LA C TA T IO N

MANA G E M E N T
ORIENTATION
 BABY-FRIENDLY HOSPITAL INITIATIVE (M)BFHI

•- IS A GLOBAL INITIATIVE OF THE WORLD HEALTH

ORGANIZATION AND UNICEF THAT AIMS TO GIVE EVERY BABY
THE BEST START IN LIFE BY CREATING A HEALTH CARE
ENVIRONMENT THAT SUPPORTS BREASTFEEDING AS THE NORM
5 MOMENTS FOR HAND HYGIENE
•BEFORE TOUCHING THE PATIENT
•BEFORE A PROCEDURE
•AFTER PROCEDURE OR BODY FLUID EXPOSURE RISK.
•AFTER TOUCHING A PATIENT
•AFTER TOUCHING A PATIENTS SURROUNDINGS
THE TEN STEPS TO SUCCESSFUL BREASTFEEDING

•STEP 1 - HAVE A WRITTEN BREASTFEEDING POLICY THAT IS

ROUTINELY COMMUNICATED TO ALL HEALTH CARE STAFF.
•STEP 2 - TRAIN ALL HEALTH CARE STAFF IN SKILLS
NECESSARY TO IMPLEMENT THIS POLICY.
•STEP 3 INFORM ALL PREGNANT WOMEN OF THE BENEFITS AND
MANAGEMENT OF BREASTFEEDING
•STEP 4: HELP MOTHERS TO INITIATE BREASTFEEDING WITHIN A
HALF-HOUR OF BIRTH

•STEP 5: SHOW MOTHERS HOW TO BREASTFEED AND HOW TO

MAINTAIN LACTATION EVEN IF THEY SHOULD BE SEPARATED FROM
THEIR INFANT.
•STEP 6: GIVE NEWBORN/INFANTS NO FOOD OR DRINK
OTHER THAN BREASTMILK UNLESS MEDICALLY INDICATED

•STEP 7: PRACTICE ROOMING-IN

•STEP 8: ENCOURAGE BREASTFEEDING ON DEMAND
•STEP 9: GIVE NO ARTIFICIAL TEATS OR PACIFIERS (ALSO
CALLED DUMMIES OR SOOTHERS) TO BREASTFEEDING
INFANTS

•STEP 10
FOSTER THE ESTABLISHMENT OF BREASTFEEDING SUPPORT
GROUPS AND REFER MOTHERS TO THEM ON DISCHARGE
FROM THE HOSPITAL OR CLINIC.
APPROACH TO CLIENT

•G – GREET THE CLIENT

•A – ASK
•T – TELL
•H – HELP
•E – EXPLAIN
•R -REPEAT/RETURN/REFER
IMPORTANCE OF BREASTFEEDING AND WHY PROMOTE BREASTFEEDING?

•BEST FOR BABY •FRESH MILK

•REDUCE ALLERGY •EASY ONCE ESTABLISHED
•ECONOMICAL •EMOTIONALLY BONDING
•ANTIBODIES RICH •DIGESTED EASILY
•IMMEDIATELY AVAILABLE
•STOOL INOFFENSIVE •NUTRITIONALLY BALANCE
•TEMPERATURE ALWAYS CONSTANT
•GASTROENTERITIS DECREASE
EXECUTIVE ORDER 51 OTHER WISE KNOWN “THE PHILIPPINE MILK CODE” AND ITS REVISED IMPLEMENTING RULES AND REGULATIONS (RIRR)-

THE FOLLOWING ARE THE UNDERLYING PRINCIPLES:

EXCLUSIVE BREAST FEEDING FOR INFANST FROM 0-6 MOS
 THERE IS NO SUBSTITUTE NOR REPLACEMENT FOR BREASTMILK

 APPROPRIATE AND SAFE COMPLIMENTARY FEEDING SHOULD

START FROM 6 MONTHS ONWARDS IN ADDITION TO
BREASTFEEDING.

 BREASTFEEDING IS STILL APPROPRIATE FOR YOUNG CHILDREN

UP TO TWO (24 MONTHS) YEARS OLD
INFANT OR MILK FORMULA MAY BE HAZARDOUS TO A CHILD’S HEALTH AND
DAMAGE CHILD’S FORMATIVE DEVELOPMENT.

ADVERTISING PROMOTION, OR SPONSORSHIPS OF INFANT FORMULA BREASTMILK

SUBSTITUTE AND OTHER RELATED PRODUCTS ARE PROHIBITED.

