend the perineum
 Multiparas – at the end of first stage
when the cervix is dilated 8-9 cm
3. POSITIONING

8. HAND MANEUVER
a. Modified Ritgen’s maneuver
– is the forward upward pressure
applied in the perineum with the main
PERINIAL PREPARATION purpose of preventing laceration as well as
promote flexion of the head in brow
presentation.
b. palpate for cord coil
c. Suction mouth and nose
MODIFIED RITGEN’S MANEUVER

5. BREATHING TECHNIQUE:
- 2 short breaths, hold 3rd
breath while pushing
- never open mouth
6. CATHETERIZATION
7. EPISIOTOMY

9. CHORD CLAMPING and CUTTING

- cut the cord when it stops pulsating.
 CARDINAL MECHANISMS

o movements of labor in vertex

presentation
o usually flow smoothly and often
overlap; failure to accomplish
one or more usually requires
obstetrical intervention
SECOND STAGE (STAGE OF o (ED FIrE ErE)
EXPULSION)

Mgt:
1. check V/S, FHR, contractions
2. I.E.

MECHANISMS OF LABOR

o HEAD FLOATING BEFORE

ENGAGEMENT
o ENGAGEMENT, DESCENT
FLEXION o EXTERNAL ROTATION
(RESTITUTION)

o DELIVERY OF ANTERIOR
SHOULDER
o INTERNAL ROTATION

o EXPULSION

o FURTHER DESCENT AND

BEGINNING EXTENSION

METHOD OF DELIVERY

1. NSVD – Normal Spontaneous

Vaginal Delivery
 Mother is
encouraged to push
o EXTENSION  Episiotomy –
Median or
Mediolateral
2. CS / LSCS – Caesarian Section /
Low Segment CS
INDICATIONS:
CPD, fetal distress, no progress in labor,
cord prolapse, malpresentation, deep
meconium stain.
3. Forceps Delivery – use of special
instrument; indication:
fetal distress, maternal exhaustion,
mother unable to push, failure of head to
rotate, poor progress of fetus
4. Vacuum Extraction
delivery with use of suction device that
is applied to the fetal scalp for
traction;
Indications:
• Prolonged second stage (most
common)
• Non reassuring EFM strip
• Avoiding maternal pushing
• Breech presentation
PLACENTAL STAGE
C. Third Stage (Placental Stage)
Begins with delivery of the baby
and ends with delivery of the
placenta.
may last from a few minutes to 30
minutes.(if more than 30 min,
placenta is considered retained)
normal blood loss: 300 – 500 ml
1. Placental Separation signs
a. Calkin’s sign
- uterus becomes globular in
shape.
 b. gushing of blood (2nd
sign)

c. Lengthening of the cord

2. Inspect the placenta

2. Placental Expulsion
a. Brandt – Andrews Maneuver
- application of traction on the cord by
moving the forcep up, down, L, R

THIRD STAGE (PLACENTAL

STAGE)

Mgt:
Medication
a. Oxytocin (Syntocinon)
- given IV after delivery of
PRESENTATION baby
b. Methylergonovine Maleate
B. Schultz Mechanism
- Shiny (fetal side) (Methergine) -
- given IM after delivery of the
placenta
Crede’s Maneuver