OTHER RELATED PRODUCT SUCH AS, BUT NOT EXCLUSIVE OT, TEATS, FEEDING
BOTTLES AND ARTIFICIAL FEEDING PARAPHERNALIA ARE PROHIBITED IN HOSPITAL
FACILITIES.
RA 10028 (“EXPANDED BREASTFEEDING PROMOTION ACT OF 2009”)

•ADOPTS ROOMING-IN AS A NATIONAL POLICY TO

ENCOURAGE, PROTECT AND SUPPORT THE PRACTICE
OF BREASTFEEDING
•EXPANDED BREASTFEEDING PROMOTION ACT REQUIRES ALL
HEALTH OR NON- HEALTH FACILITIES AND ESTABLISHMENTS
TO ALLOCATE SPACE FOR LACTATION AND STATIONS.

•GIVE WORKING BREASTFEEDING MOTHERS ADDITIONAL

BREAK IN ADDITION TO THE REGULAR TIME-OFF FOR MEALS
TO EXPRESS THEIR MILK
REPLACEMENT FEEDING

•A – ACCEPTABLE
•F – FEASIBLE
•A – AFFORDABLE
•S – SUSTAINABLE
•S – SAFE
4 CORE STEPS IN IMMEDIATE NEWBORN CARE / “UNANG YAKAP” (SHOULD BE 90
MINUTES)

1. IMMEDIATE 3. PROPERLY TIMED

AND THOROUGH DRYING. CORD CLAMPING
4. NON-SEPARATION FOR THE
2. EARLY EARLY INITIATION OF
SKIN-TO-SKIN CONTACT BREASTFEEDING
HOW MILK GETS FROM THE BREAST

•BREASTMILK PRODUCTION
HORMONES OR CHEMICAL MESSENGERS IN THE BLOOD.
DURING PREGNANCY, HORMONES HELP BREAST :
- TO DEVELOP AND GROW
- TO START TO MAKE COLOSTRUM
• AFTER DELIVERY, HORMONES OF PREGNANCY DECREASES.
HOW TO SUPPORT THE BREAST:

•- C OR U HOLD
BIRTH PRACTICES AND BREASTFEEDING

•PRENATAL
•ESSENTIAL INTRAPARTUM CARE
ADMIT TO LABOR ROOM WHEN THE PARTURIENT IS ALREADY IN THE ACTIVE PHASE.
ALLOW COMPANION OF CHOICE TO PROVIDE CONTINUOUS MATERNAL SUPPORT
ALLOW POSITION OF CHOICE DURING 1 STAGE OF LABOR, AS UPRIGHT AS POSSIBLE.
ST

ALLOW MOBILITY DURING LABOR.

• GIVE ORAL FLUIDS AND
FOOD DURING LABOR
• NO ROUTINE IVF
• RELIEVE PAIN & DISCOMFORT
DURING LABOR
• MONITOR PROGRESS OF LABOR
USING THE WHO PARTOGRAPH
• LIMIT TOTAL NUMBER OF IE TO 5
OR LESS
• UPRIGHT POSITION DURING
DELIVERY.
• ENCOURAGE PUSHING ONLY WHEN
THE MOTHER HAS THE URGE TO
PUSH
• SELECTIVE EPISIOTOMY
• PERINEAL SUPPORT AND
CONTROLLED DELIVERY OF THE
HEAD
• ACTIVE MANAGEMENT OF THE
THIRD STAGE OF LABOR (AMTSL)
2 HORMONES:

•PROLACTIN
• MAKES ALVEOLI PRODUCE MILK
• WORKS AFTER A BABY HAS TAKEN A FEED TO MAKE MILK FOR THE NEXT
FEED.
• CAN MAKE MOTHER FEEL SLEEPY AND RELAX
• LEVEL IS HIGH 2 HOURS AFTER BIRTH AND AT NIGHT
•
2. Oxytocin
.