- Gentle pressure on the contracted

uterine fundus (never on a
noncontracted uterus; uterus
 may evert and lead to o parent-infant interaction
hemorrhage)
FOURTH STAGE (STAGE OF
Classification of perineal lacerations PHYSICAL RECOVERY)
First Degree – involves the perineal mucosa Mgt:
Second Degree – involves the muscle of the 1. Assess uterine contractility
perineal body but does not involve the rectal - uterus must be firm & well
sphincter contracted
Third Degree – involves the rectal sphincter - check for uterine involution
but not the rectal mucosa
LOCATION OF FUNDUS:
Fourth Degree – involves the rectal mucosa
o Immediately after delivery -
slightly above the level of
umbilicus
STAGE OF PHYSICAL
RECOVERY o 1st 24 hrs (12-24 hrs)- @ the level
of umbilicus
o PPD1 - 1 fingerbreadth below the
FOURTH STAGE (RECOVERY umbilicus
STAGE)
o The involution of the uterus
o immediate recovery period from subsides @ 1 fingerbreadth per
delivery of placenta to stabilization day.
of maternal systemic responses
o PPD10 - (-) Palpation ;its behind
and contraction of the uterus
the symphysis pubis
o DURATION: from 1 to 4 h
o Mother begins to readjust to non-
2. Assess
STAGES OF LABOR for lochial discharge
pregnant state
STAGE PHASE Dilatation
COMPOSITION:Duration/Interval Intensity
Areas of concern include :
First Phase1- 0-4 cm 10-30 sec/ 5-30 Mild to
All but one is a normal composition
o discomfort due to Stage Latent min moderate
Phaseof lochia:
2- 5-7 cm 30-40 sec/ 3-5 Moderate
contraction of uterus (after
pain) and/or episiotomy Active
a. shreds of deciduamin to strong
Phase 3- 8-10 cm 45-90sec/ 2-3 min strong
o fatigue or exhaustion b. small clotted blood with mucus
Transition
Second From full cervical dilatation (10 cm) up to the
o hunger, thirst c. WBC
Stage expulsion of the fetus
-in the later
d.bacteriaphase of this stage, station becomes (+);
o excessive bleeding
+4 to birth
o bladder distention e. amniotic
-contraction fluid 1-2 minutes apart; fetal head
becomes
visible; increased urgency to bear down
PATTERN
3rd Placental Delivery- sudden gush of blood,
Stage lengthening of the cord, rising of the fundus,
globular uterus
4th First 4 hours after delivery of the placenta (monitor
Stage VS, fundus and lochia until stable)
 a. Lochia Rubra Danger signs of labor - fetal
➸ bloody red
o Heart rate
➸ up to 3 days
o Meconium staining
b. Lochia Serosa
➸ 4 to 6 days o Hyperactivity

➸ brownish o Fetal acidosis

c. Lochia Alba Danger signs of labor - maternal

➸ 7 to 10 days o Blood pressure
➸ whitish
o Abnormal pulse
3. Assess Perineum
o Inadequate or prolonged contractions
R - edness
o Pathologic retraction ring
E - edema
o Abnormal lower abdominal contour
E - cchemosis
D - discharges o Apprehension
A - approximation of blood loss.
Count pad & saturation
– Fully soaked pad : 30 – 40 cc
weigh pad. 1gram=1cc

MATERNAL AND FETAL RESPONSES

TO LABOR
 perineal and rectal bulging,
increased vaginal show
– Assist in techniques to foster
expulsion – encourage
PROVIDING COMFORT DURING bearing down focus on
LABOR AND BIRTH vaginal orifice (discourage
breath holding for more than
5sec), position squatting,
Intrapartal nursing management side-lying, Fowler’s as
appropriate
Stage 1
– Provide comfort measures;
o Maternal support coping measures;
- Monitor vital signs, fluid and assist support person
electrolyte balance, frequency, • Fetus/neonate
duration, and intensity of uterine
contractions and degree of – Monitor fetal heart rate and
discomfort (hourly, at minimum); regularity
urine protein and glucose with every – Provide immediate neonatal
voiding; laboratory results; care
preparedness; ROM.
• Assist
Provide comfort measures – e.g., M.D./nurse/midwife
positioning, back massage/effleurage (light in newborn care
abdominal stroking in rhythm with breathing
during a contraction to ease mild/moderate • Please refer to
discomfort), warm/cold compresses, ice ESSENTIALS OF
chips NEWBORN CARE

1.Support coping measures – reassure,

explain procedures, reinforce/teach The ENC guidelines are categorized into
breathing techniques, relaxation, focal point the time bound, non-time bound and
1. Assist support person unnecessary procedures.

• Fetal – monitor status o Time bound procedures

- should be routinely performed

first
- refer to the four core steps of ENC
Stage 2 which are immediate drying, skin to
• Maternal skin contact followed by clamping of
the cord after 1-3 minutes, non-
– Monitor physical status; separation of the newborn from the
assess progress of labor, mother and breastfeeding initiation.
 Non-time bound or non-immediate
interventions include:
 immunizations
 eye care
 Vitamin K
administration
 weighing and
washing
Unnecessary Procedures include:
o routine suctioning
o routine separation of newborn for
observation
o foot printing
o application of alcohol
o medicine and other substances on the
cord stump and bandaging the cord
stump or abdomen,
o and administration of prelacteals like
glucose water or formula.
FOUR CORE STEPS OF ESSENTIAL
NEWBORN CARE
Stage 3
o Immediate and thorough drying
o Early skin-to-skin contact
o Properly timed cord clamping
o Non-separation of the newborn and
mother for early initiation of
breastfeeding
RATIONALE
o Immediate drying prevents
hypothermia, which is extremely
important to survival.
o Instead of immediately washing the
newborn, the baby should be placed
in skin-to-skin contact with the
mother- on the mother’s chest or
abdomen to provide warmth
(prevents hypothermia), increase the
duration of breastfeeding, and allow
the “good bacteria” from the
mother’s skin to colonize the
newborn.
o Delaying cord clamping two to three
minutes after birth or waiting until
the umbilical cord has stopped
pulsating has been shown to increase
the baby’s iron reserves. It also
reduces the risk of iron-deficiency
anemia in one out of three premature
babies and one out of seven term
babies; improves blood circulation
and prevents brain hemorrhage
o Delaying the start of breastfeeding
could make the newborn 2.6 times
more prone to infection.
Breastfeeding within the first hour of
life prevents an estimated 19.1% of
all neonatal deaths.
• Maternal
– observe for signs and symptoms of
placental separation; assess amount of
blood loss; monitor blood pressure,
pulse, and fundus frequently
Neonate
 - Apgar scores at 1 and 5 min to
evaluate condition at birth
o Based on five signs:
heartbeat, respiratory effort,
muscle tone, reflex
irritability, color
o Initiate parent-child interaction
o Each sign rated 0-2 2 is top
o Instill prophylactic eye
score); all the scores are
added for total score drops/ointment – legally required to
prevent conjunctival gonococcal
o 7-10 (good condition) should infection that could lead to blindness
do well in normal neonatal in the neonate; 1% silver nitrate or
nursery; 4-6 (fair condition) 0.5% erythromycin
may require close
o Administer intramuscular vitamin K
observation; 0-3 (extremely
poor condition) resuscitation – for first 34 d of life the neonate is
and intensive care are unable to synthesize vitamin K,
acquired which is necessary for blood clotting
and coagulation
ASSESSMENT FOR WELLBEING
Apgar scoring
• Heart rate
• Respiratory effort
Stage 4
• Muscle tone
• Monitor maternal blood pressure and
• Reflex irritability pulse; uterine contractility tone and
location; amount and color of lochia,
• Color
presence of clots; condition of
episiotomy every 15 min x 4
• Monitor bladder function
• Provide comfort
FOURTH STAGE OF LABOR
First• 1-2 hEvaluate parenteral interaction Nursing Considerations
Vital signs (BP, pulse) q 15 min Follow protocol until stable
q 15 min Position – even to 1 cm/finger breadth above the
umbilicus for the first 12 h, then descends by one
Fundus
finger breadth each succeeding day, pelvic usually by
day 10
q 15 min Lochia (endometrial sloughing) – day 1-3 rubra (bloody
Lochia with fleshy odor; may be clots); day 4-9 serosa
(color, volume) (pink/brown with fleshy odor); day 10+ alba (yellow-
white); at no time should there be a foul odor
(indicates infection)
Urinary Measure first void May have urethral edema, urine retention
Bonding Encouraged interaction Emphasize touch, eye contact