- Causes muscles cells to contract

and makes milk flow down the ducts
Oxytocin reflex

Milk ejection reflex

Let down
SIGNS OF OXYTOCIN REFLEX
•PAINFUL UTERINE CONTRACTION, WITH RUSH OF BLOOD (SOMETIMES)
•A SUDDEN THIRST
•MILK SPRAY FROM THE BREAST/ LEAKING BREAST WHICH IS NOT
BEING SUCKLED
•FEELS A SQUEEZING SENSATION IN THE BREAST
TYPES OF MILK SECRETED:
• COLOSTRUM –IS THE FIRST MILK YOUR BODY PRODUCES. IT IS HIGH IN
PROTEIN, VITAMINS, MINERALS, AND IMMUNOGLOBULINS
(ANTIBODIES).IT’S OFTEN CALLED “LIQUID GOLD” BECAUSE OF ITS RICH
GOLDEN COLOR.
• FOREMILK –IT IS THIN AND WATERY AND IT LOOKS WHITE AND BLUISH, IT
IS HIGH IN LACTOSE (MILK SUGAR) AND LOW IN FAT AND CALORIES.
• HINDMILK- APPEARS THICK AND CREAMY AND HIGH IN FAT AND
CALORIES.
MILK STORAGE
• STORE IN SMALL AMOUNTS
• THAW MILK
• EXCESSIVE HEAT WILL DESTROY ENZYMES AND PROTEIN
• “SLOW DEFROST”
• CONSUME THAWED MILK
• PLACE CONTAINER OF EXPRESSED BREASTMILK IN THE COLDEST PART
OF THE REF OR FREEZER
STORAGE GUIDELINES
• FRESH MILK • REFRIGERATED (2-4°C)
• ROOM TEMPERATURE
= 8 DAYS
20°C - 37°C = 4 HRS.
• IF TEMPERATURE OF THE
15°C - 25°C = 8 HRS. REFRIGERATOR IS NOT KEPT
BELOW 15°C = 24HRS. CONSTANT = 3-5 DAYS

• > MILK SHOULD NOT BE

STORED ABOVE 37°C
•FRESH MILK
•FREEZER COMPARTMENT OF A REFRIGERATOR = 2 WEEKS
•FREEZER OF A 2 DOOR REFRIGERATOR (-20°C) = 3 MONTHS
•DEEP FREEZER =6 MONTHS
•THAWED IN REF. = 24 HRS.
HELPING WITH A FEED
•POSITION FOR BABY
•UNDERARM POSITION
•CROSS ARM POSITION
•CRADLE POSITION
CORRECT POSITION
•BABY’S BODY NEEDS TO BE:
•IN LINE WITH EAR, SHOULDER AND HIP IN A STRAIGHT LINE
•CLOSE TO MOTHER’S BODY
•SUPPORTED AT THE HEAD, SHOULDERS AND IF NEWBORN, THE
WHOLE BODY
•FACING THE BREAST
POSITIONING FOR A FEED
•4 KEY POINTS ABOUT THE POSITION OF THE BABY;
•THE BABY’S HEAD AND BODY SHOULD BE IN A LINE.
•MOTHER SHOULD HOLD BABY’S BODY CLOSE TO HER.
•SUPPORT THE WHOLE BODY, NOT JUST THE HEAD AND
SHOULDERS.
•BABY’S FACE SHOULD FACE THE BREAST.
SIGNS OF GOOD ATTACHMENT
•THE BABY’S MOUTH IS WIDE OPEN.
•THE LOWER LIP IS TURNED OUT.
•THE CHIN IS TOUCHING THE BREAST.
•MORE AREOLA IS VISIBLE ABOVE THE BABY’S MOUTH THAN
BELOW.
MILK SUPPLY
• COMMON REASONS WHY MOTHERS DISCONTINUE BREASTFEEDING
• NOT ENOUGH MILK
• MOTHER THINKS SHE DOES NOT HAVE ENOUGH BREAST MILK (500 ML -1000ML)
• BABY DOES NOT GET ENOUGH BREAST MILK.
• INEFFECTIVE SUCKLING.
• MOTHER CANNOT PRODUCE ENOUGH
• A CRYING BABY
• REFUSAL TO FEED
BREAST AND NIPPLE CONCERNS
•CAUSES OF SORE NIPPLE
• POOR ATTACHMENT
• CANDIDIASIS
• NOT PROPERLY POSITIONED PUMP
•TOO MUCH STRETCHING OF NIPPLE CAUSED BY THE PUMP /
WRONG POSITION
BREASTFEEDING SUPPORT GROUPS

•RESOURCES AVAILABLE IN THE LOCAL COMMUNITY:

•FAMILY AND FRIENDS
•PRIMARY AND COMMUNITY HEALTH CARE WORKERS
•MOTHER TO MOTHER SUPPORT GROUPS
THANK YOU