BREASTFEEDING
Breastfeeding
 is the normal way of providing
young infants with the nutrients they
need for healthy growth and
development.
Colostrum
 is the yellowish, sticky breast milk
produced at the end of pregnancy
 the perfect food for the newborn, and
feeding should be initiated within the
first hour after birth.(WHO)
Ten Steps to Successful Breastfeeding
by: WHO/UNICEF
Every facility providing maternity services
and care for newborn infants should:
• Have a written breastfeeding policy
that is routinely communicated to all
health care staff.
• Train all health care staff in skills
necessary to implement this policy.
• Inform all pregnant women about the
benefits and management of
breastfeeding.
• Help mothers initiate breastfeeding
within half an hour of birth.
• Show mothers how to breastfeed,
and how to maintain lactation even if
they should be separated from their
infants.
• Give newborn infants no food or
drink other than breast milk, unless
medically indicated.
• Every facility providing maternity
services and care for newborn infants
should:
• Have a written breastfeeding policy
that is routinely communicated to all
health care staff.
• Train all health care staff in skills
necessary to implement this policy.
• Inform all pregnant women about the
benefits and management of
breastfeeding.
THE ABCDEFGH BREASTFEEDING
Infant:
• Allergic condition reduced
• Best food for infant
• Close relationship with mother
• Development of IQ and better dental
health
Mother:
• Econmical
• Fitness: quick return to pre-
pregnancy body shape
• Guards against cancer: breast,
ovary, uterus
• Hemorrhage (postpartum) reduced
In infant:
- cleft lip or palate or any other
condition that interfere or prevents
grasp of the nipple is the only real
contraindication
 • Many drugs are excreted in the
breast milk and have harmful effects
on the developing infant; these drugs
must be avoided or taken with care if
they must be taken by the mother;
careful monitoring of the infant is
required
COMMON PROBLEMS WITH
BREASTFEEDING
• Breast discomfort and pain
– A normal full breast can be
tender. In particular, breast
engorgement can occur on
days 2-7 after birth when
milk comes in. If milk is not
removed by a feeding baby
then milk production will
soon stop.
MANAGEMENT
o Frequent feedings.
o Administer painkillers such as
paracetamol or ibuprofen for a few
days as prescribed.
o Expressing some milk by hand to
ease any engorgement.
Sore nipples
o The most common cause of this is
excess suction by your baby. It is
often caused if the baby does not
latched on well.
Management:
o If you squeeze a little breast milk out
of your nipple (this is called
expressing milk) and allow it to dry
in the air,
o Nipple creams, especially those
containing lanolin, are also available
to soothe and promote healing.
Clogged/plugged ducts
o Ducts clog because milk isn’t
draining completely.
Management:
o get adequate rest.
o Apply warm compresses to the
breasts and massage them to
stimulate milk movement.
Mastitis
- Mastitis is a bacterial infection in the
breasts marked by flu-like symptoms
such as fever and pain in your
breasts. It’s common within the first
few weeks after birth (though it can
also happen during weaning) and is
caused by cracked skin, clogged milk
ducts, or engorgement.
Management:
o The only sufficient way to
treat the infection is with
antibioticshot compresses,
most importantly, frequent
emptying.
o Use hands-on pumping,
making sure the red firm
areas of the breast and the
periphery are softened.
o It’s safe and actually
recommended that you
 continue breastfeeding when
you have mastitis.

Inverted/flat nipples
Management: 
o Use a pump to get the milk flowing
before placing baby at nipple
o use breast shells between feeds.

o Once milk supply is adequate, try

using nipple shields if baby still has
problems latching.
Cracked nipples
Causes:
o thrush
o dry skin

o pumping improperly
o latching problems.

Management:
– Check baby’s positioning
– Frequent breastfeeding, and
at shorter intervals.
– Avoid use of soaps, alcohol,
lotions, and perfumes
– Use clean water only.